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Letter from cuba.

Nancy Dock visited Cuba last year and found an extensive health care system and programme of medical innovation under strain as a result of the economic blockade imposed by the US.

Health care under the Cuban constitution is a basic human right of every citizen. Provision is universal, comprehensive and essentially free. In 1993, when 40 per cent of US citizens had no health care, the Cuban population was 100 per cent covered.

Cuba has a universal programme of vaccinations. Moreover, the infant mortality rate is seven per 1,000. In US cities such as New York and Washington DC, the infant mortality rate can approach 40-50 per 1,000.

Cuban health care focuses primarily on prevention. There is one doctor for every 175 people who live in Cuba - the highest of any nation. Doctors are located in schools, day care centres, workplaces and bus stations.

Cuba has neighbourhood clinics - one for every 3,000 people. Their existence means that attendance at the country's 238 hospitals is falling. I visited a rural clinic in a community of about 590 people. The clinic provides dental care, ambulance services, monitoring for high blood pressure and diabetes control.

Some common ailments are bronchitis and asthma. Teenagers have access to family planning advice and sex education at the clinics. There is also a senior citizens' club for cultural and physical activities.

The upkeep of this system is very expensive for the Cuban government, especially given the US economic blockade and the collapse of the Soviet bloc, which causes shortages of medicines, equipment and medical supplies.

Cuba can now only acquire 20-30 per cent of its essential medical supplies from foreign markets. Cuban children with leukaemia, for example, are denied new life-prolonging drugs. Defibrillators, often the key to surviving Cuba's number one killer - heart disease - are in short supply.

Cuba is at the cutting edge of medical advances. It has developed unique treatments for diseases that US doctors do not know how to cure. Research into the development of a cancer vaccine is now well-advanced in Cuba. US pharmaceutical companies have shown interest in Cuban formulas but, because of the blockade, they are unable to exchange information.

Humanitarianism demands the embargo be lifted. The US denies entry to any ship that has docked in Cuba during the previous 180 days. US ports are closed to third-country vessels carrying goods in which Cuba or Cuban nationals have an interest.

The US bans exports to Cuba by third-country companies of goods containing 20 per cent or more components of US origin. Licences are required for humanitarian aid and under no circumstance is the sale of food authorised.

US citizens have been told by the media and government sources that life in Cuba is barbaric. My visit confirmed to me that this was not the case and that people there have more things in common with US families than many in the US might think.

Nancy Dock is a social worker based in Michigan, US.

Background

- Cuba is the largest country in Caribbean. But with a total area of 110,860 square km, it is less than half the size of the UK. It has a population of just over 11 million - less than a fifth of the UK. Tourism plays a major role in foreign currency earnings.

- Ethnic groups: mulatto 51 per cent, white 37 per cent, black 11 per cent, Chinese 1 per cent.

- Religions: nominally Roman Catholic, who made up 85 per cent of the population before Fidel Castro came to power. Protestants, Jehovah's Witnesses, Jews, and Santeria are also represented.

- The US embargo began on 19 October 1960. Guantanamo naval base is Cuba's only "border" country. It is leased by the US and thus remains part of Cuba, and only mutual agreement or US abandonment of the area can terminate the lease.