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WIKILEAKS CUBA CABLES. The state of medical care

Posted on Wednesday, 15th February 2012 @ 11:48 PM by Text Size A | A | A

 

 

 

 

 

9HAVANA726 2009-12-05     16:04 2010-12-15     21:09 CONFIDENTIAL US     Interests Section Havana
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INFO RUCNMEM/EU MEMBER STATES COLLECTIVE PRIORITY
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RUEHWH/WESTERN HEMISPHERIC AFFAIRS DIPL POSTS PRIORITY
RUEHMD/AMEMBASSY MADRID PRIORITY 0169
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C O N F I D E N T I A L SECTION 01 OF 03 HAVANA 000726

SIPDIS

STATE FOR WHA/CCA AND WHA/PD
STATE FOR DRL CNEWLING

E.O. 12958: DECL: 12/03/2019
TAGS: PREL PHUM PGOV CU
SUBJECT: SPAIN ON HUMAN RIGHTS AND DIALOGUE WITH CUBA

REF: A. HAVANA 683 ("SPAIN ON THE LOOKOUT FOR SIGNS OF
CHANGE")
B. MADRID 1146
C. MADRID 1157

HAVANA 00000726 001.2 OF 003


Classified By: Principal Office Jonathan Farrar for reasons
1.4 (b) and (d)

1. (C) COM met December 2 with Spanish ambassador to Cuba
Manuel Cacho at the latter,s request to discuss Spain,s
plans vis--vis Cuba during Spain,s EU Presidency and the
upcoming meeting between the Secretary and Spanish FM
Moratinos. P/E Counselor separately met December 3 with his
Spanish counterpart. A preview of issues that Moratinos may
raise with the Secretary and other major points from both
meetings follow.

CONVERGING VIEWS, BUT NOT CONVERGENCE
-------------------------------------

2. (C) Ambassador Cacho stated that the USG and the
Government of Spain (GOS) used to differ on both strategy and
objectives for Cuba policy, with Spain seeking engagement and
gradual liberalization and the USG seeking confrontation and
regime change. COM noted that the United States is engaging
with the GOC in a low-key manner on issues where we believe
we can make progress, and continues to focus on improving
respect for human rights. He agreed that there is
opportunity for closer collaboration between the EU and
United States on Cuba such as the recent (successful)
approaches to the GOC to allow the travel to Spain of Elsa
Morejon, wife of prominent political prisoner Oscar Biscet.

CLOSELY WATCHING U.S. MOVES
---------------------------

3. (C) The Spanish Polcouns told his USINT counterpart that
Spain and all of the EU countries were closely watching U.S.
moves in Cuba, but dismissed that the EU would wait for
further developments in the U.S.-Cuba relationship. "We have
been traditionally ahead of you in engaging with Cuba," he
said, "we can't afford to fall behind." He dismissed reports
of new EU Foreign Minister Ashton's comments on the need to
wait for U.S.-Cuba developments as "rookie misstatements."


MINIMAL CHANGE WITHIN CUBA
--------------------------

4. (C) The ambassador and COM agreed that there so far has
been little political or economic reform within Cuba since
the passing of the GOC reins from Fidel to Raul Castro. GOC
exhortations to Cubans to work harder and more efficiently
reflect a military mindset but are insufficient to improve in
any meaningful way Cuba,s economy. Raul increasingly has
brought his people into high-level positions, which also has
increased the role and influence of the military. Ambassador
Cacho said the changes have made the GOC more centralized and
top-heavy, and that no outsiders have access to the small
circle at the top. In contrast to when Cacho arrived a year
ago, now even Cabinet ministers profess to him to have little
idea of future policy directions. No one has stepped into
the void left by the sacking of Carlos Lage. The Ambassador
sees Fidel,s influence lately to be on the rise, and even
speculated that Fidel might make an appearance at the
upcoming ALBA summit in Havana.

DO AWAY WITH THE EU COMMON POSITION
-----------------------------------

5. (C) Cacho said that Foreign Minister Moratinos likely will
raise with the Secretary Spain,s interest in doing away with
the Common Position. The GOS feels the Common Position has
failed to produce improvements in human rights in Cuba and
should be replaced by a negotiated agreement between the EU
and Cuba that would include human rights components. The
Spanish Polcouns further added that Spain and likeminded EU

HAVANA 00000726 002.2 OF 003


countries see the Common Position as an irritant to the GOC,
which impedes better EU-Cuba relations. Referring to the
GOC,s release and exile to Spain of four political prisoners
in 2007, and the release of one prisoner following
Moratinos, most recent visit to Cuba, Ambassador Cacho
asserted that the only human rights improvements in Cuba have
come through Spain,s own bilateral dialogue with Cuba. Even
those improvements were minimal, but the GOS feels the Common
Position has run its course.

6. (C) COM asked whether the GOS believes that the entry into
force of the Treaty of Lisbon means that unanimous consent is
no longer required to do away with the Common Position.
Ambassador Cacho said this remains unclear until the Council
of Europe meets next April. In the meantime, the GOS,s
position is that EU unity is more important than Cuba policy
and thus the GOS would move only if there were no objections
raised within the EU. Notwithstanding this, the Spanish are
sounding much more resolute in their aims than they did just
one months ago (Ref A).

CUBA WANTS A POLITICAL CHANNEL TO THE WHITE HOUSE
--------------------------------------------- ----

7. (C) The Spanish Ambassador said that Moratinos also is
likely to raise Cuba,s interest, as reportedly expressed to
him by Raul Castro, for a &political channel8 to the USG,
particularly to the White House. Only via such a &political
channel8 would the GOC be able to make major moves toward
meeting U.S. concerns (note: Cacho was not in the
Moratinos/Raul meeting). In response, COM ran through a list
of specific issues on which we have engaged the GOC and made
advances and of other areas, such as our offer to lift the
travel restrictions on our respective Interests Sections,
where we await concrete GOC action. The GOC should engage
seriously through the existing channels. The COM noted also
that the current domestic political situation in Cuba, as
described above, was not conducive to grand gestures by the
GOC. In a side note, Ambassador Cacho asked why the GOC had
not accepted our offer to lift travel restrictions, which he
felt would be to their advantage. Cuba,s territory was much
smaller, and the GOC would control access to GOC entities,
which encompass much of Cuba,s economy and societal
institutions. CUBINT,s potential access would be much
greater. COM said that was a question better posited to the
GOC; our offer remains on the table.

EU TROIKA AND CUBA: NOT AS BAD AS IT SEEMS
------------------------------------------

8. (C) Ambassador Cacho said the recent Troika meeting had
gone reasonably well considering the difficulty the GOC had
in engaging with the Swedish Presidency. COM noted the harsh
rhetoric directed toward the EU in the GOC statement issued
after the talks, and asked if that masked any progress on
human rights issues during the talks themselves. Cacho said
no, but that the GOS was hopeful of progress during its
Presidency. In the meantime, the EU internally was in
agreement that there was little to gain from responding
publicly to such diatribes.

CUBAN FIVE AND HUMAN RIGHTS
---------------------------

9. (C) Ambassador Cacho said he had been asked that morning
by the Damas en Blanco to demarche the GOC to ask that they
be allowed to visit their imprisoned relatives on Christmas
Day as a humanitarian gesture. He was prepared to do so but
was skeptical he would obtain a positive response. The
ambassador asked if Perez O,Conor and Salanueva, wives of
two of the Cuban Five, would receive visas to visit their
husbands. COM described the history of their ineligibilities
and the differences between the two cases. The ambassador
noted the GOC,s interest in swapping the Cuban FIVE for
political prisoners in Cuba. COM responded that the vast
majority of the Damas and their imprisoned relatives were
opposed to any such offer.

HAVANA 00000726 003.2 OF 003



DOWNWARD ECONOMIC SPIRAL
------------------------

10. (C) The ambassador said Cuban imports from Spain were
down 38% in August, similar to the decline from other trading
partners. Some Spanish exporters recently had been able to
access and transfer funds previously frozen in their Cuban
bank accounts but only if they agreed to invest some of these
proceeds in new exports to Cuba. (Spanish demands for
payment during the International Trade Fair were not well
taken, and other contacts tell us that the head of the
Spanish Chamber of Commerce had fallen from grace with the
GOC after publicly criticizing Cuba for letting unpaid bills
pile up.) Ambassador Cacho observed that the Cuban economy
is in a downward spiral with no sign of when or how it might
recover. His GOC interlocutors a year ago talked of
increasing opportunities for small scale enterprises
(paladares, etc.) and even timeshare developments, but such
talk has ceased.

