We just spent two weeks in Cuba. Most nights were on a Lindblad / National Geographic ship but days were almost all on the island. We got to see several cities as well as forests and birds (five new lifers!). Cuba is beautiful and the people are friendly – overall the trip was a joy. But a strange joy. Cuba is poor. Before the Revolution it was the richest country in the Caribbean, now it is second poorest, and the rural areas are much like Haiti. The government controls and owns almost everything. Everyone gets a basic ration to cover the necessities and a job. But the ration stores are often almost empty of those necessities and usually have huge stocks of one or two items. This week we have soap and rice cookers! The jobs pay 25-45 CUCs (non-convertible dollar equivalents) per month so as the Soviet joke had it “They pretend to pay us and we pretend to work”. To survive people scam, trade, barter and presumably pay off the police. We saw hundreds of presumably illegal sales taking place, everything from vegetables to Chinese gewgaws. Among the only legal private businesses are family run restaurants and Bed and Breakfasts, but having hundreds in a small rural town shows desperation rather than hope. People, especially elderly men and women, are begging on the street. Sex workers were not difficult to spot.

What I found most interesting was the health situation. Public health and primary health care are the shining light of the Cuban Experience. Or maybe not. Cuba has endemic typhoid and hepatitis A. It had major outbreaks of cholera in several provinces in 2012. These are all transmitted by eating or drinking food and water contaminated with human feces. Countries with even rudimentary public health measures do not have these diseases. The cholera epidemics may be over but if you believe that you believe the government – which in Cuba lies constantly. I gave up trying to count the lies and half-truths told by our lecturers and minders.

Most of the toilets we encountered in schools, public buildings and restaurants didn’t work, we saw raw sewage flowing down streets in at least three cities, the required motorcycle helmets are skull caps made of thin plastic and flimsy foam – I could crush them with one hand, our buses rarely had working seat belts and nobody else used them (28 of 30 drivers sampled – the only two who had belts on were tourists in rental cars).

We had the required visit to an “International Clinic”. These are for tourists paying cash, Cubans can go there if there is no public clinic available i.e. on resort islands. Most of the equipment seemed to work but the wheelchairs and gurneys were badly rusted. These are show clinics but because one of our guests needed an x-ray while we were in an isolated town I got to see a real public hospital. These are where Cubans go unless they have money and connections i.e. are military or Party. We were immediately segregated when we arrived and rushed through and out but I got to see a lot of interesting things. Many broken windows and no screens are not good in a tropical country in the middle of a Zika outbreak. Raw sewage flowing down the open drains. No sheets or blankets so patients in the ER are left on plastic mattresses – if they stay the family can supply them. The bloody mattresses are hosed off outside and reused. Critically ill patients being pushed to radiology and its one X-Ray machine by family members. No masks. Peeling paint. Broken equipment. Basically a bad third world hospital. Our guide said I was very lucky to see it, the government tries to keep tourists and especially foreign doctors away. He said he tries to avoid ever going there – and had me treat his infected tooth while he arranged for an appointment with a friend who is a dentist.

It is hard to see what the reality about health is. There are lots of doctors but most don’t work. Medicine is not free, it is cheap but the pharmacies are poorly stocked and nobody has money. Obesity evidently is increasing, it is not common yet and not having food available is a good way to avoid overeating. None of the statistics are trustworthy – even our government minders freely admitted that. And as for politics, our ever-present guides told us they were not to discuss it, but they did. The elections in April will not change anything, or will, depending upon who you talk to. There is only one party, it nominates the candidates at meetings where no one dissents. No matter who wins, it will be a party loyalist who is front-man for the power behind the scenes – the Castro family.

For me the bottom line is that if you want equality for the masses (though not for the rulers), are happy drinking subsidized rum and playing dominoes all day, and don’t mind not having things like soap and working toilets then Cuba is Paradise. If you have higher aspirations it may be closer to Purgatory.