Editorial

The scientific research project of Commander Fidel Castro Ruz

Geovanis Alcides Orellana Meneses^{1  *} 
http://orcid.org/0000-0001-9159-2272

Jenny Domínguez Nieto¹ 
http://orcid.org/0000-0002-6598-2493

¹Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus, Cuba.

To analyze, characterize or simply describe the relationship between Fidel and science is an action that can be developed from different perspectives, from his profile of university education and his contributions to the legal field and social sciences, to his actions as a leader in promoting policies aimed at scientific development in Cuba and the world; however, little has been described about Fidel's contributions to science, specifically to Medical Sciences, from the focus of Fidel as a researcher, a transformer and a scientist.

This analysis can start from the conceptual point of view, when analyzing the participation of the Commander as an actor-transformer within the inexhaustible conglomerate of knowledge that humanity treasures.

The scientific method, which allows the search for new knowledge, cannot be detached from Fidel's leading attitude in the development of Health Sciences. Without tracing a chronological order, but it is logical, we can describe through the documentary analysis of the Commander's interventions, his role as a researcher and scientist.

The relevant work developed by the Commander and of which he is, above all, a fundamental author and actor, is that transcendental investigation that could be entitled: "Strategy for the implementation of a Social Revolution in Cuba", from which innumerable theoretical and practical contributions have emanated; the written document that supported that investigation and constituted his most finished research project, after years of study, review and direct immersion in the field of action, had its first version in what we all know as the self-defense allegation: “History will absolve me ”, exposed on October 16, 1953 at the nurses school from Santiago de Cuba Civil Hospital. ¹

In that document Fidel described, as a good scientist, the context in which Cuba was developing in those years and defined the problem-situation that led him to reason what would be the best hypothesis (scientific from the current vision) for the Cuban people to overthrow the dictatorship will take power and also achieve the social conquests desired for years. From this analysis, the armed struggle was defined as the guiding method to materialize the main actions, objectives and strategic tasks that were projected in that allegation, among which was the health problem of the majority of the population.

It is appropriate to highlight that the historical leader of the Cuban Revolution always assumed the strategic task of developing, improving and perfecting the Cuban health system, not as an external entity but as another member of the white coat contingent. He, without having an academic training in the field of health sciences, always demonstrated his direct link with that branch of science, as he stated in his intervention in the third graduation of the contingent of the Institute of Medical Sciences of Havana, on August 27, 1990: “This year the biggest graduation in the history of our country has taken place: more than 4,000 doctors, see what a tremendous and impressive force, with which we are already around 40,000 doctors in this country. And I'm included in the list, because I've worked on this too. I am not a doctor, but I am the promoter of the health program. Sometimes I have used other words when they asked me: "Are you a doctor?" And I, with great immodesty, said: "I am not a doctor, but I am a health strategist." ²

The adequacy of Fidel's thinking with the scientific development of Medical Sciences can be analyzed based on the epistemological evolution of the definition of health, in its different stages:

• 1^st, absence of disease

• 2^nd, complete state of physical, mental and social well-being

• 3^rd, health-disease process

• 4^th, health as a social product, in which the preventive approach prevails over the curative.

In the mid-nineteenth century Medicine was considered a social science, however this trend was still underdeveloped in the late 50s of the twentieth century, in spite of Fidel, during his stay in the Sierra Maestra, no longer only had defined ideas to improve the structure of the Cuban health system, as stated in "History will absolve me", but also began to define changes that should occur in the health process, which would allow for better integration between the components of that system and, by consequently, improve medical care for the most unprotected population groups throughout Cuban colonial and republican history.

In that sense, Fidel explained: “It is not possible that this peasant population, the pure soul of our land, remains abandoned, hungry, without medical assistance, without education, destroyed their organisms by parasites or by malaria. You have to bring health to the countryside, you have to clean up these mountains like all the rural areas (...) You don't have to wait for the diseases to arrive with their gloomy threat, you have to prevent them, you have to avoid them. From now on, health plans, such as economic, social and educational ones, must be elaborated and all coordinated with demanding functional efficiency. ” ⁽³

On this preventive approach, I would say a few years later: “... we will fight disease by disease, thus we will decrease the number of epidemics, the number of deaths, the number of victims. And so that great purpose will be fulfilled: going from therapeutic to preventive medicine that is, preventing citizens from getting sick. ” ⁴

With the revolutionary triumph, on January 1, 1959, another stage of the research project prepared by Fidel was being fulfilled. After that stage, the scientist Fidel developed, as a good strategist, the aspects that would define his vision of future scenarios to which the Cuban government and people had to work.

