Nube Carla Miguez

Institut für Sozial und Kulturantropologie

Modul „Religion, Medizin und Psyche“ 0108dB1.3.2
Seminar: Politics of Traditional Medicine
Dozent: Karoline Büchner

MEDICAL PLURALISM IN CUBA’S REVOLUTION

Nube Carla Miguez

N ATION AL GEOGR APH IC S ESPAÑ A - FOTO GR AFÍA D E N AT ALIA FAVR E

Table des matières
I N T R O D U C T I O N : ......................................................................................................................................................... 2
H I S T O R I C A L A N D C U L T U R A L B A C K G R O U N D ............................................................................... 3
THE SOCIALIST REVOLUTION AND THE CONSEQUENCES ON THE
H E A L T H C A R E S Y S T E M ......................................................................................................................................... 5
N O N - B I O M E D I C I N E A N D T H E G O V E R N M E N T ............................................................................... 6
C O N C L U S I O N ................................................................................................................................................................. 8

INTRODUCTION:

The topic I chose for this paper is not a casualty. When I was looking at the texts to be read
during the Politics of Traditional Medicine Seminar, one in particular caught my attention. It
consisted of demonstrating how Chinese medicine had been imported into Cuba, not really through
the migration of Chinese people to the island, but rather through the ideological kinship of these two
countries, both authoritarian socialist regimes. What these models had in common, as with the
Soviet Union, their other ally, was that they had been through a revolution, which was intended to be
for the people, against American imperialism and Western capitalism, even if this meant restricting
individual freedoms. As a good communist regime, the health of the people is a priority for the
Cuban government, which wants to show the example of a revolution that works. Their treatment of
traditional medicine is indicative of a strong desire to emphasize health as something of primary
importance. Now, Cuba is an island of mixed cultures, and therefore with a great variety of
traditional medicines, which have influenced the concrete practices of the inhabitants, regardless of
their ethnic origin. But it also has a fairly great advance in biomedical research, quite rare for a
developing country “The WHO Health Report ranks Cuba 39th among 191 countries surveyed,
whereas the United States is ranked 37th, suggesting that there is no link between gross domestic
product (or health expenditures) and health outcomes”. The biomedical institutional system has
been extended to traditional medicine. I discovered all this while doing more research on this text,
and the Cuban context seemed exciting.

So I asked myself: to what extent was the Revolution, a term that designates the event of 1958,
but also the regime, the ideology, and the government in place, able to use this diversity to its
advantage, how it used it to illustrate its ideology, but also as a statement against imperialism and
capitalism? I will first present the Cuban diversity, the origins of all these different traditions, and
then quickly retrace the history of the revolution and the consequences of this history on the Cuban
medical system. I will then look at the institutionalization of all these practices, which also has its
limits, and what the Revolution as such gets out of it.
HISTORICAL AND CULTURAL BACKGROUND

First of all, I will try to show where the variety of Cuban population comes from, and how the
different "traditional" medicines that we can find on the island were formed. Indeed, we can observe
the use of four main traditions, which have been added through time, mixed, "in a process of
syncretism and transculturation" 1, adapting to the population and its needs, as well as to the political
context of the Revolution.

The first and best known indigenous Cuban people that populated the island when the colonists
arrived were the Tainos, Arawaks, who today no longer exist as a people. However, they are still alive
in some traditions, and in the very mixed blood of some Cubans. In fact, there is evidence that the
Tainos based their medicine on "the ingestion of infusions prepared from medicinal herbs and other
vegetable products, vomit, diets and massages, accompanied by magical practices"2 according to
their culture. Rodriguez Fuentes reports a few of the plants that were used at that time, and that
Cuban traditional medicine keeps on using, though it might be prepared in a different way, for
example the Guaiac wood (Guaiacum officinale), whose bark and resin provide relief from
rheumatism. Fuentes also explains that the proportion of Tainos from originally between 60 and 50
thousand inhabitants to about 900 by 1544, but that it is likely that the last survivors passed on their
knowledge of the island to the new inhabitants, especially those who were also dominated by the
colonizator, the slaves who came from Africa.

