About the Writer: Joan Marie Malerich, Universal Single-Payer
Health Care Advocate, who has had healthcare insurance for only two
of last 12 years. Malerich has studied Cuban issues for two years and
visited Cuba September of 2003. She also educated US students about
the Latin American School of Medicine (LASM) in Cuba. September of 2000,
Cuba offered 500 free medical school scholarships to American students
who could not afford the cost of US medical school. There are currently
about 90 Americans students studying free in Cuba. The students must
make a moral commitment to return to the US at the end of their studies
and practice in underserved areas. Currently, President Bush is trying
to put an end to this great opportunity via his absurd increased travel-ban
restrictions, which are part of his and Colin Powells "Commission
for Assistance to a Free Cuba," all bottled-up in 500 pages of
Bloodletting: Life, Death, Healthcare is an inspiring
documentary that awakens one to the reality of the plummeting healthcare
system in the United States. The visual techniques and the music play
off one another and are very effective in setting the tone. The comparisons
of Cubas humanitarian healthcare system to the United States
profit-driven system drive home the fact that better healthcare in the
US is possible and should be mandated.
Greens weaving in and out of her familys
healthcare problems and the experts facts and testimonies molds
reality with truth. Bloodletting documents a healthcare crisis that
daily devours more and more working people in the United States, the
"richest" country in the world. The viewer ponders: If a third-world
country, under a 42 year US embargo, can make healthcare a priority
and serve all of their people, why cant the US provide quality
care for ALL of its people?
The film begins in California with rap music
playing, people scurrying, and the mighty Dow Jones drumming its economic
beat. Irony and reality set the scene at a healthcare rally in Oakland,
CA., as an uninsured home-healthcare worker makes her pitch, while the
police arrest nonviolent demonstrators.
Using frequent-flyer miles and a borrowed camera,
Green starts her journey to Cuba to search for answers about the complexities
of healthcare administration and treatment. Is Cubas system as
complex as the US? What drives the Cuban healthcare system, and does
it succeed in serving the people?
CUBA: WHERE THE SUN NEVER SETS
Green, an African-American describes a county
where 60% of the 12 million multi-ethnic population are of African decent.
Dr. Elsira Fernandez, pediatrician, states, "Education and healthcare
are the greatest achievements of the Revolution."-- won January
1, 1959. Cuba has an infant mortality rate lower than the United States
and a life span into the late 70s, same as the United States. (Cubas
rates represent the whole country, while in the US the rates vary between
wealthy areas and poor minority areas.) Cubas literacy rate is
95%. (If not counting the severely mentally impaired, the rate is 100%).
There are no homeless. Green goes beyond the statistics and makes a
reality check showing people full of life and vitality. It is said that
the Cubans move with a love song.
Green spends four weeks following the US Healthcare
and Trade Union Delegation, a group of American and Canadian healthcare
workers who travel to hospitals and clinics with medicines for which
the US embargo prohibits sale to Cuba. When Cuba was hit with Dengue
Fever in the early 1980s, 300,000 fell sick within days. Though Panama
had the medicine, the US made it and forbade Panama to sell the life-saving
treatment to Cuba. After searching, Cuba was able to purchase the medicine
from Japan; but, the shipping cost was higher and the delivery time
longer. The result: Cubans, including children, died. The viewer begins
to question why the US is so blatantly hostile to Cuba and its healthcare
system? Could it be that those who control the US economics do not want
the Americans to see the accomplishments of a benevolent and successful
The complicated made simple: Sonia Ruiz-Valdez,
a social worker, says that when it comes to healthcare, money is not
an issue. She speaks about a boy who needed blood. They announced it
on the radio. The next day people with the boys blood type were
lined up to give their blood. A childs life was saved.
Doctors free to practice: Steve Thornton, American
Union Organizer, is awed by the dedication of the healthcare teams.
He states it is "driven by determination to serve people,"
to make sure the country is strong and healthy. Thornton describes his
visit to a neighborhood healthcare center: It has 582 patients, covered
six blocks, has a map and chart of all patients, and the doctor knows
their patients and their needs. The US dollar entered the Cuban market
after the fall of the Soviet Union. Cuba turned to tourism as a means
of funding the free healthcare and free educational systems. As a result,
doctors often earn less than a tour guide. Thornton seems to allow his
capitalist perspective label this as a big problem. However, Sonia Ruiz-Valdez,
a nurse and social worker, states, "No matter what we are lacking,
we keep making doctors and nurses."
The elderly respected, Gomez Gendra Senior Center,
a typical facility: Thornton found the number of staff amazing. Ruiz-Valdez
explains that a multi-disciplinary staff, called ELEMAG, composed of
a geriatrician, licensed psychologist, nurse and social worker work
with the family doctor. Ruiz-Valdez says old people should be with people
who love them, "who are sweet to them,"...the "elderly
feel good with us. Theyre reborn. Its like a flower that
blooms when we water it." This is a shock to the American viewer,
who is all too familiar with the horror stories of nursing homes and
elderly care in the US, especially for the poor.
The most vulnerable, mentally ill, treated with
dignity: Green takes us to the Havana Psychiatric Hospital. Thornton
comments that before the Revolution, it was more like a house of horrors.
A Cuban explains that before the Revolution, Africans and elderly were
often placed in the psychiatric hospital, even though they were normal.
Before the Revolution, the US was a major player in the Cuban economic
system. Since the Revolution, the psychiatric care has been innovated.
Dance and music therapy techniques are used.
Ruiz-Valdez sums up the Cuban healthcare philosophy:
"Health is most important thing. Without health you have nothing.
