Lack of ambulance worsens care for a peasant injured with a machete in Camagüey

The shortage of medical transport in Cuba stems from a combination of factors: an energy crisis, a chronic lack of fuel, and a deteriorated vehicle fleet that prevents most units from remaining operational. A farmer bleeding out, with his thumb tendon cut and no ambulance available to travel 50 kilometers to the provincial hospital: that was the real emergency that Esmérido Muñoz Hidalgo endured in the community of Manolín, in Camagüey province, after being attacked with a machete by a neighbor. Far from being an exceptional case, the incident portrays the current state of emergency medical transport throughout Cuba. The ambulance assigned to the area was out of service. Medical personnel could only offer the family the possibility of transporting the injured man on an internal-use bus, with stops along the way and without conditions to support a patient hooked up to an IV drip. The origin of the attack was a dispute over cattle theft. Muñoz confronted a neighbor after the man stole a mare from him, and the argument ended with a machete blow that severely damaged one of his hands. The incident is not isolated in the area. Rural communities such as El Pilar, Carrasco, and La Belén, in addition to Manolín, have been denouncing a sustained increase in animal theft without authorities offering any response. After the attack, Muñoz was taken to the Najasa polyclinic. There, the lack of anesthesia and suture thread prevented his wound from being closed immediately. "At the polyclinic there was no anesthesia, no stitches, nothing. They couldn't stitch him up cold because he had lost a lot of blood. He was pale, vomiting," recounted his daughter, Dianelis Muñoz. The on-duty doctors had to temporarily seal the damaged blood vessel to stop the hemorrhage. Only later did the family manage to find another doctor willing to suture the wound, which had affected the thumb tendon. The shortage of medical transport in Cuba stems from a combination of factors: an energy crisis, a chronic lack of fuel, and a deteriorated vehicle fleet that prevents most units from remaining operational. A patient is loaded into an ambulance in Havana (Cuba), in a file photo. EFE/Ernesto Mastrascusa The Ministry of Public Health (MINSAP) itself acknowledged in 2023 that the country had barely 39.6% technical availability of its ambulances, a deficit that according to later reports worsened in recent months. Dianelis described bluntly the situation her family faced. "The ambulance here is broken, there was nothing to get him out of here," she told Martí Noticias. The alternative they offered her was unviable given her father's condition. "In the state he was in, I couldn't take him on that bus, making stops from here all the way to Camagüey, him with an IV, nearly fainting. And guess what, the ambulance never came," she added to the outlet. Dr. Milagros González explained to Martí Noticias that the Integrated Medical Emergencies System (SIUM), whose function is to provide first aid and transport critical patients, has ceased functioning regularly in everyday Cuban life. An artistic representation illustrates the crisis caused by the shortage of schizophrenia medications and its impact on families in Cuba. (Illustrative image Infobae) According to the doctor, the deterioration is due to the "deficit of resources and personnel and the paralyzing bureaucracy that forces management to be channeled through the family doctor, a procedure that delays the response until it becomes useless." González warned in the publication that the service today is only activated for catastrophes or mass accidents. That leaves individual emergencies without coverage: heart attacks, domestic accidents, or assaults like the one Muñoz suffered. The pattern repeats in other provinces with variations that confirm the magnitude of the problem. In Sancti Spíritus, of the 52 ambulances assigned to the territory, only between 15 and 18 operate each day, far below the daily activations demanded by the population, according to data released this year by provincial health authorities. The case of Guantánamo illustrates another dimension of the crisis. There, a doctor denounced in September that her ten-month-old baby, with neurological complications, waited from midnight until past nine in the morning to travel by ambulance to Villa Clara, where she was to undergo an MRI. Fatal outcomes are also accumulating. In April, a man died in Santiago de Cuba after waiting more than four hours for an ambulance that never arrived. In September, a 21-year-old young man died in Regla, Havana, after a motorcycle accident, while his family denounced a delay of nearly an hour in the transport. The collapse forces families to sustain with their own resources what the State should guarantee. In Melena del Sur, Mayabeque, the municipality's only ambulance remains inoperative most of the time due to lack of fuel, and it is the patients themselves who must provide the money or gasoline needed to guarantee an emergency transport. Similar cases repeat in other provinces. In July, a citizen identified as Juan Carlos León had to pay out of his own pocket for a part to repair the state ambulance that was supposed to transport his wife to oncology treatments, after the vehicle sat for half a year in a workshop without spare parts. Cuban cancer patients remain admitted in a room at the Institute of Oncology and Radiobiology in Havana (Yamil Lage/AFP) The government has attempted to mitigate the deficit with occasional additions of units, including electric ambulances made in China and international donations. However, those deliveries are not enough to reverse a problem that health authorities themselves described as a system "on the verge of collapse." As long as the shortage of basic supplies and the lack of emergency transport persist, families like that of Esmérido Muñoz will continue facing every medical emergency with the same fear his daughter summed up: the certainty that, when life depends on minutes, help may never arrive.