Ciuba's Cure: Cuba Exports Its Health-Care Miracle to

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Ciuba's Cure: Cuba Exports Its Health-Care Miracle to

Via NY Transfer News Collective All the News that Doesn't Fit

YES! Magazine - May 30, 2007

http://www.yesmagazine.org/article.asp?ID=1733

Cuba's Cure

Why is Cuba exporting its health care miracle to the world's poor?

by Sarah van Gelder

Cubans say they offer health care to the world’s poor because they have

big hearts. But what do they get in return?

They live longer than almost anyone in Latin America. Far fewer babies

die. Almost everyone has been vaccinated, and such scourges of the poor

as parasites, TB, malaria, even HIV/AIDS are rare or non-existent.

Anyone can see a doctor, at low cost, right in the neighborhood.

The Cuban health care system is producing a population that is as

healthy as those of the world’s wealthiest countries at a fraction of

the cost. And now Cuba has begun exporting its system to under-served

communities around the world—including the United States.

The story of Cuba’s health care ambitions is largely hidden from the

people of the United States, where politics left over from the Cold War

maintain an embargo on information and understanding. But it is

increasingly well-known in the poorest communities of Latin America,

the Caribbean, and parts of Africa where Cuban and Cuban-trained

doctors are practicing.

In the words of Dr. Paul Farmer, Cuba is showing that “you can

introduce the notion of a right to health care and wipe out the

diseases of poverty.”

Health Care for All Cubans

Many elements of the health care system Cuba is exporting around the

world are common-sense practices. Everyone has access to doctors,

nurses, specialists, and medications. There is a doctor and nurse team

in every neighborhood, although somewhat fewer now, with 29,000 medical

professionals serving out of the country—a fact that is causing some

complaints. If someone doesn’t like their neighborhood doctor, they can

choose another one.

House calls are routine, in part because it’s the responsibility of the

doctor and nurse team to understand you and your health issues in the

context of your family, home, and neighborhood. This is key to the

system. By catching diseases and health hazards before they get big,

the Cuban medical system can spend a little on prevention rather than a

lot later on to cure diseases, stop outbreaks, or cope with long-term

disabilities. When a health hazard like dengue fever or malaria is

identified, there is a coordinated nationwide effort to eradicate it.

Cubans no longer suffer from diphtheria, rubella, polio, or measles and

they have the lowest AIDS rate in the Americas, and the highest rate of

treatment and control of hypertension.

For health issues beyond the capacity of the neighborhood doctor,

polyclinics provide specialists, outpatient operations, physical

therapy, rehabilitation, and labs. Those who need inpatient treatment

can go to hospitals; at the end of their stay, their neighborhood

medical team helps make the transition home. Doctors at all levels are

trained to administer acupuncture, herbal cures, or other complementary

practices that Cuban labs have found effective. And Cuban researchers

develop their own vaccinations and treatments when medications aren’t

available due to the blockade, or when they don’t exist.

Exporting Health Care

For decades, Cuba has sent doctors abroad and trained international

students at its medical schools. But things ramped up beginning in 1998

when Hurricanes George and Mitch hammered Central America and the

Caribbean. As they had often done, Cuban doctors rushed to the disaster

zone to help those suffering the aftermath. But when it was time to go

home, it was clear to the Cuban teams that the medical needs extended

far beyond emergency care. So Cuba made a commitment to post doctors in

several of these countries and to train local people in medicine so

they could pick up where the Cuban doctors left off. ELAM, the

Havana-based Latin American School of Medicine, was born, and with it

the offer of 10,000 scholarships for free medical training.

Today the program has grown to 22,000 students from Latin America, the

Caribbean, Africa, Asia, and the United States who attend ELAM and 28

other medical schools across Cuba. The students represent dozens of

ethnic groups, 51 percent are women, and they come from more than 30

countries. What they have in common is that they would otherwise be

unable to get a medical education. When a slum dweller in Port au

Prince, a young indigenous person from Bolivia, the son or daughter of

a farmer in Honduras, or a street vendor in the Gambia wants to become

a doctor, they turn to Cuba. In some cases, Venezuela pays the bill.

