While waiting for their luggage at Havana's posh Jose Marti airport, arriving foreign visitors can hardly miss the barrage of advertising for Cuba's hot vacation option: hospitalization.
A closed-circuit television perched over the baggage carousel shows doctors in white coats greeting tourists at the door of the Cira Garcia Central Clinic in Havana. Technicians fuss over patients strapped to sleek high-tech imaging machines, laboratory workers peer expertly at blood samples, and recuperating patients lift weights under the watchful eye of personal trainers.
Forget lazy days on the white-sand beaches and sightseeing in Cuba's Spanish colonial cities.
Tourists -- including a growing number of Americans -- are flocking to this socialist island to have their noses reshaped, their breasts lifted, their knees replaced or to find help for chronic problems, from neurological damage to psoriasis.
"We hear it really works," said Nicholas Herve, a French tourist who waited with his 15-year-old daughter, Aurelie, recently for a vitiligo treatment.
The disease, which destroys the skin's pigment and leaves white spots, didn't respond well to ultraviolet light treatments at home, Herve said. He hopes his daughter is cured by Cuba's treatment, which is derived from human placental cells and costs the family $450 and three days' worth of visits to an outpatient clinic.
The family decided the cross-Atlantic trip was worth it. "In other parts of the world they don't know how to cure this vitiligo," Herve said. "Here I hope we'll get rid of it for good."
Most health-care tourists to Cuba come seeking cures they don't believe they can find elsewhere. Others are looking for cut-rate deals on plastic surgery or weight-loss programs.
Some, tired of cost-cutting HMO health-care back home, simply like the personal attention possible on an island with one of the world's highest concentrations of doctors.
"There's a lot of tenderness and human warmth and concern here in Cuba, and that in itself helps a lot," says Rosa Maria Medina, a spokeswoman for the International Center for Neurological Restoration, one of Cuba's tourist hotspots.
"I think that in developed countries -- and we get a lot of people from developed countries -- there are great medical facilities," said Dr. Ramon Prado, the director of Cira Garcia, a Cuban clinic that serves primarily tourists.
"But people who come here are looking for another option, for a solution they couldn't find at home," he said. "They know there are good doctors here and 40 years of development of a strong medical system."
Cuba, despite its famed legions of highly trained doctors, is no health-care paradise. Most hospital facilities for Cubans have peeling paint, missing light bulbs, and electrical and water outages.
Doctors, short on supplies, are forced to reuse latex gloves, and patients bring their own sheets for beds.
Medicines are scarce, in part because of the long-standing United States embargo against the island.
The island's tourist facilities, however, are another world. At Cira Garcia, a tidy clinic adjoining Havana's wealthy Miramar neighborhood, silk plants line the newly painted corridors, and bright blue and yellow signs point to the well-stocked pharmacy, the ultrasound room, the X-ray center.
Nurses stroll to piped-in music, and the receptionist offers brochures in Spanish, French and English.
The center, which attracted nearly 1,300 foreign health-care tourists as inpatients last year, and thousands more as outpatients, offers everything from herniated disk repair -- $4,570 including anesthesia and two-week hospital stay -- to laser eye surgery and liposuction.
Patients who pay in dollars enjoy "all the comforts of the most modern clinics," note the brochures, including cable television, air conditioning and 24-hour international fax service.
On average, prices are about a third lower than in the United States, Prado said.
Cira Garcia's most sought-after service, he said, is plastic surgery. About 80 percent of patients come from Latin America and the Caribbean, but the facility has attracted clients from as far away as Japan and Finland.
Prado claims a 98 percent satisfaction rate from patient surveys last year. But perhaps the better indicator is return patients: 31 percent of the clinic's clients last year were repeat customers.
"The best promotion we have is our patients," he said.
TREND REPORTEDLY GROWING
According to Cubanacan Tourism and Health, the umbrella organization charged with promoting Cuba's health tourism facilities, the island last year attracted 3,500 health tourists, a number that is growing by 20 percent a year.
