In January 1959, the world woke up to the Cuban Revolution and the overthrow of the former Cuban dictator, Flugencio Batista. Fidel Castro, the leader of this revolution, would shortly become and long remain a thorn in the side of the United States government. The revolution’s other leader, Dr. Ernesto “Ché” Guevara would influence not only Castro’s vision of the revolution but equally Castro’s policy of attempting to change the world. Guevara’s understanding of socialism and his vision of Social Medicine was both radical and historically significant for he would oversee the introduction in Cuba of institutions based on Social Medicine.
Though long ignored in the English-speaking world, Social Medicine was a major influence not only in Cuba but in the history of medicine as such, particularly in pathology and epidemiology. Social Medicine is now a highly and respected form of research, teaching and clinical practice in the Latin American region. In the English-speaking world there exists a gap in knowledge with Social Medicine. “This gap in knowledge derives partly from the fact that important publications remain untranslated from Spanish or Portuguese,” (Waitzkin, AMJPH, 2001, pp.1592). Another reason for Social Medicine’s lack of impact is the belief from places like the United States and elsewhere that nothing scientifically or even intellectually productive can come from the developing world. However, it would be erroneous for pathologists, or those who study Public Health, to ignore such successful implementations of Social Medicine ideas in places like Cuba with Ché Guevara, in Chile with Dr. Salvador Allende (President of Chile, 1970–73) and, to some extent, even Argentina. The best examples of Social Medicine have originated from Latin American countries. One reason for rejection of such programs is that they emerged from countries suffering from political and social upheaval. Nonetheless, Social Medicine has proven to be as a historically significant contributor to the advancement of medicine.
Social Medicine, though more prominent in Latin America, actually originated in Europe in the nineteenth-century. The man given credit with first originating the ideas of Social Medicine was Dr. Rudolf Virchow. Dr. Rudolf Virchow (1821–1902), was a famous physician and pathologist. He founded cellular pathology and was the first to urge the use of microscopes and the first to recognize leukemia. Cellular Pathology is a type of pathology where the nature of the cell is used to study the causes of many diseases. He was an important figure in not only medicine, but also politics. Dr. Virchow was leader of the liberal progressive party that was opposed to the policies of Otto Von Bismarck (1815–1898). It was Vrichow’s political actions and beliefs that made a greater contribution to Social Medicine than anything else. In 1848, Virchow was active as a staff physician at the Royal Charité Hospital in Berlin, where he examined an endemic outbreak of typhus in the Prussian region of Silesia. “Virchow identified social factors, such as poverty and the lack of education and democracy, as key elements in the development of the epidemic,” (Anderson, AJPH, 1987, pp. 81). Virchow wrote in his essay:
“Artificial epidemics…are attributes of society, products of a false culture or of a culture that is not available to all classes. These are indicators of defect produced by political and social organization, and therefore affect predominately those classes that do not participate in the advantages of the culture,” (Cited in G. Rosen, From Medical Police to Social Medicine [New York: Science History Publications, 1974]. pp. 82).
Virchow defined Social Medicine as a type of social science that focuses on illness-generated social conditions. He argued that physicians should act as attorneys for the poor.
What is Social Medicine, then? Social Medicine has varied meanings and practices now — especially in Latin America. According the Matthew Anderson and his associates, certain common principles underlie the concept of Social Medicine: “Social and economic conditions profoundly impact health, disease and the practice of medicine. The health of the population is a matter of social concern. Society should promote health through both individual and social means,” (Ibid, pp. 81). Fundamentally, Social Medicine presents a Marxist analysis based on the dialectic. “Social Medicine has emphasized social class, as defined by the relations of economic production …Practitioners of social medicine have argued that the exploitation of labor remains an inherent condition…” (Waitzkin, AMJPH, 2001, pp.1598). Health or illness is viewed as a dialectic process generating criticisms of non-Marxist approaches that use monocausal explanations. Simply put, Social Medicine pathologists believe that, “multicausal models, such as those that consider the interaction among agent, host, and environment, still define disease in a relatively static fashion,” (Ibid., pp. 1599). There are new emerging trends in Social Medicine which this paper will explore later.
