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Designed to comply with the World Health Organization's Framework Agreement for the Control of Tobacco to which Cuba is a signatory, the country enacted sweeping changes to public smoking laws on February 7 that not only limit where you can smoke, but also who can buy cigarettes and where. In addition to banning smoking in enclosed places, the new laws prohibit the sale of cigarettes 100 meters from a school or playground and to people under 16. Running headlong into the historical heritage of an island famed for its rich, black tobacco, the government took the dramatic step in an effort to curb smoking-related illnesses, which still account for 30% of cancer deaths. Indeed, according to Rolando Camacho, director of the national oncological program, cancer may soon surpass heart disease as the number one killer in Cuba. Prevention is Important... In a health system noted for its emphasis on prevention, smoking is one area where indicators are not keeping pace: Nearly half of the adult population is still lighting up and the rise in teenage smoking - almost twice as many teenagers smoke today as did in 1990 - means grim health horizons for the next generation. Still, there's a new, cleaner wind blowing and you'll get whiffs of it in taxis and theaters, restaurants and offices. In an effort to reinforce the no smoking message, radio and TV campaigns blanket the airwaves, and as reported in these pages last November, cigarette packs now come plastered with anti-smoking slogans (see November issue Headlines: Smoke Signals). The impetus for the new regulations came from the desire to increase life expectancy from an already impressive 75 to 80 by 2010, by changing attitudes and sparking "a movement that respects the rights of non-smokers," according to the official resolution. Unfortunately, Cubans from Miami to Manzanillo, smokers or no, tend to laugh off the new smoking laws with just a touch of incredulity. Still, the arrivals lounge at José Martí International Airport was refreshingly smoke free the other day as many Cubans waiting for deplaning loved ones smoked outside. Other preventative regulations enacted at the same time, but with less fanfare include the banning of cigarette vending machines - technology which to our knowledge does not even exist yet in Cuba - and the prohibition of alcohol sales to people under 16 and to anyone, anywhere between midnight and 6am Monday-Friday, except in hotels. You can read the full text of the regulations in Spanish at http://www.sld.cu/temas.php?idv=2041. But Enforcement is Key Everyone agrees the challenge lies in changing a deeply ingrained culture that swirls around smoking: Cubans light up over hot, sweet espressos or highballs of rum, the country exports US$200 million worth of cigars annually and the government continues to distribute cigarette rations to those who had already been receiving them before the new regulations were enacted. Nevertheless, the political will exists for the anti-smoking cause and is reinforced by creative financing ideas like donating US$703,256 in auction funds raised during the ever-popular Festival del Habano (Cigar Festival, held in Havana from February 20-25), to the national health system. Whether substantive, sustainable change is possible depends more on the people themselves, than any laws. As long as parents send their children to buy their cigarettes - children as young as 10 can be seen buying Populares around Havana - and young clerks continue to sell them to underage kids, the process will be hamstrung; Nicely turned out gentlemen will still smoke in pharmacies until a second person pipes up, 'she's right compañero, you can't smoke in here,' like happened here the other day. |
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"Compañero, you can't smoke in here. You know, the new laws and all," a young woman says to the gentleman in line at the pharmacy. "Bah! New laws won't stop me!" he replies, assuming the attitude the majority of Cuban smokers share about the new smoking regulations.
 Intern Luther Castillo is back home in Honduras. |
Eighty of the 128 Haitian medical students, as well as 51 Venezuelans, 70 Hondurans and 150 Guatemalans due to graduate from Cuba’ s Latin American School of Medicine this July, are back home finishing their studies in the field.
This will be the first class to be graduated from the school. Also for the first time, 50 Cuban 6th-year students are doing their internship in Guatemala, where they are working side-by-side with the Cuban specialists there.
According to Dr. J.J. Ceballos, special Advisor to the Cuban Ministry of Public Health for Medical Education, the foreign students are doing part of their internship in their country of origin so they can familiarize themselves with conditions in their country.
Dr. Ceballos told MEDICC Review they have just started and the results are already amazing.
In an exclusive interview with MEDICC Review, Cuban Dean of the Santiago Campus of the Latin American School of Medicine Program, Dr. Rosa Duconger, who is supervising the students in Haiti, said they chose 65 male and 15 female students with top grades (4.68 out of 5) and well-rounded preparation.