It was from that moment that a process of transformations would begin in the field of Cuban revolutionary public health and had among its main fundamental aspects:

1. The development of human capital.

2. The coverage of the population with the services provided with the most modern technologies.

3. Solidarity as an ethical principle in health services.

4. Scientific research as the foundation of health actions.

5. Internationalism practiced without political conditioning.

Concerning human capital in the scientific field, Fidel expressed so early on January 15, 1960: “Today, in the new homeland ... scientists, researchers ... are pleased to know that there is a revolutionary government which seeks for the truth, and needs the scientists ... well, the scientist ... has today the ideal setting where his intelligence and talent can find full development in searching the truth and welfare, because the homeland has entered the way where intelligence is not pursued but rather stimulated and rewarded: the homeland has entered the way in which it is necessary for all of us to study and start investigating ... The future of our homeland has to be necessarily a future of men of science, has to be a future of men of thought, because it is precisely what we are foment the most; what we are foment the most are opportunities for intelligence ...” ⁵

Fidel, in his concept of human capital outlines the socialist dimension of it: “Human capital implies not only knowledge, but also -and very essentially- consciousness, ethics, solidarity, truly human feelings, spirit of sacrifice, heroism, and the ability to do a lot with very little.” ⁶

In that sense, and defining the characteristics of human capital, specifically in the health sector, on October 17, 1962, the Commander in Chief exposed at the opening of the Victoria de Girón Institute of Basic and Preclinical Sciences: “... we are going to create, to train doctors, in massive quantities, much better, and much better! And we understand that this is a duty that the Revolution has with people. With a view to the future, the only one, the true one, the definitive solution, is the massive training of doctors. And the Revolution today has strength and resources and has organization and has men -men! the most important thing- to begin a plan for training doctors in the necessary amounts. And not only many, but especially good ones; and not only good as doctors, but also good as men and as women, as patriots and as revolutionaries!” ⁴

Together with human resources, the Cuban Revolution, as a great strategic project, has allowed the development of a health infrastructure that provides universal and free medical coverage to the entire Cuban population, directing its actions to the reorganization of the system and the formation of the resource human in health through:

• The introduction of the family doctor and nurse program.

• Full coverage with the family doctor and nurse in the urban and rural community, as well as in schools, children's day care centers and work places.

• The design and development of the comprehensive family care program.

• The achievement of organizational and conceptual changes.

• The consolidation of institutional and home care.

• The attention to the hospital network.

• The community and intersectoral participation in the model of comprehensive health care, developed together with political and mass organizations, governmental and social.

• The empowerment of individuals and families to become agents of their own health and community.

When evaluating the results of a scientific investigation, they must meet, among other aspects, the criteria of being reproducible. In accordance with the above criteria, Fidel conceived solidarity among the pillars of the health system, not with the objective of reproducing in other countries ideological aspects of the Cuban Socialist Revolution, but with the objective of sharing the effectiveness of the formation of professionals with high levels of humanism, solidarity, academic training and deep social orientation.

In this regard, he stated in the Constitution of the I Contingent of the Medical Sciences Detachment "Carlos J. Finlay" on January 6, 1982: "... we must defend the principle of having a doctor with solid basic knowledge and a doctor who doesn´t have such a narrow profile, that later cannot face many problems facing life, especially when traveling abroad and going to countries like Angola, Nicaragua, Iraq, Libya and many others.” ⁷

That idea was materialized in the superlative level with the constitution of the "Henry Reeve" contingent, on September 19, 2005, where he expressed: "... this glorious organization, the first of its kind in the history of a humanity every increasingly required cooperation and solidarity [...] We will demonstrate that there is a response to many of the tragedies of the planet. We show that the human being can and should be better. We demonstrate the value of conscience and ethics. We offer lives. [...] You have to train doctors who require the fields, villages, marginalized and poor neighborhoods of third world cities ... We offer to train professionals willing to fight against death.” ⁸

Fidel, as a man of thought and action, in his conception of what the training model of the Cuban doctor should be like, stated that "there was no need to oppose theory and practice at any time", that the doctor "should have a solid formation in theory and a solid training in practice as well” ⁷, elements that identify not only the doctor, but all health workers in Cuba and that constitute one of the main foundations of the educational system in Medical Sciences.

