Tourists and travel to Cuba: What the travel agencies don't tell you about health and hygiene

 In July 2013 an Italian tourist returned from Cuba with severe renal failure due to Cholera. New York high school teacher Alfredo Gómez contracted cholera during a family visit to Havana during the summer of 2013 and was billed $4,700 from the government hospital. A total of 12 tourists have been identified who have contracted cholera in Cuba.

Read more here: http://www.miamiherald.com/2013/08/26/3587434/cuba-reports-more-cholera-among.html#storylink=cpy

Cholera patients in Cuba (CNN)

Cuba is normally safe as long as you are reasonably careful about what you eat and drink. The common travel-related diseases, such as dysentery and hepatitis, are acquired by the consumption of contaminated food and water. While Cuba has a relatively low incidence of HIV any visitors should take obvious precautions if engaging in intimate relations on the island.
Mosquito born illnesses are not a significant concern on most of Cuba although you should be aware when there is a periodic outbreak of dengue. Sand flies can be a serious irritant on certain beaches but this is to be expected as the price of paradise!
Tap water in Cuba is not considered as reasonably safe to drink. Most Cuban households will boil water before drinking and foreigners should follow this procedure unless you have good quality purification filters. - Visit Cuba FAQs

Compared to the rosy descriptions offered on crime in Cuba by the travel industry, the advisories above are a little better but there is still a lot that is left out. First, the claim that Cuba has a low incidence of HIV is based on government provided statistics. Secondly, there is no mention of the Cholera out break that was announced in July of 2012 and is still ongoing across the island with official reports emerging from Camaguey, Granma, Guantanamo, Havana, and Santiago de Cuba.

This cholera outbreak needs to be placed in context. The current Cuban government, in power over the past 55 years, claims to be a healthcare super power. The current cholera outbreak is the first one in Cuba in 130 years. That is to say that the last cholera epidemic was while Cuba was still a Spanish colony. During Cuba's Republican era beginning in 1902 sanitation and hygiene were decent enough that cholera was not an issue.

Complicating the deterioration in the healthcare infrastructure is also the Cuban government's lack of candor in reporting on outbreaks of contagious diseases such as cholera and dengue. International media in Cuba are cautious about reporting bad news from Cuba. Journalists in Cuba have ample reason to fear being expelled having seen colleagues such as Chicago Tribune's Gary Marx, the BBC's Stephen Gibbs and Cesar Gonzalez-Calero of Mexico's El Universal all expelled in 2007 from Cuba for offering reporting that although bending over backwards not to offend still ran afoul of the regime.

News of the outbreak in Manzanillo, in the east of the island, broke in El Nuevo Herald on June 29, 2012 thanks to the reporting of the outlawed independent press in the island. The state controlled media did not confirm the outbreak until days later on July 3, 2012. The BBC reported on July 7, 2012 that a patient had been diagnosed with Cholera in Havana. The dictatorship states that it has it under control.  Calixto Martinez, the independent journalist who reported the story on July 13, 2012, was imprisoned in September of 2012 in horrible conditions and released in April of 2013 for informing the public about the healthcare threat and the poor government response. Amnesty International had declared him a prisoner of conscience in January of 2013.

Pan American Health Organization reported that Cuban officials informed on September 27, 2013 that there have been 678 cases of cholera and 3 deaths but now claim that there are no new cases reported as of October 1, 2013. 

The Cuban regime made the same claim that the outbreak was over more than a year earlier on August 29, 2012 when they admitted that there had been 417 cholera cases and 3 cholera deaths.

An employee of the public health ministry, "who declined to be identified because he was not authorized to comment to the media," told Reuters on August 22, 2013: "There is cholera in various places and you can imagine we are having a very busy summer ..."Many of us think the government should stop keeping it a secret."

This is not the first time that someone suffered for speaking out to protect the public from an epidemic or that the Cuban government has tried to cover it up.

In 1997 when a Dengue epidemic broke out in Cuba the dictatorship tried to cover it up. When a courageous doctor spoke out he was locked up on June 25, 1997 and later sentenced to 8 years in prison for enemy propaganda and called a liar. Amnesty International recognized Dr. Desi Mendoza Rivero as a prisoner of conscience. He was released from prison under condition he go into exile in December of 1998. The Cuban government eventually had to recognize that there had been a dengue epidemic.

Hospital in Cuba

"The Cuban government has established a for-profit medical system for foreigners called SERVIMED, which is entirely separate from the free, not-for-profit system that takes care of Cuban citizens. There are more than 40 SERVIMED facilities throughout the country including in all of the major tourism centers. The major clinic for foreigners in Havana is the Cira Garcia one in Miramar.
In the event of an accident or other emergency foreigners may be taken to the nearest accident and emergency center, which may be at a Cuban state hospital. Conditions here at least aesthetically are likely to be below expectations for many foreigners although the standard of care is typically very good from the doctors. Once a foreign patient can be moved typically he will be transferred to a SERVIMED clinic such as Cira Garcia in Havana, which is set up to deal with foreigners." - Visit Cuba FAQs

Travel agencies also claim that Cuban healthcare is adequate but that depends on where you wind up. There is a two tiered health care system as they describe above, and Cubans will tell you that the standard of care and hygiene at the hospitals for nationals is terrible not to mention the chronic shortages.

Katherine Hirschfeld, an anthropologist, in Health, Politics, and Revolution in Cuba Since 1898 writes how her idealistic preconceptions were dashed by 'discrepancies between rhetoric and reality,' she observed a repressive, bureaucratized and secretive system, long on 'militarization' and short on patients' rights. In a January 10, 2008 article in The Miami Herald, "Author disputes Cuban healthcare 'myths'"reported on her first hand experience with the Cuban healthcare system:

Her stays were mostly in Santiago, from 1996 through 1998, when she was a graduate student at Emory University and Cuba was in the midst of a dengue fever epidemic that the government tried to hush up. When she experienced the symptoms -- aching joints, fever, nausea, sore throat -- she was taken to a Santiago hospital and placed in a large ward guarded by a man with a gun. She asked to make a phone call to tell people where she was. The guard said there were no working phones.
' `Oh my God,' I thought to myself. 'This place doesn't exist,' '' at least not officially, because the epidemic was a state secret. During her stay, she says she never saw a doctor. She was given one pill -- a vitamin. Fortunately, she had a mild case. Because there were few nurses, she and other patients who were able did what they could for the sickest, especially those who were bleeding or vomiting.

 This is again another reminder that Cuba is unlike any other country in the Western hemisphere because it is a totalitarian communist dictatorship that has more in common with North Korea than it does Costa Rica or the Dominican Republic. The failure of the travel industry to take this into account when reporting on Cuba is not only a travesty but a disservice to their clientele.