The majority of the adherents to Vrichow’s vision of social pathology immigrated to Latin America near the turn of the 20thcentury. These immigrants mostly moved to Chile and Argentina, which at the time were the most successful countries in South America. Most would end up with teaching positions at the universities. In a medical school of the University of Chile these disciples of Virchow they influenced Dr. Salvador Allende, a medical student activist, pathologist, physician and future president of Chile (1970–73).
Salvador Allende (1908–1973) played a key role in the advancement of Social Medicine. He was born into a family with a long history of political activism. His grandfather was one of the founding members of the Chilean Radical Party in the 1860s, (Tedeschi, 2003, pp. 2014). Allende himself would end up being one of the founders of the Chilean Socialist Party, in 1933. In 1939, Allende was named minister of health, prevention and social assistance in the Popular Front government, a position which he held until 1942, (Ibid., pp. 2014). He used this influential position in Chile to help him publish La Realidad Médico-Social Chilena (The Chilean Socio-Medical Reality) during the same year. “This remarkable analysis of the social determinants of disease and death underpinned his view that only radical social change — land reform, nationalization of industry — could alleviated the situation” (Ebrahim, 2005, pp. 721) that Chile faced.
La Realidad Médico-Social Chilena, a ground-breaking work in pathology, would help firmly establish the field of Latin American social medicine. In the International Journal of Epidemiology, Waitzkin wrote:
“The introduction of La Realidad explored the dilemmas of reformism and argued that incremental reforms within the health-care system would remain ineffective unless accompanied by broad structural changes in the society. Allende emphasized capitalist imperialism, particularly the multinational corporations that extracted profit from the Chilean natural resources and inexpensive [labor]. He claimed that to improve the health care system, a popular government must end capitalist exploitation,” (2005, pp.740).
At the time, the direction the Allende took was considered unique because of its advocating of social rather than medical solutions to health problems. Allende saw, as do most social medical pathologists see, that solutions to medical problems rely in improving social conditions rather than improving on health-care facilities. Health-care facilities can be the most advanced in the area, but help no one if they exist outside of society instead of as part of the community. In other words, Allende was arguing that high-tech medical facilities help only those who can afford it. He wrote, “The problem of the nation’s health affects everyone,” (Allende, Cited in AMJPH, 2003, pp. 2012).
In 1942, Allende would become leader of the Chilean Socialist Party and in 1945 was elected to the Chilean Senate which is the upper house of Chile’s parliament. As a senator he introduced much legislation that implemented action based on his own social medical conclusions. In the 1950s, he created the first national health service which was the first program in the Americas to offer universal health care. He remained a senator until 1970, when he elected President by the Chilean parliament. This fostered the first time socialism would come into power in Latin America not from a violent revolution, but through peaceful democratic votes. As president, he called for profound economic and social changes. He sponsored the decentralization of health care by empowering local health councils hoping the serve the impoverished masses. The Chilean doctors felt threatened because Allende’s programs meant less income for their private practices. Being a socialist president in the America’s during the Cold War did not help his relationship with the United States, either. On September 11, 1973, his government fell to a military coup led by General Augústo Pinochet. Allende was later found dead that same day.
Allende sought reforms in medicine that would have achieved structural changes throughout society. Sadly, he would die for his beliefs which have proven as a dark trend among social medical activists. He met with much hostility from his opponents. As happens many time in Latin America, when a socially-active government official attempts to attack the corrupt institutions in their country they are often met with a violent end. The aftermath of such violence usually spurs more violence as Pinochet was considered one of the worse dictators in all of Latin America.
Before Allende became president of Chile and was assassinated, the Cuban Revolution happened in 1959. The Cuban Revolution brought not only its notorious leader, Fidel Castro, but also the Revolution’s just as notorious but very popular icon, Dr. Ernesto “Ché” Guevara. Ché Guevara would be the first actually to attempt implementations of social medical concepts. He was the one who helped influenced the Cuban Revolution into a socialist revolution. And he was the one whose zealous belief in the ideals of socialism would inspire many others.