COMMENT: VALUE IN COORDINATION
------------------------------

11. (C) Despite differences in our views, we see value in
coordinating with the GOS on human rights issues in Cuba both
in capitals and on the ground in Havana. Spain leads a
substantial bloc within the EU that favors engagement with
the GOC at almost any cost but will raise human
rights-related issues privately with the GOC when persuaded
to do so (e.g., the upcoming Damas en Blanco demarche and
previous efforts on behalf of Elsa Morejon). Spain desires
to speak for the entire EU when it comes to Cuba policy and
is quick to reinterpret the public statements of other EU
interlocutors, e.g., European Commissioner for Development
and Humanitarian Assistance de Gucht and EU Foreign Minister
Ashton, when they don't fit the Spanish line.
FARRAR

 

 

 

 

==================================================

 

 

 

2010-12-15   21:09

CONFIDENTIAL US Interests   Section Havana
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DE RUEHUB #0153 0651949
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TO RUEHC/SECSTATE WASHDC IMMEDIATE 4203
INFO RUEHWH/WESTERN HEMISPHERIC AFFAIRS DIPL POSTS PRIORITY
RUEHKO/AMEMBASSY TOKYO PRIORITY 0035
RHMFISS/CDR USSOUTHCOM MIAMI FL PRIORITY
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RHEHAAA/WHITE HOUSE WASHINGTON DC PRIORITY 0022
C O N F I D E N T I A L HAVANA 000153

--------------------------------------------- -------
C O R R E C T E D C O P Y -- CLASSIFICATION PARA 4
--------------------------------------------- -------

SIPDIS

E.O. 12958: DECL: 03/05/2019
TAGS: PGOV PINR PINS PREL CU
SUBJECT: LAGE AND PEREZ ROQUE ADMIT "ERRORS" AND RESIGN ALL
POSTS; REMIREZ DE ESTENOZ OUT TOO

REF: A. HAVANA 140
B. HAVANA 150

Classified By: COM Jonathan Farrar for reasons 1.4 (b) and (d)

1. (U) In virtually identical letters published in the
official media on March 5, former Vice President Carlos Lage
and former Foreign Minister Felipe Perez Roque admitted that
they had committed unspecified "errors" for which they
assumed full responsibility, and then resigned from their
remaining positions. In Lage's case this included his
position as Vice President of the Council of State, Deputy in
the National Assembly, Member of the Council of State, and
member of the Communist Party Central Committee and Political
Bureau. Perez Roque resigned from all of the same positions,
except for that of Vice President.

2. (U) Although there had been no official announcement of
his departure, Fernando Remirez de Estenoz, the Communist
Party chief of Foreign Relations, was replaced by the deputy
chief Jorge Marti Martinez. This news became public when the
media published a list of attendees at a meeting between
President Raul Castro and Honduran President Zelaya which
included Marti Martinez with the title of Communist Party
Chief of Foreign Relations.

3. (C) COMMENT: The language used by Fidel to justify the
firings of Lage and Perez Roque together with the tone of the
published resignation letters (reminiscent of similar
confessions during China's cultural revolution) have led many
observers on the island to speculate that one or both may be
brought to trial. Fidel's comments alone amount to a virtual
charge of treason against them. The departing Japanese
ambassador told COM on March 4 that changes in the foreign
policy leadership had severely damaged Tokyo's plans for
relations with Cuba as the GOJ had placed great hope in
personal relationships with Lage, Perez Roque and former
foreign trade minister De la Nuez--all now fired. Remirez de
Estenoz had come up frequently in diplomatic conversations as
a serious interlocutor who could improve Cuba's relations
with the world. He is credited by some with being the
mastermind of the GOC's very successful policy to build good
relations with the other Latin American and Caribbean
governments as a further bulwark against the U.S. These
kinds of successes, while benefiting Cuba demonstrably, may
have resulted in the downfall of their authors when they
became too closely associated with them personally.

4. (C) COMMENT CONTINUED: The changes may also be part of the
process of preparing for the Communist Party congress,
announced for later this year but for which no date has been
set. As Raul continues to consolidate his power, there is
growing evidence that the inner circle of Castro regime is
turning further inward (and backward). A longtime (20 plus
years) local observer of Cuban politics theorized last night
to COM that the changes are meant to consolidate power and to
lateral the succession away from the Lage/Remirez de Estenoz
generation and to the military and civilian generation who
cut their teeth during the Angolan war years. Speculation
runs rampant: those few who truly know are not talking with
us or with our diplomatic colleagues. End Comment.
FARRAR

 

 

 

—————————————————————————

Reference ID

Created

Released

Classification

Origin

07HAVANA258 2007-03-16   18:06 2010-12-15   21:09 CONFIDENTIAL US Interests   Section Havana
VZCZCXRO8161
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RUESDM/JTLO MIAMI FL
RUCOGCA/COMNAVBASE GUANTANAMO BAY CU
C O N F I D E N T I A L SECTION 01 OF 02 HAVANA 000258

SIPDIS

SIPDIS

E.O. 12958: DECL: 03/16/2017
TAGS: PGOV PINR CU
SUBJECT: CUBA: HOW BELIEVABLE IS A FIDEL CASTRO COMEBACK?


HAVANA 00000258  001.3 OF 002


Classified By: COM Michael E. Parmly; Reasons 1.4 (b/d)

1. (C) Summary:  XXXXXXXXXXX
passed us a document March 14 that describes Fidel Castro's
declining health, as analyzed by a respected, retired Cuban
doctor.  The document concludes by saying that Castro has a
terminal condition, and will suffer an inevitable
deterioration of his faculties until he dies.  But he is not
about to die "immediately."  This contrasts with a flurry of
news and public statements by key regime figures about Castro
making a comeback, including his having spoken to Hugo Chavez
on the phone while the latter was in Haiti.  We believe that
a full comeback is unlikely, but that Fidel Castro is more of
a presence behind the scenes -- and even "on stage" as a
presence -- than he was a few months ago.  End Summary.

2. (U) Media have reported increased activity on the part of
Fidel Castro this past week: Speaking on the phone to Hugo
Chavez during the Venezuelan's visit to Haiti; and receiving
Colombian author and long-time sympathizer Gabriel Garcia
Marquez.  Both Foreign Minister Felipe Perez Roque (in
Europe) and Parliamentary Speaker Ricardo Alarcon stated
publicly that Fidel Castro was making a comeback and would
return to the GOC's helm.  Alarcon's statement included
Castro's "winning reelection for president" in 2008.  Interim
dictator Raul Castro has kept a low profile during the past
few weeks.

3. (C) XXXXXXXXXXX, on Wednesday evening March 14, passed COM and
Pol-Econ Counselor a document XXXXXXXXXXX.  The
document traces Fidel Castro's critical condition from its
onset last July, through the various ups and downs with his
local medical staff and with the visiting Spanish doctor,
Garcia Sabrido.  Most of this repeats what has previously
been reported, with one new development:  Castro has fired
his long-time personal physician, Dr. Selman.  Informal
translation of this document follows in Para 4.

4. (C) Doctor's Statement:

"The illness began in the plane from Holguin to Havana (Note:
after a full day of July 26, 2006 activities.  End note).  As
this was a short flight there was no doctor aboard and they
had to land urgently once they knew of his bleeding.  He was
diagnosed with diverticulitis of the colon.

This illness is characterized by diverticulae in the large
intestine, generally.  A diverticula is a protuberant sack in
a segment of the intestine, not in itself necessarily
dangerous.  Waste gets trapped in them, for example.
Nevertheless, they can cause hemorrhaging, inflammation and
infection, resulting in diverticulitis.  (Health Unit
Comment:  Simple diverticulitis, without perforation,
hemorrhaging or infection, is treatable.  End Comment.)

The condition requires surgery when the diverticulae are
gigantic, because they are more likely to become infected and
burst.

He had a perforation in the large intestine and needed to
have a colostomy done; which he opposed, saying that they
should splice out the infected part and reattach the
intestine to his colon.  Dr. Selman, who was chief of the
medical team, was in agreement, but the rest of the team
opposed.  But Fidel Castro, capriciously, did not permit the
colostomy.

