Educational Media Reviews Online

Since 1959, more than a dozen documentaries have been produced on the organization and delivery of health care in revolutionary Cuba. Most have been simple travelogues featuring political tourists who give effusive endorsements as they shuttle between the tour bus and a series of clinics, day care centers and hospitals. These films are dull to watch and give little solid information. Predictably, most of them are not widely circulated.

In 2006, however, two engaging, substantive and well produced documentaries on healthcare in Cuba were released, both of which are readily available and organized for classroom use. What separates these two films is the frame in which each is embedded. ¡Salud!: What Puts Cuba on the Map in the Quest for Global Health highlights the international dimension of Cuban medical activism while Cuba: The Accidental Revolution looks at evolution and adaptation at the national level.

Cuba: The Accidental Revolution is set squarely in post-1990 Cuba. It examines how the government has adapted agricultural production and health care to the unplanned and economically devastating loss of Soviet aid (hence the “accidental” revolution forced upon the ongoing political revolution). Each of the two 45-minute parts can stand alone having been originally broadcast as segments of the Canadian Broadcasting Corporation’s long running science and technology program The Nature of Things hosted by Dr. David Suzuki. Essentially the series provides best practice examples of how the Cubans have made a virtue of their economic necessity.

In the field of agriculture, some of the large and sluggish state farms have been reorganized by breaking them into smaller cooperatives where farmers can make some profit after meeting state quotas. At the same time, small urban plots have been introduced. According to the Cuban office of national statistics, for several years these innovations boosted domestic food output of tubers, beans and vegetables while reducing the use of chemical inputs. Since 2005 output has declined and remains well below 1989 levels.

The documentary looks on the bright side of the reforms stressing the ecological value of organic practices and presenting vignettes of the most successful cooperation between agricultural engineers and farmers. The analysis stops there without addressing the productivity of the agricultural sector as a whole or its place within the national economy. No comparison is made between pre-1990 production and current levels.

Since the release of Cuba: The Accidental Revolution, Fidel Castro has resigned leaving his brother Raul to lead the nation. Raul has pledged to extend incremental agricultural reform by allowing cultivation of unused government holdings in an effort to reduce food imports. The film provides a starting point for discussion on a rapidly changing topic.

Where the agricultural sector made some positive changes by reducing centralized farms, the health care system faces the dilemma of maintaining universal availability of service and uniformly high standards in an environment of reduced resources. The documentary illustrates four factors that have maintained positive outcomes: emphasis on prevention, use of green medicine, development of biotechnology and the personal commitment of medical personnel living in the community they serve.

The film follows nurses and doctors on their daily neighborhood rounds to convey a real sense of how prevention is practiced. For those of us who equate healthcare with a costly trip to the doctor’s office, the sight of doctors knocking on the patient’s door is revolutionary indeed. An organic connection between health workers and their community is evident. Both parts of this visually pleasing documentary would make an superior accompaniment to print materials in classes on Caribbean history, international health or social welfare.