How Cuba’s Medicine Crisis is Playing Out

Exchanges, donations, notifications, sales and smuggling

Photo: Sadiel Mederos.

By Glenda Boza Ibarra and Meilin Puertas Borrero (El Toque)

HAVANA TIMES – Lisi Solis is the admin of a medicine exchange group on WhatsApp. She created it in May 2020, when medicine shortages in Cuba were already clear.

“The group’s regulations are clear: no buying and selling and no hoarding,” she says. “Here, people swap – or donate – the medicines they have.

With 256 members, the group (mainly comprised of women) writes messages saying what they need and what they are offering. They sometimes find somebody they can swap medicines with, sometimes people give people what they are looking for and those with less luck don’t always get a response.

“I needed salbutamol because I’m asthmatic,” Ruth Carmona says. “Several people replied to my request, offering to give me one for nothing in exchange. I could have got three, but I left a message in the group saying that I would leave the other two in case anyone else needed them.”

However, Lisi Solis says that not everyone makes Ruth’s kind gesture “Sometimes, people take advantage and hoard medicines, and then we find out that they’ve been selling them.”

When somebody reports a freeloader, they are kicked out of the group and their information is shared so that they can’t “scam anyone” again.

Lisi says that “there have also been cases of people offering someone a medicine, and then another group member tries to get hold of it first. People don’t always have the best intentions and many people take advantage,” she laments. However, the majority of the group’s experiences have been positive.

Cubans have also organized themselves on other social media platforms – such as Telegram and Facebook – to exchange medicines.

“I swapped Metronidazole for Metamizole, which were in shortage and are always in high-demand. I had some Metronidazole left over from a treatment,” Ruth says.

With just a quick search of the word “medicine”, you can find exchange groups on social media, with names of provinces and municipalities. Some also offer alerts and information about drugstore stocks, phone numbers, addresses or retail information.

Donations

Edesio Alejandro, Hector Noas, Barbaro Marin and Ulises Toirac are Cuban artists who have taken to social media in order to ask for help in getting a hold of missing medicines.

“I have to give a public, clear and brief expression of my gratitude. The post asking for a salbutamol inhaler mobilized many people. (…) Solidarity and generosity are very beautiful gestures. I have been touched to the heart with all of your support. Thank you,” Toirac wrote on his Facebook page.

In the “Medicine donations” group on WhatsApp, medicines and other products are not allowed to be sold, nor can links to websites be posted, nor can viral messages be sent: “It’s a group to help one another. Without profits, for free,” Tamara Carballo, one of the group’s 148 members, explains.

“I’m not giving anything if I’m not getting anything in exchange, no matter how selfish it might sound, but the reality is that you might need any pill you have at home later down the line, with all of these shortages,” a user admits.

However, thanks to medicines donated by people who no longer use them, the Corazon Solidario project in Santa Clara has managed to continue treating many psychiatric patients and has even been able to deliver medicines to those who need them.

Photo: Jessica Dominguez

“Here at Corazon Solidario, we have been inviting people to bring the medicines they no longer use for a while now, whether they want to exchange them or if their treatment has finished, or if a family member has passed away. This is how we are able to continue helping people,” Victor Cuevas, the project’s founder, explains.

In order to deliver the medicines available in his dispensary, Victor asks for a medical prescription, card or some other method. He is aware that there are people who prey on other people’s good will and make a fortune off shortages; “but this isn’t the majority,” he says.

In Vueltas, Villa Clara, Anel Perez, a member of the Health Pastoral, says that for years they’ve been receiving donations of medical equipment and medicines, which they then deliver to those who need them – when they’ve presented a medical prescription beforehand.

“We always check the medicines haven’t expired and that they are in a good condition,” Anel says, who graduated in Pharmacy. “We have a rental service for wheelchairs, anti-dust mite mattresses, bedside commodes and crutches.”

In addition to medicines, medical supplies such as syringes, disposable gloves, catheters, collection bags, oxygen tanks, etc. are also exchanged, sold and donated in social media groups.

“A few months ago, a woman gave me a catheter that she was left with when her mother passed away,” Maribel says, who is looking after her father who has prostate cancer. “I was willing to buy one, I wrote in a Telegram group and the woman kindly gave it to me.”

Maribel remembers that at the beginning of the pandemic, she couldn’t get a blood test done because of a lack of syringes. “I had to beg the [hospital] oncological nurse to give me one,” she says. “But I didn’t get my blood test done. I put the syringe away in case one of my daughters or my father needs it.”

Cuba’s Essential Medicines List comprises 619 products: 351 for hospitals and 268 for drugstores. Out of these, 263 (42%) are imported and 356 (58% are nationally produced: 350 products by BioCubaFarma, 5 by the food industry and 1 by the National Center of Agricultural Health.

An average of 85 medicines manufactured by BioCubaFarma were missing on the shelves in 2020. As well as imported medicines that were unable to enter the country in recent months.

Faced with shortages at drugstores, Cubans have sought out other channels to find medicines: social media group for donations, requests and exchanges; sales on the black market; ordering medicines abroad.