But most of the time, Cuba covers tuition, living expenses, books, and

medical care. In return, the students agree that, upon completion of

their studies, they will return to their own under-served communities

to practice medicine.

The curriculum at ELAM begins, for most students, with up to a year of

“bridging” courses, allowing them to catch up on basic math, science,

and Spanish skills. The students are treated for the ailments many

bring with them.

At the end of their training, which can take up to eight years, most

students return home for residencies. Although they all make a verbal

commitment to serve the poor, a few students quietly admit that they

don’t see this as a permanent commitment.

One challenge of the Cuban approach is making sure their investment in

medical education benefits those who need it most. Doctors from poor

areas routinely move to wealthier areas or out of the country

altogether. Cuba trains doctors in an ethic of serving the poor. They

learn to see medical care as a right, not as a commodity, and to see

their own role as one of service. Stories of Cuban doctors who practice

abroad suggest these lessons stick. They are known for taking money out

of their own pockets to buy medicine for patients who can’t afford to

fill a prescription, and for touching and even embracing patients.

Cuba plans with the help of Venezuela to take their medical training to

a massive scale and graduate 100,000 doctors over the next 15 years,

according to Dr. Juan Ceballos, advisor to the vice minister of public

health. To do so, Cuba has been building new medical schools around the

country and abroad, at a rapid clip.

But the scale of the effort required to address current and projected

needs for doctors requires breaking out of the box. The new approach is

medical schools without walls. Students meet their teachers in clinics

and hospitals, in Cuba and abroad, practicing alongside their mentors.

Videotaped lectures and training software mean students can study

anywhere there are Cuban doctors. The lower training costs make

possible a scale of medical education that could end the scarcity of

doctors.

U.S. Students in Cuba

Recently, Cuba extended the offer of free medical training to students

from the United States. It started when Representative Bennie Thompson

of Mississippi got curious after he and other members of the

Congressional Black Caucus repeatedly encountered Cuban or

Cuban-trained doctors in poor communities around the world.

They visited Cuba in May 2000, and during a conversation with Fidel

Castro, Thompson brought up the lack of medical access for his poor,

rural constituents. “He [Castro] was very familiar with the

unemployment rates, health conditions, and infant mortality rates in my

district, and that surprised me,” Thompson said. Castro offered

scholarships for low-income Americans under the same terms as the other

international students—they have to agree to go back and serve their

communities.

Today, about 90 young people from poor parts of the United States have

joined the ranks of international students studying medicine in Cuba.

The offer of medical training is just one way Cuba has reached out to

the United States. Immediately after Hurricanes Katrina and Rita, 1,500

Cuban doctors volunteered to come to the Gulf Coast. They waited with

packed bags and medical supplies, and a ship ready to provide backup

support. Permission from the U.S. government never arrived.

“Our government played politics with the lives of people when they

needed help the most,” said Representative Thompson. “And that’s

unfortunate.”

When an earthquake struck Pakistan shortly afterwards, though, that

country’s government warmly welcomed the Cuban medical professionals.

And 2,300 came, bringing 32 field hospitals to remote, frigid regions

of the Himalayas. There, they set broken bones, treated ailments, and

performed operations for a total of 1.7 million patients.

The disaster assistance is part of Cuba’s medical aid mission that has

extended from Peru to Indonesia, and even included caring for 17,000

children sickened by the 1986 accident at the Chernobyl nuclear plant

in the Ukraine.

It isn’t only in times of disaster that Cuban health care workers get

involved. Some 29,000 Cuban health professionals are now practicing in

69 countries—mostly in Latin America, the Caribbean, and Africa. In

Venezuela, about 20,000 of them have enabled President Hugo Chávez to

make good on his promise to provide health care to the poor. In the

shantytowns around Caracas and the banks of the Amazon, those who

organize themselves and find a place for a doctor to practice and live

can request a Cuban doctor.