If you dont have health, you cant work. If you dont
have health, you cant study. If you dont have health, there
is no development (for the People) in a country. Health is a fundamental
factor for a human being." It is this philosophy that led to the
control of diarrhea, infectious diseases, and malnutrition that killed
children before the Revolution, when the infant mortality rate was over
60% and Africans often died in their 40s.
BACK TO THE UNITED STATES: WHERE
THE SUN DOES NOT SHINE
Flickering shots of the living dead dancing in
the streets jolts the viewer back to reality of life for a growing population
of Americans. Green very effectively reflects the depression and repression
of the people in the streets. The people appear to be locked into a
Green weaves between the healthcare experiences
of her family (mother and brother) and commentary by healthcare experts.
Greens mother, Evelyn Sheppard, age 62, has been a pre-school teacher
for 32 years. She has asthma and high-blood pressure. Before the HMO
took over, she had good healthcare benefits. However, the HMO cost over
$400 a month, half of her pay. She had to drop it, which meant paying
for medicine and office visits out of her pocket. As many older people
do, she tried cutting back on her medication, which led to more problems.
Her height of desperation was resorting to cutting an abscess off of
her finger, what she calls her "kitchen surgery." Joseph,
Greens brother, developed dental problems requiring a root canal. Joseph
worked himself up from an assembly person to a forklift driver/material
manager at a furniture plant. His pay was $10 an hour, not enough to
meet minimal living requirements in California. The root canal was over
$2000. When the dentist drills, one can fill the painful drilling away
of healthcare for the average person in the US. Joseph went to the management
to represent himself and other employees for better healthcare coverage.
He was laid-off, which was the companys way of firing him for
daring to ask for what the employees deserved and needed to survive.
He has more dental problems. As a last resort, he goes to the county
hospital. He waits hours before being led into an office, where his
tooth is yanked out. The shots of Joseph spitting blood draw the viewer
into a depressing reality. Joseph is a strong person, but Green captures
his moments of desperation and feeling of being isolated from humanity.
Lorna states, "Falling on hard times because you ask for more healthcare
benefits is crazy, but watching your brothers life get ruined
because of it and watching him go from my couch to my mothers
to nothing is worse."
Green lines up an interesting and convincing
group of healthcare experts--doctors, nurses, single-payer advocates.
Their key point is, profit is more important than people in the US healthcare
- Nora Roman, RN, San Francisco General Hospital:
For-profits limit your care to maximize profits. Even if tests, medicines,
surgery are approved by the doctor, they often are denied treatment
by the bean counters.
- Melinda Paras, Alameda County Medical center:
"Its a systematic way in which people are killed, in which
people are deprived of their ability to work and live well.... Healthcare
is so much about morality. Its one thing to talk about privatizing
and the production of widgets, but were talking about something that
involves life and death for people." (Paras also points out that
seven million people in California do not have health insurance. Seven
million is almost three-quarters of the Cuban population, where ALL
- Rachel Kagan, Alameda county Medical Center,
Oakland, CA: Portion of people who have no jobs and healthcare insurance
is becoming a national phenomena.
- Dr. Lorca Rossman: Physicians are leaving
medicine. Freedom to practice medicine as they see fit is being curtailed.
Due to getting the run around, people come in late. People with coughs
are diagnosed with TB weeks after they should have been treated. "Any
society as rich as ours has an obligation to provide the basics--food,
shelter and decent healthcare for its people."
- Jerome McCochran, RN, Kaiser Permanente: $300
million profit at Kaiser Permanente, and they are still crying about
losing money. Managed care does not want to take care of working-class
people, people of color, unemployed. They would rather NOT SEE them.
Managed care became short-cut care. The practitioner does not ask
a lot of questions because if you ask a lot of questions youre
going to have to treat. Becomes a way of saying, no, youre not
going to get the cardiologist or endocrinologist because you came
in with a headache. They are saying that all of these other contributory
factors as far as were concerned we didnt hear them and
were not going to treat them.
- Frances Payne, Single-Payer initiative activist:
Strategy of for-profits is to get money from healthy people and treat
as few as sick as have to treat. 96% of people who lose their jobs
lose their healthcare too. This radically changes the quality of their
- US Census Bureau: 70% of uninsured work every
CONCLUSION and RECOMMENDATION
The contrasts between the Cuban and the US healthcare
system are clearly defined. Cuba has a love affair with humanity, while
the US has a love affair with profits. Cuba serves the most vulnerable,
the US pushes the most vulnerable (children, elderly, mentally ill)
off the cliff, out of sight. Cuba has a single-payer (the government)
system with a clear vision, while the United States complicates issues
with a multi-payer system and has a narrow vision of being obligated
to serve only the privileged. Cuba makes the connection that a healthy
workforce is important to build the country, while the US replaces unhealthy
workers who complain with workers (healthy or unhealthy) who will honor
the code of silence and transform their human qualities to machine functions.
Cuba has an innovative and creative system that incorporates music and
dance with its advanced medical technology, while the US repressively
turns to increasingly expensive drugs, which can create more complications
requiring more drugs, which, in turn, creates more profit.
I highly recommend this informative and insightful
film. Bloodletting: Life, Death, Healthcare takes on the challenge of
visually awakening the American public to the plight of the United States
healthcare system and motivates the viewers to act before they become
further entrenched in a system that does not work. The US is the only
country in the industrialized western world that does not have a universal
health care system. As Green clearly illustrates, if Cuba, a third-world
country, afflicted with the US embargo and travel ban, can succeed in
treating all of its people in a humane and effective manner, the US
healthcare system could and should do the same. Greens intensity,
both personally and professionally, pushes the viewer out of the armchair
and into the arena of action.