This unpublished text is a rough draft of an unfinished manuscript, The Role of the Doctor in Latin America, of which only a few paragraphs were written between 1954 and 1956. Che began work on this book in Guatemala (see his letter dated February 12, 1954), and continued sporadically during his time in Mexico. Despite being a rough draft, this document has great value, presenting Che’s views on social medicine, and shows how advanced his positions were. The bibliography he consulted is also important because of its breadth and heterogeneity.
When initiating the struggle for the people’s health, as a first step doctors should investigate what possibilities already exist in their complex surroundings. Earlier analyses have shown that facilities vary in different regions, countries, social classes and ethnic groups, and doctors must respond accordingly.
The struggle should always be expressed within a general framework that guarantees success and that leads doctors to win first the confidence and then the affection of those for whom they are medically responsible. Even though the problem can only be outlined in general terms, it should be noted that a doctor’s first weapon is flexibility. Flexibility—without any very obvious probing—will allow a doctor to gain the respect of the population generally. Naturally, the conditions of struggle will vary greatly, but doctors should always take this first step along the path of consolidation.
One of the first pitfalls to be avoided is offered by colleagues and others in related professions—in small towns, a rival doctor or the pharmacist; in larger towns, a variety of colleagues and specialists. In any case, the first skirmish will always be waged on the monetary front. After a doctor has demonstrated that he is absolutely impregnable to bribes, he will be subjected to harsher attacks. Good use should be made of this period between armed neutrality and open warfare. Later, war should be waged not only against the commercial disgraces of the profession but also against deficiencies of other kinds.
The struggle to obtain better working conditions for workers and adequate medical attention will easily lead doctors to clash with the established authorities in the sector, who are always lickspittles responding to the orders of those who hold the purse strings in the area, and with whom the authorities are sometimes confused. All activities should be carried out taking into account local public opinion supporting the popular cause that is being defended; this is where doctors should use their abilities as psychologists to the utmost—above all, in those places where the struggle must be waged directly against capital, without the help of any labor laws. Strikes are very hard to organize, unless the pretext is of such seriousness that it is understood even by those with a low level of consciousness, which is the case among the masses of workers in our continent. In general, one must be very careful not to be labeled a strike doctor, because that can finish off a professional’s reputation in some places.
If it is not possible to remain entirely on the sidelines, the doctor’s general role will be to provide an ideological orientation, without indicating any apparent interest in the popular movement itself. Small towns contain elements that cannot be underestimated. Public opinion is much more important in such places than in the cities, and doctors should always have anecdotes to draw on to highlight the poor working and living conditions of the people they defend.
To draw up a general outline of how to conduct oneself, one must enter the battlefield armed with a good basic knowledge [of the locality]. This includes the birth rate; the infant, prenatal and general mortality rates... and, assisted by other data, the general morbidity. In cases in which there are no death or other records—which means most places in Latin America—it is a good idea to visit the local people’s homes so as to gradually learn about their domestic situation.
The general picture of diseases will give you an idea of the main problems to be solved. Later, I’ll go into the need for the doctor to get the inhabitants to take an active part in health care, but it can always be said that epidemic diseases—and especially endemic ones—can be combated by making correct use of the general public health system, helped by a precise understanding of the problem, explained by the doctor.
One of the doctor’s most successful—though always dangerous— methods is to create health cooperatives. They are always a double-edged sword, and are usually promptly taken over by the “ladies” of the town and by other people who, in general, tend to stifle the normal development of health care. However, in those places where cooperatives must be created, this is easy to do if there is nothing else, as they will always be a step forward. Right now, to avoid being smeared as “red”—a charge which would be immediately extended to the doctor—it is not necessary to insist on having workers and peasants represented in the charitable societies, but it is important that, using a lot of common sense, the doctor start raising consciousness among the needy classes, making them aware of what an important role health care plays in problems of daily life.
Medically, it is essential to stress how important nutrition is in all the most common endemic diseases. Correct nutritional treatment and its corresponding success will draw attention to its importance. Doctors should remember that, in the present conditions, economic worries are primary, followed (as a complement to the former) by health care and then education.
Someone who eats well will be immediately concerned about their health care, and when that is improved—which will be a real achievement in unhealthy, marginalized communities—will then worry about the next problem: their education and that of their families.
With regard to this last aspect, while doctors should play an important counseling role, it is not a good idea for them to be in the foreground— especially in studies the nature of which will inevitably lead them to clash with the ideology of the ruling classes.
In places with deeply rooted religious traditions, one must also be careful there—at least until those who are best placed to offer systematic opposition to doctors have been neutralized.
In terms of public health, it should always be remembered that children should receive the best possible treatment. Always try to achieve success through collective action by the community rather than from the individual effort of the doctor.