Every day, a Cuban “resolves” (gets a hold of) medicines they need using the Internet: without a prescription, without a medical certificate, without a card. On Facebook, Telegram, WhatsApp or Twitter. All you have to do is post your request for help and, almost always, somebody replies saying they have it.

Expired medicines: no, but yes

A mother took her son to ER at the Santa Clara Pediatric Hospital. Her son’s left ear had become inflamed and red after seemingly being bitten by an insect.

“He has a cellulite,” the doctor told her. “What antibiotics do you have at home?”

“Which one do I need for what he has?” the mother replied.

“Cefalexin would be the ideal, but tell me which ones you have at home and we can adjust the treatment.

“I have Cefaxelin, but I think it’s expired.”

“It doesn’t matter, if it stills look OK, it’ll work,” the doctor replied while telling the mother how to take the medicine.

“I was a bit afraid to give my boy those expired pills, but I didn’t have any other choice,” the mother says, who preferred not to give her name. “I asked the doctor for a prescription, and I kept it for months in my purse. When it came out at the drugstore, the prescription had expired, and my son had recovered a long time ago. If I hadn’t had those expired pills…”

Photo: Sadiel Mederos

According to the Public Health Ministry (MINSAP), “there are studies that prove how certain quantities of medicines at home expire without ever being used, and this also creates pressure on the system.”

However, some Cubans argue that, if they buy medicines when they’ve been able to rather than when they need them, they hold onto them forever. During this crisis, if it weren’t for these products (expired ones too) Cubans wouldn’t have been able to treat their ailments, or help others out.

“Over the past few months, many people have “got by with expired medicines, Lili Solis says. “When somebody offers something in our group and explains that it is expired or is about to expire, people don’t care. I myself have used medicines that expired three years ago, and they were effective.”

“I had a bottle of ibuprofen for children that had been sent to me from the US and I announced it in a Facebook group, some weeks before it was about to expire,” Diliana Labrada says. “A young woman immediately wrote to me saying that she needed it for her son, and came to my house to pick it up.”

Others, like Cynthia de la Cantera, make the most of drugs that have reached their expiry date, by using them to treat animals.

“I picked up a stray dog a while ago, that had given birth and needed iron, prenatal vitamins and folic acid, and animal rights advocates helped me to find them,” she says. “I posted in a Facebook group and several people helped me to get what I needed that very same day.”

Cynthia maintains that while these medicines may have expired, they can still always be used for veterinary use, as long as they haven’t changed in color, consistency, etc.

Illicit market and buying and selling groups

Indira* used to sell all kinds of medicines on Telegram: Simeticone and Scott’s emulsion for 225 CUP; Ibuprofen Oral Suspension for 200 CUP; different kinds of gummy vitamins for 375 CUP; menthol, vitamin C, slimming pills, Chanca piedra (gale of the wind) and others, some 20 products in all.

However, her business that had boomed at the beginning of medicine shortages in 2016, began to dwindle in April 2020 when borders closed and she was no longer able to travel to Haiti to stock up.

“I have Haitian citizenship and would travel with my husband and daughter,” she says. “Each of us were able to bring back 10 kg of medicines free of cost, in accordance with Customs regulations.” The most “highly-sought after” products were Diclofenac pills or lotion, nasal decongestants and vitamin C, which Indira says she also bought upon demand.

Indira says that she always warned buyers that “before taking any pill, they should consult a doctor”; but this guidance isn’t always observed.

A publication on Holguin’s Provincial Board of Health warned that a bottle of pills with the name “Chlordiaze poxide” was being sold in this eastern city, but that “laboratory tests had proven that it wasn’t the tranquilizer commonly known in Cuba as Chlordiazepoxide.”

In the comments section of the post, many users mentioned secondary effects such as fever, muscle aches, palpitations and high blood pressure.

The authorities informed that this medicine has toxic components and recommended against its use. They also warned of the dangers of self-medicating and taking medicines that don’t belong to Cuba’s Essential Medicines List and are sold by international travelers.

However, it’s common for doctors themselves to prescribe a medicine produced abroad as an alternative to shortages at Cuban drugstores.

“When my father began to have problems with his prostate, the doctor told us that if we could, we should get him Prostasan and another one which is made with Saw Palmetto which are natural,” Maribel says.

Jose Angel Perez, a doctor in Havana’s Playa municiaplity, recognizes that patients might not always be able to get a hold of medicines belonging to the first, second or third-line of treatment.

“When they are unable to get a medicine, they are forced to spend some time without treating the ailment. Some share pills with friends, ask families abroad for them, buy them on the illicit market or turn to swapping them.”

Out of the most-consumed medicines in Cuba, 53% are concentrated in 12 drugs that are mostly linked to treating chronic disease. Some of the most well-known are Enalapril, Captopril, Amlodipine, Salbutamol and Metformin.

Perez believes that people with chronic disease are the ones most at risk because “they require treatment over long periods of time, for life most of the time”; and their quality of life depends upon this treatment.

While you can find ads from people donating or needing medicines, these controlled medicines – and others solely for hospital use – aren’t so easy to get a hold of, not even on the illicit market or in exchange or donation groups.