Furthermore, Dr. Duconger said the students in Haiti are distributed in all nine Haitian Departments where they have to adapt to the hygienic, sanitary and health conditions. There are six Haitian medical students in the city of Gonaives which was hard hit by flooding last September when over 3,000 people lost their lives and thousands were hurt and sick. Cuban doctors who were already serving in the area worked around the clock to treat patients in health stations they quickly set up to help the neediest. For MR’s coverage of the story, see Cuban Doctors Quietly Saving Lives in Haiti and Cuban Doctors Give 'Help with Dignity' in Gonaives.
Dr. Duconger told MEDICC Review the Haitians are really pleased with the graduating students who treat them like the Cuban doctors treat them - with professionalism, affection and understanding.
At present, there are over 485 Haitians studying medicine at ELAM's Santiago Campus on the eastern end of the island, fewer than 100 kilometers from Haiti. They have all pledged to return home upon graduation to help the Haitian population and gradually replace the some 500 Cuban medical personnel working there as part of the Comprehensive Health Program Cuba offers nearly a dozen Third World countries; for a detailed discussion of this program, see International Cooperation Report making South-South Collaboration Count.
Cuban Physician Wins American
Academy of Neurology Award
“This is the first time in the 20-year history of the award that the honor goes to an expert of Latino origins.” |
Cuban physician and neuroscientist, Calixto Machado Curbelo, will receive the prestigious McHenry Award for 2005, an honor designated once a year by the American Academy of Neurology. This important recognition was given to the Cuban expert for ‘the first organ transplant from a brain-dead donor,’ an historical analysis and exhaustive revision of the literature covering the development and clinical utility of the concept of brain death in relation to organ transplantation.
The work demonstrates the pioneering role of Belgian surgeon Guy Alexandre and establishes his place in history as the first person to perform an organ transplant (kidney) from a brain dead donor to a human recipient. Alexandre revolutionized the field when he performed the successful transplant in 1963, five years prior to the 1968 publication of the “Harvard Criteria for Brain Death,” long considered the milestone in establishing that death be defined on the basis of neurological criteria.
The award was announced recently by the President of the American Academy of Neurology, Professor Sandra Olson, M.D., who highlighted the fact that this is the first time in the 20-year history of the award that the honor goes to an expert of Latino origins. “Hence, of course,” Dr Olson commented, “[this is] the first time a Cuban receives the award. I will be there at the American Academy of Neurology’s Awards Ceremony to personally present Dr. Machado with his Certificate of Recognition.”
The American Academy of Neurology was founded in 1948, and currently boasts world-wide membership of over 18,000 professionals. The 2005 annual meeting is scheduled for April, with more than 8,000 neuroscientists expected to attend. The annual Scientific and Career Milestones Awards Luncheon will be one of the highlights of the meeting where some of the top accomplishments in neuroscience research will be recognized. Dr. Machado, as recipient of this year’s Lawrence C. McHenry Award, has been invited to present his work in scientific session and to formally receive the award at The Awards Ceremony Luncheon in Miami Beach, Florida, pending a visa from the United States. The McHenry award recognizes excellence in research in the history of neurology.
New Health Titles at
the 2005 International Book Fair
Included among the dozens of new Cuban titles presented at the XIV International Book Fair held in Havana in February, 11 were in the field of medicine/health. From technical texts written for health professionals, to books for both expert and lay readers alike, the new titles were clearly of interest to the general public. As a group, the books (click here for full list) reflect a wide range of expertise and highlight the importance of health, health education and access to care in Cuba. All of the presentations were well-attended by the visitors to the Book Fair, often with standing room only. There were lively discussions during the question and answer periods and many stayed on for further conversations with the authors. It was not an uncommon sight to see readers waiting in line to have a newly-purchased book signed by the author.
According to publishing representatives, several of the health titles were completely sold out by the end of the Book Fair and will go to second printings later this year. Of these, the following are examples of some of the most popular titles:
- Salud Ecológica (Health Ecology), by Jorge Ávila, M.D. and Pedro Fonte, M.D., published by Ciencias Medicas, and presented by Leoncio Padrón Cáceres, M.D., National Director for Natural and Traditional Medicine of the Ministry of Public Health. The authors are both specialists in internal medicine, with advanced training in Complementary/Alternative Medicine (CAM). The book presents a fusion of conventional Western medicine and a number of ancient natural and traditional medical practices and other complementary medical therapies; the authors advocate a more sustainable medical practice which addresses the needs of the planet as well as the health needs of human beings.
