Pundits have been discussing the merits (or not) of Fidel Castro’s legacy as his body lies in state. The Cuban healthcare system is often stated as one of El Commandante’s greatest achievements. But how great is the system really? As someone who trained as a doctor in Cuba, I’d like to give you an insider’s view.

The Cuban healthcare system, borne out of its revolutionary socialist ideology, regards accessibility to healthcare as a fundamental right of its citizens. It focuses heavily on a preventative approach to medicine and offering the simplest check-up to the most complex surgery, free of charge. Dental care, medicines and even home visits from doctors are all covered by the system.

The island has the health statistics to support this seemingly impeccable system. An infant mortality rate of 4.2 per thousand births (compared with a rate of 3.5 per thousand births in the UK in 2015), life expectancy of 77 years for men and 81 years for women (on par with the UK’s life expectancy of 79 years for men and 83 years for women), and a doctor to patient ratio of one per 150, which surpasses many developed nations (UK ratio from the latest World Bank data is 2.8 doctors per 1,000 patients). It is no surprise therefore, that the secretary general of the United Nations, Ban Ki-moon, during a visit to Cuba hailed its healthcare service as, “a model for many countries”.

Doing a lot with a little

Is all of this just propaganda? My answer would be no. I had the opportunity to spend seven years in this country as a medical student and saw firsthand the positives as well as the negatives of this healthcare service.

As an American citizen, I was always impressed by how much Cubans were able to accomplish with so little. The professionalism and humility displayed by healthcare workers was without doubt commendable. It is these people who though receiving paltry salaries (doctors earn about £52 a month), are in many instances overworked because thousands of their colleagues were sent to other countries such as Venezuela and Brazil to participate in healthcare missions.

In addition they do this without access to the latest in diagnostic technology or have to wait weeks for basic equipment to arrive at hospitals to perform procedures, even at times without electricity or running water. They still find the strength to push through all these obstacles and challenges to deliver a service worthy of praise.

Cuban doctors generally remark that becoming a doctor in their country is not about the money but about the need to help others. This was one of the first things I was taught in medical school. Though a noble sentiment, this is a main issue with the Cuban model. The government spends roughly US$300-$400(£240-£320) per person each year on healthcare, pays doctors $64 (£52) per month, but gains about US$8 billion (£6.4 billion) annually as a result of its overseas medical missions. It’s difficult to say where the gains obtained by the government is invested.

Many doctors opt for participating in these missions as the salaries they receive are remarkably better (even though the Cuban government receives about a third of it). Sending thousands of doctors overseas, though a commendable action, leaves a domestic system under pressure. With fewer doctors and specialists at home, queues at hospitals and clinics are longer, and so are waiting times. Doctors have more work to cover in a stressful profession with limited resources. A patient may end up travelling to another province to visit a specialist because the one stationed nearest to him or her has been sent to Venezuela. This may be the reason why many more medical professionals are currently being trained across Cuba to help fill the void left by those sent around the globe.

Crumbling infrastructure

The healthcare infrastructure in Cuba also requires serious attention. Some of the clinics and hospitals in operation are in dire need of repairs. So too is the urgent need of more modern medical equipment and stable electricity and water. These issues however, cannot be solely placed at the feet of the Cuban government as the trade embargo placed on Cuba by the US government has had detrimental effect. An example of this is sourcing medical equipment from as far as China instead of a neighbouring country like the US. With all these difficulties the country’s continued emphasis on primary healthcare and prevention may be the key to its success.

The island continues to offer hundreds of scholarships annually to foreign students including those from the US. These scholarships are generally open to students from low income families who may not have been able to attend medical school because of their socioeconomic background. The Latin American School of Medicine (Escuela Latinoamericana de Medicina) is one of the largest medical schools in the western hemisphere with thousands of students from over 100 different countries.

The Cuban healthcare service has stood the test of time. It has afforded a foreigner like myself the opportunity to study a career free of charge while many of my colleagues are thousands of dollars in debt after attending medical schools in the US. It ensures that open heart surgery doesn’t result in lifelong indebtedness. It has created globally competitive biotechnology and pharmaceutical industries. It doesn’t turn people away because of their socioeconomic status. It is a system that has been there for its people. Yes, it has its flaws and challenges which need remedying, but it is not merely a propaganda tool for the powers that be.