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Thirteen years ago this spring after the world's worst nuclear mishap, Tarara as the hospital is called is a showcase for the fiasco's lingering medical mess. The children being treated here are victims not only of the catastrophe but also of the larger breakdown of the Soviet empire. The mismanagement of the nuclear reactor, the economic collapse of the Soviet Union and its republics, and the resulting failure to clean up the Chernobyl area and provide adequate health care have conspired against Tarara's young patients. And the fact that Cuba is still taking them in speaks to the small country's valiant insistence on providing humanitarian aid despite its own declining fortunes.
The radioactive contaminants and toxic heavy metals spewed by the nuclear reactor over northern Ukraine and Belarus are considered responsible for some 200,000 deaths. Local life expectancies have plummeted men in some surrounding towns now live an average of about 50 years and cancer rates have soared. Among children, the worst affected because their growing organs are especially sensitive to radiation, levels of thyroid cancer in some areas near the reactor site have climbed to 100 times the predisaster rate.
Kids born after the 1986 blast never saw the plume coming from the nuclear plant and were never exposed to the highest levels of radiation, in the seven days following the explosion. But they nevertheless have abnormally high rates of thyroid and other cancers. With about 3.5 million people still living in contaminated areas and some of the radioactive isotopes expected to take hundreds of years to break down, birth defects are as much as twice as common as before the accident.
Most of the children now filtering through the Cuban resort-turned-hospital are younger than 13, and thus suffering from the aftermath of Chernobyl rather than the event itself. A few children make their way around the pristinely kept grounds in ancient wheelchairs. Some are bald. Still others seem healthy though appearances may be deceiving.
Planes began ferrying sick children 16 and younger to Cuba in 1989, when the hospital was a logical expression of Soviet-Cuban solidarity. At the time, the Soviet Union was still spending billions to subsidize the small nation. The Russians provided the Cubans with military and technical aid. They even helped construct Cuba's very own nuclear reactor, which remains in a state of half-completion. In exchange, the Cubans, who have more than 63,000 doctors (roughly one for every 163 people, as opposed to one for every 358 in the U.S.), were able to offer their medical expertise.
After a few weeks at Tarara, the latest crop of visitors are already beginning to see their skin darken, pick up a few essential Spanish phrases ("No comprendo" is a favorite), and settle into a daily routine: After spending the nights in separate casitas, the children have a morning meal together. Kids who have appointments for treatments then head off to meet with various doctors and nurses. Later, those who are able make a short trek down the palm treelined paths to the beach, where they swim and run around until they tire themselves out.
So far, more than 15,000 children and 3000 parents have passed through the hospital. Every two months, Ukrainian medical personnel and the one Cuban doctor permanently stationed in the Chernobyl area select about 250 kids to visit Tarara. Kids with the worst illnesses leukemia, lymphomas, kidney problems, and cancerous tumors sometimes stay as long as five years, though most spend only a couple of months benefiting from Cuban medical know-how and seaside repose.
But what the impoverished Cubans can do is limited. On this particular day, for example, some of the latest arrivals are delaying their daily beach jaunt in order to have their teeth checked or, more precisely, to wait to have them checked. The power has gone out in the main building, which houses the dental clinic, temporarily suspending any drilling of teeth or shining of light in the children's mouths. These little patients are accustomed to such dysfunction, both at home and here, where blackouts are not uncommon. So they just wait patiently on the benches even the youngest, whose feet swing well above the floor. When the electricity eventually does come back on, a dentist pokes her head out of the office and calls a strapping 12-year-old named Alexander, beckoning him with the internationally understood kissy face and arms held wide.
Indeed, these days, as both Cuba and the former Soviet Union struggle financially, Tarara has little to offer other than the spirit of goodwill its workers wordlessly bestow on its young patients. (There is at least one Russian-Spanish translator in the group, but when he is occupied, patients and staff often resort to facial expressions and gesticulation.)
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.