Revolutionary Medicine: Health and the Body in Post-Soviet Cuba by P. Sean Brotherton (review)

Cuba’s health system is a compelling case, one that has attracted the attention of countless outsiders, including researchers, journalists, health professionals and filmmakers. Its intrigue lies essentially in its puzzlingly advanced national health statistics despite poor economic performance and an unorthodox political model. How was it possible for a tiny, resource-strapped island under political and economic siege to produce health outcomes that rival those of the developed world, even through severe economic crisis? Cuba’s socialist regime has its own official story to accompany these health statistics. It goes more or less like this: Responding to the devastating health situation pre-1959, the new revolutionary government made it its mission to improve the health situation for the population. It nationalized health systems, carried out mass vaccination programs, built new hospitals, introduced a system of free universal public health services, and pioneered a new primary health care model. The government’s unceasing commitment to improving the population’s health brought drastic health improvements, and Cuba is now exporting its health model around the world as a gesture of humanitarianism and solidarity.

While neither entirely true nor entirely untrue, this is an enchanting story, and one that has been regularly reproduced. On the opposite pole are those who vehemently reject the story, declaring it a fairy tale with little grounding in reality, the statistics fabricated, and that the “real” state of health in Cuba is one of horror and neglect. These polarized positions (often ideologically fueled, as is characteristic of many Cuba-related debates) have in common a fixation on health statistics and commonly a detachment from the grounded realities of everyday life on the island—few accounts of Cuba’s health system qualitatively explore what the country’s health statistics represent or their underlying social and political dimensions. Brotherton’s Revolutionary Medicine: Health and the Body in Post-Soviet Cuba is one of these few.

Brotherton’s book is a comprehensive, engaging, and original account of the health landscape in Cuba from the outset of the “Special Period” of the 1990s. While the author covers the usual themes relevant to the Cuban health sector, he breathes life into them, adeptly weaving explanatory, contextual tracts with insightful theoretical reflections built on personal narratives that illustrate some of the complex ways in which health policies unravel through the lives and bodies of the Cubans who experience them. As such, this work manages an impressive breadth and depth. Particularly valuable is Brotherton’s contribution to our understandings of the mélange of strategies Cubans employ to deal with their personal health challenges, combining formal health services with informal networks of socios, self-diagnoses, and homespun remedies.

Many of Brotherton’s narratives, based on his ethnographic research, provide insights not only into the health sector but also into life on the island more generally. One such example is the brief but captivating discussion of the Cuban government’s reintegration of medicina verde (herbal medicine) that coincided with limited access to Western pharmaceuticals during the 1990s. Here Brotherton provides glimpses of popular attitudes permeated with the residue of postcolonial prejudice. On the one hand, Cubans appeared to regard Chinese medicine, including acupuncture, with confidence, perceiving China as having a long history of development in medicine. Herbal medicine, on the other hand, carrying a strong association in Cuba with traditional African curadores, was more often regarded with skepticism or dismissed.

Most absorbing and illuminating though are those narratives that provide insights into the real-life tensions that played out on the ground at the sites of Brotherton’s field research. The “family doctor program” so often outlined with neat descriptions and diagrams in the broader literature comes alive in Brotherton’s book, revealing a microcosm of political and personal intricacies surrounding each family doctor’s office and its corresponding neighborhood. In one community, the family doctor is loved and appreciated by some, reviled...