Indeed, as the natives were dying, the Colonizers imported African slaves. This is how a new
crossbreeding of cultures was created, importing some plants, but above all beliefs. The gods in
which the Yorubas believed, a people that stretches from Nigeria to Benin, were assimilated to the
Christian Saints of the colonists. Santeria was born. It is a religion that worships Virgin Mary as well as
the orishas, for example the entity of Jesus corresponds to the god Elegua. It is a practical religion: it
focuses on obtaining or maintaining health, money, love in order to have a happy earthly life. One of
the main preoccupations is to get along with the Orisha who is considered to be a parent, so that a
person can maintain good health: the death of a person already exists at birth, but through a healthy
relationship with the Orisha, we can prevent it from arriving sooner than it was decided by the
Orisha. This results in a great attention to health, and the practice of rituals and the use of infusions
and other natural treatments helps to keep it stable. It is a medicine of herbs and natural foods, such

1
Rodriguez Fuentes, Alicia, La influencia Aborigen en la Medicina Popular Cubana, 2003, Boletin
Latinoamericano y del Caribe de Plantas Medicinales y Aromáticas, available on https://imbiomed.com.mx/
2
Ibid, according to Guarch (1979), p. 2
as "smoked jutía (a type of water rat, a native Cuban mammal), feathers, shells, smoked fish, bones,
turtle shells and other animal products" 3, which prevents illness and keeps the body healthy rather
than curing a body that is already sick. We will see that it is with this goal that the Revolution, after
abolishing Santeria, revived it in the 90s.

Other influences on Cuban natural medicine include Chinese medicine. In the mid-19th century, a
huge diaspora of Chinese workers arrived in Cuba, where they lived as a community in Sagua La
Grande. They had their own doctors, or physicians who had a good reputation in the island. But
contrary to what one might think, that is not the principal reason that made Cuba adopt this type of
medicine, even though it introduced it. The case was that TCM (Traditional Chinese Medecine) was
never as strong as when Mao Zedong introduced it in the National Health Care System (after having
rejected it). All that influenced these ways of implementing acupuncture is the result of the urgence
in which the country was of building this Health Care system, due to the political and economic
situation. The goal was not to understand the whole Chinese culture and paradigm to be able to
reproduce it identically. The consequence was an change in what acupuncture meant, a change that
the authors name ‘glocalisation’, which is the process of adapting a phenomenon from abroad to suit
particular needs, emergencies and cultural interpretations of a country. Transforming what is global
to a local scale. It might be due to the sensibility of a population to a practice that comes from the
other side of the world, because of a similar past or traditions.

These are the principal non-biomedicines that are historically linked to Cuba. But, as we shall see,
in recent decades many other medical practices have been established on the island. They come
from all over the world and explore very diverse spiritual beliefs, fauna and flora. But Cuba is also
known for its progress in bio-medicine. It could also be called a tradition, descended from the
colonization of the Spanish, who founded a university in the 15th century whose first section was
that of medicine. The Cuban revolution wanted to invest only in it at first, giving itself legitimacy with
the science of developed countries, and is indeed a country where research continues. We can see it
today with the development of the vaccine against Covid, and at the time of the embargo when oil
was inaccessible, with the exchange of Venezuelan black gold for millions of Venezuelans operated
on for cataracts, and the infant mortality rate has reached the same level as the United States in
20034, as well as "the lowest HIV prevalence in the Americas and one of the lowest in the world" 5,

3
Gold Marina, 2014, Healing Practices and Revolution in Socialist Cuba, Social Analysis, p. 53
4
Kadetz Paul, Perdomo Delgado Johann, 2010/11, Slaves, Revolutions, Embargoes, and Needles: The Political
Economy of Acupuncture in Cuba, in Asian Medicine 6 95–122, p. 96
5
The World Health Organization, Approaches to the Management of HIV/AIDS in Cuba, 2004
with a GDP six times lower. We will see how this fits in with the non-biomedicine during the
revolution.

THE SOCIALIST REVOLUTION AND THE CONSEQUENCES ON THE

HEALTHCARE SYSTEM

In 1959, the guerrillas of the revolution, led by Fidel Castro, overthrew Fulgencio Batista's
dictatorship. First, it does not seem to have a big international consequence, but they appeared
quickly afterwards. In 1960, the United States broke off all diplomatic relations with the island, after
Castro's government nationalized two U.S. oil companies, and showed its friendship and ideological
alignment with the USSR in the middle of the Cold War. From 1962, a total embargo was imposed on
all exports to Cuba, including food and medicine. But its friendship with the great Soviet empire
allowed it to receive what it lacked, as well as oil, in exchange for Cuban products (such as sugar).