With the passage of time, as the colon was infected, the
operation collapsed and the reattached part separated.  They
had to operate again, but found a fistula.  It wasn't known
at that time what he had, but normally a fistula in the
abdomen has the effect of blocking the digestion of
food--resulting in the loss of 40 pounds.  They began to feed
him by IV serum, and they used a Korean-made device to treat
the fistula, which didn't have much success.  That was when
they called in the Spanish doctor, the one who said that they
Cuban team had done what they could, but the correct
treatment should have been a colostomy.

At that point they removed Selman from the team, who is now
working as a low-level doctor someplace else.

XXXXXXXXXXX

HAVANA 00000258  002.3 OF 002


this illness is not curable, and will not, in her opinion,
allow him to return to leading Cuba.  He won't die
immediately, but he will progressively lose his faculties and
become ever more debilitated until he dies."

5. (C) This report is consistent with our reporting that
Fidel Castro probably came close to death in July, 2006, and
then again around October.  Since then, as we have seen in
video and audio broadcasts, Castro has been able to engage
with Hugo Chavez and others for limited periods of
conversation and other forms of carefully controlled
activity.  He has not appeared live on TV or in any other
public context during the entire period of his critical
illness, which caused him to miss the September, 2006
Non-Aligned summit and a large-scale celebration of his
birthday and armed forces day in December, 2006.

6. (C) Cubans react to news about Fidel Castro with
resignation and wild speculation.  XXXXXXXXXXX
told us March 15 that he thought last month's taped call-in
by Castro to Hugo Chavez's radio show was fake and that he
would die by May.  XXXXXXXXXXX, described the Castro illness as having a similar
effect on the public as the Pope's 1998 visit:  Greatly
raised expectation for change, followed by disappointment and
reversion to the totalitarian norm.

7. (C) Comment:  We are missing too many variables to be able
to predict accurately how many more months Fidel Castro will
live.  Frankly, we don't believe anyone, including Castro
himself, can state that with certainty.  However, while he is
still alive, even in a reduced capacity, his presence has a
chilling and retardant effect on Cuban society.  The high
expectations for change are still out there, but are mostly
associated with the idea that the dictator has to die first
before anything substantial will happen.
PARMLY

 

 

 

 

=======================================

 

Reference ID

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Classification

Origin

06CARACAS2367 2006-08-10   02:02 2010-12-15   21:09 SECRET//NOFORN Embassy   Caracas
VZCZCXRO6327
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RUEHBO/AMEMBASSY BOGOTA PRIORITY 6884
RUEHBR/AMEMBASSY BRASILIA PRIORITY 5695
RUEHBU/AMEMBASSY BUENOS AIRES PRIORITY 1390
RUEHLP/AMEMBASSY LA PAZ PRIORITY 2255
RUEHPE/AMEMBASSY LIMA PRIORITY 0500
RUEHMU/AMEMBASSY MANAGUA PRIORITY 1399
RUEHME/AMEMBASSY MEXICO PRIORITY 3945
RUEHQT/AMEMBASSY QUITO PRIORITY 2340
RUEHSN/AMEMBASSY SAN SALVADOR PRIORITY 0966
RUEHSG/AMEMBASSY SANTIAGO PRIORITY 3695
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RUEHGL/AMCONSUL GUAYAQUIL PRIORITY 0582
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RUMIAAA/HQ USSOUTHCOM MIAMI FL PRIORITY
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S E C R E T SECTION 01 OF 04 CARACAS 002367

SIPDIS

NOFORN
SIPDIS

HQSOUTHCOM ALSO FOR POLAD
DEPT PASS TO AID/OTI RPORTER

E.O. 12958: DECL: 08/09/2016
TAGS: PREL PGOV KDEM VE CU
SUBJECT: CASTRO'S ILLNESS; IMPACT ON THE BRV, ON BRV-GOC
RELATIONS

CARACAS 00002367 001.2 OF 004


Classified By: Classified by CDA Kevin Whitaker for reason 1.4(d.)

Summary
-------

1. (S/NF) BRV reaction to the announcement of Castro's
illness and recovery directly mirrored that of the Cuban
regime. There is no reason to believe that the fundamentals
of the Cuba-Venezuela relationship -- with Venezuela
providing huge resource flows, and the Cubans providing tens
of thousands of "advisors" -- will change through the medium
term. Castro's absence from the scene will deprive Chavez of
an avuncular presence and a proven crisis manager, which may
increase Chavez' vulnerability. In the event of Castro's
permanent departure from the scene, the mercurial Chavez may
become even more unpredictable. Chavez may believe his
regime's survival is tied to that of a Castroite successor
government, and under a conceivable set of circumstances
might even be willing to deploy Venezuelan military assets in
support of a successor regime. Embassy believes this would
be an apt moment to warn the BRV against intervening in Cuba
during its transition. End summary.

Initial BRV Reactions to Castro Announcement
--------------------------------------------

2. (U) Initial Bolivarian Republic of Venezuela (BRV)
reaction to the news of Castro's illness and temporary
hand-over of power has been limited to parroting the Cuban
line. Speaking on August 1 in Vietnam, Chavez seemed a bit
taken by surprise and uninformed, but said he had talked to
Cuban officials who assured him that Castro "would return to
his job in some weeks." The same day, the Venezuelan Foreign
Ministry announced that they "had received, with
satisfaction, news from Cuban authorities" that Castro was
recuperating. Vice President Jose Vicente Rangel similarly
said that he spoke with his Cuban counterpart Carlos Lage and
Cuban Foreign Minister Felipe Perez Roque, who assured him
that the Cuban leader was recovering normally.

3. (S/NF) Chavez returned to Caracas on August 3,
apparently without stopping in Havana. SIMO reports indicate
that he had wanted to do so, but the Cubans waved him off,
fearing that his presence would undercut their efforts to
convey a sense of normality. Chavez got the point; during
his August 6 "Alo Presidente," Chavez said he had learned out
that Castro was up and talking, and expressed his confidence
that the Cuban leader would be back in action soon.
Interestingly, Chavez did not suggest he'd spoken personally
to Castro. Too, he engaged in a lengthy digression about his
appreciation for being able to meet and work with a hero from
his youth. Certainly it was not his intention, but this part
of Chavez' comments took on the tone of an elegy.

Speculation on Raul-Chavez Relations
------------------------------------

4. (C) Regardless of whether Fidel is alive or not, it
would appear that Raul will continue to play a larger role
than in the past. Public and other sources have included
speculation about the lack of chemistry between Chavez and
Raul Castro. While we question the reliability of such
judgments, because it's unclear to us the basis for reaching
them, they are worth being aware of. Americo Martin, a
former Venezuelan Communist close to the Castros in the
1970s, told El Universal that the younger Castro views Chavez
with distrust and caution. Former Venezuelan Ambassador and
ubiquitous international relations analyst Julio Cesar Pineda
told poloff August 8 that he has heard that Chavez is close
to FM Perez Roque, and VP Lage, who it would appear are going

CARACAS 00002367 002.2 OF 004


to continue to play important roles in Cuba. Exiled Cuban
intellectual Carlos Alberto Montaner probably made the most
relevant observation in noting that Raul and Chavez lack the
emotional ties that bind Fidel and Chavez.

What Does it Mean for Venezuela?
--------------------------------

5. (C) While there are a number of unknowns in the
equation, there is no reason to believe much will change in
the bilateral relationship in the short to medium term. Both
countries derive benefits from the relationship. Cuba
benefits from the millions in oil and transfer payments for
services rendered; Venezuela benefits from the advice of
Castro and tens of thousands of "trainers" and doctors.
Apparent Cuban influence in Venezuela has grown dramatically,
to the point that opposition Venezuelans sardonically refer
to "Venecuba" or "Cubazuela" (both forms are acceptable).
Chavez relies heavily on Cuban advisors to implement programs
that are one of the keys to his political success. We assess
there could be as many as 40,000 Cubans currently in
Venezuela, managing, guiding, and implementing Chavez' social
missions (e.g., Barrio Adentro medical program, Mision
Robinson literacy program, Mercal state-owned grocery chain,
etc.) Rumors swirl about Cubans taking central roles in
sensitive government functions, including in Chavez' personal
security, the military, the National Electoral Council, the
national identification Office, even land titling offices.
None of that is going to change soon. The Bolivarian regime
is deriving political and organizational benefit from it, and
the Cubans are getting paid hard currency for it.