Guevara came from a country with a tradition of superior research in social pathology and epidemiology Argentina. That fact that he would support (or introduce) a Public Health policy based on the ideas of social medicine in Cuba should come as no surprise. For most of the late nineteenth-century, Argentina had been building up institutions that would foster medical research that even today is surpassing most other places in the world. “The members of the Generation of 1880 had laid the foundation by building medical and hygienic infrastructure, but it was their students who benefited most from intense interest and involvement of the state,” (Rodriguez, 2006, pp. 50). A case in point would be that the Argentineans have won the most Nobel Prizes for Physiology or Medicine of any Latin American country. Bernardo Houssay (1887–1971) won in 1947 for his experimental investigation of the role of the anterior hypophysis gland in the metabolism of carbohydrates, particularly in diabetic mellitus. Luís Federíco Leloir (1906–1987), won the Nobel Prize for Chemistry for determining the cause of galactosemia, a severe form of lactose intolerance. César Milstein (1927–2002), won the Nobel Prize for Physiology or Medicine in 1984 for developing the hybridoma technique for the production of monoclonal antibodies. It is erroneous to assume that Guevara was not aware of these men and their research, knowing that he was alive when these Argentinean Nobel winners were.
Although, the Nobel Prize winner Houssay was ousted from his position as the chair of physiology at the University of Buenos Aires Medical School when Guevara was a student there (1947–1953), he had already left a lasting impression on the institution before his forceful dismissal. Houssay’s devotion to political freedom caused him much trouble with the Argentinean dictatorship of Juan Perón. He would return in 1955 after Perón and his Peronista government was ousted from power. Houssay would remain there until his retirement. Houssay’s political activism is congruent with the ideals of social medicine. Guevara, a student here, would get more lessons in political activism from research than from what he had received from his liberal parents or his own activism beforehand. However, it would take a trip across the continent of Latin America on a motorcycle called La Poderosa II (“the mighty one”) to truly radicalize Guevara.
During his trip with his friend Dr. Alberto Granado, a twenty-nine year old biochemist, Ché would not only see the beauty of Latin America, but also the various forms of injustice and those who suffered physically, mentally and spiritually from these injustices. It was during a trip to Tucumán on the road to Salta where he wrote in his diary:
“‘I realize that something was growing inside of me for some time…has matured: and it is the hate of civilization, the absurd image of people moving like locos to the rhythm of that tremendous noise that seems to me like the hateful antithesis of peace,’” (Anderson, 1997, pp. 62).
Ché’s growing political awareness coupled with his medical teachings fostered in him a need to enact change in the world. He was exposed to not only what seemed to him validation of the radical ideas of what corruption (namely capitalistic corruption) affects society. He was also exposed to another prominent medical figure that was also very politically active although, this exposure to social medicine was much more intimate than his previous exposure to Allende. Granado and Guevara would meet Dr. Hugo Pesce, a leprologist in Lima, Peru. Guevara’s close affinity to Dr. Pesce went far enough to where he started calling him “el maestro.” “After graduating medical school in Italy, Pesce had returned home, me the Peruvian Marxist-philosopher José Carlos Mariátegui, and became a disciple,” (Ibid, pp. 85). Pesce was also a prominent member of the Peruvian Communist Party. In Anderson’s biography on Che Guevara, he argues that the beliefs and practices were examples for a potential structure for him to emulate. However, Anderson is mistaken to argue that this would be his first true exposure because social medicine had existed before and after Guevara’s medical studies.
Political socialism coupled with medical research is the basis of social medicine, but not the end. However, Che would take this foundation and radicalize it. Nowadays, social medical pathologists are trying to expound on social medicine by moving from a Marxist-thought to a socialist thought. Some practitioners even have adopted the ideas of the philosopher Althusser and his concept of interpellation. Yet Guevara’s vision of expounding on social medicine was by radicalizing the world so that its implementation would fit perfectly. Virchow saw physicians as “attorneys for the poor.” Guevara’s response to this can be found in a speech he gave in 1960 to the Cuban Militia entitled “On Revolutionary Medicine” where he said: “…I realized a fundamental thing: For one to be a revolutionary doctor or to be a revolutionary at all, there must first be a revolution.” Like a social medical pathologist, Guevara believed health problems were not a problem of the isolated medical research. Rather, he saw the way to cure things on treatment of the disease and especially the environment that disease existed in. This multicausal vision provoked Che in his effort to cure the environmental and political problems that contribute to disease and health problems.