The greater access to (medical) universities and the strengthening of the teaching and learning process in these institutions after the revolutionary triumph was an element that Fidel always listed as essential in the development of the country, giving priority above all, to the need of incorporating, generating and generalizing knowledge. In this regard, he expressed at the closing of the First Congress of the Cuba Communist Party, on December 22, 1975: ⁹

“[...] with the Revolution itself, universities are open to all ... and there comes a time when knowledge is the heritage of not a few individuals but of the masses.

[...] And our Revolution ... marches along that path in which knowledge gradually becomes the heritage of the masses. Then there will be no such huge differences between the knowledge of a few and the knowledge of the masses. And the time will come when these differences are minimal ...

[...] And in mankind there are no geniuses. There are bright men. You will have read that one is given the prize as such and more so; but genius is not in individuals: genius is in the masses. When someone stood out in mathematics it is because hundreds of thousands could not study mathematics. And someone stood out in economics or in history or in any branch of human knowledge, because others could not have the opportunity to study. But when the masses have access to culture, they have access to study, they have access to knowledge, then the differences disappear, because instead of one genius there are 1000, there are 10 000 geniuses. And where there are 10 000 geniuses there is no genius, there is a collective genius.”

In addition, Fidel did not base the development of human capital in Medical Sciences only with national experiences, but he promulgated the idea of seeking updates in the international arena, which reinforces his thinking of a constant researcher. For this reason he expressed on March 12, 1982, in the act of constitution of the Detachment of Medical Sciences "Carlos J. Finlay": "Medical science is constantly developing. As a result of experience, of research, new methods, new techniques arise; we have to get hold of those techniques. This requires a great effort of international relations and exchanges, for us to say: which country is more advanced in this, which country is more advanced in the other, and in the other, and in the other, and make continuous exchanges, simply so that we can occupy the vanguard places in each of the medical branches. [...] Because the doctor has to do with human life, human health; the immense, the infinite responsibility of caring for the lives of human beings is upon the doctor: of a child, an old man, a young man, an adult, a woman, a man, who puts himself in his hands to relieve pain, to alleviate a disease or to preserve life. ” ¹⁰

It was consistent with the ideas he defended, he always conceived as a key strategic action in his project the training and teaching activity to the new generations, mainly in relation to the study and the acquisition of knowledge. In this regard, Fidel spoke to university students at the closing ceremony of the first Congress of the University Student Federation, on March 13, 1979: “... really one of the noblest ways to serve the country, to serve the people, to do revolution, of building the future, is to devote oneself to study. [...] What and how should our contribution be to the effort and struggle of the other peoples of the world? How can we put our grain of sand and how many grains of sand are necessary in the solution of the future problems of our people and humanity? And what do we need? We need two things: we need awareness and we need knowledge.” ¹¹

With the same objective of overcoming the new generations, but analyzed from another point, Fidel also demanded teachers with responsibility in the formation of the medical model that the Revolution and the Cuban people need, which was reflected in their intervention at the closing of the fourth Congress of Higher Education, on February 6, 2004: “... because a doctor who graduates today and does not study more, in ten years is a dangerous practical doctor, an ignorant practical doctor ... ; therefore, I study and work with the doctor, we have to educate him ... There is nothing more than to look at the doors of contemporary technology and science to ask if it is possible to live and know that future world without a huge flow of preparation and knowledge.” ⁷