6. (S/NF) We judge that Chavez will also want to continue
Venezuela's generous petroleum support to Cuba, which we
currently estimate at 98,000 barrels per day, worth at least
$7 million a day, or $2.5 billion a year. SIMO reporting
indicates that Chavez directed that his staff find ways of
increasing resource flows to Cuba. We can think of two
motivations Chavez might have in increasing cash flow to
Cuba: first, to help a friend in need; the one thing he has
is cash, and he can give more of it. Second, it may also be
true that Chavez is looking to bump up transfer payments in
order to increase his influence in Cuba at this critical
moment. The economic assistance could become a problem,
however, if the egoistic, increasingly intrusive Chavez used
it to promote his own candidate in any ensuing power
struggle, prolonging the infighting and delaying a democratic
transition.

How Does Chavez Act if Castro is Debilitated or Dead?
--------------------------------------------- --------

7. (S/NF) Castro's prolonged convalescence or even death is
likely to cause headaches for the region and roil bilateral
relations. Some argue that Castro has had a moderating
influence on Chavez, and so he'll really let go if Castro is
gone. The predicate seems wrong to us. It's hard to see
much moderation in Chavez' recent behavior: open
interventionism and tendency to pick fights with leaders
throughout the hemisphere, his embrace of pariah states
(including especially the vote for Iran at the IAEA and the
apparent endorsement of the DPRK's July 4 missile launches),
and his government's relentless assault on basic freedoms
within Venezuela. It may be closer to the mark to observe
that Castro is one of the few people who could contradict
Chavez or give him news he didn't want to hear. We've
received numerous reports that Chavez is left surrounded by
yes-men, because he simply won't accept bad news or
criticism. The absence of Castro -- to Chavez, respected and
avuncular -- could make the mercurial Chavez even more

CARACAS 00002367 003 OF 004


unpredictable and radical.

8. (S/NF) Over time, Chavez will probably move toward
assuming the mantle as (in Castro's words) "my successor to
advance social revolution." Chavez will need to work this
issue slowly, as he does not wish to suggest prematurely that
Castro is dead and inadvertently cause problems for -- or
with -- any successor Castroite regime. That said, Chavez
has neither the intellectual candlepower nor the
international environment to replicate Castro's rise to
international prominence. That doesn't mean he won't try,
and he'll play his best card -- oil wealth -- whenever he
needs to. And whatever the force of his arguments, his
checkbook is going to speak loudly.

9. (S/NF) We should be particularly mindful that Chavez
will be a committed advocate of the continuation of a
repressive regime in Cuba. Chavez has been on a losing
streak, with the electoral results in Peru and (it seems) in
Mexico; were Cuba now to turn toward democracy, Chavez would
be increasingly isolated as the sole radical leftist in the
hemisphere. Chavez may believe that the survival of his
regime is tied to that of the Castro regime.

10. (S/NF) There are some even more troubling scenarios
that one can play out in this regard. Chavez has said as
recently as this April that he'd be willing to spill
Venezuelan blood to save the Cuban regime (although he was
speaking about a U.S. invasion). Were there to be an
internal civil conflict in Cuba, we believe it possible that
Chavez would consider intervening militarily on the side of
pro-regime elements. It is not clear to us that such an
intervention would be militarily effective, but the presence,
or even threat, of a Venezuelan force in Cuba would have
important implications for Cuba and for us. Perhaps the most
likely scenario would have the Venezuelans providing lift
capability to loyalist troops; the Venezuelan Armed Force
(FAV) does retain some fixed-wing and rotary lift capability.
That said, a Venezuelan navy troopship regularly plies
between Venezuela and Cuba, and could conceivably be used to
move FAV troops to the island.

(11. (C) Comment: As noted in previous email traffic,
Embassy suggests that this may be an apt time to warn the BRV
against intervening in Cuba.)

An Achilles' Heel?
------------------

12. (S/NF) These are some fairly gloomy scenarios. We can
conceive how Castro's absence might actually make Chavez more
vulnerable. Hugo Chavez is a master tactician, regularly
assessing the domestic political situation better and faster
than the opposition, and making moves to box in his
democratic opponents. What Chavez is less good at is crisis
management. To take a recent example, Chavez' first instinct
to go to Castro's sickbed was wrong, because it would have
undercut the regime's "all is well" line. There are
historical examples, of Chavez cracking under pressure. In
both the 1992 and the 2002 failed coups, evidence suggests
that Chavez lost his nerve at key moments. His military
colleagues were willing to fight on in 1992 when he was holed
up in the Military Museum, but he surrendered them all. In
2002, a weepy Chavez was reportedly ready to sign the letter
of resignation and flee to Cuba. Castro has proved his worth
to Chavez as a proxy crisis manager. It was Castro who told
Chavez to fight on in 2002, and it was Castro who worked the
phones to reassemble a pro-Chavez consensus in the armed
forces. In 2004, as the recall referendum approached, it was
Castro who conceived and executed the "misiones" plan to buck

CARACAS 00002367 004.2 OF 004


up Chavez' popularity. In Cuba, from the Cuban Missile
Crisis to Mariel to the Maleconazo to the Special Period,
Fidel Castro has proven himself to be a superb crisis
manager. Should Chavez confront a thorny crisis, especially
a domestic crisis, he may suffer significantly from the loss
of Castro's steady hand at his back. This, in turn, could be
an advantage for us in our efforts to urge a return to full
democracy in Venezuela.

 

 

=============================================

 

Reference ID

Created

Released

Classification

Origin

05BRUSSELS1530 2005-04-18   13:01 2010-12-15   21:09 CONFIDENTIAL Embassy   Brussels
This record is a partial extract of the original cable. The full text of the original cable is not available.
C O N F I D E N T I A L SECTION 01 OF 03 BRUSSELS 001530

SIPDIS

E.O. 12958: DECL: 04/18/2015
TAGS: PREL PHUM PINR EAID CU EUN USEU BRUSSELS
SUBJECT: CUBA: EU COMMISSIONER MICHEL BOLSTERS CUBAN FONMIN

REF: A. A) BRUSSELS 1389
     B. B) BRUSSELS 1217
     C. C) STATE 50857

Classified By: USEU POLOFF TOOD HUIZINGA, FOR REASONS 1.4 (B) AND (D)

 1. (C) SUMMARY: According to his adviser on Cuba, European
Commissioner for Development Louis Michel believes the EU
must bolster Cuban FM Felipe Perez Roque as the best hope for
improved EU-Cuba relations.  During his March 24-27 visit to
the island (REFS B-C), Michel offered Perez Roque better
relations with the EU, apparently implying that the EU wished
to offset the U.S. embargo.  Michel reportedly was struck by
the "frozen" world-view of the other Cuban officials he met,
including Castro, who appeared to believe Cuba's
relationships with Venezuela and China rendered closer
relations with the EU unnecessary.  Michel's analysis of
EU-Cuba relations seems unaffected by his meetings with the
opposition.  He believes the U.S. embargo soured the
Communist experiment on the island, and that "constructive
engagement" with Cuba is the EU's only alternative.  His view
has the upper hand in the EU, but continued Cuban
intransigence could result in pressure to toughen EU policy
by the time of the EU's June/July Cuba policy review.  END
SUMMARY.

----------------------
A CONFIDENTIAL READOUT
----------------------

2. (C) XXXXXXXXXXXX (STRICTLY PROTECT), who covers
Cuba in the cabinet of European Commissioner for Development
Louis Michel, called Poloff on April 14 for a "confidential"
readout of Michel's March 24-27 visit to Cuba.  XXXXXXXXXXXX
accompanied Michel to the island and attended all of his
meetings except the encounter with Castro.  During his trip
Michel met with Perez Roque, Vice President of the Council of
State Carlos Lage, National Assembly President Ricardo
Alarcon, Minister of Foreign Investment and Economic
Cooperation Marta Lomas and, for three hours, with Fidel
Castro.  In addition, Michel met Cardinal Jaime Ortega and
Cuban opposition figures Oswaldo Paya, Marta Beatriz Roque,
Vladimiro Roca and the Women in White, a group of wives and
family members of imprisoned dissidents.  XXXXXXXXXXXX said he
had offered the readout to assure Poloff that Michel fully
shared the objective of democratic transition in Cuba and had
reasons for his differences with the U.S. on tactics.