- Alcoholismo, Abordaje Integral (Alcoholism: A Comprehensive Approach), by Ricardo González, M.D. and published by Oriente. Dr. González is one of Cuba’s most important figures in the area of addiction. A practicing psychiatrist and Professor of Medicine, Dr. Gonzalez is also the elected President of the Cuban Society of Psychiatry. Author of hundreds of articles and books on a wide variety of topics, he is particularly well-known in Cuba for his work on alcoholism, as well as his commitment to patients’ rights and medical ethics. In remarks to MEDICC Review , Dr. Gonzalez said, “This work is very rewarding because it opens you up as a medical professional to recognize the importance of spirituality for health, no matter what your belief system…there must be a spiritual component along with the physiological and psychological.”
- ¿Qué Nos Pasa en la Pubertad? (What Happens During Puberty?), by Dr. Mariela Castro Espín, published by Pueblo y Educación. One of several titles about and/or for adolescents and young people, psychologist Mariela Castro, Director of the National Center for Sex Education, presented this important volume. The book quickly sold out and is considered a significant contribution to the growing body of Latin American adolescent health literature. Dr. Castro has been a leading advocate of open public discussion on issues often or previously considered difficult or taboo, including STIs and homosexuality, and has made significant, internationally recognized contributions in her field.
- Muy en Serio y Algo en Broma, (Very Seriously/Just Kidding: A Dialogue with Adolescents), by Dr. Elsa Gutierrez; published by Editorial Cientifico-Técnica. Another important contribution to adolescent health literature, this small yet compelling volume was clearly one of the most popular at the Book Fair, bought by professionals, young people and parents alike. The book is a series of vignettes based on case histories as well as conversations with young people describing the often dilemma-laden adolescence. The topics covered were selected by adolescents themselves. Dr. Gutierrez is president of the child and adolescent section of the Cuban Society of Psychiatry, Professor of Medicine, and Director of the Adolescent Clinic in Havana. She has written numerous scientific articles and 16 books. This book also sold out at the Book Fair and many young people stood in line to talk with the author and have her sign their copy. A junior high school student told MR “this is one of the best books I ever read! I bought it a few days ago and liked it so much I came back to hear the ‘doctora’ and get her to sign it for me. I also bought three more for my friends!” Dr. Gutierrez, clearly pleased with the response, also spoke with MR , saying “… nothing makes me feel better than knowing that the young people love my book. Really, it’s their book, so I’m happy they are responding like this!”
The following is a complete list of the new titles in health by Cuban authors presented at the XIV International Book Fair:
Salud ecológica, Jorge Ävila Guethón y Pedro Fontes González
Cómo protegernos de los riesgos reproductivos, Goliat Reina Gómez
Control de la calidad de la atención de salud, Benito Narey Ramos
EDITORIAL ORIENTE
Enfermedades cerebrovasculares, Jorge Miranda
Alcoholismo, abordaje integral, Ricardo González
Muerte encefálica y transplantes de órgano, Ricardo Odelin
PUEBLO Y EDUCACIÓN
Qué nos pasa en la pubertad, Mariela Castro Espín
EDITORIAL CIENTÍFICO-TECNICA
La Psicología en el campo de la salud, Ricardo González
Psicología de la epilepsia, Reinaldo Justo Fabelo
Muy en serio y algo en broma, Elsa Gutierrez Baro
Qué pasa en la adolescencia, Carlos Ortíz
Cuba Begins Using 4-in-1 Vaccine
On March 1, the Cuban National Immunization Program began inoculation of babies at 2 months of age with a new 4-in-1 vaccine which will protect the infants from four diseases: diphtheria, tetanus, whooping cough and hepatitis B. The new combined vaccine was developed in Cuba through the joint work of the Finlay Institute and the Center for Genetic Engineering and Biotechnology.
 Two Cuban friends are all smiles awaiting their vaccines outside a family doctor’s clinic. |
According to Cuban studies, the 4-in-1 vaccine has been shown to be 95% effective against diphtheria and tetanus, 80% effective against whooping cough and 98% against hepatitis B.
This new combined vaccine forms part of Cuba’s comprehensive immunization program that protects children and the general population against 13 diseases (see Spotlight: Cuba's National Immunization Program in MR's October issue). The first national vaccination campaign against diphtheria, whooping cough and tetanus as well as tuberculosis was launched in 1962 for all children under 15. Today, more than 95% of Cuban children under two years of age are protected against these and other diseases, including meningitis B and C, haemophilus influenza type B, measles, mumps, polio, rubella, and typhoid. In March 2005 alone, over half a million Cuban children will receive the oral polio vaccine.
 Taking her vaccine like a champ. |
In a recent report on the new combined vaccine, Dr. Miguel Galindo, Director of the National Vaccination Program of the Ministry of Public Health, stated that the 4-in-1 vaccine will be given to all Cuban children born on or after January 1 of this year when they reach the age of 2 months. Thus, the first inoculations began at the beginning of March. A second dose is administered when the child is 4 months old and a third dose at 6 months. At 18 months, each child will receive a booster shot with the triple vaccine DPT that protects against diphtheria, tetanus and whooping cough.