At that time, the socialist ideology placed the health of its inhabitants as a priority, and the
established healthcare system wanted the health of the individual body to reflect the health of the
social body6. Before, doctors were difficult to access and expensive, but now they are more
numerous and are assigned to several families: they are the consultorios, clinics that take care of
about 150 households. But in the beginning, the Castro government forbade any religious practice
such as Santería, and the government employees could not belong to any cult. Medical practices not
supported by science and reason and traditional practices are banned, treated as ineffective
witchcraft. Thus, Santeros went into hiding and Chinese pharmacies closed. But this changed in 1975,
when Health was included as a priority in the constitution, and the lack of resources led to the search
for other alternatives to biomedicine. It was also in this year that the first acupuncture surgical
analgesia was performed, with Chinese equipment and expertise. But the situation worsens when
the Soviet bloc collapses in 1991 and all previously possible imports are suddenly interrupted. In
addition to this, several American blocking plans were implemented, such as the Cuban Democrac y
Act in 1992, which completely isolated the island from international trade. The consequences for the
population were dramatic, and everyone remembers the so-called "Periodo especial". Cubans had no
food, became ill, and could not get medical care. The embargo "resulted in the scarcity of
medications and the inability to repair and replace medical equipment, making the most basic

6
Brotherton, P Sean, Revolutionary Medicine, Health and the Body in Post-Soviet Cuba, 2012, University of
Chicago.
materials, such as bandages, hospital disinfectants, and needles, unattainable" 7. The GDP dropped by
35%, and deaths from infectious diseases increased by 67% 8. It was during this period that informal
medicine developed, and the trade of medicines and food was organized more in the form of barter.
They could exchanged a good for a service, and they needed personnal contacts to survive. They
called it sociolismo, a play on the word "socialismo" and "socio", which means an economic partner,
a colleague. Goods also came from abroad, from Cuban emigrants, who, at first considered "traitors",
"gusanos" of the revolution, became "comunitarios" 9, part of the great worldwide Cuban community.
This participated to the creation of a new social space, where Cubans had to seek by themselves for a
way to provide health, en mélangeant les pratiques “state sponsored et les pratiques informelles,
incluant le commerce au marché noir, afin d’obtenir des “divisas”, dont la circulation a été permise
par l’état à cette époque. (Brotherton, Revolutionary Medicine p26)

All this has forced the Cuban government to find other solutions for the health of its
population, always with the idea that a healthy human body can be transposed to an equally healthy
social body. So it took advantage on the resources mentioned above. Indeed, most of the Yerberias
are less than 20 years old in 2003, and the operations anesthetized only by acupuncture are
practiced in all the hospitals. We will see how the government has paradoxically lost some control
over the population through these informal practices, while strengthening it with the
institutionalization and financial support of alternative practices. Indeed, the developpement of
informal practices, that are or illegal or not state sanctioned, could be followed a big weakening of
the power of the government, that is in collective imagination necessarily very controlling of
everything the individuals do. But, as Brotherton argues, the freedom of the people by practicing
alternative medicine does not lead to a more liberal society, so a failure of the socialist government,
but as the Revolution claims, an integration of every social space into its system.

NON-BIOMEDICINE AND THE GOVERNMENT

The Ministerio de Salud Publica, after having financed scientific research on medicinal plants
during the previous years, sets up in 1991 the Programa para el desarollo y la generalizacion de la
medicina traditional y natural (Program for the development and generalization of MTN). This
medicine brings together a large number of different medical practices, including those mentioned

7
Gold Marina, 2014, Healing Practices and Revolution in Socialist Cuba, Social Analysis, p. 46
8
Kadetz Paul, Perdomo Delgado Johann, 2010/11, Slaves, Revolutions, Embargoes, and Needles: The Political
Economy of Acupuncture in Cuba, in Asian Medicine 6 95–122, p. 105
9
Gold Marina, 2014, Healing Practices and Revolution in Socialist Cuba, Social Analysis
above. They are institutionalized through scientific research and then learned in medical universities.
In the article by Marina Gold, a doctor practicing in a consultorio, Lonei explains that "Santeros learn
things from their ancestors. I may prescribe the same herb as a santero but I learnt it at university" 10.
The knowledge of Santeria is passed down from generation to generation, and is derived from a very
long observation, which sometimes is validated by science, and biomedical doctors can also prescribe
plants that can be purchased in a Yerberia. Thus, the hospitals have developed green wings, cabinets
"filled with gadgets from different healing traditions. Acupuncture needles, homoeopathy jars,
radiesthesia rods and pendulums are stacked in disarray". All this belongs to the state, and since it
finances all these practices, they are legitimate and used in a safe way. The Universities give a
general medicine course and some specializations in different types of non-biomedicine, such as
acupuncture. The Socialist administration very well adapted to Chinese medicine, without a lot of
resources but willing to give access to health to everyone equally. Acupuncture in Cuba was not
adopted as a copy of Chinese acupuncture. Indeed, it is learned during medical studies among a lot of
other non-biomedical practices, but in the same way (that could be called experimental) as
biomedicine is taught (eg: training on cadavers, biomedical diagnosis). Another example is the
medicinal plant gardens, which have been established all over the country, and which sell their
production to the state for distribution. Today, 42 different species of plants are cultivated and
officially used by doctors. The consultorios are also state owned and free for the population. They
practice biomedicine and MTN, but sometimes other unofficial practices. For example, to make a
diagnosis, some may use the Pendulum (like Reisi), which is not scientifically proven, and not
supported by the state.

