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Headlines in Cuban Health Accompanied Labor: Improving the quality of care during labor and delivery has been the focus of obstetric professionals, staff and others involved in the specialty in Cuba. One of the principal issues is whether the father's presence is allowed at the birth - currently not an option in most health institutions worldwide. Common practice in Cuba up to now has allowed for a female companion during labor. When women are accompanied during labor, results are positive: accompanied labor has demonstrated a significant reduction in terms of time in labor, the administration of pain killers, the number of caesareans, and unnecessary obstetric interventions. From February 1, 2005, fathers have been permitted in the labor room in every maternity hospital in Cuba. The policy aims to add an important new element to Cuba's Maternal-Child Health Progam, which already registers excellent health indicators when compared to the rest of Latin America,. As a result, medical institutions have been mandated to create adequate conditions to ensure implementation and provide for the presence of fathers at the birth of their children. The World Health Organization has challenged nations to reduce maternal mortality by 75% for 2015 - a nearly impossible task for most developing countries. Nevertheless, Cuba has achieved a direct and indirect maternal mortality rate of 3.9 per 10,000 births and an infant mortality rate of 5.8 per 1,000 live births. Cuba's infant mortality rate is the lowest in Latin America. At present, virtually 100% of pregnant women in Cuba receive comprehensive medical attention before, during and after birth, including whatever additional or specialized assistance might be required on a case by case basis. Since 1992, a new system called the Conscientious Parenting Program has emphasized paternal participation, involving the future father from the early stages of pregnancy and including the possibility of his presence during delivery (see MR Feature: Cuba's Maternity Leave Extended to Fathers, But Few Dads Take It ). Rock Star Treatment for Kids with Cancer
The pediatric oncology specialists at the National Institute of Oncology and Radiobiology in Havana so suffuse the antiseptic air with determination and hope, it's not surprising such resilience and verve rubs off on their young patients. What is surprising however, are the smiles on the faces of these children fighting against different forms of cancer, which grew even wider during a recent visit by progressive rock pianist Rick Wakeman. The rock star visited each child at their bedside and distributed toys at one of the regularly-scheduled parties organized by the Association Friends of Cuba for children with cancer. Wakeman, known as a keyboard virtuoso (most notably with the rock band Yes ), accompanied by his wife, members of his band and the blues group Cross Fire , spent a morning getting to know the 20 young patients currently receiving treatment at the cancer ward. It quickly became evident that the real stars are these young fighters. Through a translator, the visitors talked with 18-year old Jonier, a new arrival awaiting his lymphoma test results and cradled Yosledis, not yet a year-and-a-half old and fighting eye cancer. Several members of the entourage fought back tears with varying success during the experience.
The activity was one in a series coordinated by the Swiss organization Association Friends of Cuba that, along with Havana's Sociedad Cultural José Martí, hosts cultural and recreational activities for Cuban kids suffering from terminal illnesses. Mario Ramseier, President and Founder of the Association, has been coordinating such parties and donations since 1997. On the day of the musicians' visit, there were toys to spare and a computer for the ward among the donations. During Wakeman's visit, the children sat around in pajamas - some hooked up to IVs, most with knit caps or scarves covering their heads - laughing and singing with the clowns while eyeing the cake and piles of toys that awaited them. "For the four hours that these children are coloring or painting, that's four hours that they are not thinking about being sick," says Erasmo Lazcano, Vice Director of the Sociedad Cultural José Martí. Indeed, the psychological boost provided by these visits was illustrated most eloquently by the glee on each child's face when they received a stuffed tiger or an autograph from Mr. Wakeman. "There are no words to express what I have seen here, how far ahead the doctors are. Everyone looks so well, it's incredible. We will never forget what we've seen here," said Wakeman about the visit. The children aren't likely to forget either. In Latin America, Cuba is one of the countries with the highest probability of eliminating tuberculosis as a health problem in the near future. That means achieving an incidence lower than 5 cases per 100,000 inhabitants - already a reality in over 100 municipalities of 169 total across the country. At the end of 2004, the country showed the lowest tuberculosis prevalence rate in Latin America with a disease incidence of 6.4. In spite of a decades-old cure, tuberculosis has caused the death of more than 200 million people since its cause was discovered in 1882. According to WHO, the tuberculosis epidemic is now worse than ever before, due to the emergence of drug resistant strains that threaten to revert the epidemic to 'pre-antibiotic era' levels. According to a WHO report published in Geneva, each year up to 300,000 new cases of multi-resistant tuberculosis are reported in the world. World Tuberculosis Day is commemorated on March 24th, with the purpose of building public conscience that tuberculosis is still an epidemic out of control in a large part of the world. In Cuba, the National Program against Tuberculosis has three main pillars:
