headlines in cuban health
HIV/AIDS Education Across Cuba
Cuba fulfilled the 2005 World AIDS Day’s promise to fight AIDS with a week of educational activities organized by the national team for the management and fight against HIV/AIDS. This multidisciplinary team - GOPELS according to its Spanish acronym - comprises major ministries, media and civil groups.
The main thrust for December 2005 was to “educate, educate and educate,” said Dr. Rosaida Ochoa, Director of Cuba’s National Center for Prevention of STIs and HIV/AIDS. “We are trying to work on the relationship between individuals and their communities,” explained Ochoa, a designer of the prevention strategy contributing to Cuba’s low prevalence rate, which is rising but is still less than 10% of the Caribbean rate of 1.6% as cited by UNAIDS (2005).
Dr. José Juanes, member of GOPELS, explained in an organizational meeting for World AIDS Day, that Cuba has screened for the disease since 1986, testing all blood donors, pregnant women and those requesting anonymous HIV tests. Dr. Juanes also cited the importance of universal free access to antiretroviral therapy here for those needing it. He said that to date in Cuba there have been 6,682 cases of HIV, with 2,784 developing into AIDS and a total of 1,314 deaths. Males are still the predominant carriers of the disease here, at 80.4% percent of cases; of those, 85% are men who have sex with men.
|Health promoter Zulima Fis
On the eve of World AIDS Day the agenda was packed, with some street work highlighting prevention in downtown Havana carried out by young health promoters, which was boosted to a full-fledged campaign all over the country the next day. Trained youth sat at information tables or stood with boxes of condoms and leaflets, educating passersby about the most effective ways to prevent the disease.
These volunteers had participated in workshops on sensitivity training, group dynamics, face-to-face consulting and telephone techniques for their 24-hour AIDS hotline, in place all over the country. Promoter Zulima Fis, involved with the project for two years said, “all our community prevention tours in the AIDS van have been well received, and I hope people use the condoms.” In Cuba, when they’re not being given out free like today, condoms only cost five cents apiece.
International and Homegrown Initiatives
World AIDS Day has been celebrated in Cuba since 1988 when the World Health Organization first declared it in London, and international cooperation has been decisive at various moments in Cuban AIDS history. Current and past collaborators include UNDP, UNESCO and UNAIDS, as well as NGO’s like Doctors Without Borders, Hivos and Population Services International. Nevertheless, many initiatives are homegrown now, with Cuba producing generic antiretrovirals since 2001, and HIV/AIDS prevention centers and related offices, hotlines, promoters and events all over the country.
A couple of days later, the Hope Awards for prevention, mutual support and solidarity were given at Cuba’s National Theater, with performances by visual artists, musicians, dancers and actors. Lianett Rodríguez and Mardelis Martínez, a duo from the internationally renowned troupe Danza Contemporanea, told MEDICC Review their choreography was designed to help “raise consciousness and support self esteem.” They explained how both are particularly important to people with HIV, who “suffer from rejection by uninformed people,” and that their mission is to “give AIDS a face.”
Daniel Vila, Coordinator of the Amigos del Este HIV/AIDS support group, told MEDICC Review that he had unprotected sex with a woman one night eight years ago and contracted the HIV virus. When his test came out positive he said he felt the world was falling apart and was thankful a psychologist was there to help him learn how to cope.
“It took me a long time to assimilate,” he said, “and at first I ran around trying to finish as many things as possible.” That is what is called the “elaboration of grief,” he explained, now well-versed in the language of catharsis and an international speaker on the Cuban experience. There are 31 self-help groups in Havana and 79 in Cuba, and he said there is a palpable commitment from the government to actively fight and inform about AIDS.
“Without that, words fade off into inaction,” he said, “everyone has a particular situation but at least national policy supports us, and we all have our meds.” As Daniel walked off the risers at Havana’s National Theater, MEDICC Review asked when was his best moment during almost a decade of HIV infection. Without skipping a beat the award winner said: “Today.”
Cuba & Bolivia Sign Cooperation Accords in Health
Bolivian President Evo Morales’ first foreign visit after winning a majority vote in December was to Cuba, where he signed important cooperation accords in health, education and sports. Among these was an agreement between the two countries to establish a non-profit organization to provide poor Bolivians ophthalmological treatment to cure or prevent loss of eyesight.
