Mason Essif Cuba Report

Published: Dec 30, 2002

The Henry J. Kaiser Family Foundation

By Mason Essif
April 21 – May 2, 2001

For ten days the six Fellows of the 2000/2001 Kaiser Media Fellowship program explored and evaluated the health care system of Cuba. They met with doctors, nurses, administrators, experts and government officials. The topics ranged from housing conditions to mental health and from STD/HIV prevention to cardiac surgery. While most of the time was spent in Havana, a few days were spent traveling into the mountains to analyze how universal access is guaranteed in the remote and rural areas.

While we were exposed to so much during the trip I divided my video material into four main areas: The Embargo, HIV/AIDS, Primary Care and Natural Medicine. Each segment strings together fragments of discussions with the experts in hopefully a rational manner. There is no narration just these excerpts and pictures of some of the sites and sounds encountered.

Overview
The Embargo
HIV/AIDS
Primary Care
Natural Medicine

Overview: Cuba is quite proud of its health care system and seems to have every right to be. A poor island country whose limited resources are further circumscribed by a strict embargo, Cuba has nevertheless managed to provide health care to every citizen as a basic right. Their doctors and other health care providers are knowledgeable, extremely dedicated and believe in what they are doing. Cuba is a shining example of the power of public health to transform the health of an entire country by a commitment to prevention and by careful management of its medical resources. They share this expertise with the world and many countries have a lot to learn from them. And while public health concerns in the United States have always be tempered by the rights of the individual to take care of himself, Cuba does not seem to have the same dilemma. The right to privacy seems to suffer at the expense of helping the community. Their system is a government system and the same arguments that can be made against their form of governing can be made against the government’s control of the health care system. The government sets the priorities and the system complies. It works well for those who are willing to participate. While the trip was sanctioned by the United States and the agenda approved by Cuba, the veil of politics is not so easily lifted.

The Embargo: This segment begins with Dr. Herminia Palenzuela who is chief of Clinical Medicine at the Pediatric Heart Center at the William Soler Pediatric Hospital in Havana. This center is the hub of a national network of pediatric cardiocenters, which have been key to the early detection and treatment of children with congenital heart problems. She articulates what it means to have the premier country for health technology – the United States – closed to Cuba for business. Since they have to go elsewhere for their medical devices and equipment, the costs are inevitably higher and in many cases prohibitive. The result is she cannot give her patients the best medicine has to offer. Next is Dr. Alex Carreras Pons a family doctor with a community practice associated with the Plaza de la Revolucion Community Polyclinic. In his practice the most prevalent disease is high blood pressure and the embargo hurts his ability to get his patients the drugs they need to manage it. Careen Foster is finishing her medical degree at the University of Colorado in Denver and is participating in the MEDICC (Medical Education Cooperation with Cuba) program. Some 300 students from 82 U.S. schools of medicine and public health have pursued rotations in Cuba through the program since 1998. Dr. Foster is working with a community physician in the Villa Clara area. She echos Dr. Pons concerns about the lack of hypertensive drugs and adds that front line antibiotics are also hard to get due to the embargo. As an American she displays exasperation with current U.S. policy. Dr. Raul Herrera Valdes is the director of the National Nephrology Institute. The institute level is the tertiary care level in Cuba, providing medical services but also charged with research. Nephrology or the study and treatment of kidney diseases is highly dependant on sophisticated technology and therefore has also been one of the fields most affected by the U.S. embargo. He gives the philosophical perspective on how Cuba decides to handle the problems created by the US embargo by emphasizing human talent over material riches.
View – The Embargo

HIV/AIDS: Manuel Hernandez started the first AIDS prevention program in Cuba. He is now at the Center for STD-HIV prevention in Havana. The center was established in 1994 and works with young people across the country and with various groups identified as high risk. They have a library, computers, and a hotline where people can call and get information. A wall along the outside of the building is painted with scenes promoting safe sex and condom use. Hernandez says that while the Cuba HIV infection rate has been and is still very low they have always maintained a commitment to prevention. But Dr. Foster (see above) contends the numbers are most likely higher than what the government reports. Dr. Rigoberto Torres is an epidemiologist and gives a break down of these official numbers past and present. Dr. Jorge Perez is the current deputy director of the Pedro Kouri Institute of Tropical Medicine and was the founder of Cuba’s national AIDS program and director of the AIDS sanatorium for over a decade. He defends the numbers and says that Cuba will continue to fight to keep those numbers low. Dr. Ileana Artiles works for the National Center for Sex Education. She says a big concern of the center is the lack of condoms due to the fact that Cuba has no factory and has a lot of difficulty shipping them from abroad. For those already infected, Dr. Torres says just a little more than half can get the drugs they need to fight the disease and of those who do many get them from friends and relatives from other countries.
View – HIV/AIDS

Primary Care:Providing Primary Care: Dr. Raul Herrera Valdes (see above for description) articulates why Cuba has made the delivery of primary care and hence preventive care the foundation of the health care system. Next Dr. Pons (see above) is seen leaving his home apartment that is located above his office. He talks about how valuable it is to live and work in the same place. Patients know where to find you anytime of the day or night. He also explains how doctors in Cuba keep records on their patients and how they are categorized. For his practice, the biggest problem is high blood pressure and he is continuing to see an increase in rates among his patients. Dr. Foster (see above) comments on the strong relationship Cuban doctors seem to have with the people of their community. The doctor s office is practically neighborhood hangout. And according to her the home visit that the doctor performs every afternoon as a part of their practice is an integral part of diagnosing and treating less obvious diseases and problems in the community.
View – Primary Care

Natural Medicine: Dr. Henry Vazquez practices the full range of medicine in his rural practice in Boquerones, Cuba but the 27 year old is particularly proud of his use of natural medicines or herbs to treat his patients. As he walks around his herb garden behind his office and home, he talks about which plants treat which ailments. Dr. Pedro Rafael Regal is a specialist in rehabilitation at the 19 de Abril Community Polyclinic and an expert in complementary and alternative medicine. He comments on how Cuba has made a commitment to incorporate what they call natural and traditional medicine into standard medical therapy. Not only are they using herbs indigenous to their culture but they are also looking to traditional Chinese medicine such as acupuncture. Unlike in the rural areas where people can grow their own, in Havana there are herb merchants that can provide you with the ingredients you might need for a medicinal concoction. Dr. Jorge Sosa Gallardo also practices and does research at the 19 de Abril Community Polyclinic and he says that they are currently studying how treating asthma with natural remedies has reduced the dependence on steroids and therefore reduced the side effects association with them. He contends that the more they find out about the successful uses of natural medicine the more Cuba doctors will be encouraged to use them.
View – Natural Medicine

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