---------------------------
PEREZ ROQUE: THE GREAT HOPE
---------------------------

3. (C) XXXXXXXXXXXX repeated often that Perez Roque was the only
Cuban official Michel met with whom it was possible to have a
give-and-take discussion.  Perez Roque appeared to be looking
ahead to a post-Castro era, and thinking pragmatically about
how to pursue Cuba's present and future interests.  In this
context, he listened with interest to Michel's suggestion
that Cuba join the Cotonou Agreement and thereby establish a
comprehensive basis for closer political, trade and
development-assistance relations with the EU.  (NOTE: The
Cotonou Agreement is the framework for
development-assistance, trade and political relations between
the EU and the 79 members of the African, Caribbean and
Pacific Group of States.  In exchange for a more favorable
trade and aid relationship, Cotonou would commit Cuba to a
regular political and human rights dialogue with the EU.  END
NOTE.)  According to XXXXXXXXXXXX, Michel told Perez Roque that
a Cotonou-based relationship with the EU could act as a
counterbalance to Cuba's isolation from the U.S.  He further
suggested that, under Cotonou, the EU might be able to help
the Cubans in sending medical doctors to countries in the
region, as they are doing in Venezuela.

------------------------------
PEREZ ROQUE NONCOMMITTAL TO EU
------------------------------

4. (C) Perez Roque's response to the Cotonou offer was
noncommittal.  XXXXXXXXXXXX said the Cuban FM's negotiating
style could be described as "I'll tell you the time if you
give me your watch."  In that spirit, Perez Roque repeatedly
told Michel the prerequisite for closer EU-Cuba ties was the
EU's dropping support for the U.S. CHR resolution on Cuba.
Denying that Michel had ever advocated dropping support,
XXXXXXXXXXXX said that Michel's response was always that (1)
Cuba must release its imprisoned dissidents; and (2) since
the CHR resolution was purely procedural, the EU could not
fail to support it.  XXXXXXXXXXXX said Michel raised the
possibility of Cuba's inviting UN High Commissioner for Human
Rights Louise Arbour or her Cuba Representative Christine
Chanet to visit the island, in order to signal Cuba's desire
to work with the international community.  According to
XXXXXXXXXXXX, Perez Roque said he would consider the idea but
never followed up.

-----------------------------------------
MICHEL'S EFFUSIVENESS WAS FOR PEREZ ROQUE
-----------------------------------------

5. (C) XXXXXXXXXXX said Michel was quite aware that trying to
buttress Perez Roque was a risk.  No one could be sure
whether he was acting in good faith in his contacts with the
EU, or simply "the smartest" member of a completely
intransigent regime.  Nonetheless, Michel felt that Perez
Roque represented the EU's only hope of influencing Cuba
toward reform and respect for human rights.  XXXXXXXXXXX said
Michel's effusive public optimism about EU-Cuba relations
after the visit was meant to bolster Perez Roque.  In
reality, said XXXXXXXXXXXX, Michel came away sobered and
distressed.  Perez Roque would have to come through soon,
said XXXXXXXXXXXX, by freeing more dissidents or allowing the UN
human rights visit, or Michel and the Spaniards would no
longer be able to advocate full constructive engagement.
When pressed on whether "soon" meant before the upcoming
June/July review of EU Cuba policy, XXXXXXXXXXXX said, "we'll
probably have to give him more time than that."

----------------------------------
MICHEL: CASTRO, OTHERS, DELUSIONAL
----------------------------------

6. (C) XXXXXXXXXXXX was at pains to contrast Perez Roque with
the other Cuban officials they had met.  XXXXXXXXXXXX said
Michel was struck by how "frozen" and delusional Cuban
officials' view of the world was.  The meeting with Vice
President of the Council of State Carlos Lage was emblematic
of this, said XXXXXXXXXXXX.  Lage seemed truly to believe that
all was well on the island, that time was on Cuba's side
regarding the U.S. embargo, that the Cuban peso revaluation
would make the economy strong and, above all, that Cuba's
growing relations with Venezuela and China rendered closer
relations with the EU unnecessary.  Although XXXXXXXXXXXX did
not attend the meeting with Castro, Michel told him the
three-hour encounter started with an almost surreal tour
through a room Castro had showcasing Chinese products as if
it were a museum exhibition.  Castro, too, seemed fixated on
Venezuela and China.  Although the Alarcon meeting was less
substantive, according to XXXXXXXXXXXX, Alarcon expressed views
similar to Lage.  XXXXXXXXXXXX said Minister of Foreign
Investment and Economic Cooperation Marta Lomas was the most
wooden of all, sticking so close to her talking points that
no exchange was possible.

-------------------------------------
MICHEL: EMBARGO FEEDS CUBAN DELUSIONS
-------------------------------------

7. (C) XXXXXXXXXXXX stressed that a central element of the
official Cubans' world-view was the U.S. embargo.  The Cuban
David had weathered the American Goliath's embargo for forty
years, proving the regime's strength and lending it moral
legitimacy.  XXXXXXXXXXXX said Michel felt vindicated in his
opposition to the embargo, since he had now witnessed the
role it played in Cuban officials' delusions.  XXXXXXXXXXXX
added that Michel believed that Communism might have turned
out well for Cuba if the embargo had not helped push the
regime down the hard-line path.  This was yet another reason,
XXXXXXXXXXXX said, to choose a Cuba policy of engagement rather
than isolation.

-------------------------------------------
OPPOSITION: LITTLE EFFECT ON MICHEL'S VIEWS
-------------------------------------------

8. (C) Michel's analysis of EU-Cuba relations seems
unaffected by his meetings with the opposition and the
Church.  XXXXXXXXXXXX said Michel had three separate meetings
with dissidents, one with Oswaldo Paya, another with Marta
Beatriz Roque and Vladimiro Roca, and a third with the Women
in White.  XXXXXXXXXXXX said little of note was discussed during
the Paya meeting, and that Roca was the only opposition
figure who completely opposed the lifting of the EU measures.
 Beatriz Roque, said XXXXXXXXXXXX, opposed it as well, but was
willing to wait and see what the upshot would be.  The Women
in White made a deep impression on Michel, according to
XXXXXXXXXXXX, with their personal stories.  However, they did
not discuss policy.  XXXXXXXXXXXX had little of substance to say
about Michel's meeting with Cardinal Jaime Ortega.

---------------------------------------
MICHEL GOING TO MAT FOR FULL ENGAGEMENT
---------------------------------------

9. (C) COMMENT: Michel apparently will stop supporting full
constructive engagement with Cuba only if Cuban intransigence
-- and pressure from within the EU -- makes his position
politically untenable.  He is also willing to sell the EU
approach to the Cubans as a counterweight to the U.S.
embargo.  Our sense is that this attitude, buttressed by
Spanish support, is still carrying the day in the EU.  (NOTE:
On April 15, Perez Roque called EU support for the CHR
resolution on Cuba "pathetic;" a Commission spokeswoman's
response was to say that the EU supported the resolution
because it did not condemn the Cuban authorities.  END NOTE.)
 As the June/July review of EU Cuba policy approaches, the
commitment of anti-Castro member states such as the Czech
Republic and Poland, and, in Brussels, of the center-right
activists in the European Parliament (REF A) will be key.  If
the Castro regime remains as uncompromising as it has been in
its reaction to the CHR resolution, they might have a window
of opportunity to modify the current policy of full
engagement.  END COMMENT.

SCHNABEL

 

 

 

 

===========================================

 

10CARACAS187 2010-02-12 20:08 2010-11-30 21:09 CONFIDENTIAL Embassy Caracas

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DE RUEHCV #0187/01 0432020

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TO RUEHC/SECSTATE WASHDC 0463

INFO EU MEMBER STATES COLLECTIVE

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RHMFISS/HQ USSOUTHCOM MIAMI FL

C O N F I D E N T I A L SECTION 01 OF 02 CARACAS 000187

 

SIPDIS

HQSOUTHCOM ALSO FOR POLAD

AMEMBASSY BERLIN PASS TO AMCONSUL DUSSELDORF

AMEMBASSY BERLIN PASS TO AMCONSUL LEIPZIG

AMEMBASSY ATHENS PASS TO AMCONSUL THESSALONIKI

AMEMBASSY BRIDGETOWN PASS TO AMEMBASSY GRENADA

AMEMBASSY OTTAWA PASS TO AMCONSUL QUEBEC

AMEMBASSY BRASILIA PASS TO AMCONSUL RECIFE

 

E.O. 12958: DECL: 2020/02/12

TAGS: PGOV PHUM PREL KDEM CU VE

SUBJECT: Increased Harassment of Approved Cuban Medical Parolees

 

REF: 09 CARACAS 1374; 09 CARACAS 442

 

CLASSIFIED BY: Robin D. Meyer, Political Counselor, DOS, POL; REASON:

1.4(B), (D)

 

1. (C) Summary: Harassment of Cuban Medical parolees has

increased significantly since December 2009. Recent media

coverage has exacerbated difficulties experienced by parolees

attempting to exit Venezuela. These Cuban medical professionals

who staff President Chavez’s flagship medical service program for

the poor, Barrio Adentro, report that they inflate their patient

numbers and are required to conduct political work. Cubans who

have abandoned their Barrio Adentro clinics find it difficult to

legalize their presence and benefit from basic services. Most

parolees do make it out of Venezuela, but some undergo a harrowing

ordeal before being able to exit. End Summary.

