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Che’s role in Social Medicine



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On 09 October the world commemorated the 50th death anniversary of the revolutionary Marxist leader Ernesto (Che) Guevara. It is hard to believe that Che died 50 years ago. Che, living or dead, his popularity has not withered a bit. He continues to be loved and sought after by millions of his followers, the world over.


Although the world knows enough of Che Guevara as a revolutionary, not much is said about his contribution in the field of ‘Social Medicine’. Although less talked about as a medical doctor, his writings on health related topics in contemporary health literature has carved a definite place for him as a pioneer in the field of ‘Social Medicine’.


First as a young boy, then as a medical student and later as a young doctor, Che was a different person altogether to his medical colleagues. A voracious reader of Marx, Engels and later Fraud, even as a young boy, he was never the ‘academic’ type and excelled mainly in literature and sports. Rugby was one of his favourite sports.


Che qualified as a doctor from the University of Buenos Aires in 1953. His teacher Prof. Bernardo Houssay, who won the Nobel Prize for physiology or medicine in 1947, was known to have made a lasting impact on young Che’s life.


Although Social Medicine was born and nurtured in Europe, it developed into a full-fledged discipline in Latin America. A mass exodus of intellectuals from Europe to Latin America, especially Chile and Argentina, around the turn of the 20th century due to growing Nazism across Europe, found a new breeding ground for social medicine in Latin America. Essentially socialist in nature, social medicine regarded "social causes" such as poverty, illiteracy, inequity and oppression; over and above the conventional web of agent-host-environment factors in the epidemiology of disease causation. In the Latin American context, the likes of Dr. Salvador Allende, the former Chilean President, and Che Guevara were the pioneers to practice social medicine in the real political realm.


After graduation, Che went to La Paz, Bolivia during the national revolution. From there he went to Guatemala, during the socialist Jacobo Arbenz’s presidency. While in Guatemala, he saw with disgust how Arbenz’s government was overthrown by the CIA. When Arbenz fell, Che went to Mexico City in September 1954, where he worked in the General Hospital. In Mexico he met and made friends with Fidel and Raul Castro, then political émigrés, and realized in Fidel he found the leader he was seeking. He joined the other Castro followers at a farm where the Cuban revolutionaries were given a tough commando training in guerrilla warfare by the Spanish Republican Army captain Alberto Bayo. Soon Che became his star pupil and was made a leader of the class.


When the Cuban revolutionaries invaded Cuba, Che went with them, first as a doctor, but soon changed to a commandant of the revolutionary army; considered one of the most aggressive, clever and successful of the guerrilla officers, and earnest in giving his men a Leninist education. At the triumph of the revolution, Che became a prominent leader of the new government. He organized and directed the Institute Nacional de la ReformaAgraria (National Institute of Agrarian Reforms) to administer the new agrarian laws expropriating the large landholders, ran its Department of Industries, and was appointed the chief of the National Bank of Cuba. As the Minister of Industries in February 1960 he signed a trade pact with the USSR, which freed the Cuban sugar industry from dependence on the US market.


Below is a summary of some writings of Che (From Works of Che) which explicate Che’s noble vision towards an equitable and fair health system within a just social system.


"Years ago I began my career as a doctor. And when I began to study medicine, when I began as a doctor, the majority of the concepts that I have today as a revolutionary were absent from my store of ideals. Like everyone, I wanted to succeed. I dreamed of becoming a famous medical research scientist. I dreamed of working indefatigably to discover something which would be used to help humanity, but which signified a personal triumph for me. I was, as we all are, a child of my environment.


After graduation, due to special circumstances and perhaps also to my character, I began to travel throughout America, and became acquainted with all of it. Except for Haiti and Santo Domingo, I have visited, to some extent, all the other Latin American countries. Because of the circumstances in which I traveled, first as a student and later as a doctor, I came into close contact with poverty, hunger and disease, with the inability to treat a child because of lack of money, with the stupefaction provoked by the continual hunger and punishment, to the point that a father can accept the loss of a son as an unimportant incident, as occurs often in the downtrodden classes of our American homeland. I began to realize at that time that there were things that were almost as important to me as becoming famous or making a significant contribution to medical science. I wanted to help those people.


