Market Focus : Cuba Hopes Its Doctors Can Cure the Economy : Researchers have developed a number of treatments unavailable elsewhere. Havana is luring patients from abroad with package deals that combine tourism with surgery.

Sitting in a hospital hallway, the patient, a stocky man with bandaged eyes, told of the desperation that had driven him halfway around the world on a gamble to save his sight.

The patient, Jimmy Engineer, is the $110-a-month sales manager of a dairy in Surat, India. Doctors at home had informed him there was no proven cure for retinitis pigmentosa, the degenerative ailment that was making him blind. As the darkness closed in, his wife left him, he became unable to read and, at age 38, faced losing his job.

Then someone read him a magazine article about early successes in Cuba of a still-experimental treatment for the disease. One cured patient from India, the article claimed, was able to play tennis at night. The sales manager borrowed against his life insurance policy and company annuity, scraped together $6,000 and traveled here alone for the surgery.

While waiting for the bandages to come off, he was told it will take 18 months to ascertain whether the two-hour operation worked, whether his gamble paid off. “It is a time of patience,” he said.

The suspense of this private drama is shared by the Cuban government, which is gambling its own precious dollars on research and marketing, trying to become a world medical power. Cuban scientists have invented a number of medicines and treatments unavailable elsewhere, and are counting on successful sales promotions to help Cuba overcome the worst economic crisis of President Fidel Castro’s 32-year-old revolution.

Fees are low, and foreign surgical patients can take advantage of package deals that include an excursion to Varadero Beach or an evening at the Tropicana nightclub before or after surgery.

While a severe fuel shortage is forcing farmers to replace tractors with oxen, Cuba’s state-run medical establishment leads the Third World, with development of an artificial heart and a cure for meningitis. While ordinary Cubans often cannot get prescription drugs, a worldwide clientele of dollar-spending “medical tourists” are flocking here for operations that would be far more expensive back home, or simply unavailable.

The payoff, Cuban officials say vaguely, is “tens of millions of dollars” in foreign exchange each year, as medicine becomes one of this sugar-based economy’s most promising industries.

Castro said in a recent speech that austerity measures imposed because of declining Soviet aid would not pinch Cuban scientists, whom he hailed as “great instruments in the battle to accelerate the country’s development” with “skills more valuable than petroleum.” The Communist Party newspaper Granma declared that the “era of biotechnology” in Cuba “could do away with the frontiers that separate the First and Third World countries.”

Cuba’s special devotion to medicine began about 30 years ago, when the Communist government instituted free, universal health care and went all-out to train new physicians. Although many doctors and other professionals fled the island after 1959, Cuba today has 45,000 doctors for its 10 million people, compared with 6,000 doctors for a prerevolutionary population of 6 million.

Cuba’s infant mortality rate has fallen to the lowest in Latin America, 10.7 per 1,000 live births last year, from more than 60 per 1,000 in 1959. Cubans have mastered the treatment of a wide variety of Third World ailments while working as missionary doctors abroad, and have benefitted from extensive scholarship and exchange programs with the Soviet Union and other socialist countries.

Only in the past decade, however, has Cuba invested heavily in its own technology. In 1986, at an officially estimated start-up cost of $80 million, the government opened its Center for Biotechnology and Genetic Engineering, a campus with modern amenities rare in Cuba. It is home to more than 200 young scientists and technicians who can exercise in a gym, play tennis and baseball, and work 14 hours a day, six days a week.

“This is a place for people who aspire to the Nobel Prize,” said Dr. Jorge Machado, who, at 30, is older than most of his colleagues at the center.

Machado said the center has produced 15 drugs through DNA recombination, compared to the few achieved elsewhere in the Third World, and is trying to market them abroad. The products include a competitively priced interferon for cancer treatment, a skin-growth treatment for burn, an AIDS detection kit, a hepatitis B vaccine and melangenia for vitiligo, a disease that destroys pigmentation and leaves white spots on the skin.

