HAVANA — For a dollar, Cuban podiatrist Serafin Barca will spend a half hour cutting the corns off a senior citizen's foot, or nearly an hour removing a stubborn wart.
The 80-year-old is among the last private medical workers in communist Cuba, which prides itself on its free, universal state health care and which has barred the creation of new private medical practices since 1963 — the year Barca graduated in his specialty after four years of study.
Barca is busy from morning until night treating patients frustrated with the inefficiency of the state system. "The service is of higher quality," Barca said. "If you get a patient and you don't treat them well ... you don't get them back."
Some Cubans believe that allowing more private practices would improve services and help ease the state's burden, allowing it to concentrate on more complicated surgeries and treatments that require sophisticated technology. A growing number of Cubans in recent years have begun to complain about the quality of free medical services, which many say has been affected by doctors leaving on international health missions or moving to countries such as the U.S. in search of higher salaries and a better quality of life.
Martha Garcia, a 72-year-old retiree, has been visiting Barca for her foot problems for more than a decade.
"I could go to the Policlinico, but I don't get the help I need when I've gone because they say they don't have the necessary equipment," she said of a free health clinic in Havana.
She envisions private practices for optometrists, physiotherapists and others.
"This would allow the state to take charge of more complex things," she said.
Cuba continued to allow private medical practices for the first few years after the 1959 revolution. But as the country veered toward socialism and the health system was nationalized, about half of Cuba's doctors poured out of the country, leaving only about 5,000.
The revolutionary government poured resources into health care, and there are now 70,000 doctors — many of whom serve on medical missions in other countries, which have become a significant source of income for the government.
Only a handful of private practitioners remain because no new ones have been allowed in more than half a century.
President Raul Castro has allowed the legal privatization of businesses ranging from cafeterias to masonries to hair salons, but professionals including doctors and engineers, lawyers and architects have not been given the same opportunity. For now, there are no signs state authorities will expand that liberalization to the medical field, considered strategic by the government.
Officials have tried to raise awareness among Cubans about the value of its medical services, though.
Posters at clinics across the island tell patients of the costs the government is paying: a consultation is $1, an X-ray nearly $4, an MRI $32 and a gallbladder surgery $36 — costs dramatically lower than in most nations due in part to the low salaries for medical workers, but still significant to Cubans, who on average make the equivalent of about $20 to $30 a month.
Still, a few Cubans prefer paying for private treatment. Among them is Mayra Hernandez, a 55-year-old hotel worker who said getting treated by Barca is worth paying for the bus trip to his office and the fee he charges.
"He's the best podiatrist in Havana and all of Cuba," she said, adding that she visited public clinics but was unable to get the treatment she needed. She said she'd been 10th in line at one when "the specialist came out and said, 'I have five scalpels and that's it.'"
Barca said he will continue to welcome patients into his crowded office as his health permits. He works four seven-hour days a week.
"I like my profession," he said as he sat in his small office with worn seats and aging furniture that seemed frozen in time since the 1950s.
"Everyone who had a private practice was allowed to work until they retired or died. I'll be here until I die."