 

 

 

HARASSMENT OF CUBAN MEDICAL PAROLEES

 

2. (C) In the last two months, Cubans approved for humanitarian

parole through the Cuban Medical Professionals Program (CMPP) at

Embassy Caracas have experienced increased difficulty leaving

Venezuela through the MaiquetC-a (Caracas) airport. Almost all

experience some sort of harassment, ranging from passports being

confiscated to physical and verbal abuse. Many of those who are

allowed to board their flights to Miami are only able to do so

after paying sizeable bribes (generally $700-$1000) to Venezuelan

immigration officials or Cuban officials who are said to be working

at the airport. From 2009-2010, more than 20 parolees have been

detained for extensive questioning, which has reportedly included

verbal and physical abuse, confiscation of official and regular

passports, strip search, and threats of deportation. Most of those

Cubans detained are not allowed to proceed to their flights.

However, there have been no reports of these parolees actually

being deported to Cuba, and they have all been released after

several hours of detention. In fact, most parolees eventually make

it out on a subsequent attempt.

 

 

 

MEDIA COVERAGE MAKES IT WORSE

 

3. (C) The problem has been exacerbated by January 2010 news

coverage of the CMPP in U.S., Venezuelan, and Colombian media

outlets. Harassment has increased significantly since the first

article was published in the Miami Herald on January 7 and was

subsequently picked up by Globovision and other media outlets in

Venezuela. Some CMP parolees have chosen to transfer their cases

to Colombia rather than take the risk of leaving via Venezuela.

Others have simply traveled to Colombia and departed using the

travel documents issued in Caracas. Since 2009, 10 of those unable

to fly have crossed the border to Colombia and have flown to Miami

from BogotC!. There are no reports of harassment once parolees are

in Colombia.

 

 

 

FAKE STATISTICS AND POLITICAL WORK

 

4. (C) Post collected the following anecdotal evidence recounting

the difficulties applicants encounter during and after the mission.

While in the mission, applicants live off a very a meager stipend

(967 Bolivares Fuertes per month, approximately $372 USD at the

official exchange rate) and work six days a week. Doctors are

required to see 50-70 patients daily, a number unattainable for

most doctors who, in reality, average 10-20 patients. Almost all

applicants claim they are forced to doctor their statistics to meet

these requirements. Many applicants also describe mandatory

political work, especially around elections, when applicants are

instructed to read propaganda in clinics and gather potential

voters. In addition, they are often required to staff politically

charged health drives on Sundays. (Note: Some Venezuelans have

accused Barrio Adentro of being primarily a political program. See

Ref A for more details. End Note.)

 

 

 

CUBANS’ PLIGHT AFTER ABANDONING THE MISSIONS

 

CARACAS 00000187 002 OF 002

 

 

5. (C) Applicants encounter severe difficulties once they abandon

the mission. At this point, the applicants are considered illegal

immigrants and are subject to deportation. Most find it difficult

to ever legalize their stay in Venezuela or benefit from basic

services. One applicant gave birth the day after her parole was

accepted but has been unable to get a Venezuelan passport for her

child. Officials told her that they are forbidden to give passports

to “deserters.” Other Cubans have not been able to legally marry in

Venezuela. While there is no confirmed deportation of a parolee, an

applicant was recently sent back to Cuba as a precautionary measure

when his girlfriend abandoned the mission.

 

 

 

CMPP NUMBERS TO DATE

 

6. (C) From 2006 to 2007, 497 Cubans applied for parole through

the CMPP at Embassy Caracas. 407 of those applicants were approved,

70 were denied, and 8 cases are still pending. In 2008, there were

201 applicants, 154 approvals, 28 denials, and 8 cases are still

pending. In 2009, Embassy Caracas received 237 applications, 161

of which were approved, 36 denied, and 40 still pending. There have

not been any approvals or denials yet in 2010. Since Post began to

use YY foils instead of transportation letters in March 2009 (due

to fraud concerns), 277 of such foils have been issued. It

should be noted that the vast majority of our approved CMPP

applicants actually do successfully leave Venezuela. Most

successfully leave on their first attempt flying out of Venezuela

with a visa foil or travel letter. Those that are initially

detained have apparently often been able to bribe their way out on

a subsequent attempt. The rest, as noted above, have made the trek

to Colombia and been able to get on a flight to Miami.

 

 

 

7. (C) COMMENT: Post generally receives CMPP approvals in large

batches. Given the parole requirements of traveling within 21 days

of YY foil issuance, many parolees attempt to exit Venezuela during

the same time period. This creates a situation whereby these

applicants will travel in waves. Post is unaware whether

harassment is the result of deliberate Government of the Bolivarian

Republic of Venezuela (GBRV) guidance or based on the actions of

individual immigration officers. Certainly, the recent publicity

about Cuban doctors bribing Venezuelan and Cuban officials has put

an unwelcome spotlight on the program. Yet it does seem clear that

the GBRV does not yet systematically attempt to detain all

parolees. Finally, the information provided by the applicants

during the interview process appears to corroborate claims from

many Venezuelans that the Barrio Adentro program is as focused on

political propaganda as it is on improving health.

DUDDY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CUBAN HEALTHCARE: “AQUI NADA ES FACIL”