Cuba has already provided the National Ophthalmological Institute in La Paz with modern equipment and specialized personnel who, along with Bolivian doctors and recent graduates from the Latin American Medical School (ELAM), have treated over 1,500 patients free of cost.
The new accords stipulate for the opening of two additional centers, one in Cochabamba and another in Santa Cruz, which will each treat 50 patients a day; in La Paz, doctors will be able to attend to 100 a day. As a result, Bolivia will have the capacity to operate on a minimum of 50,000 people annually.
Additionally, Cuba offered 5,000 more full scholarships to educate doctors and specialists as well as other health personnel at ELAM. At present, there are some 500 young Bolivians studying at the school and another 2,000 have started the pre-med bridging course. The six-year education is provided free for low-income students committing to practice medicine in underserved communities upon graduation.
During the ELAM’s first graduation last August, Venezuelan President Hugo Chávez announced that his country will establish a second Latin American Medical School, so that jointly with Cuba, the two countries will be able to provide free medical training to at least 100,000 physicians for Third World countries over the next 10 years. See MEDICC Review Vol. VII, No. 8, 2005.
The Cuba-Bolivia Cooperation Accord also offers aid for the new President’s literacy program (slated to start in July), with the aim of teaching all Bolivians to read and write in 30 months. Cuba will provide didactic material and technical means, as well as experience to the program. Venezuela just ended a two-year literacy campaign using the Cuban method known as “Yes, I Can,” during which over 1.4 million people learned to read and write. Presently Cuba is helping Brazil, Mexico and other countries with similar literacy programs. The accords also include sports, cultural and scientific exchanges.
In January, President Morales visited Caracas where Bolivia also signed cooperation accords with Venezuela, which together with the Cuban accords, fit into a bigger regional integration plan called the Bolivarian Alternative for the Americas or ALBA, as it’s known.
Medical Education Cooperation
with East Timor Expanded
East Timor pre-med students Aleito Menezes, Délio da Silva & María Geremias en route to Havana.
Known as the ‘first independent state of the millennium,’ the island nation of East Timor will celebrate four years of independence on May 20th. Since 2004 – nearly half the young country’s life - Cuba has had a medical cooperation program with East Timor that was recently expanded to include a greater presence of Cuban doctors in-country and additional medical scholarships for East Timorese students.
Providing education and training for human resources for health is a top priority in a country that was left with only 35 physicians after violent clashes in August 1999 displaced 75% of the population. In response, Cuba offered over 800 full scholarships for young East Timorese to study at Havana’s Latin American Medical School (ELAM). The first phase of the scholarship program is well under way, with 361 students from East Timor already matriculating in the medical school. The balance began arriving this January to begin the pre-med bridging course, the preparatory course to the standard six-year curriculum (see Spotlight, MEDICC Review Vol. VII, No.8, 2005).
“There are so few doctors in my country and I want to help” said arriving student Délio da Silva about why he decided to apply for an ELAM scholarship. Prospective students are chosen from the 13 districts throughout East Timor, to promote more equitable distribution of the future MDs. The hope is that these students will return to their country to help alleviate the human resources for health crisis there, since ELAM students commit to practicing medicine in underserved communities upon graduation.
Creating a sustainable health system where East Timorese provide health services for their own is the long-term strategy, says Dr. Francisco Medina, head of Cuba’s Comprehensive Health Program (CHP) in the small island nation. There are currently 182 Cuban professionals and technicians working in East Timor under the medical cooperation project.
“We’re the first to get rid of the desk separating doctors from their patients, and many times the first to see them not just as cases, but as human beings,” Dr. Medina told MEDICC Review. This humanist approach is the philosophy underscoring medical education in Cuba and is the foundation for East Timor’s future doctors.
Notes & References
- Source: East Timor Health Sector Situation Report, January-June 2000, World Health Organization, 2000. According to Cuban officials in East Timor, there are currently 45 doctors there, only 26 of whom work in the public sector.
- The students are distributed as follows: 27 in 1st year, 15 in 2nd year; and 319 in 3rd year.