HAVANA, Cuba (AFP) — Rosa Valentina Perez has been lying in a bed in Cuba’s main cancer clinic for nearly three weeks, waiting for a CT scan to diagnose loss of mobility in her legs.

Perez underwent surgery for breast cancer two years ago.

She urgently needs a scan to know whether the cancer has spread to her spine, but the only working CT scanner in Havana is at the city’s neurology hospital — and the waitlist there is long.

“You can’t imagine what it’s like to have this pain, to know that your life span is being diminished, and to hear them say: ‘Let’s see when we can do that scan,'” the 64-year-old told AFP.

Perez was born a few years after Fidel Castro and his comrades overthrew a US-backed dictator and installed a communist regime that provided free, high-quality healthcare and education for all.

The health system particularly was the crowning glory of the revolution, with Castro deploying doctors around the world to showcase Cuba’s achievements.

But that system is now on life support, with the Covid pandemic, the tightening of US sanctions and an energy crisis exacerbated by US President Donald Trump’s six-month-old fuel blockade pushing it to the brink.

Days-long power outages, acute shortages of medicine, an exodus of medical staff to better-paid jobs abroad or in the private sector, and serial breakdowns of ageing equipment have created the perfect storm in Cuban health facilities.

The cash-strapped government has concentrated resources on a handful of priority areas including cancer, cardiology, nephrology and maternal and child health.

But these departments too are at breaking point.

At the National Institute of Oncology and Radiobiology (INOR), the waitlist for radiotherapy tops 1,200 patients.

Eighty percent of the equipment used in diagnostics and treatment is obsolete or broken, institute director Luis Eduardo Martin told AFP.

“We administer medication without at times being able to verify they are having the effect we expect… because we don’t have the reagents or the equipment to monitor them,” he said.

Children are on the frontlines of the crisis, despite being prioritised for treatment.

The country’s childhood cancer survival rate has fallen from 85 per cent pre-crisis to 65 per cent currently, according to government data.

Mariuska Forteza, head of INOR’s pediatric oncology unit, said routine but essential blood tests were being cut back because of a lack of equipment and fuel to ferry samples between hospitals.

“It’s very frustrating to know you can save the child, achieve a better survival rate, and you can’t do it because your hands are tied,” she said.

In time-honoured Cuban tradition, technicians work to repair equipment as best they can.

“Sometimes I have to come to the hospital at midnight or 2 am to repair equipment so the patient can begin their (cancer) treatment,” said Alexis Amado Dominguez, a repair technician.

Treatment of heart disease is also taking a hammering.

Jose Esteban Abreu, a doctor at the National Institute of Cardiology and Cardiovascular Surgery, said the number of heart surgeries conducted annually had fallen from more than 400 in 2018 to barely 100 currently.

Around 130 patients are waiting to be fitted with pacemakers.

In the hospital’s maintenance department, technician Luis Alexis Duncan showed AFP a large array of equipment awaiting repairs, from anesthesia and cardiopulmonary bypass machines to heart monitors, some of which have been dismantled for spare parts.

“We’re always inventing, working, innovating,” he said.

Inventiveness is not always enough though.

In the workshop where 80 per cent of Havana’s medical equipment is repaired, faulty incubators and neonatal ventilators are piling up.

A personnel shortage has made an already dire situation untenable.

The health sector has haemorrhaged doctors, nurses and technicians, unable to survive on pittance state wages paid in heavily devalued Cuban pesos.

In the dialysis unit of the Hermanos Ameijeiras Hospital, a beacon of Cuban medical excellence in Havana, nurses are overwhelmed.

The hospital’s head of nephrology, Iamara Castro, told AFP some dialysis sessions had to be cut from four to two hours to ensure more patients receive treatment and “avoid overworking the only staff we have.”

Deciding to trim a patient’s life-saving treatment is excruciating, she said.

“When you shorten the hemodialysis period, you are shortening life,” she said gravely, adding that the service was kept going by dint of sheer “compassion”.

One of her patients, 81-year-old Nelson Companioni, said he often feared the equipment would cave in before his session was finished.

He described watching staff trying to coax a small pump back to life.

“You see the nurses kneeling there, hitting it to get it working.”