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Reference ID

Created

Released

Classification

Origin

08HAVANA103 2008-01-31   19:07 2010-12-17   21:09 CONFIDENTIAL US Interests   Section Havana
VZCZCXRO9040
RR RUEHAO RUEHCD RUEHGA RUEHGD RUEHHA RUEHHO RUEHMC RUEHNG RUEHNL
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R 311952Z JAN 08
FM USINT HAVANA
TO RUEHC/SECSTATE WASHDC 2800
INFO RUEHWH/WESTERN HEMISPHERIC AFFAIRS DIPL POSTS
RUCOWCV/CCGDSEVEN MIAMI FL
RUEAIIA/CIA WASHINGTON DC
RHEHAAA/NATIONAL SECURITY COUNCIL WASHINGTON DC
RUCOGCA/COMNAVBASE GUANTANAMO BAY CU
RHMFISS/HQ USSOUTHCOM MIAMI FL
RHMFISS/JOINT STAFF WASHINGTON DC
RHEFDIA/DIA WASHINGTON DC
RUEATRS/DEPT OF TREASURY WASHINGTON DC
RUCPDOC/DEPT OF COMMERCE WASHINGTON DC
Thursday, 31 January 2008, 19:52
C O N F I D E N T I A L SECTION 01 OF 06 HAVANA 000103
SIPDIS
SIPDIS
DEPT FOR WHA/CCA
EO 12958 DECL: 01/25/2018
TAGS PGOV, PINR, PREL, ECON, AMED, SOCI, AMGT, CU
SUBJECT: CUBAN HEALTHCARE: “AQUI NADA ES FACIL”
(HERE NOTHING IS EASY)
REF: HAVANA 0076
Classified By: COM: Michael E. Parmly: For reasons 1.4 b/d
1. (C) SUMMARY: This cable is a follow up to Reftel and provides anecdotal accounts from Cubans about their healthcare, based on USINT FSHP’s (Foreign Service Health Practitioner) interactions with them, her unauthorized visits to Cuban hospitals, and her care of USINT American and Cuban personnel. End Summary.
2. (C) The following anecdotes were obtained from Cubans of various walks of life: domestic employees, neighbors in the Havana suburbs, USINT Local Contract National (LCN) employees, service providers such as manicurists, masseuses, hair stylists, chauffeurs, musicians, artists, yoga teachers, tailors, as well as HIV/AIDS and cancer patients, physicians, and foreign medical students.
-- A Cuban woman in her thirties confides, “It’s all about who you know. I’m okay because I am healthy and I have ‘friends’ in the medical field. If I didn’t have my connections, and most Cubans do not, it would be horrible.” She relates that Cubans are increasingly dissatisfied with their medical care. In addition to the general lack of supplies and medicines, and because so many doctors have been sent abroad, the neighborhood family physicians now care for 300-400 families and are overwhelmed by the workload. (Note: Neighborhood doctors are supposed to provide care for only 120 families. End Note.) In the absence of the physicians, patients go to their municipality’s “polyclinic,” but long lines before dawn are common, with an all too common 30-second diagnosis of “it’s a virus.”
-- A 40-year old pregnant Cuban woman had a miscarriage. At the OB-Gyn hospital they used a primitive manual vacuum to aspirate the contents of her womb, without any anesthesia or pain medicine. She was offered no emotional support for her ‘loss’ and no pain medication or follow up appointments.
-- A 6-year old Cuban boy with osterosarcoma (bone cancer) is admitted to the oncology hospital. Only his parents are permitted to visit, and then only for limited hours. He does not have a television nor any games or toys. The hospital offers no social support services. The parents do not seem informed as to their son’s case. When asked by the FSHP what they know about the management of the disease, they shrug their shoulders. According to the FSHP, cancer patients do not receive on-going basic care utilizing testing procedures common in much of the world to monitor cancer care -- such as blood chemistries and tumor markers, sonograms, x-rays, CT and bone scans, MRIs, PET scans, etc. Patients are generally informed of the type of cancer they have, but know little of its staging, tumor size, metastasis, or prognosis. They may be offered surgery followed by chemotherapy and/or radiation but are not given choices to decide an aggressive versus less aggressive approach, nor are they allowed internet access to learn more of their disease.
-- Many young cancer patients reportedly have become infected with Hepatitis C after their surgeries. Contracting Hepatitis C after surgery indicates a lack of proper blood screening prior to administering transfusions. All blood should be screened for Hepatitis B, C, HIV and Syphilis prior to use. Patients have no recourse and are not fully informed of the seriousness of such an inadvertent infection.
-- During chemotherapy and radiation treatments, patients receive little in the way of symptom or side-effects care (i.e., severe nausea, vomiting, low blood counts, fever, diarrhea, radiation burns, mouth sores, peripheral neuropathies,etc.) that is critically important in being able to continue treatments, let alone provide comfort to an already emotionally distraught victim. Cancer patients are not provided with, nor can they find locally, simple medications such as Aspirin, Tylenol, skin lotions, vitamins, etc. Most Cuban patients are not offered Hospice Care or any social support programs for children, adults, or their care providers.
-- HIV positive patients have had the letters ‘SIDA’ (AIDS)
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stamped on their national ID cards. Needless to say, in a country where the national ID card must be shown for everything from getting monthly rations to buying a train ticket, the person is stigmatized for life. There is no patient/doctor confidentiality and discrimination is very strong. (Note: According to Pan-American Health Organization (PAHO) officials in Havana, stamping ID cards used to be the case but is no longer the practice in Cuba, something we could not independently corroborate. End Note.)
-- Some newly diagnosed HIV/AIDS patients are held in what has come to be known as “Prision de Pacientes con SIDA de San Jose” (Prison for AIDS patients). There they are started on antiretrovirals AZT, D4T, 3TC. It is unclear to them why they were put in this prison-like facility but believe it is plain discrimination due to their homosexuality. The average period spent at this facility seems to be 18-24 months.
-- AIDS patients are not given prophylaxis medication for the prevention of PCP (Pneumocysti carinii pneumonia), and for lack of newer medicines some patients are re-started on antiretroviral regimens that were stopped due to significant side effects. The Cuban family physicians who care for these patients’ primary care needs do not have the authority to treat their HIV/AIDS disease. There is only one facility in Cuba, Instituto Pedro Kouri, located in Havana, where HIV positive patients can receive their specialty care, antiretroviral medications and treatments. According to HIV positive Cubans known to FSHP, one usually waits for months for an appointment, but can often move ahead in line by offering a gift or hard currency. We are told five Cuban convertible pesos (approximately USD 5.40) can get one an x-ray and more can get one a CD4 count. Patients on the island must travel to the capital city for their specialist visits and medication. Due to the lack of island-wide transportation and the cost of travel, many HIV-positive patients may be seen only once per year.
-- While the GOC claims there is a network of organizations that provide social support for HIV/AIDS patients, many of our sources say they have never been to one. Because they are “marked” as HIV positive, many are prevented from pursuing university studies and few can find gainful employment -- many must resort to menial jobs to survive.
-- A physician XXXXXXXXXXXX told the FSHP that he works 14 hours every other day, then has to hitchhike home because he cannot afford to own a car.
-- XXXXXXXXXXXX stated that Cuban authorities have banned Michael Moore’s documentary, “Sicko,” as being subversive. Although the film’s intent is to discredit the U.S. healthcare system by highlighting the excellence of the Cuban system, he said the regime knows the film is a myth and does not want to risk a popular backlash by showing to Cubans facilities that are clearly not available to the vast majority of them. When the FSHP showed Sicko to a group of XXXXXXXXXXXX, some became so disturbed at the blatant misrepresentation of healthcare in Cuba that they left the room.
-- Even the Cuban ruling elite sometimes goes outside of Cuba for the best medical care. Fidel Castro, in July, 2006 brought in a Spanish doctor during his health crisis. Vice Minister of Health Abelardo Ramirez went to France for gastric cancer surgery. The neurosurgeon who is Chief of CIMEQ Hospital (reportedly one of the best in Cuba) went to England for eye surgery and returns periodically for checkups.
-- According to a local pediatrician, the approximate breakdown of Cuban physicians’ salaries are: 1st & 2nd year residences earn 325 pesos monthly (USD 15.00); 3rd year residences earn 355 (USD 16.00); 4th year residences (specialists) earn 400 pesos monthly (USD 18.00). For every four years of medical practice thereafter, a physician receives an additional 20 pesos (USD 0.89 cents) per month.
-- There is reportedly such a shortage of nurses that within the last few years, a high-school graduate is now offered an
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accelerated training course of just ten-months duration entitled, “Enfermeras Emergentes” (Emergency Nurses). These “quasi” nurses are not trained to start Intravenous lines, interpret lab results or draw blood.
-- Few medical professionals are allowed access to the internet and are rarely allowed to travel to participate in international conferences or continuing education courses. Access to up-to-date medical literature is not available. Some physicians have confided to the FSHP, “All of us want to leave.” They are dissatisfied with their salaries and their own medical care. They receive no special privileges - most of them do not even have access to care at the better foreigner hospitals, even if they work there.
-- As described in reftel, the best medical institutions in Cuba are reserved for foreigners with hard currency, members of the ruling elite and high-ranking military personnel. These institutions, with their intended patient clientele in parentheses, include: Clinica Central Cira Garcia (diplomats & tourists), Centro Internacional de Investigaciones Restauracion Neurologica (foreigners & military elite), Centro de Investigaciones Medico Quirurgicas (military & regime elite), Clinica de Kohly (Primer Buro Politico & Generals of the Ministry of Interior), and the top floors of the Hermanos Ameijeiras Hospital (foreigners) and Frank Pais Hospital (foreigners). These institutions are hygienically qualified, and have a wide array of diagnostic equipment with a full complement of laboratories, well-stocked pharmacies, and private patient suites with cable television and bathrooms.
4. (C) Below are first-hand observations from USINT’s Foreign Service Health Practitioner’s (FSHP) impromptu and unauthorized (by the GOC) visits to major Havana hospitals where average Cubans receive their healthcare, and from conversations with Cubans in many walks of life.
