The article by Roman on the epidemic of nutritional neuropathy in Cuba [1] was timely. I recently spent a week in Cuba with a group of medical students, physicians, and medical anthropologists. Our purpose was to study the health care system of Cuba and to provide humanitarian relief supplies.

The Cuban health care system has much to teach us. For example, access to care is not an issue in Cuba. "Consultorios" are on every block and in every school and work place. Specialty maldistribution is also not a problem. Cuba has approximately as many medical students as does the United States, almost all of whom become what are called family doctors (although many students I spoke with aspired to be subspecialists). The motivation to pursue a career in health care is essentially intellectual and humanitarian, given that physicians' salaries are similar to those of other workers. Infant mortality and life expectancy in Cuba compare favorably with those of other western countries, suggesting that quality health care can be provided despite severe budgetary restrictions.

The biggest obstacle to comprehensive quality care is shortages of many goods. The American embargo and the consequent "special period" make charity, provided largely by the European Economic Community, critical for day-to-day functioning. The political and economic issues notwithstanding, it is obvious that the embargo directly affects the ability of our well-trained, highly motivated Cuban peers to function effectively as physicians. Everyone I spoke with stressed that they are "getting by for now," but their health care system remains a frustrating blend of the systems of developed and Third World countries. Physicians everywhere should encourage their political leaders to end the embargo on medical and humanitarian supplies to Cuba.