The problems of individual health care are not so much the concern of the revolutionary doctor as collective health care. In terms of preventative health care, in addition to the measures that should be taken in each individual case, in accord with the established rules and regulations, doctors can set up systems for seeking and isolating diseases in the areas where they are found. When attempting to do this in an important community, Dr. Germinal Rodríguez’s book Higiene y Profilaxis [Health and Prophylaxis] offers a good model.
It makes for a quite pretentious office, but the doctor needs a secretary, a lab assistant, two social workers and some volunteers in order to do this effectively. In addition to the invaluable health service it offers, a clinic of this kind also has the virtue of winning over the inhabitants to the idea of exercising their rights as citizens—which, when they get used to it, will lead many “lone wolves” to rejoin the community.
One of the points to which doctors should pay close attention is that of ensuring the government’s neutrality, if nothing else. There is an apparently wide range of systems of government in Latin America, but nearly all of them share the common denominator of colonialism. This encapsulates the tragedy of the human communities now living in Latin America and has certain general features:
• control by large landowners,
• powerful authorities who oppose the people,
• control by the clergy,
• an absence of effective social laws and
• the predominance of foreign monopoly corporations.
In this panorama, with the authorities as the direct representatives of the upper social classes, doctors have to take things very slowly in order to keep the government neutral or win it over. Therefore, they should fulfill their obligations to the higher health authorities, while at the same time demanding that those authorities provide as many resources as possible. They must wage virtually a personal struggle against the exploiters, separate from the central bureaucracy, while ensuring that their medical-social activities are not seen as part of the political struggle.
It seems hardly necessary to emphasize that the doctors’ work should be carried out with complete dedication, for this is what will make their ideas triumph over the inconsistent, mercenary activities of their individualistic colleagues, who view their role only as a means toward their desired goals— whether this is power (the relative power wielded by the doctor in a village), fame or money. Revolutionary doctors should always remember that it is their duty to attack whatever problems adversely affect the people, who are the only ones they should serve.
• Need for study.
• Need for exchanges with medical journals.
Works Consulted (1954-56) for The Role of the Doctor in Latin America
Adams, Richard N., Un análisis de las creencias y prácticas médicas en un pueblo indígena de Guatemala (Con sugerencias relacionadas con la práctica de medicina en el área maya) [An Analysis of Medical Practices and Beliefs in an Indigenous Village in Guatemala (With Suggestions Related to the Practice of Medicine in the Mayan Area)]. Special publication 17 of the National Indigenous Institute, Guatemala: Editorial del Ministerio de Educación Pública, 1952. (C.).
Constitución (ley fundamental) de la U.R.S.S. [Constitution of the USSR] (Moscow: Ediciones en lenguas extranjeras, 1947) (C.).
Heiser, Víctor, La Odisea de un médico por 45 países [A Doctor’s Odyssey through 45 Countries], Buenos Aires: Editor Juaquín Gil, 1938.
Lipschutz, Alejandro, El indoamericanismo y el problema racial en las Américas [Indo-Americanism and the Racial Problem in the Americas], Santiago, Chile: Editorial Nascimento, 1944, (c.) (I.).
Rodríguez, Germinal, Higiene y Profilaxis [Health and Prophylaxis], Buenos Aires: Editorial Américalee, 1944.
Troise, Emilio, Materialismo dialéctico [Dialectical Materialism], Buenos Aires: Editorial la Facultad, 1938.
Vinogradov, N., La protección de la salud de los trabajadores en le Unión Soviética [Protection of Workers’ Health in the Soviet Union], Moscow: Ediciones en lenguas extranjeras, 1950.
Important Works for The Role of the Doctor in Latin America
Cottevieille-Giraudet, R., “Questions de raciologie humaine,” in Revue Antropologique, Paris, No. 46, 1937.
Gauze, G.F., The Struggle for Existence, Baltimore: Williams and Wilkins Co., 1934.
Malaria and Its Influence in World Health, New York: New York Academy of Medicine, 1943, Vol. 19, p. 599.
Mason, J.A., Idiomas indígenas y su estudio [Indigenous Languages and Their Study], Mexico City: América indígena, 1943, Vol. 3, p. 231.
Newman, H.H., Twins, a Study in Heredity and Environment, Chicago: University of Chicago Press, 1937.
Poblete Troncoso, M., El standard de vida de las poblaciones de América [The Standard of Living of Different Populations in the Americas], Santiago, Chile: Prensas de la Universidad de Chile, 1942.
Redfield, R., Levels of Integration in Biological and Social Systems, Lancaster, Pennsylvania: Jacques Cattell Press, 1942.