But all of this was put in place not only to value Cuban diversity and to manage the crisis. The
crisis is indeed a trigger for the valorisation of all these practices, but it could also a reason for
Cubans to stop believing in the Revolution (because of the shortages and poverty). This rapid and
resilient organization and adaptation has allowed the revolution itself to be inscribed in the health
and bodies of Cubans, which continues to live on through them today. Indeed, Marina Gold argues
"that the revealing phenomenon of the Cuban case is not that different medical practices co-exist per
se, but rather that the state, through concerns with health and healing, has found new spaces in
which to prosper and thus is able to make of the Cuban Revolution a permanent process”11. This
"green medicine" allows an in-between between the freedom of individuals to practice their

10
Gold Marina, 2014, Alternative Medicine, Santería and the Biomedical System in Cuba, in Social Analysis 58,
p. 8
11
Gold Marina, 2014, Healing Practices and Revolution in Socialist Cuba, Social Analysis, p. 45
personal beliefs and ways of healing, legitimizing them, and at the same time allowing the
government to keep some control over the lives and biology of its population.

Moreover, the ideological importance of integrating traditional medicine into the health
system gives a new epistemological understanding of medicine. Indeed, it is no longer about curing a
sick body but about maintaining a healthy body. It integrates all the complexity of traditions and
cultures, allowing people to feel closer to and more in control of their bodies. Medicine administered
by learned doctors whose main activity is to prescribe drugs, which will have uncontrollable side
effects, takes the individual away from the understanding of their own body, and "individual citizens,
[...] have highly medicalized understandings of their body”12. This allows the Cuban government to be
a pioneer in this approach, along with some other countries that have gone through equally difficult
times, such as Vietnam mainly. By considering traditional medicine as a medical practice in its own
right, the government is adapting to its population, siding with them and thus being able to fly its
flag, the flag of interculturality, diversity and integration.

But this epistemological and ideological approach is above all a way of countering American
imperialism, a constant objective of the revolution. Indeed, one of the main actors and friends of
capitalism is the pharmaceutical industry, which makes huge profits, often at the expense of the
health and well-being of the population. And this is perhaps the paroxysm of this imperialism, of
democracies that are subservient to capital, whether they have a health system for all or not. They
allow companies to become rich from the disease of individuals. Castro and the socialist and anti-
capitalist Cuban government have understood this and have found a way, by being deprived of this
pharmaceutical, to finally take an ideological turn and turn to another way of seeing health and the
human body. Again, if the health of a body is in some way the responsibility of the person because
he/she understands it (not necessarily in a biomedical way), the correspondence of the human body
with the social body will give citizens more involved, united, and integrated in it. Hence the survival
of the Revolution.

CONCLUSION

We can see through the research made that the socialist Revolution used traditional
medicine and a lot of diverse practices for an ideological purpose. We however do not want to be
convinced of the efficiency of the programs, and health in Cuba nowadays, mostly after the Covid
pandemic, very at risk: most of the materials and infrastructures are very old, and the state can’t

12
Brotherton, P Sean, Revolutionary Medicine, Health and the Body in Post-Soviet Cuba, 2012, University of
Chicago, Introduction p. 4
subvention the replacement. Traditional medicine was an alternative that changed the way of
understanding health and bodies and maintained them connected to it.

LITTERATURE :

GOLD Marina, 2014, Alternative Medicine, Santería and the Biomedical System in Cuba, in Social
Analysis 58

GOLD Marina, 2014, Healing Practices and Revolution in Socialist Cuba, Social Analysis
MADARIAGA Reina, 2018, Medicina natural y tradicional en Cuba, en marcha, in Cubadebate
Noticias Salud
KADETZ Paul, PERDOMO DELGADO Johann, 2010/11, Slaves, Revolutions, Embargoes, and
Needles: The Political Economy of Acupuncture in Cuba, in Asian Medicine 6 95–122

KHALIKOVA Venera. 2021, Medical pluralism, In The Cambridge Encyclopedia of Anthropology,

edited by Felix Stein
BROTHERTON, P Sean, 2012, Revolutionary Medicine, Health and the Body in Post-Soviet Cuba,
University of Chicago
The World Health Organization, 2004, Approaches to the Management of HIV/AIDS in Cuba,
2004, available in https://www.who.int/
RODRIGUEZ FUENTES, Alicia, 2003, La influencia Aborigen en la Medicina Popular Cubana, Boletin
Latinoamericano y del Caribe de Plantas Medicinales y Aromáticas, available on
https://imbiomed.com.mx/