Guevara suffered his entire life from Asthma. He spent much of his life trying not let asthma prevent him from being normal. In 1957, while Che was in Mexico training to be in Castro’s militia, he worked in medical research and a treatment clinic for those who suffer from allergies. A young woman who suffered from asthma died while Guevara was treating her. He used tragedies like Maria’s to further rationalize his socialistic cause with what he described as “red vengeance,” (Ibid., pp. 183). It was during this time of Guevara’s growing political activism that he tried to lend his own hand at medical research. He began experimenting on cats for his medical research.
In April, Ernesto traveled to Leon in Guanajuato state [in Mexico], to attend an allergy conference. There he presented his papers: ‘Cutaneous Investigations with Semidigested Food Antigens.’ It received what he described as a ‘discreet reception’…” (Ibid, pp.168). This less than enthusiastic reception of Guevara’s paper made him more active in political change than in isolated research.
After the Cuban Revolution’s success, Che had grown confident to publish his ideas again, though this time there weren’t being published for scarce academic journals. Instead, he wrote articles for magazines, wrote books and speeches for the masses. In an article he wrote for the magazine
“Verde Olivo,” he wrote: “‘We applied certain formulas, [the results] of discovery of our empirical medicine for the great ailments of our beloved Latin America, empirical medicine that rapidly became a part of scientific truth,’” (Ibid., 505).
In Anderson’s biography of Guevara, he agues in his book that this scientific discovery was, “the culmination of a process of searching that had begun with his work in medicine,” (Ibid., 505). Che had been looking for a cure to not only just illness, but the illness of man’s continuous suffering in an imperfect society. For Dr. Ché Guevara, the only means to cure man’s ills was through guerrilla warfare. He also believed that through under the ideals of Marxist-Leninism that all injustice would end and spawn the creation of a new form of man, the “social” man.
Guevara would leave Cuba for good in his attempt to expand his idea of a pan-American revolution. His efforts would bring him to the continent of Africa in the Congo region and then back to South America in Bolivia where he was killed in an ambush. He would be buried in a secret spot in Bolivia that to this day is still unknown. That Guevara died so young and so romantically only added to his aura. Nowadays, Guevara is often used as a symbol of an oppressed people fighting for humanitarian rights. Guevara’s absence in Cuba allowed Castro to commit more human right violations — changing the Cuban Revolution from a socialist revolution to one that spawned the rule of a dictatorial government.
Cuba is considered a triumph in public health. Ché’s work for social medicine and his influence to Cuba’s public health lives to this day. “While Cuba’s primary health care lacks equipment that British general practitioners take for granted and spends a fraction of the UK budget on health, it has health indicators equal to those of Europe,” (Chamberlain, 2003, pp.147). Guevara has thus proven that social medicine can insight change that affects health and society as a whole.
All of the adherents of social medicine were politically active socialists who contributed greatly in the advancement of medical research. The United States consistently has political debates over the problems with public health policies. The arrogant view of the first world countries like the U.S. has hurt its public health record by not considering some of the concepts of social medicine. Though, anything that relates itself to Marxist thought is often shunned and highly scrutinized. Another problem for social medical researchers is political oppression. Many have died for their work in social medicine, like Allende or Guevara. Such oppression causes some research that might prove to be significant to be lost. Bernardo Houssay was one of the few lucky in that he was not killed while Peron was in power — possibly because of the fact that he had already received the Nobel Award for Medicine in 1947. However, to this day, his influence in the Medical Faculty of Buenos Aires University has created one of the most respected medical institutions in the world. The same can go for the radical institutions started by Dr. Ernesto “Che” Guevara. For Cuba, it does not take wealth or pharmaceutical businesses to improve health, but the people.
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Originally published at www.jordanaubryrobison.com on July 14, 2014.