Alternatives

In the most recent meeting between Cuban government leaders and MINSAP, the minister of Public Health Jose Angel Portal explained that the medicine situation in the country was still tense, but that production was picking up and natural and traditional medicines were being used.

One of the meeting’s outcomes was that the essential natural products list was going to increase to 172 products.  The officials noted that already they were producing double past production, the most in history.

“Green medicine, and more specifically phytotherapy, has resolved many of my patients’ problems, especially skin conditions and mild psychiatric conditions. But most of these plant-based treatments are prepared at home, as these products are also missing at drugstores,” doctor Perez says.

In his opinion, alternatives such as phytotherapy, acupuncture and digitopuncture, can be effective in some cases; although he is always transparent when it comes to the treatment needed. “I’m very honest with my patients. When they need a specific and certain treatment, I tell them without hesitation. There is a “policy” of not prescribing what can’t be found at drugstores so as not to create problems for the patient, but I completely disconnect from this: if they need it, they need it. Many people don’t share this view.”

In statements broadcast on national TV, health minister Jose Angel Portal has said that Cuba will ensure at least one medicine in every pharmaceutical group so that patients have some support.

“A lot of the time, dissatisfaction comes from being prescribed a medicine that isn’t available,” the official said. “It isn’t a matter of bad intentions, but sometimes we aren’t able to get this information to the doctor on shift in time for them to know what it is in the drugstore when they write a prescription, and what doses are available.

Cubans have also had to turn to concoctions, prepared for veterinary use or even non-conventional products in medicine.

Yudier says that he was taken aback when his doctor told him to treat the healing of an abscess in the buttock with an alcoholic drink. “The surgeon had to poke me quite a bit and, as the healing process is long and there is no medicine for it, the doctor suggested I treat it with red wine,” he says. “But the nurse who treated me didn’t like this invention.”

He didn’t only ask about experiences of the healing process of abscesses in an exchange group, but he was also told where he could buy the wine which, he never put on his skin in the end.

Yudier says that he also tried to treat it with Shostakovsky Balsalm, but he discovered that you can only buy it with a medical prescription from the international drugstore in Santa Clara. “You can only buy two flasks per person.

Perspectives

According to BioCubaFarma, medicines in Cuba are classified according to their use for the treatment of different diseases. Those that fall under priority 1 – with control cards, linked to blood disorders, mother-child care and medical treatment for critical cases; treatments for HIV patients, and other for outpatient centers for the Cuban population – were the hardest hit in January – October 2020.

“My girlfriend’s grandfather has cancer. He is 79 years old, but with the right medicine he can lead a normal life; there are only problems when the medicines aren’t available,” Alejandro says. “There’s no Cosedal or Metamizole, or painkillers or syringes to inject himself when the pain becomes too much.”

Alejandro’s family have managed to slowly find what he needs on WhatsApp and Telegram groups for medicine exchanges and sales.

“We have even paid in USD, but sometimes you can’t even get them like that, because there is such high demand,” he says. “We’ve also given my grandfather a placebo: we tell him that we’ve put some painkiller in his juice. However, if the pain isn’t too bad, the psychological factor helps.”

MINSAP authorities have repeated that the US embargo against Cuba is the main reason for Cuba’s medicine crisis. According to statements made by Eduardo Martinez, president of BioCubaFarma, key problems manifested when normal suppliers of raw materials stop supplying all of a sudden, out of fear of this affecting their sales in the US. 

Playa drugstore, Havana, Cuba, medicines. Photo: Jorge Beltran.

In other cases, foreign clients have delayed payments to Cuban export companies – or they are retained by banks – and it’s impossible to reinvest this money in payments to suppliers. Easy and flexible payment schemes are unavailable to Cuba. Factories closing down in India and China was also a reason given over the years. This has also affected access to medical equipment, reagents, diagnosis means, devices, equipment and spare parts.

When it comes to the population, there are reasons linked to the “improper use of medicines, wrongful prescription and prescription out of convenience that sometimes increase consumption for no reason,” MINSAP authorities have said.

“The matter here is that there used to be a lot of medicines before, and people would ask for prescription to keep medicines at home,” Tamara Carballo says. “Multivit was given to pigs; contraceptive pills were put in shampoo; Permethrin was used to kill ants… But then the years of shortages came, so if I walk past a drugstore and I find out something has come in, I go to the doctor and ask for a prescription.”

While Cuba’s medicine crisis began in 2016, it was only in April 2020 that the highest number of medicines missing from drugstores was recorded: 139.

Non-availability of raw materials, finished products, materials and equipment breaking down, are the main reasons for national shortages. While problems with distribution and transport have also played a minor role.

The most optimistic reports assure that medicines will be manufactured with national raw materials; inventory and leveling out key products in shortage or in low coverage among the provinces; rescuing medicines that were once produced in the country and looking for new suppliers to act as immediate replacements.

While strategies are being organized and solutions are being planned, drugstore shelves remain empty and so do families’ medicine cabinets. In the short and mid-term, online medicine exchange and sales groups will continue to be a means to navigate Cuba’s medicine shortages.

*Pseudonym for someone who asked to remain anonymous.

Read more from Cuba here on Havana Times.