The Gift of Health

Abstract

Drawing on ethnographic data collected over 13 months of fieldwork in family doctor clinics in Havana from 2004 to 2005, I examine the shifting moral and material economies of Cuban socialist medical practice. In both official ideology and in daily practice, the moral economy of ideal socialist medicine is based on an ethos of reciprocal social exchange-that is, the gift-that informs not only doctors' relationships with the Cuban state and with individual patients but also the state's policies of international medical service to developing nations. The social and economic upheavals after the fall of t Soviet Union, however, have compelled both the state and individual doctors to operate in a new local and global economy. The gift remains the central metaphor of Cuban medical practice. Nonetheless, as ideologies and practices of gifting and reciprocity encounter an emerging market economy, gifts--whether on the level of the state policies of international humanism or in patient-doctor relations--are open to new significations that highlight the shifting material and moral economies of post-Soviet Cuba.

Science, Sentiment, and the State

“…That is how a country with so few economic resources can seemingly maintain statistical health indicators that are comparable to and, in some cases better than, many Euro-American countries. Although these indicators have ensured that public health has long stood as an important symbol of the success of a 50-year socialist project (see Feinsilver 1993 ), recent studies nevertheless suggest that this profile is being undermined by the effects of the long-running U.S. embargo and the collapse of Soviet subsidies in the 1990s (Andaya 2010 ).…”

“… 2 Health workers, along with biotechnologies and pharmacy products, comprised 37% of the total export market in 2007 (see Andaya 2010 ). …”

“… 4 Published data in 2001 suggested a ratio of doctors to patients 1:175 (MINSAP 2001 ). These ratios are likely to be significantly less in the current context, with many doctors either having left the country or sent on medical missions (Andaya 2010 ). …”

“… 13 The idea of el hombre nuevo is closely linked to older state discourse about how citizens and particularly medical professionals should reject material goods and self-interested concerns and instead turn their attention to the collective success of the socialist revolution (see Andaya 2010 :362). …”

“… 14 Medical missions to other countries by Cuban doctors have long been part of the program of socialism linked closely to the ideology of self-sacrifice (Feinsilver 1993 ). However, recent missions to Venezuela in return for oil have highlighted the fact that this enables doctors to earn extra money, generating uncertainty about the meaning of the Cuban gift of health (see Andaya 2010 :369). …”