BY GREG ROSENBERG
NKANDLA, South Africa - High atop a mountain in the verdant landscape of northern KwaZulu-Natal province lies Ekombe Hospital. The 170-bed complex, run by the South African government, is the only full-service medical facility in reach for tens of thousands of blacks living in destitute rural villages that dot this rolling countryside. For more than two years, Ekombe had no doctor. In February, Dr. Abel González and a colleague arrived to assume full-time duties - from Cuba.

"The people here have good opinions of us," said González in an interview. The Cubans were greeted on arrival by ululating workers from the hospital kitchen. Ekombe - some 40 kilometers from the nearest paved road - lies in the heart of the old apartheid KwaZulu "homeland." The region is associated with strong support for the Inkatha Freedom Party, which actively opposed the deployment of Cuban doctors in South Africa. "I like to work in Africa," said González, who comes from Las Tunas province in Cuba, specializing in obstetrics and gynecology. "The people are suffering too much. Tuberculosis is very common here. The TB ward is full - all 30 beds."

An average of 100 people a day make their way to the hospital. González stressed that having trained doctors posted at this facility could often make the difference between life and death. "For example, in late April there was a big accident here involving a minibus taxi. Eight people were hurt and one killed. Without a doctor two or three more would have died."

Volunteered on request of ANC
González is one of 96 Cuban doctors working at hospitals and clinics throughout South Africa - 12 of them in this province. The Cubans volunteered for duty at the request of the African National Congress (ANC)-led government to provide health care in rural areas that face a critical shortage of trained physicians.

"We have economic problems in Cuba, due fundamentally to the U.S. government blockade of our country," González said. In addition to his first concern - providing medical care to those who need it - the doctor said that "my visit here permits me to help my country and my family." He sends the Cuban government and family members a portion of his salary, which is too low for many South African doctors who have left the state hospitals to seek more lucrative employment in the private sector.

"Cuba helps many countries in Africa with health care," González said, consistent with the revolution's course of aiding the oppressed throughout the world. "Cuban blood was spilled in Africa. Many Cubans died fighting the [former] South African army in Angola. But without that, there would have been no liberation of Namibia - and no president Mandela."

Expansion of free health care
Lulu Madalane, coordinator of health policy for the ANC, enthusiastically offered to drive this reporter to visit another Cuban doctor working in Sebokeng township in Gauteng province. She reported that due to legislation enacted earlier this year, primary health care is now by law free to all South Africans. The challenge, Madalane stressed, is making that medical care accessible to all, especially in rural areas.

In the three years leading up to May, 3,411 nurses in Gauteng alone resigned from government hospitals. Most joined the exodus to the private sector in search of higher pay. Nearly 800 of the most experienced nurses quit their jobs in the past year. Plans are already under way to build new clinics and deploy mobile health centers in sprawling squatter camps that continue to grow throughout South Africa, as well as train more community health workers. In addition, the primary school feeding program, an initiative of the ANC, provides meals to 5.5 million schoolchildren free of charge.

"Bringing Cuban doctors here was an initiative of the ANC long before it got to government," she said. "Cuba offered, as did few other countries."

Madalane, one of the thousands of ANC members who went into exile as part of the battle to overturn apartheid, recalled the impact of hearing of the Cuban internationalist troops in Africa. Hundreds of thousands of Cubans volunteered to fight in Angola from the mid-1970s to the late 1980s, helping to repel successive South African invasions of that newly independent country.

Madalane was in Tanzania when she heard of the defeat inflicted on Pretoria's armies at Cuito Cuanavale in southern Angola in 1988. "This humiliated the racists," she said. "They thought they were the bosses around southern Africa and suddenly discovered they weren't - they were dying on the battlefield. They still don't want to talk about it! That history has to be taught in South Africa. Many of our own people still don't know," she concluded.

South African health minister Nkosazana Zuma announced June 3 that an additional 200 Cuban doctors would arrive this month to bolster the free health care program. Discussions are also being held with several European governments to see if their assistance can be secured.

`I want to help the people'
Norys Mayo Castro, who also hails from the Cuban province of Las Tunas, is the only physician at Empilisweni clinic, which serves the population of Sebokeng.

"I came to help the people," said the 30-year-old Mayo. The Cuban health ministry, she said, had last year asked for volunteers to work in rural South Africa. Those who offered to help had to pass a battery of exams, which included basic English, and tests of medical knowledge. Most, Mayo said, had previously served in Africa.

"The condition of the people varies. Some are very good. But many are very, very bad. We came to help the latter group. Especially those living in shacks - they have nothing.

"People come in with respiratory infections, especially tuberculosis, a number one health problem in South Africa. There are sexually transmitted diseases, malnutrition, and pregnant women with anemia.

"In Cuba," Mayo pointed out, "we provide preventative care. But here it's curative. I've tried to educate about preventative care, but it's not easy because of the living conditions. We must talk to the people about food, rest, vitamins. In Cuba, for instance, we provide vitamins to all pregnant women.

In April, Mayo saw 995 patients, and reported that in May the figure would rise.

Mayo added that in Cuba, she is a family doctor. "I would never have so many patients in a month. But I know everybody in my neighborhood - their diseases and histories. People with chronic illnesses are seen every three months. The healthy are seen twice a year."

Some nights, Mayo works at nearby Sebokeng Hospital. "There are many people with inflicted wounds, especially on the weekends, from bullets and knives. Wounds to the chest, back and abdomen. I saw some wounds like these when I worked in Zambia for two years - but I've never seen these wounds in Cuba."

Like González, Mayo is on duty six days a week, but in practice often works every day. She is the only doctor at the clinic. Primary health-care nurses are being trained to treat conditions like flu and hypertension. Both doctors report the supply of medicines and equipment is largely adequate to treat patients. Mayo sends 30 percent of her salary to the Cuban government and 27 percent to her family. The doctor is excited about a project she plans to initiate in the near future to begin making calls to people's houses and shacks in Sebokeng to carry out preventative treatment of tuberculosis.

People begin lining up as early as 4:00 in the morning at Empilisweni to see the doctor. "It is so crowded that sometimes they go home without seeing anyone. Sometimes it is not possible," Mayo said. "Cuba is not a rich country, but it is a medical power. In Cuba, I never turned anybody away. We are a socialist country."  
 
 
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