One of Cuba’s biggest successes stemmed from an epidemic in 1979 of group B meningococcal meningitis, a deadly bacterial infection spreading in other parts of Latin America, Asia and Western Europe. A crash project involving 10 Cuban scientists, some of whom were sent abroad to do research, produced the first vaccine against the disease in 1985. Last year, Cuba began marketing the vaccine and has sold $140-million worth to Brazil.

While the Soviets have moved to end Cuba’s long-standing privilege as a subsidized trading partner, they are negotiating over a Cuban offer to sell Moscow $230-million worth of drugs and medical equipment this year. “The level of equipment in Cuban hospitals makes us jealous,” said an article in the Soviet magazine Literaturnaya Gazeta.

Diplomats and industry analysts in Havana wonder whether the payoffs are worth the large investments in developing medical technology that will be needed to market it successfully. They note that the vaccine sale to Brazil went through only after delays, caused in part by allegations that some doses were ineffective or contaminated. Also, they say, proposed sales of Cuban skin-growth treatment to a European pharmaceutical company have been held up for lack of research data on its long-term toxic effects.

Rolf Burchardt, a Bayer executive with whom Health Ministry officials consulted, tells them it is “unrealistic” for a country such as Cuba to compete with multinational giants in the pharmaceutical field. He said the development and marketing of any new drug costs at least $150 million.

“They cannot afford the international marketing structure,” Burchardt said. “I think their scarce resources are not too well spent in this field.”

The Cubans, he said, have ignored his advice and pushed ahead at Castro’s insistence. “He’s somewhat of a missionary when it comes to (challenging) the First World,” Burchardt said.

Cuba hopes to claim the first cure for retinitis pigmentosa, the ailment that has brought the Indian salesman and more than 1,000 others to Havana’s Ciro Garcia Clinic for microsurgery over the past three years.

Dr. Ricardo Roque Izquierdo, director of the clinic, said that in every case so far, progression of the eye disease has been halted without complications, and reversed by three out of four operations. Doctors will publish their findings next year, he said.

With the influx of eye patients, Cuba has set up a state company, Servimed, to attract other foreigners seeking cheap or special care. Servimed ‘s director, Ricardo Martinez Rojas, said that about 2,000 visitors last year spent between $4 million and $5 million for surgeries ranging from heart and liver transplants to face lifts, nose jobs and “executive checkups.”

“Our best specialists and our best institutions treat them,” Martinez said.

Fees are low because Cuban doctors work for a government salary. The retinitis treatment, including 21 days in a private hospital room (with color TV and meals), costs $3,300. A kidney transplant that would typically cost more than $50,000 in Los Angeles is $15,000 here.

Meanwhile, Cuba continues its tradition of giving free care to fellow Communists and other friends of the revolution. About 260 guerrillas from El Salvador are recovering from war wounds here. Since last March, 2,681 children have been treated here for leukemia, malignant tumors and other disorders caused by the Chernobyl nuclear power plant accident in the Soviet Union.

Dr. Carlos Dotres, chief of medical services at the seaside youth camp that has been turned over to the Chernobyl patients, said the rehabilitation program is both a goodwill gesture and an opportunity for Cuban doctors to develop valuable knowledge of illnesses caused by radiation.

Shedding Some Light on RP?

Retinitis pigmentosa is an inherited disease, caused by a number of different genes, that has produced blindness in about 100,000 Americans and 1.5 million people worldwide. RP occurs when the light-sensitive photorecepter cells in the retina of the eye degenerate. It is most often diagnosed in childhood when the first symptom, night blindness, appears. As the patient ages, he or she develops “tunnel vision,” a reduction in vision around the edges of the visual field. Generally the patient eventually becomes blind. More than 1,500 new cases of RP are diagnosed in the United States each year.

CROSS SECTION OF THE EYE

The retina is the inner layer of the eye. Rods and cones, the light-sensitive cells of the retina, receive the image formed by the lens. Rods distinguish light and dark, cones detect color. The image is carried to the brain by the optic nerve

THE RETINA

Retinitis pigmentosa first appears near the edges of the retina as dark clumps of pigment due to the deterioration of light-sensitive photoreceptor cells.