Why medical students get more experience in the US than Cuba, and what this has to do with inequality

By Don Fitz

November 19, 2020 — Links International Journal of Socialist Renewal — During the past 10 years I have written multiple articles documenting how Cuba has better medical practice and education than the US. To be honest, I have known for a long time that there is an area of medical training where medical students in the US get considerably more training than do those who study in Cuba.

This realization came to me when my daughter Rebecca was in her first year of medical school in Havana. When I phoned after she had been there for a few months, she said, “Dad, I am really glad that when I was a girl you gave me a needle and thread to sew up rips in my clothes. In clinic today, we saw someone with his head whacked open by a machete and a medical student was sewing it back together. It was clear that the guy trying to sew the wound did not have experience with a needle and thread and that the guy getting his head patched up could tell. With the sewing I’ve done, I know that I could handle a wound.”

We chatted about other injuries she had come across and I asked, “How many gunshot wounds have you seen?” She told me that she had never seen one, but she would ask other students in her class. None of her friends had treated a gunshot wound. 

The subject dropped until a couple of years later when she let me know, “A while back you asked me if any of the med students I know had seen a gunshot wound. Well, someone just told me she had. She treated a cop who had taken a gun out of his holster after getting off work, and, before he put the safety on, he dropped it, it hit the floor and went off, with a bullet going into his foot.”

At that moment I understood that, while there are innumerable false accusations regarding Cuban medicine, one thing could be said that is true: students who study medicine in Cuba get a lot less practice in handling gunshot wounds than do those who study in the US. 

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Why is it that Cuba has so many fewer gun injuries that does the US? It is definitely not because it is an island of pacifists who never get in fights. When I was walking down a back street early one morning, a rum bottle came skipping along the pavement and stopped near my feet. I saw two men trying to restrain a third who was yelling something in Spanish that I was unable to understand. Ten or 15 yards away another guy was similarly yelling and being held back. In my daughter’s home, I described the scene and heard, “They had probably been drinking rum all night and got into a fight over a woman. There’s cuts and bruises in the Emergency Room all the time from crap like that.” Other events I heard about taught me that Cubans can get into pointless scraps as much as Americans do.

Could less gun violence be because Cuba has virtually no crime? No, that is not it. I remember being awakened from the screaming of a neighbor’s outrage at his two turkeys being stolen from his Havana yard. I’ve been robbed three times in my life – twice in St. Louis and once in Havana. When boarding a Havana bus, I was knocked down, thinking that someone had slipped against me. But when we got off the bus, I reached in my briefcase for my camera to find it missing. My daughter explained, “I bet that guy bumping into you was not an accident. He might have seen your camera at the last stop and grabbed it out of your bag when you fell down.” Getting robbed is thoroughly unpleasant anywhere, but it is quite a bit less odious to have something picked from your briefcase than have a gun pointed at you (as occurred both times when I was robbed in the US). 

This leads directly to the question of whether gun violence in the US could be greater than it is in Cuba due to the availability of guns. Vastly more Americans keep a gun handy. “The United States is the most heavily armed country in the world with 90 guns for every 100 citizens.” Yet, the Centre for Economic Policy Research found no support for the belief that more guns cause more homicides and documented methodological flaws in research that claimed a link existed. 

Additionally, I suspect there is a difference between Cubans and Americans in their attitudes toward guns. Not being an expert in Cuban law, I asked multiple folks about laws on gun ownership. Some said they could not own a gun and others said they could. The clarity that emerged from this ambiguity is that none of the Cubans I spoke with seemed to be concerned with the topic until I asked them. Not one Cuban said anything remotely like, “I must have a gun to protect myself from someone breaking into my home.”

What a sharp contrast to the US! While some say that guns would cause more danger than protection, millions insist that a gun is the best way to keep their families safe and a very large number become hysterical at the very thought that guns could not be an important part of their lives. 

Could the reason that there are so many homicides by firearm in the US be that so many Americans are trained to fight in wars? David Swanson thinks so. He did a careful analysis of mass shooters in the US and found that “34% of US mass shooters … are military veterans, as compared with 14.76% in the general population.” After a string of mass shootings in the US, he insisted that the solution would be to “Ban the damn guns. All of them. Everywhere. Do it now, you fucking idiots!” 

That’s a very intense opinion; but it is also a wrong one. In addition to the previously mentioned research showing more guns do not lead to more homicides, mass shootings account for only for a small number of gun deaths in the US.

Also, there is the contrast between US veterans in its war against Viet Nam versus Cuba’s participation in the Angolan Wars of 1975–88, which I document in Cuban Health Care: The Ongoing Revolution. Those military interventions had profound effects on each country. While 2.5 million Americans had tours in Viet Nam, over a third of a million soldiers from Cuba (a much smaller country than the US) served in Angola. Cubans were roughly three times as likely to go to Angola as Americans were to go to Viet Nam. Of course, a major difference was that US actions were to bully a smaller country while Cuba’s actions were in solidarity with Black Africans and were critical for elimination of Apartheid domination in South Africa. 

