Blame Somebody Else

4-mazorraIn spite of the fact that the rumor had traveled from mouth to mouth, the information from the Ministry of Public Health on January 16 left the Cuban people astonished. Twenty-six patients had died at the Psychiatric Hospital in Havana. After attributing these deaths to low temperatures, patient’s risks factors, biological deterioration, respiratory infections and other ailments, a note issued by the Ministry attributed these deaths also to the inadequate measures of care, and announced that the people responsible for these events would be taken to the corresponding court of justice, which indicates that the cause is somewhere else.

A disaster of such magnitude -in a hospital where the services were depressing until 1959 and to which enormous human resources, technicians and financiers were dedicated to make it a leading institution in mental health care- requires other explanations.

Love goes before medicine

Fifteen centuries after Avicena and Claudio Galeno wrote medical treaties in the II Century, these texts have continued to be the basic ones for this discipline. In spite of the thrust given by Italian universities during the Renaissance, we had to wait  for the development of chemistry, biology and biochemistry and for the treatment of diseases. It was not until 1628 that an Englishman called William Harvey discovered blood circulation, the function of the heart and refuted Galeno’s theories. At the end of the XIX Century, the Frenchman Luis Pasteur elaborated the theory of germs and founded Microbiology. In regard to Psychiatry and the mental health diseases, a design of a system of identification and classification for these problems that did not appear until the last decade of the century. In the case of Cuba, it was Dr. Tomas Romay in 1834 who inaugurated the class of Medical Clinic in the hospital ward. It was then that medicine on the island started down the scientific path

These events demonstrate that man’s diseases precede medical science and treatment precedes the emergence of science. It also explains how people who practiced this occupation for so many years without any specialized preparation, although armed with a principle that, to parody Jose de la Luz y Caballero, could be summarized as: anyone can attend the sick, to heal, only those capable of practicing the love for the neighbor.

Since the XVI Century, when the first hospitals were founded in Cuba, members of different Religious Orders took care of the treatment for the sick. One of them, the Hospital San Juan de Dios, was under the care of the Juaninos Brethren since the year 1603 when they arrived in Cuba. From that date on, any type of illness, including mental patients, were treated in their facilities. In 1942, many centuries after, the same Order inaugurated the Sanatorium San Juan de Dios, especially for Psychiatric illnesses. It is symptomatic that in spite of lack of medical knowledge, their facilities never were the object of criticism, as has occurred now with the Psychiatric Hospital in Havana. It was not by chance that all of the 16 private sanatoriums owned for nervous patients that existed in Havana, were nationalized in May of 1964, with the exception of San Juan de Dios, an act demonstrating the importance that love has in the treatment of patients, especially the mentally ill.

The Psychiatric Hospital in Havana

Even though the forceful seclusion of the mentally ill patients was initiated in 1804, it was in 1857 that the “Casa General de Dementes de la Isla de Cuba” (Home for the Mentally Ill of the Island of Cuba) known popularly as Mazorra, was inaugurated. The common denominator of that Institution -reflected by the media before and after 1959- was the malnutrition of the patients, disease transmission and early death. In January of the same year, Commander Eduardo Bernabe Ordaz Ducunge was put in charge of this Institution. He remodeled the facility, transformed the caring system and introduced a scientific emphasis in the medical treatment directed towards the rehabilitation of patients. It was under his direction that concert bands, baseball teams the psychoballet were formed and the publishing of a specialized magazine started. As the years went by, Mazorra seemed to be part of the past, to the point that in the Central report to the Cuban Communist Party, Fidel Castro said: The National Psychiatric Hospital was during the Capitalistic era a warehouse filled of patients, where horrible things were happening and many times the patients died of hunger and abuse to the extreme that some directors were doing business with funeral homes.  To mention Mazorra was to mention Dante’s Inferno.”

Epilogue

The question is whether what happened is a single occurrence or a manifestation of decline. It is illusory to think that in any society, where all the elements are interrelated that one of them, say public health or any other, may function with efficacy when all the others do not. It only requires mentioning three aspects without which efficiency in  health care is impossible: the manifest productive incapacity, the insufficiency of salaries that makes all workers seek any additional source of income, most of the time illegally, and the moral decadence that all these factors bring about.

These and other elements, missing from the note of the Health Department Ministry, explain the lost of food, clothing and medications in Mazorra, as well as the lack of attention to the mentally ill. It is not until the authorities proceed to make profound structural changes, from the economic to the ethical education and the love of thy neighbor that it will be possible to come out of this state of deterioration. These changes are impossible without the corresponding civic liberties and without the political willingness to confront them.

The guerrilla style and the voluntarism have been exhausted. It is not enough to give patients in a matter of hours what they never should have been without and that those supposed guilty be punished, since the original causes, as they lay somewhere else, will provoke, here today and there tomorrow, similar or worst effects.

Translated by: David Fernandez

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