RE: [escepticos] Aislamiento y SIDA ERA [escepticos] Más sobre Cuba yel SIDA (largo)

["Ramón Díaz-Alersi" <rda@...>]

----- Original Message -----
From: FJose Ra. <fragua en wanadoo.es>
To: <escepticos en ccdis.dis.ulpgc.es>
Sent: Saturday, January 29, 2000 10:41 PM
Subject: Re: [escepticos] Aislamiento y SIDA ERA [escepticos] Más sobre Cuba
yel SIDA

En estas fechas se está celebrando el aniversario del Holocausto, y de todos
es sabido que, puntualmente, han salido los inevitables nombre de los campos
de exterminio.
Lejos de mi intención está, ni por soñación ( que quede bien claro) en
equiparar a Mig a un nazi o algo que de lejos se lo parezca, pero me parece
que no se ha dado cuenta del peligro que encierra la simple existencia de
aquellos lazaretos. Me ha llamado la atención, y a la reflexión, la defensa
que hace de esos "campos" cubanos donde, por lo visto (yo lo ignoraba), se
internan a los enfermos contagiados por el SIDA

[Ramón]

Hasta ahora nadie ha dado una referencia exacta de esos supuestos campos de
concentración para enfermos de sida en Cuba, así que os remito esta url de
una carta publicada en el British Medical Journal,por médico holandés
perteneciente a Médicos sin Fronteras. Creo que tanto revista como
organización pueden ser consideradas fiables:
http://www.bmj.com/cgi/content/full/311/7010/935

Aunque es recomendable leer la carta completa para comprender el contexto,
considero que esta parte que transcribo es el más importante en cuanto al
sida. Especialmente interesante el último párrafo donde el autor,
especialista en salud pública, da su opinión:

BMJ 1995;311:935-937 (7 October)
Education and debate
Letter from Cuba: Cuba: plenty of care, few condoms, no corruption
Hans Veeken, public health consultant
Medecins Sans Frontieres, PO Box 1001, 1001 EA Amsterdam, Netherlands

Caring for patients with HIV

"Don't worry, a Cuban will never do something against his will. Everybody is
admitted voluntarily and everybody can leave if he wishes." The director of
the AIDS sanatorium looks at me penetratingly but his arguments do not
convince me. It seems a suspect method to intern everyone who is HIV
positive. The more so as the Cuban health system is very much orientated to
the community. Taking people out of their community seems to go against this
principle. I argue cautiously that in every other country this method would
not work, the patient would simply refuse.

Up to now only 1089 people have been diagnosed as positive. What about the
undetected cases; what will the Cubans do when the figures rise; what about
the lack of condoms and the tourism; what about the false positives? I pose
too many questions to answer. "Come and I will show you the place and you
talk to the patients yourself," says the doctor, grabbing me by the arm.
"This is the dentist's room"--and he swings open a fully equipped treatment
room. "How often does the dentist visit the place?" I ask. The doctor seems
not to understand the question. It seems that the dentist is working full
time for the institution which has 34 patients (and 58 workers). Quickly I
calculate the tooth:dentist ratio (do they still have all their teeth?). The
dentist cannot see more than three teeth a day; I'm visibly astonished.

The sanatorium is well kept, the living quarters are friendly. "This is our
laboratory assistant," the doctor says and he stops a girl in the corridor.
"She is also a patient." The girl smiles and walks on. There does not seem
to be stigma attached to the disease. The doctor stops another boy in the
corridor: "This is a patient too." "How long will you stay?" I ask the boy.
He smiles too and answers that he does not know. The place is fine and he is
well looked after. His salary is paid; why should he wish to leave? "It is
better like this," he adds. "It is not lifelong," the doctor explains. "He
is counselled and receives psychological assistance. If he copes he can go
back to his family, but he should be able to live with his 'disease.' Some
stay five months, others have been admitted for eight years."

"What do they do during the day?" I ask. "Well, there is a garden for
growing vegetables; they read, they can go out to the village, they play
dominoes, just what other people do in hospitals. And during the weekend he
can go home. First with a 'guard' to supervise his behaviour; at a later
stage a family member can take over this duty. You see, it's voluntary, just
like vaccinations; everybody complies with it but it is not obligatory. Just
because it is best, people will do it."

I'm surprised by the atmosphere in the sanatorium--certainly it is not a
concentration camp. Still, I'm puzzled by the logic of the concept. From a
mere epidemiological point of view, strict isolation (life-long?) could
contain the epidemic in a closed society. In practice, however, the patients
do have contacts outside the sanatorium. Furthermore, the island opened the
doors to tourism, with a side effect of increasing prostitution. Both facts
make the "isolation" porous, to say the least. The compliance must have to
do with the Cuban culture, in which it is accepted that this is the best
solution for society as a whole. To me the concept seems highly
unsustainable; the costs must be outrageous.

Saludos.

Ramón Díaz-Alersi