Rare private doctors fill medical gaps
Published January 23, 2005

HAVANA · Dr. Aurelio Domech's private pediatric practice in his Havana home has been around so long that many of his original patients now bring their grandchildren in for checkups.

Across town, at Dr. Narciso López's apartment, patients line up as early as 6:30 in the morning to secure a place on his 1940s-era dental chair.

Both are relics of a bygone era, doctors and dentists -- in their 70s and 80s -- who run Cuba's few remaining private practices in an otherwise universal, government-run health-care system.

They are not listed in Havana's Yellow Pages, and often a discreet plaque by the front door offers the only clue that there is a doctor in the house.

Still, generations of patients have sought them out for minor aches and pains as an alternative to the government's free dental and medical clinics.

"When you pay you have the right to demand good work. At a state clinic it's free and, as the saying goes, you shouldn't look a gift horse in the mouth," said Febe Lescay, 32, who went to a private dentist to fill a cavity in a tooth because she couldn't wait for an appointment at a government clinic.

At López's central Havana home office, his patients don't seem to mind that his old dental chair has seen better days. They say they prefer coming to him rather than waiting months for a root canal or dentures at a government clinic.

"At the clinics there is one dental chair next to the other and a lot of noise and distractions," said Susana Garcia, 32. "A root canal can take two months, from one appointment to the next. Here you can get it done in a week."

Dr. José Gilberto Fleites, 79, a gynecologist, said his private practice serves a dual purpose: It keeps him tied to his lifelong medical vocation and helps supplement his $11 monthly state pension.

Like other doctors his age, Fleites had a prosperous clinic that was nationalized after Cuba's 1959 revolution. In those tumultuous years, about half the island's 6,500 doctors left. Fleites stayed behind and became a medical professor. Like others who could prove they owned private practices before 1963, Fleites was allowed to continue seeing patients at his home office.

"I am from the capitalist era, and socialism got me," Fleites said.

At private medical practices, patients pay about $1.50 for checkups and physical examinations. Dentists charge about $1.50 to pull a tooth and $5.50 for a root canal. Partial dentures cost about $10. The fees are paltry by U.S. standards, but for the average Cuban worker they can be steep. Some patients pay with gifts or services.

"Some people still come like in the past, with a chicken or eggs," said Domech, 85, the pediatrician.

"Others say, `I don't have the money to pay you. God will repay you.'"

Like other parents and grandparents in Domech's sunlit waiting room, Hugo Posada said he prefers paying for a checkup for his grandson to waiting hours at the government's clinics.

"Domech examines the children in depth. He talks to the mothers, he goes into detail. He has a lot of accumulated experience. That's not common," said Posada, who began bringing his infant daughters to Domech 22 years ago.

Cuba's universal healthcare system extends into rural communities across the island and offers free medical care, from cancer treatments to brain surgery. Havana research centers have developed unique vaccines. This month the Cuban government announced the infant mortality rate had dropped to 5.8 per 1,000 live births, lower than the United States' rate.

But the Cuban system suffers from chronic shortages. Many medications are scarce and equipment is often outdated. Hospitals are badly deteriorated and patients must often bring their own buckets to bathe with because of dilapidated plumbing. Doctors are paid about $25 a month, spurring a system of bribes in exchange for special treatment.

Private doctors say they can only treat minor ailments because they are lacking the sterile conditions and equipment required for medical procedures. They can write prescriptions for government pharmacies, but patients must go to government clinics if they require a referral for laboratory work.

Cuba's private doctors and dentists predate other "private entrepreneurs," who were licensed for work in the mid-1990s and have since dwindled because of strict regulations and high taxes.

Officials at the government agency that collects taxes from the private doctors and dentists said they could not provide information on the number of home practices in Cuba. Doctors and patients say only a small number remain.

Renowned cardiologist Dr. Guillermo Franco Salazar, 79, who has written medical textbooks and helped establish two medical schools in eastern Cuba, compared his modest home office to that of an old-time family physician.

"Patients like to feel like a person, not a cog," he said. "I give them that. I maintain a Cuban tradition that the doctor was a friend to the patients."

Vanessa Bauzá can be reached at vmbauza1@yahoo.com

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