As in Cuba, these doctors and nurses live where they serve, and become

part of the community. They are available for emergencies, and they

introduce preventative health practices.

Some are tempted to use their time abroad as an opportunity to leave

Cuba. In August, the U.S. Department of Homeland Security announced a

new policy that makes it easier for Cuban medical professionals to come

to the U.S. But the vast majority remain on the job and eventually

return to Cuba.

Investing in Peace

How do the Cuban people feel about using their country’s resources for

international medical missions? Those I asked responded with some

version of this: We Cubans have big hearts. We are proud that we can

share what we have with the world’s poor.

Nearly everyone in Cuba knows someone who has served on a medical

mission. These doctors encounter maladies that have been eradicated

from Cuba. They expand their understanding of medicine and of the

suffering associated with poverty and powerlessness, and they bring

home the pride that goes with making a difference.

And pride is a potent antidote to the dissatisfaction that can result

from the economic hardships that continue 50 years into Cuba’s

revolution.

>From the government’s perspective, their investment in medical

internationalism is covered, in part, by ALBA, the new trade agreement

among Venezuela, Bolivia, Nicaragua and Cuba. ALBA, an alternative to

the Free Trade Area of the Americas, puts human needs ahead of economic

growth, so it isn’t surprising that Cuba’s health care offerings fall

within the agreement, as does Venezuelan oil, Bolivian natural gas, and

so on. But Cuba also offers help to countries outside of ALBA.

“All we ask for in return is solidarity,” Dr. Ceballos says.

“Solidarity” has real-world implications. Before Cuba sent doctors to

Pakistan, relations between the two countries were not great, Ceballos

says. But now the relationship is “magnificent.” The same is true of

Guatemala and El Salvador. “Although they are conservative governments,

they have become more flexible in their relationship with Cuba,” he

says.

Those investments in health care missions “are resources that prevent

confrontation with other nations,” Ceballos explains. “The solidarity

with Cuba has restrained aggressions of all kinds.” And in a statement

that acknowledges Cuba’s vulnerabilities on the global stage, Ceballos

puts it this way: “It’s infinitely better to invest in peace than to

invest in war.”

Imagine, then, that this idea took hold. Even more revolutionary than

the right to health care for all is the idea that an investment in

health—or in clean water, adequate food or housing—could be more

powerful, more effective at building security than bombers and aircraft

carriers.

[sarah van Gelder, executive editor of YES!, was in Cuba (legally) in

December 2006 visiting medical schools, clinics, and hospitals. Her

travel was supported by The Atlantic Philanthropies, and MEDICC

provided program consulting.]

¡Salud! Cuba’s Global Health Mission

The film ¡Salud! follows Cuban doctors to Honduras, Venezuela, the

Gambia, and other poor countries where they offer medical care and

training. The 90-minute documentary also tells of the thousands of

international medical students studying in Cuba, and what it means to

their communities when they return. See: http://www.saludthefilm.net

MEDICC (Medical Education Cooperation with Cuba), distributes ¡Salud!

and supports international medical students and graduates trained in

Cuba who are returning to under-served areas to practice medicine.

MEDICC publishes MEDICC Review, a peer-reviewed journal on Cuban

medical and public health, and Cuba Health Reports, an online news

service, and assists U.S. health professionals exploring the Cuban

public health experience. See: http://www.medicc.org

A vaccine with proven effectiveness against Meningitis B was developed

in Cuba in the 1980s. Since then, 55 million doses have been

administered in Cuba and other countries. But not in the U.S., where

outbreaks still kill children.

Dr. Robert Fortner, MD, wanted to find out why. His findings are at:

http://www.yesmagazine.org/vaccine or see the article at NY Transfer:

"Meningitis B: Cuba's Got the Vaccine; Why Don't We? (May 16, 2007)

http://olm.blythe-systems.com/pipermail/nytr/Week-of-Mon-20070514/062614.html

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