Thousands of other tourists also saw the inside of Cuban health facilities for treatment of everything from bad sunburns to broken legs. This March alone, U.S. tourists accounted for a third of the emergency cases at Cira Garcia, Prado said.
For health-care tourists, the island's top attractions are its treatment program to slow the progress of retinitis pigmentosa, a hereditary disease that eventually causes total blindness; its center for the treatment of vitiligo and psoriasis; its neurological restoration center for treatment of trauma victims and sufferers of strokes and diseases like Parkinson's; and its drug and alcohol addiction recovery programs, which have attracted the rich and famous, including Diego Maradona, Argentina's soccer star.
"People with a lot of money are looking for our services," said Dr. Carlos Leyvsa, vice president of Cubanacan Tourism and Health. "For them it's not an issue of price but of quality."
At the island's neurological restoration center, doctors are using fetal stem cells -- controversial technology in the United States -- to try to restore brain and nerve function in victims of accidents and in sufferers of diseases such as Parkinson's.
Patients are assigned multidisciplinary teams of experts, from psychologists to language rehabilitation specialists, as well as their own physical therapist.
After a week of consultation, patients undergo at least 28 days of treatment and rehabilitation, though the majority of patients stay three to six months, or as long as a year, Medina said.
FIVE WEEKS FOR $11,000
The program's cost, which averages about $11,000 for five weeks, is half that of comparable neurological rehabilitation programs in the U.S., Medina said, and 80 percent of the hospital's 252 beds are usually occupied.
Right now the hospital has one U.S. patient, she said, but Americans rank 19th on the list of most common nationalities at the facility.
"Most people come to Cuba looking for hope they haven't found in other places," Medina said.
At the vitiligo and psoriasis center, which treats 80 foreign patients a month, doctors claim an 84 percent success rate in treatment of vitiligo and 78 percent for psoriasis, a chronic skin disease.
Treatment, much of it done at home with Cuban-developed products, can take two years, but if the program is followed to the letter, some patients may be cured, said the center's director, Dr. Miyares Cao.
"In other parts of the world they treat these diseases but don't cure them," Cao said. "We offer a cure."
Letters in the clinic's registry book from Mexican, Spanish, Guatemalan and Japanese patients suggest that while most are still waiting for results, some have seen progress.
'I SEE MYSELF CURED'
"I look in the mirror and see myself cured and more handsome than ever," writes Pepe Gower of Spain, a vitiligo sufferer.
"I thought I would go back to my country and not have even one spot, and that has not been the case," a 9-year-old Guatemalan patient writes in another letter. "But even so the spots are being cured and already there are very few."
Cuba's growing health tourism effort has roused bitter reproach from the nation's critics, who accuse the regime of President Fidel Castro of creating an apartheid system of health care, in which foreigners -- and Cuban party elite -- get top-class service while average Cubans must make do with dilapidated facilities, outdated equipment and meagerly stocked pharmacies.
In 1994, Dr. Hilda Molina, the founder of the International Center for Neurological Restoration and a pioneer in the treatment of Parkinson's disease with fetal stem cells, quit her job in protest of a government demand that she boost the number of foreign clients paying in dollars.
Molina has since refused to do the brain surgery that made her famous and has returned the medals Castro awarded her for her work.
OFFICIALS DEFEND SYSTEM
Cuban officials defend the system, saying the $20 million or more that foreign health-care tourists bring to the island each year goes to bolster cash-starved Cuba's general finances and support the overall state health system.
"Health care (for Cubans) is free here, and that's expensive. This (foreign) money helps Cubans," Prado said.
"Foreign money pays the bills for research," added Cao, of the vitiligo center. "It's very useful."
But a group of Cuban doctors who fled to the United States in 1997 told U.S. State Department officials a different story.
"Our people's poor health-care situation," they said, according to a State Department report, results in part from a decision by Castro's government "to divert scarce resources to meet the needs of the regime's elite and foreign patients who bring hard currency."