Revolutionary Doctors.

• Author: Fitz, Don
• Position: Book review

Revolutionary Doctors: How Venezuela and Cuba are Changing the World's Conceptualization of Health Care, by Steve Brouwer, New York: Monthly Review Press, 2011,245 pages, $18.95

As Venezuela becomes the first country to reproduce the Cuban medical model on a massive scale, it is doing so in ways that are unique in both form and process. Steve Brouwer's Revolutionary Doctors is essential reading for anyone interested in the transformation of medical systems at a cost vastly less than in the US and other overdeveloped countries. Readers knowledgeable of developments in Cuba and Venezuela as well as those first learning about them can learn from Brouwer's insights into how medicine intertwines with national and international politics.

Revolutionary Doctors builds upon the growing body of information about medicine in Cuba. Some of the best recent writings include Linda Whiteford and Laurence Branch's Primary Health Care in Cuba (2008) and John Kirk and Michael Erisman's Cuban Medical Internationalism (2009). Together, the three works show how the Cuban model grew by responding to a series of contradictions.

The first was the enormous disparity in the quality of medical care between rich and poor, urban and rural, and light-skinned vs. dark-skinned Cubans that characterized the island in the 1950s. The revolutionary government immediately devoted itself to increasing the number of hospitals throughout the island.

Expansion of access to medical care during the 1960s presented a new contradiction. The best medical care would be preventive rather than hospital-based reaction to disease. So the 1970s saw the introduction of polyclinics, which provided preventive care in the form of inoculations and education for 20,000-40,000 residents. (Brouwer points out that they now serve 40,000-60,000, p. 69)

Cuba was probably the first country in the world to recognize that clinics, though invaluable, do not create the close contact between health professionals and patients that are essential for genuine preventive care. In the 1980s the Family Doctor Program began Basic Health Teams (BHTs), which are a doctor and nurse pair living at the small medical office, or consultorio, in the community they serve. The most revolutionary concept of Cuban medicine is family doctors being responsible for everyone in a defined geographical area.

Unlike the first three contradictions, that of the 1990s was 100% external in origin. The fall of the Soviet Union, the crash of...