The new vaccine enhances Cuba’s immunization program and has numerous advantages over the separate vaccinations employed previously. Studies have shown that the use of the combined vaccine does not increase the risk of negative side effects that occur in about 30% of inoculations with the vaccines administered in separate injections, such as fever, inflammation of the skin in the area where the vaccine is administered or general malaise. By reducing the number of injections, the number of incidents of such negative side effects will be decreased. In addition, the combined vaccine will reduce the number of visits parents must make with their children to the vaccination centers, and will also free up more time to the health care workers who attend to these inoculations.
However, the 4-in-1 vaccine is not administered to infants born to mothers who are carriers of hepatitis B. Children born to these mothers will receive vaccines to protect them from these four diseases and others, but the vaccines will be administered under a different protocol. During pregnancy, these women receive a vaccination against hepatitis B. The newborn infant receives a “second” injection against this disease at one month of age, a third at two months and a booster at one year. In order to protect them against the other 3 diseases included in the 4-in-1 vaccines, these children receive the triple DPT vaccine at 2, 4 and 6 months with a booster shot at 18 months.
Cuban researchers continue to investigate ways to improve the vaccination program and are currently working on a 5 in 1 vaccine that will protect against these four diseases plus type B haemophilus influenza.
A First for Cuba:
Voluntary Blood Donations Meet National Needs
Beginning in March, Cuban hospitals no longer required families to donate blood for relatives needing surgery, since the country’s voluntary donation program is meeting national needs.
The program, organized through the Committees for the Defense of the Revolution (CDRs), relies on suggested quotas for block committees, who turn to local volunteers for support. Each donor receives a certificate from the blood bank, and the donation is chalked up to their block committee. By December, 2004, eight of Cuba’s 14 provinces had already ended the practice of requiring family donations for surgery patients, and the remaining six were expected to do so by mid-March.
International research indicates that the best option for guaranteeing an adequate supply of safe blood is the cooperation of such healthy, regular voluntary donors who give blood without financial reward. However, according to the World Health Organization (WHO), of 178 countries recently surveyed, only 39 have 100% voluntary, unpaid blood donations (www.news-medical.net/?id=2370) - with Cuba now becoming number 40.
The WHO estimates that 82% of the world’s population does not have the certainty that they will receive blood should they or their families need it, and have no guarantee that the blood they receive will be safe. Additionally, 89% of low and medium Human Development Index (HDI) countries rely on family replacement donations and paid donations. In those countries, the seroprevalence for transfusion-transmissible infections (HIV, hepatitis B and C and syphilis) in blood donors is much higher than in countries with full voluntary, unpaid donations. The survey also showed that 20 countries in the world do not have 100% screening for HIV, 24 for hepatitis B or syphilis and 37 for hepatitis C. Furthermore, a number of countries do not test at all for these infections (one country for HIV, four for hepatitis B, 31 for hepatitis C and nine for syphilis). Cuba tests for all of these, including HIV since 1985-86 (see MEDICC Review , AIDS in Cuba).
For more on World Blood Donor Day, celebrated globally each June, the campaign “Blood, a Gift for Life” and activities in different parts of the world, log in to www.wbdd.org or www.who.int.
Cuban National Union of Health Workers
Holds its 9th Congress
Under the banner “an army of white coats en route to excellence,” the National Union of Health Workers held its 9th Congress in Havana, February 14-16th. The Health Workers Union is one of the largest in Cuba with over 360,000 members, including doctors, nurses and other health professionals as well as technicians and those who perform a multitude of service and administrative work in the public health sector. Approximately 95% of health workers in Cuba belong to the union, 75% of whom are women.
More than 500 delegates elected from their local unions attended the congress, including 86 who were serving abroad as part of Cuba’s international medical cooperation program. In addition to elected delegates and union leaders, Cuban health authorities, including the Minister of Health, José Ramón Belaguer, also took part in the plenary discussions.
Like the other national unions in Cuba, the Health Workers Union plays a dual role: it works together with administrators and officials of the Ministry of Public Health to develop and implement strategies for improving health services to the population, and it represents the interests of its members in the workplace and with respect to national labor policies.
