Daniel Palacios Almarales* (Café Fuerte)
HAVANA TIMES — Today, Cuba’s dentistry field is characterized by generalized corruption, poor services and the migration of specialists and technicians towards the private sector.
Though this is by no means unique to dentistry, the fact of the matter is that having your teeth worked on has gone from being a free to a paid service. In Havana, the cost of a dental procedure can be anywhere from 10 to 150 CUC (1 USD is equivalent to 0.87 CUC, and the average monthly salary in the country is 18 CUC), depending on the complexity of this procedure.
Cuba’s legislation stipulates that services offered at any dental clinic are completely free of charge. In effect, primary care offered in the more than 200 clinics of this kind around the country is free.
Securing an appointment, however, can be a long and painful process and, no few times, people are forced to lose many days of work because of the many problems that undermine the quality of this service.
“I’ve come to the clinic three times to get a filling, and it’s always a different story: they have no running water, the instruments haven’t been sterilized, the power is out or there isn’t enough filling paste to treat all of the patients,” said Amarilis Soler, a single mother who works as a cashier at the electrical company.
Soler explained the reasons why Cubans resort to private services, in spite of the high prices.
“Sometimes you get lucky and you don’t have to wait long to see the dentist, because it so happens they’ve got all they need that day. But, in most cases, they’re out of one thing and you get an incomplete service. That’s why those who have the money go to private clinics, because the procedure is much quicker there,” she explained.
Generally speaking, dentists with private clinics are specialists or technicians from the field who continue to work for the State or quit their day jobs in search of financial improvement. They have clinics with basic conditions at home and no license to operate. In fact, no one is authorized by the government to offer health services privately, as a self-employed professional.
Another practice consists of offering dental appointments and diagnostic procedures outside State clinics, in private residences, and conducting the actual surgery in the government institution, using the equipment and supplies there illegally.
“Our salaries aren’t enough to live on and we’re forced to make a living anyway we can. That’s why we set up our own dentistry businesses and, in most cases, use the supplies from the State clinics, which are taken from the workplace and used for private procedures,” a source involved in this business, who wished to remain anonymous, explained to us.
“Me,” he added, “I have ‘connections’ [contacts] in warehouses and I get all of my supplies before they’re inventoried. Making a huge effort and facing many problems to earn 20 dollars a month and making 10 dollars for one dental cleaning in the comfort of your own home are very different things indeed.”
Our source added that some people continue to avoid going to private clinics for more complex surgical procedures, but that this situation is rapidly changing.
“We’re seeing more and more people unwilling to go through the disastrous experience of a State clinic and come to us every day,” he said.
Waiting for Dentures
The preparation and production of dentures is one of the public services facing the greatest number of problems in the field. Many a time, material shortages lead to long waiting times. Most of the materials used to make dentures are imported and are included under the health services subsidized – and rationalized – by the State.
A lack of qualified personnel to make these dentures has also resulted in the suspension of these services at different clinics for prolonged periods of time. According to several people interviewed, the waiting time for these dentures can be as long as two years – something which forces many to resort to the quicker and far more efficient private services.
“A few years ago, a denture cost you 70 Cuban pesos or less, and you got them in no time. Now, sometimes you have no other choice but to pay a good buck at a private clinic, which, many a time, offer their services in the very premises of the State clinic,” said Roberto Mirelles, a self-employed worker who claims to have paid 20 CUC for a lower jaw implant.
“I don’t know where they get their materials from exactly. What I can tell you is that they do high-quality implants and they do what you actually need them to do,” Mirelles added.
Despite efforts to contact the National Dentistry Office, under the Ministry of Public Health, we were unable to get a statement on this situation from any public official.
Patients from Abroad
Rosa Hinojosa, a Cuban residing in the United States, paid 150 CUC for an upper jaw denture and a cleanup.
“This may be expensive for people living in Cuba. But I didn’t have to wait forever for an appointment and didn’t have to pay 300 CUC at a State clinic that offers services (to foreigners) in hard currency. I got everything done at someone’s home, where they had all of the equipment, anesthesia and materials they needed. I’m pleased.” Hinojosa declared.
In the United States, a complete denture costs around 800 dollars.
The growing number of specialists and technicians who are leaving their government jobs and gravitating towards the private sector, be it to offer illegal dental services or become involved in other activities, is a growing trend.
One such professional (who chose to remain anonymous) graduated as a dental technician in 2009 and has been working at home since last year. He alternates between being a “private dentist” and a licensed watch repairman.
“My relatives send me some of the supplies I need from the United States. There are some that are expensive over there and I have to find some way of getting those from State clinics,” the dentist said.
He added that this is a fairly common practice.
“Most do what I do, and when supplies are deviated to private clinics, you get shortages in the State clinic. People therefore turn to the private sector for their dental services. It’s a vicious circle and the only way to break out of it is to respect the work of dentistry professionals and pay them a proper salary. Failing that, we will continue to have two options: a free but inefficient service and an illegal and costly but effective and prompt private service,” the dentist explained.
Similarly, dental technicians who work at State clinics and offer private services illegally make use of the government workshops where they work, using the materials and equipment from these clinics, particularly to make dentures.
Long waiting times for appointments, the lack of sterilized instruments or equipment needed for certain procedures and incidents such as loss of power and water supply prevent most Cuban dentistry clinics from offering the public a quality service.
Increasingly, patients must line-up outside State clinics in the early hours of the morning in order to be seen by a dentist, for, as the day progresses, it is not uncommon for supplies to run out and for services to be suspended as a result of this.
* Former journalist for Cuba’s Juventud Rebelde newspaper and author of the blog “Visor Cubano”