PALPITE, Cuba, is just a few miles away from Playa Girón, along the Bay of Pigs, where the United States attempted to overthrow the Cuban Revolution in 1961. Down a modest street in a small building with a Cuban flag and a large picture of Fidel Castro near the front door, Dr Dayamis Gómez La Rosa sees patients from 8 am to 5 pm. In fact, that is an inaccurate sentence. Dr Dayamis, like most primary care doctors in Cuba, lives above the clinic that she runs. “I became a doctor,” she told us as we sat in the clinic’s waiting room, “because I wanted to make the world a better place.” Her father was a bartender, and her mother was a housecleaner, but “thanks to the Revolution,” she says, she is a primary care doctor, and her brother is a dentist. Patients come when they need care, even in the middle of the night.

Apart from the waiting room, the clinic only has three other rooms, all of them small and clean. The 1,970 people in Palpite come to see Dr Dayamis, who emphasizes that she has in her care several pregnant women and infants. She wants to talk about pregnancy and children because she wants to let me know that over the past three years, not one infant has died in her town or in the municipality. “The last time an infant died,” she said, “was in 2008 when a child was born prematurely and had great difficulty breathing.” When we asked her how she remembered that death with such clarity, she said that for her as a doctor any death is terrible, but the death of a child must be avoided at all costs. “I wish I did not have to experience that,” she said.

The region of the Zapata Swamp, where the Bay of Pigs is located, before the Revolution, had an infant mortality rate of 59 per 1,000 live births. The population of the area, mostly engaged in subsistence fishing and in the charcoal trade, lived in great poverty. Fidel spent the first Christmas Eve after the Revolution of 1959 with the newly formed cooperative of charcoal producers, listening to them talk about their problems and working with them to find a way to exit the condition of hunger, illiteracy, and ill-health. A large-scale project of transformation had been set into motion a few months before, which drew in hundreds of very poor people into a process to lift themselves up from the wretched conditions that afflicted them. This is the reason why these people rose in large numbers to defend the Revolution against the attack by the US and its mercenaries in 1961.

To move from 59 infant deaths out of every 1,000 live births to no infant deaths in the matter of a few decades is an extraordinary feat. It was done, Dr Dayamis says, because the Cuban Revolution pays an enormous attention to the health of the population. Pregnant mothers are given regular care from primary care doctors and gynecologists and their infants are tended by pediatricians—all of it paid from the social wealth of the country. Small towns such as Palpite do not have specialists such as gynecologists and pediatricians, but within a short ride a few miles away, they can access these doctors in Playa Larga.

CUBA’S PRESIDENT

In 1994, Miguel Díaz-Canel began a new position in Santa Clara, not far from his birthplace of Placetas, as the provincial secretary of the Cuban Communist Party. He set aside the air-conditioned car given to him and went to work each morning on his bicycle, his long hair and jeans defining him. Díaz-Canel organised rock concerts, spent time with his family at El Mejunje, the local LGBTQ cultural centre, and roamed about talking to people on the streets. This closeness to the people defined his tenure at Santa Clara, which shaped the man who is now the president of Cuba.

Raised by a teacher and a factory worker, Díaz-Canel saw firsthand the Cuban Revolution’s comprehensive programme of social justice in which millions of members of the working class, peasants, Black people, and women began to access for the first time on equal terms the right to work, study and live with dignity. Díaz-Canel’s generation grew up in a period under Fidel Castro’s leadership in which, despite the existence of a US blockade, most Cubans saw their standards of living and quality of life rise significantly due to national development plans, favourable trade relations with the Soviet Union and a growing network of support in the nonaligned world. Díaz-Canel studied electrical engineering at the Central University of Las Villas, but early on in his career teaching engineering there, he devoted much of his time to local activism with the Young Communist League. That led him to an internationalist mission in Nicaragua where, along with thousands of Cuban doctors and teachers, he served among the poorest, often in remote corners of this Central American country that was then trapped under a US-funded war of counterinsurgency.