Two years later, on February 3, 2006, at the ceremony of the International Award "José Martí" of UNESCO to Hugo Chávez Frías, where he said: "Create human capital that is not depleted ... will know much more and they will have multiplied when they receive their titles, they will have multiplied again when they dominate a specialty, they will have multiplied when they have completed one, two or the necessary internationalist missions; they will have multiplied when they have a master's degree or a doctorate, as our doctors have already massively in the near future. ” ¹²

The objectives set by the Commander in the strategic planning of the development of the Revolutionary Health System in Cuba always included tasks of immediate fulfillment and tasks that, with future projection, taught to think and dream about achieving superior results, always supported by sacrifice and individual and collective improvement. That is why, since 35 years ago, on June 11, 1982, he stated: “... we must get used to think about comparisons, not with Third World Countries ... but with developed countries. [...] Becoming a medical power is not just a matter of prestige ... first, the benefit that our people would receive ... secondly our collaboration with the Third World, for the extraordinary services that we can lend them to other countries. [...] There is a need to delve into all disciplines, in all specialties ... in each of the branches, and simply adopt the willingness and desire to put ourselves at the forefront ...“. ⁷

The development of scientific activity in the branches of health in Cuba, according to Fidel, was also in the need of having a system of institutions where research could be carried out more and more in line with technological advances worldwide and where human capital could be developed. In accordance with this strategy, the biotechnology sector emerged from 1981, when Biotechnology itself was hardly being invented in the countries with the greatest technological advances. That constituted a momentous organizational innovation, which became the embryo of the high tech socialist enterprise, today called to higher tasks within our economic model. ¹³

As in the years of the guerrilla struggle, before 59, in the most difficult moments of the Revolution, the Commander in Chief considered the development of science as a priority; for example, in 1991, when the crisis of the socialist camp was already unfolding and the gigantic task of defending our sovereignty was raised, he said: “Independence is not a flag, or a hymn, or a shield. Independence is not a matter of symbols. Independence depends on development, independence depends on technology, and it depends on science in today's world.” ¹³

Also in 1993, when the economic crisis of the special period hit bottom, Fidel resumed the idea of the functions of science in the economy when he said: “Science and the productions of science must someday occupy the first place of the national economy. But based on the scarce resources, especially the energy resources that we have in our country, we have to develop intelligence productions, and that is our place in the world, there will be no other.” ¹³

The results of the research carried out by the unforgettable Commander in Chief have crossed the borders of Cuba and are also theoretical and practical contributions worldwide. Fidel himself said in the early of July 26, 1984, in the Central Act for the XXXI anniversary of the assault on Moncada in Cienfuegos that the experience of Cuba, the Cuban Revolution has made contributions to the solution of the health problems (worldwide); I think the most important are the following: first the rural medical service; second, rigorous selection of medical personnel; third, extension of teaching to all hospitals in the country; fourth, participation of all the people in health tasks; fifth, I believe that the concept of comprehensive general medicine as a specialty will succeed; sixth, the scheduled development of all specialties and, seventh, the family doctor. ¹⁴

To those mentioned by Fidel, we can also add the theoretical contributions made regarding laws, norms and rules that allowed the entire population access to free health services with high scientific qualification, as well as the design of the system and model of the National System of Cuban Health, which would allow the structuring and interrelation of each of its components based on providing a high level of medical care.

Fidel's research work has not concluded or will conclude, because as a good researcher, at each stage he knew how to give feedback to his strategy, both with the results that were achieved and with the constant review of international literature and the use of observational and experimental methods as a result, he maintained the enrichment of the results of his research, keeping science in a privileged place and leaving future generations, as a recommendation for a thesis for later studies, which was his last advice, exposed during his intervention in the closing of the Seventh Congress of the Cuba Communist Party, on February 19, 2016, when it defined as the main challenge of current and future generations the urgent need of the human being to “know more and adapt to reality”, with the objective that "the species survives a much longer period of time" and "know much more than us." ¹⁵

That is the same Fidel that we all know, the guerrilla, the leader, the immense, but also the intellectual, the researcher, ... the scientist who contributed an enormous wealth of knowledge to the Cubans and to all humanity and that even in the last days of his physical existence he was faithful to his research project.

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Received: July 05, 2019; Accepted: July 10, 2019