The Congress was the culmination of more than 15,000 local meetings where the fundamental issues of concern to the union were debated. The primary focus of the agenda centered on the role of the union, representing the “army of white coats,” in assuring the success of the national strategy of integrating health services, improving the quality of health services and bringing them closer to the community. Since the last congress five years ago [Cuban unions convene every five years, and are governed by a secretariat and national council in the interim], hundreds of neighborhood polyclinics have been fortified and their services substantially broadened, including the introduction of new equipment and technologies. These transformations have required reorganizing the distribution of health care workers and incorporating additional technicians. Another issue of great concern discussed among union delegates was the incidence of pilfering and diversion of medications into the black market and the role of the union, hand-in-hand with management, to devise measures to prevent these losses.
With respect to work conditions, the congress adopted a resolution calling for the guaranty of the necessary equipment and measures for the health and safety of health care workers. Although the number of workers injured on the job decreased from 1,125 in 1999 to 481 in 2003 - a substantial drop considering the growth in the sector - the union is pressing for further improvement. Union members also discussed ways of strengthening grassroots union organization and its effectiveness of local union organizations in broadening worker participation in solving workplace problems and motivating all workers in the sector to rededicate themselves to achieving the highest quality services possible.
Record Number of Health Professionals
for Cuba… and the World
This fall, an unprecedented number of young people will be eligible for technical and university careers in the health sciences, with 29,000 new openings for scholarships in the health professions. Of the total number, 5,500 new openings are destined for medicine, 1,015 for dentistry, 11,570 for allied health careers, 8,745 for university-level nursing, and 480 for psychology, among others. The biggest jump corresponds to the allied health careers, training technicians in 21 fields mainly to staff expanded services opened at Cuban community polyclinics across the island in the last two years - including physical therapy, minor surgery, electrocardiography, endoscopy, diagnostic ultrasound, allergy testing and others. Personnel is also needed for the over 100 intensive care units added at the municipal level, and 15 new dialysis facilities opened nationwide in 2003-2004.
In addition, Cuban training facilities are looking over the horizon as requests for Cuban health assistance mount from other developing countries. Already, 23,909 physicians, nurses and technicians serve in 67 nations, according to figures released at the 9 th Congress of the National Health Workers Union in February. Meeting this demand has put more pressure on the Ministry of Public Health, the ministry responsible for medical education as well as services. Thus, the decision to increase enrollment is part of a strategy aimed at providing enough health professionals for growing programs abroad as well as amplified services at home.
A total of some 365,000 Cubans are employed in the health sector, 60,000 of them incorporated in the last five years.
As in previous years, newly enrolled students in health careers this fall will be studying on full scholarship, awarded through a competitive process in each province. For university-level professions, high school grades, college entrance exams and a commitment to serve where they are most needed are among the factors taken into consideration.
Nearly 30,000 students are currently enrolled in medicine, 10,400 of them international students; a total of 3,700 physicians are expected to graduate this summer. (See Cuban Med Schools Open with Record Enrollment, MEDICC Review.)
Cuba : No Tetanus Cases in 2004
Havana - According to official statistics, no tetanus cases were reported in Cuba in 2004. An important epidemiological accomplishment!
Tetanus is a serious disease of the nervous system that is caused by the Clostridium tetani bacillus. As it multiplies, this germ produces large quantities of a very powerful toxin that causes serious muscular spasms. These spasms may even affect the muscles involved in the breathing process, and thus cause death. Up to a million cases - most in developing countries - are reported internationally every year.
Tetanus was discovered by Arturo Nicolaies in 1894. Thirty years later, French microbiologist Gaston Ramon discovered the anti-tetanus vaccine, which was used extensively after World War II. In Cuba, it started to be used frequently after 1959.
Over 95% of the Cuban population is currently immunized using the Tetanus Toxoid. This vaccine is included in the national vaccination plan administered by the Ministry of Public Health, with application of the first three doses in three consecutive months after the baby is three months old. Booster shots are applied at 17 months and 5 years of age, and every ten years thereafter.
Year |
No. cases |
Deaths |
1962 |
645 |
410 |
1970 |
223 |
81 |
2000 |
1 |
1 |
2001 |
2 |
- |
2003 |
3 |
1 |
2004 |
- |
- |
Cuba 's National Immunization Program has been recognized as superlative by the World Health Organization and the Pan American Health Organization (see MEDICC Review), which lauded the country's commitment to the population's health through an integrated, state-funded health system. In addition to tetanus, another seven diseases have also been eradicated: poliomyelitis, diphtheria, measles, pertussis, German measles, and parotiditis (mumps); as well as two severe clinical forms: tuberculosis meningitis in children under one year old, and neonatal tetanus, which was completely eliminated 33 years ago. 
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