But I continued to be, as we all continue to be always, a child of my environment, and I wanted to help those people with my own personal efforts. I had already traveled a great deal. I was in Guatemala at the time, Guatemala of Arbenz, and I have begun to make some notes to guide the conduct of the revolutionary doctor. I began to investigate what was needed to be a revolutionary doctor. Then I realized a fundamental thing. For one to be revolutionary doctor or to be a revolutionary at all, there must first be a revolution. Isolated individual endeavour, for all its purity of ideals, is of no use, and the desire to sacrifice an entire lifetime to the noblest of ideals serves no purpose if one works alone, solitary, in some corner of America, fighting against adverse governments and social conditions that prevent progress.


And now we have come to the nucleus of the problem we have before us at this time. Today one finally has the right and even duty to be, above all things, a revolutionary doctor, that is to say a man who utilizes the technical knowledge of his profession in the service of the people. But now old questions reappear. How does one actually carry out a work of social welfare? How does one unite individual endeavor with the needs of society?


We must review again each of our lives, what we did and thought as doctors, or in any function of public health. We must do this with profound critical zeal and arrive finally at the conclusion that almost everything we thought and felt in the past period ought to be deposited in an archive, and a new type of human being created. If each one of us expends his maximum effort towards the perfection of that new human type, it will be much easier for the people to create him and let him be the example of the new Cuba. It is good that I emphasize for you, the inhabitants of Havana who are present here, this idea, in Cuba a new type of a man is being created, who we cannot fully appreciate here in the capital, but who is found in every corner of the country. Those of you who went to the Sierra Maestra on the twenty-sixth of July must have seen two completely unknown things. First, an army with hoes and pickaxes, an army whose greatest pride is to parade in the patriotic festivals of Oreinte with hoes and axes raised, while their military comrades march with rifles. But you may have seen something more important. You must have seen children whose physical constitutions appeared to be those of eight or nine-year-olds, yet almost all of whom were thirteen or fourteen. They are the most authentic children of the Sierra Maestra, the most authentic offspring of hunger and misery. They are the creatures of malnutrition.


In this tiny Cuba, with its four or five television channels and hundred of radio stations, with all the advances of modern science, when these children arrived at the school for the first time at night and saw the electric light bulbs, they exclaimed that the stars were very low that night. And those children, some of whom you must have seen, are learning in collective schools skills ranging from reading to trades, and even the very difficult science of becoming revolutionaries.


Those are the new human beings born in Cuba. They are being born in isolated areas, in different parts of the Sierra Maestra, and also in the cooperatives and the work centers. The task of educating and feeding youngsters, the task of educating the army, the task of distributing the lands of the former absentee landlords to those who labored every day upon that same land without receiving its benefits, are accomplishments of social medicine which have been performed in Cuba.


The principle upon which the fight against disease should be based is the creation of a robust body, but not the creation of a robust body by the artistic work of a doctor upon a weak organism. Rather, the creation of a robust body with the work of the whole collectivity upon the entire social collectivity.


Someday, therefore, medicine will have to convert itself into a science that serves to prevent diseases and orients the public toward carrying out its medical duties. Medicine should only intervene in cases of extreme urgency, to perform surgery or something else which lies outside the skills of the people of the new society we are creating.


The work that today is entrusted to the Ministry of Health and similar organizations is to provide public health services for the greatest possible number of persons, institutes a programme of preventive medicine, and orient the public to the performance of hygienic practices. But for this task of organization, fundamentally it is the individual who is needed".


These visionary words of Che still remains valid and aspiring in the formation and execution of health care services around the world, fifty years since his death.


The true internationalist Che Guevara, having fought many a peoples’ battle in Africa, Latin America and Caribbean, laid down his life while taking part in the Bolivian liberation campaign in the Yuro ravine. Che was executed by the Bolivian army on 09 October 1967.


 


 
 
 
 
 
 
 
 
 
 
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