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Since the revolution, Cuba's health profile has changed almost as dramatically as its politics. Between 1959, when communists toppled the dictator Batista, and the early 1990s, life expectancy in the country gradually rose from 57 to 75, roughly the same as in the United States. Communist Cuba provides its citizens with free medicine and health care, and has become famous for exporting its doctors to needy areas of the world, including rural South Africa and Central America. Even in its current beleaguered state, the island has dispatched more than 2000 health professionals to work in 57 countries, offering services to Central American victims of Hurricane Mitch and to Kosovar refugees.
But, following on the heels of the Chernobyl disaster, the monumental collapse of the entire Soviet Union has stanched aid to Cuba, and the intense U.S. embargo has further hobbled Cuba's economy. El bloqueo, as Cubans angrily refer to it, has left hospital cupboards and pharmacies practically bare. The 1996 Helms-Burton Act not only forbids U.S. companies from doing business in Cuba but even imposes sanctions on other countries that provide anything that could be seen as economic aid. Because Helms-Burton also specifically bans medical and biotechnological exports, including those from foreign subsidiaries of U.S. companies, Cubans lack both spare parts for their aging medical equipment and crucial pharmaceutical drugs, 50 percent of which are made or patented in the U.S.
This is not what Cuban doctors (who are, of course, government employees) will tell you, however. In Tarara's main office, where a picture of Fidel Castro and the Cuban minister of health hangs on the wall, the story of Tarara is upbeat. Of the thousands of sick children who have been treated here, only a few have died, according to Tarara's medical director, Dr. Maria Teresa Rosello. Some have undergone cutting-edge procedures, such as kidney transplants and heart surgery, while in Cuba. And Rosello tells of Ukrainian teens who have such fond memories of Cuba that they return to the island to guide younger Ukrainian kids after they recover. "They go back in very good health," Rosello says of Tarara patients, then adds a mild qualification: "Sometimes they have a cold."
Yet at the end of a tour of Tarara's grounds, one health worker pulls a reporter aside to scribble down the names of drugs she urgently needs but can't get in Cuba. "Could they be sent from the U.S.?" she whispers.
Ukrainians and Belarussians are in no position to turn their noses up at any offers of assistance, no matter how limited. Ninety percent of the Ukrainian population now falls below the country's official poverty line of roughly $20 per month. Like Cuba, Ukraine in principle guarantees free health care, but doesn't have the money to provide much of it. Meanwhile, the people near Chernobyl are reckoning not only with medical needs resulting from the nuclear catastrophe but also from poverty and other environmental problems.
The health effects of these multiple problems are now inseparable, according to Rosello. About 3 percent of the Ukrainian children now come to Tarara because of cancer, while another 20 percent of patients are there for thyroid and kidney problems. Because there were no accurate records of cancer rates before Chernobyl, it's difficult to determine exactly what portion of these illnesses to blame on the accident. And some seemingly healthy children may have dangerously high levels of lead in their thyroid glands, a condition that could lead to cancer, according to Rosello.
Others, she says, suffer the anxiety of living in the wake of environmental disaster. "They connect any health problem with the accident in their minds," says Rosello. To ease their psychological burden, Tarara offers these children group therapy, music which Rosello says puts children's minds at ease and, of course, the beach.
Cubans might argue that their own problems, such as shortages of food and fuel, trump some of the more esoteric complaints tended to at Tarara. Daily life on the island can involve two-and-a-half-hour waits for buses, which are bound to be standing-room-only when they finally show. Poorly maintained buildings collapse with regularity. And the average salary of the employed, at about $10 per month, often places basics like clothing out of reach.
Helping the children of Chernobyl is an extravagant step for people facing such hardship. But it is also a reminder: As besieged as Cubans may be, others are suffering more.