A. Hermanos Ameijeiras Hospital
-- Address: San Lazaro #701 Esquina A Belascoain, Centro Habana, Havana
-- Date of visit: October, 2007
-- Built in 1982, this newly renovated 600 bed, 24 story hospital is depicted in Michael Moore’s film “Sicko,” where some 60 surgeries are performed daily including heart, kidney, and cornea transplants, mostly to patients who receive free treatment as part of Operation Milagro (mostly from Venezuela, but also from the rest of Latin America). The two top floors (shown in the movie) are the most modern and are reserved for medical tourists and foreign diplomats who pay in hard currency. The hospital has three intensive care units and all medical specialties except Pediatrics and Obstetrics/Gynecology and has no emergency room. The facility has a CT scanner (often said to be out-of-service), MRI and hyperbaric chamber capabilities.
-- Upon entering the building the FSHP was struck by the grand and impressive lobby with a four-story ceiling, polished terrazzo floors and an elegant center reception booth. No one was in the reception booth, which displayed a digital streaming ticker-tape announcing an outdated hospital event; 30 or 40 people were sparsely scattered in the leather-like chairs throughout the lobby. There were no wheel chairs or other obvious signs this was a hospital.
-- She was told the majority of patients came from Venezuela and each received weekly one bar of Palmolive bath soap, Palmolive shampoo, and a tube of Colgate toothpaste. She was also told the Venezuelan patients frequently take these items outside to the front parking lot and sell them to local Cubans. Cuban in-patients receive one tube of Colgate toothpaste and no other toiletries.
-- Due to the high volume of foreigners receiving treatments and surgeries, most Cubans do not have access - the only chance might be a through a family member or connection working there and a gift or 20 CUCS (USD 21.60) to the Hospital Administrator. Cubans are reportedly very resentful
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that the best hospital in Havana is “off-limits” to them.
B. Ramon Gonzalez Coro Hospital
-- Address: Calle 21 #856 between 4th & 6th Avenues, Vedado Plaza, Havana
-- Date of visit: July, 2006
-- What is today the Obstetrics & Gynecology (OB-Gyn) hospital for Havana, used to be a private clinic prior to the revolution. The hospital has: 300 beds and reserves 12 beds for foreigners; an Intensive Care Unit for women as well as a Newborn Intensive Care Unit (using a very old infant ‘Bird’ respirator/ventilator - the model used in the U.S. in the 1970s); an Intermediate Newborn Care Unit; one room for babies less than five pounds needing weight gain; a Genetics Department with a specialized laboratory; and five surgical suites.
-- The FSHP visited this hospital with a pregnant USINT American patient. Normally USINT staff is required to go to Cira Garcia Clinic, but because there were possible OB complications the FSHP was able to arrange, through a Cuban medical contact, for the patient to be seen by a highly-recommended obstetrician.
-- This hospital, located in the densely populated residential area of Vedado, had a dilapidated and crumbling exterior. The FSHP was stopped at the entrance by a guard, but upon mentioning the name of the doctor they were to see, were allowed to proceed to the second floor - supposedly the nicest part of the hospital, which is reserved for foreigners; it reminded the FSHP of some of the poorest hospitals she had seen in Africa - unkempt rooms, old wrought-iron beds, flat mattresses with only one sheet, no A/C, no TV, no amenities. At the nursing station there was no nurse, but a metal cabinet with glass doors that had one jar filled with cotton and one half-full 16 ounce bottle of isopropyl alcohol. There were no other supplies nor any indication this was a nurse’s station - no stethoscopes, no computers, no medical charts, no papers or pens on the desk - there was a lone dial-type black telephone.
-- After waiting 15 minutes a nurse in a white uniform appeared and told the FSHP and her patient to wait. She wasn’t friendly. There was no waiting room, so they found some chairs in the hall. It was very hot and the patient was very anxious and in pain. After 45 minutes and several attempts in a polite manner to move things along, a young female doctor came out smiling and asked for the patient - she asked that her husband remain in the chair, but did allow the FSHP to go with her upon insisting. At the end of a long hallway, the FSHP and the patient were guided into an “exam room.” There were no chairs, screens, posters, any medical supplies or equipment; only one old rusting sheet-metal table without any covering, extensions or stirrups. She asked the patient to undress and climb on the table with no intention to drape her. Having worked in third-world countries, the FSHP brought with her a bag of supplies that included paper drapes, which she placed on the table and over the patient. The doctor pulled out of a nearby drawer an old Pinard fetal heart stethoscope made of aluminum (funnel-shaped, like those used at the turn of the Century ) to listen for the baby’s heart beat. The FSHP could not believe her eyes -- this was one of the best OB/GYN hospitals in Cuba. When the FSHP offered the doctor a portable fetal Doppler she had brought from the USINT Health Unit (HU), she gladly accepted.
-- Although the doctor appeared to be clinically competent, she was abrupt and rough with the patient. FSHP believes this to be typical of the hierarchical doctor-patient relationship in Cuba. She stated, “She has an infection and needs an antibiotic,” and gave the FSHP a written prescription for an antibiotic generally not recommended during pregnancy. Upon returning to the HU the FSHP did a culture that returned negative for a bacterial infection. Needless to say, the FSHP did not give the prescription to the patient. As a result of this experience, the FSHP concluded that the best care for her unstable female pregnant patients in Havana -- barring a MEDEVAC to the U.S. -- would
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be by the FSHP in their own home with telephone consults to an obstetrician in the U.S.
-- XXXXXXXXXXXX told the FSHP that XXXXXXXXXXXX foreign medical students are increasingly covering for the gross shortages of physicians in Cuban hospitals.
C. Calixto Garcia Hospital
-- Address: Avenida De Universidad Y 27 De Noviembre, Vedado, Havana
-- Date of visit: November, 2007
-- Built in the late 1800’s, this dilapidated 400-bed hospital was the first teaching hospital in Cuba and is only for Cubans. FSHP believes that if Michael Moore really wanted the “same care as local Cubans,” this is where he should have gone. The 22-bed emergency room receives all the major trauma and accident victims from Havana City, plus there are large Intensive and Intermediate Care Units. It also has a CT scanner and an MRI, which are reportedly often out of order. The hospital provides specialist care in all medical fields except OB-Gyn and Pediatrics.
-- During the hospital visit, FSHP was struck by the shabbiness of the facility -- no renovations were apparent -- and the lack of everything (medical supplies, privacy, professional care staff). To the FSHP it was reminiscent of a scene from some of the poorest countries in the world.
-- In an open-curtained exam room inside the emergency room, FSHP saw a middle-aged man lying on a gurney in his own soiled clothes with a large bloody bandage wrapped around his head - he was breathing, but was neither moving nor talking - there was no IV, oxygen (in fact no piped-in oxygen at all at this facility) or monitoring equipment. Neither did there seem to be any sense of urgency to his care.
-- The hospital is spread out over several city blocks consisting of many two-story buildings with various specialties: Internal Medicine, Cardiology, General Surgery, Orthopedics, Ophthalmology, and Neurology, etc. Each building is set up in dormitory style, with 44 metal beds in two large open rooms.
-- The laboratory equipment is very rudimentary - a simple CBC (complete blood count) blood test is calculated manually by a laboratory technician looking through a microscope and counting the individual leucocytes, lymphocytes, monocytes, etc.
-- As the FSHP exited a building, XXXXXXXXXXXX drove up in a badly dented 1981 Moskovich that belched exhaust fumes. The private car, which is a luxury in Cuba, was a gift from his deceased father. He was a thin man, appearing disheveled, unshaved, with a cigarette between his lips, wearing a tattered white lab coat without a shirt underneath. He said his salary was 565 pesos (approximately $22) per month.
D. Salvador Allende Hospital
-- Address: Calzada Del Cerro # 1551, Cerro, Havana
-- Date of visit: November, 2007
-- This 400-bed hospital is located in Cerro - a poorer and more densely populated section than the others visited in Havana. It is an old, run-down facility similar in appearance to Calixto Garcia Hospital in that there are several two-story buildings each with a medical specialty.
-- The FSHP was dropped off a few blocks away so the guards wouldn’t see the diplomatic plates. When she walked in, the guards smelled of alcohol. In the emergency room there were about 40 mostly poor-looking Afro-Cuban patients waiting to
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be seen. It appeared to be very orderly, clean, and organized.
-- The rest of the buildings were in shambles . The FSHP did not see any “real” medicine or nursing practiced during her almost one-hour walk through most of the buildings. As she saw patients, she could not help but think that their own home might provide more value-added than remaining in that hospital. Patients had to bring their own light bulbs if they wanted light in their rooms. The switch plates and knobs had been stolen from most of the rooms so one had to connect bare wires to get electricity. There was no A/C and few patients had floor fans. Patients had to bring their own sheets, towels, soap and supplemental foods. Hospital food service consisted of rice, fish, rice, eggs, and potatoes day after day. No fresh fruits, vegetables, or meat were available.
5. (C) Comment: After living in Cuba for two and a half years, treating numerous Cuban employees at USINT, and interacting with many other Cubans, the FSHP believes many are malnourished and psychologically stressed. Hypertension, diabetes and asthma are widespread, but poorly treated. Common prescription and basic over-the-counter medications are unavailable. Given the large number of chronic diseases treated by the FSHP, preventive medicine in Cuba is a by-gone ideal, rather than the standard practice of care. PARMLY

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