To have an accurate picture, it is important to be aware that the US is not the most violent country in the world and Cuba is not the most non-violent. The PBS News Hour lists Brazil as the most violent, with 43,200 gun-related deaths and the US as the second most violent with 37,200 such deaths. Other countries topping the most violent list are largely in Latin America, along with South Africa. Knoema gives Cuba a ranking of fifty-third most violent with 27 gun deaths annually, below many European countries. Though the US has about 30 times the population of Cuba, it has 1378 times as many gun deaths.

This enormously higher level of gun killings in the US than Cuba cannot be explained by pacifism on the island, absence of Cuban crime, the higher level of US gun ownership, or involvement in international conflicts (though the last mentioned could have a strong twist). However, two factors are likely to play a strong role in American gun killings. 

There is a climbing mountain of consistent and well-researched evidence that unequal wealth distribution is associated with death by firearms. The journal BMC Public Health documents that, among 3244 US counties, those “with growing levels of income inequality are more likely to experience mass shootings.” Authors reason that income inequality fosters anger and resentment, leading to mass murder. 

Research between countries likewise confirms that a high rate of homicide by firearms accompanies greater income inequality. An article in Scientific American summarized multiple research reports. One reported an “unambiguous” finding that “income inequality alone explained 74% of the variance in murder rates.” Also, World Bank research confirmed a global link between unequal distribution of resources and murder rates. 

The other likely factor in gun deaths is based less on numbers because it is historical and cultural. As Noam Chomsky describes so clearly, the US War for Independence was based on the desire of wealthy colonists to (a) expand westward to thieve more land from Native Americans and (b) increase slavery. Since England opposed both, the colonists created a culture of gun violence to crush Indian and slave revolts. Chomsky explains that the US Civil War was followed by a lull in the desire for guns, but the craving was exhumed decades later by fabricated visions of the Wild West.

Many Cubans find American obsessions with violence to be a bit vile. As Cuban physician Dr. Gilberto Fleites Gonzalestold interviewer Candace Wolf: “There are many things that are very bad in the States, such as not having universal health care and the high rate of violence in your society.… You are on your way to destroying the earth and the peoples of the planet with your greed and your nuclear weapons.”

Part of the reason that liberals want to take away guns rather than understand the centrality of a culture of violence is their intense belief that capitalism is eternal, making it impossible to create a different society. They fail to grasp that violence has been nurtured by capitalism much like racism and sexism are exacerbated by economics of dominance. Just as racism and sexism and many other forms of oppression will exist long after capitalism has fallen, so violence in general and gun violence in particular require struggles of consciousness to overcome them. No shortcuts such as “taking guns away” will ever work as long as economics of dominance are in the drivers’ seat. 

Just as it would be foolish to “wait until after the revolution” to combat discrimination, we cannot delay challenging the culture of violence that permeates every aspect of capitalism. Struggles which challenge oppression without being victorious will prepare us for and prefigure struggles that can change humanity once the disease of capitalism has been overcome.

Nevertheless, it is critical to recognize that personal squabbles are not in the same league as violence taught in a culture of domination. Such a culture trains people from childhood that they are entitled to kill because they are superior to others – superior because of their class, or superior due to race or religion or caste, or, increasingly important, superior because they live in a country that has an inborn right to rob wealth from people of the world they consider to be inferior.

This is what is fundamentally different from the US incursion into Viet Nam and Cuba’s participation in wars of southern Africa. The US went into Viet Nam to subjugate that country to its will. Cuba went into Angola and fought South African troops to liberate people from racist domination. Thus, wars could well prepare soldiers for mass killings if they are wars of domination.

This charts a meaningful path to lowering gun violence in the US. The US must end its massive and increasing wealth disparity and non-stop wars of domination if it is to reduce killings within its borders. Or, to put it another way, it must cease the plundering of wealth both internally and externally.

Omitted from most rants against gun ownership is a very old, very true and very obvious observation: If the government takes away everyone’s guns, then the only ones to have guns will be the government. It is time for folks to get real about the US government, military and police. There is no force on Earth more violent and murderous than the US ruling class, which for over 200 years has been drenched in the blood of native peoples whose land it pillaged, slaves dragged into chains at gunpoint for forced relocation and labor without pay, and waves of immigrant groups who have successively been beaten down and now watch their children in cages. Are we to believe that these legalized butchers are the ones to “protect” us by having a monopoly of guns? Please be serious.

A final note on the bright side. An American who is thinking of going to medical school in Cuba should not worry about being ill-prepared for treating gunshot wounds. Completing a residency in any US city and working in the Emergency Room during a couple of Friday and Saturday nights will give that student all the practice needed.