Díaz-Canel returned from Nicaragua in 1989 as the USSR neared its final days and as the US government seized the opportunity to tighten restrictions on Cuba. In 1991, Cuba entered a Special Period as trade fell by 80 per cent. Cubans were eating less (caloric intake decreased by 27 per cent from 1990 to 1996), long queues for food became common, electricity became a rare occurrence, and millions took to riding bicycles as the island faced a severe oil shortage under an intensified blockade. Díaz-Canel was one of those on a bicycle. Cuba’s resilience during the Special Period shaped his view of the world.

In 2018, Díaz-Canel was elected to be the president of Cuba. US President Donald Trump had tightened the US blockade on Cuba, with 243 new sanctions measures, the prevention of remittances from overseas Cubans coming to the island, and Cuba being placed back on the United States’ State Sponsors of Terrorism list. This campaign of maximum pressure has hurt the Cuban economy, which began to see fuel and food shortages that echoed the Special Period. The Biden administration has kept each one of these measures in place.

Díaz-Canel places a great deal of emphasis on the local capacities of each municipality, such as the town of Palpite. “We are defending the need to increasingly expand democracy on the basis of people’s participation and control in our society,” said Díaz-Canel. This approach has already opened the door to deep debates about how to eradicate the vestiges of racism that remain in society, the transformation of neighbourhoods in disrepair, and a proposed legal code that would radically expand the rights of LGBTQ people, including marriage. In hundreds of meetings, many of which are recorded and televised, Díaz-Canel listens patiently to religious leaders, university students, artists, intellectuals, community organisers, social activists, and other sectors of Cuban society who have much to say. These meetings can quite often be tense. Díaz-Canel smiles and says, “We have learned tremendously, proposals are made, we can share criteria, we can clarify doubts, and then we all go out together to work.”

ADVANCES DESPITE THE BLOCKADE

Walking through the Playa Giron museum earlier that day, the museum’s director Dulce María Limonta del Pozo tells us that the many of the captured mercenaries were returned to the US in exchange for food and medicines for children; it is telling that this is what the Cuban Revolution demanded. From early into the Revolution, literacy campaigns and vaccination campaigns developed to address the facts of poverty. Now, Dr Dayamis reports, each child gets between 12 and 16 vaccinations for such ailments as smallpox and hepatitis.

In Havana’s Centre for Genetic Engineering and Biotechnology (CIGB), Dr Merardo Pujol Ferrer tells us that the country has almost eradicated hepatitis B using a vaccine developed by their Center. That vaccine—Heberbiovac HB—has been administered to 70 million people around the world. “We believe that this vaccine is safe and effective,” he said. “It could help to eradicate hepatitis around the world, particularly in poorer countries.” All the children in her town are vaccinated against hepatitis, Dr Dayamis says. “The health care system ensures that not one person dies from diarrhea or malnutrition, and not one person dies from diseases of poverty.”

What ails the people of Palpite, Dr Dayamis says, are now the diseases that one sees in richer countries. It is one of the paradoxes of Cuba, which remains a country of limited means—largely because of the US government’s blockade of this island of 11 million people—and yet has transcended the diseases of poverty. The new illnesses that she says are hypertension and cardiovascular diseases as well as prostate and breast cancer. These problems, she points out, must be dealt with by public education, which is why she has a radio show on Radio Victoria de Girón, the local community station, each Thursday, called Education for Health.

If we invest in sports, says Raúl Fornés Valenciano, the vice-president of the Institute of Physical Education and Recreation (INDER), then we will have less problems of health. Across the country, INDER focuses on getting the entire population active with a variety of sports and physical exercises. Over 70,000 sports health workers collaborate with the schools and the centres for the elderly to provide opportunities for leisure time to be spent in physical activity. This, along with the public education campaign that Dr Dayamis told us about, are key mechanisms to prevent chronic diseases from harming the population.

If you take a boat out of the Bay of Pigs and land in other Caribbean countries, you will find yourself in a situation where healthcare is almost nonexistent. In the Dominican Republic, for example, infant mortality is at 34 per 1,000 live births. These countries—unlike Cuba—have not been able to harness the commitment and ingenuity of people such as Dr Dayamis and Dr Merardo. In these other countries, children die in conditions where no doctor is present to mourn their loss decades later.