In 2004, 717 new cases were detected (69 fewer than in the same period for the previous year), while AIDS-related tuberculosis remains at very low levels and drug resistance does not constitute a health problem. Treatment for the patients is supplied by the family nurse during the six months the treatment lasts. The Cuban government guarantees 100% of the salary during that period and returns the person in their job once they are discharged. This favors rehabilitation and contributes to cure rates in the country of over 90%. Strengthening bio-safety, stratification of the cases in each territory, improving the evaluation and monitoring methods, and increasing research on the subject are among the projections of the Cuban program for the year 2005. Cuba has eradicated six other diseases (poliomyelitis, diphtheria, measles, whooping cough, rubella and mumps), as well as tuberculous meningitis in children under one year old and neonatal tetanus. It also reported zero tetanus cases at the end of 2004. For more, click here ). Related websites:
Cuba and Venezuela Step Up Health Cooperation:
In May, the Cuban and Venezuelan governments agreed to sponsor free ophthalmological care in Cuba for 100,000 hardship patients from throughout the Americas, including the USA. The initiative extends services that were already being offered to Venezuelans since July 2004, as a result of which several thousand low-income people recovered or improved their sight. Under the arrangement, transportation, lodging and medical services will be covered jointly by the two governments, and some 600 specialists in Cuban health facilities will attend to participants in the program. It is estimated that some 4 million persons in Latin America alone suffer from some degree of untreated visual impairment. The joint offer came at the end of President Hugo Chávez's April visit to Cuba, where dozens of agreements were signed with President Fidel Castro's government in both the public and private sectors. The accords were penned as a result of the new trade and cooperation plan outlined last December by the two governments, intended as a Latin American integration strategy buttressed economically by the area's oil and other resources. It aims to bring greater social equity to the region. Among the most important health-related actions, the governments have agreed to join forces to:
In addition, the Venezuelan and Cuban education ministries will be working to complete the literacy drive in Venezuela, expected to conclude with 1,406 million persons learning to read and write, thus virtually eliminating illiteracy in the country. Cuba's own literacy campaign, conducted in 1961, reduced illiteracy to less than 4%, earning praise as "a great event in the educational field" from UNESCO in its 1964 report Methods and Means Utilized in Cuba to Eliminate Illiteracy. Cuban Vaccine Wins Gold Medal from WIPO The World Intellectual Property Organization (WIPO) has awarded a Cuban biotech innovation with a gold medal for the sixth time since 1986. This year WIPO awarded the coveted prize to the pioneering synthetic vaccine Haemophilus influenzae type b (Hib). Safer than vaccines produced from live bacterium, the synthetic vaccine has been shown to provide 99.7% long-term protection against the bacterium that causes meningitis and pneumonia in infants (Read More...) . Dr. Vicente Vérez, Director of the Center for the Study of Synthetic Antigens of the University of Havana, received the award on behalf of the team that collaborated in its development, which included the Finlay Institute, the Pedro Kourí Tropical Medicine Institute, the National Center for Bioreagents, the Center for Genetic Engineering and Biotechnology (CIGB) and Canadian scientists at the University of Ottawa. In its March-April 2004 issue, WIPO Magazine highlighted the success of Cuba's biotech industry for its innovative developments. Praising Cuba as "an example of the considerable benefits to be reaped from a national policy of encouraging the growth of creativity (and harvesting its fruits)," WIPO reports that Cuba has "linked scientific skill with IP awareness," with more than 150 biotech patents, almost 70 of which are being used in other countries. The other five Cuban products previously awarded Gold Medals by WIPO in recognition of their significant health contributions are: Meningitis B vaccine (1986); Ateromixol or PPG (1996), a natural cholesterol-lowering medication; Biocida (2000), a medication effective against a variety of fungi and bacteria that destroy resistant strains of many antibiotics; H-R3 (2002), a monoclonal antibody effective in the therapeutic treatment of advanced cancers; and Stabilak (2002), a milk preservative. Haemophilus influenzae type b causes up to 600,000 child death under the age of five each year, primarily in developing countries. Although the conjugate vaccine that uses a natural molecule to produce the antigen was developed more than 13 years ago, approximately 90% of the world's children are still not protected against the deadly disease. Since January 2005, all Cuban newborns have been vaccinated with the synthetic Hib vaccine. More Gold Medals for Cuba's Innovative Health Products Cuba's twelfth "Health for All" international trade fair brought together an impressive display of pharmaceutical and medical products from around the world (Read More...) . During the closing ceremonies, gold medals were awarded to 17 of the products featured at the fair, including three Cuban innovations. BIOMAT, of the University of Havana, took a medal for Tisuacryl, a highly effective tissue adhesive used to close small wounds without sutures. The product is registered in Cuba and numerous Latin American countries. Another Cuban medal winner was CARDIODEF 2, a defibrillator/monitor produced by the Cuban Institute of Digital Research. The third gold medal went to the National Center for Scientific Research for its rapid microbiological diagnosis equipment, DIRAMEC 10. Other countries receiving medals included Japan, Brazil, Italy, Panama and Germany. The German company, Siemans, was recognized for its new magnetic resonance imaging (MRI) equipment, MAGNETON AVANTO. Leon Wortham, president of the US company Wortham Laboratories, attended the fair to present his company's unique product FastAct, which stops bleeding in a matter of seconds. Along with the medical and pharmaceutical innovations presented, the fair yielded more than 30 important commercial contracts with foreign companies and signed numerous letters of intent for future purchases. After many years of uncertain food supplies and lower than recommended daily caloric intake levels, recently released statistics indicate that Cubans are joining the ranks of the global obese. The trend worries health professionals in Cuba, who are confronting a rise in diseases such as diabetes and heart disease, two conditions related to obesity. According to Dr. María Tosar Pérez, Director of the Center for the Development of Natural and Traditional Medicine in Havana, between 20% and 30% of the population - some 2 million Cubans - show some degree of obesity. Though this is still below levels found in most developed countries where obesity is up to between 25% and 45% of the population, the trend has sparked research and development in several specialties, most notably nutrition. Several factors related to Cuban diet and lifestyle are blamed for the increase in overweight individuals, including a diet high in fat, cholesterol, carbohydrates and sugar, and lack of exercise. Indeed, traditional eating habits in a place where some consider meat, tobacco, liquor and sugar to be the four major food groups poses a challenge to dieticians and nutritionists. Genetic influences are also part of the equation. In the 1990's, severe food scarcity in Cuba saw caloric and vitamin intake levels plummet, leading to dramatic weight loss in adults and a concurrent spike in deficiency-related disorders including optic neuropathy, low birth weight and anemia in pregnant women. Slowly improving economic conditions, coupled with a multi-pronged public health campaign promoting fruit and vegetable consumption and exercise, however, have been showing marked results. According to Economic Minister José Luis Rodríguez, by the end of 2004, daily caloric intake in Cuba had reached 3,305 and 85.5 grams of protein, surpassing minimums set by the UN Food and Agricultural Organization of 2400 daily calories and 72 grams of protein. Improbably, Drought Worsens in Cuba
You know the quick sizzle and pop you get when you sprinkle water on a hot griddle? That's the effect the few spurts of recent rainfall has had on Cuba's shriveling crops, empty reservoirs and dried water pipes. It's June already and it should be raining from Guantánamo in the east to La Bajada in the west, but it isn't and it hasn't, meaning the most dramatic drought to hit the country since 1901 is getting worse. For MEDICC Review's previous coverage of the crisis, click here) . In February 2004, faced with a water shortage of critical proportions, the Cuban government convened a special committee to draw up short, medium and long term plans for confronting the drought. While kilometers of water pipe were constructed or repaired and conservation measures were enacted from the classroom to the kitchen, it still failed to rain. As a result, some two million of the island's 11 million people currently do not have reliable running water. Grasping the importance of effective water management, the National Institute of Hydraulic Resources sprang to action by identifying 4,000 kilometers of new pipe to be laid and plugging up leaks in existing pipes, which cause 50% of all water to be lost in transit. Water-filled trucks called pipas began hauling water to urban zones and neighbors lined up patiently to fill buckets and jugs. "My family only gets water every 28 days," from the water trucks, says a woman from Camagüey, the hardest hit of all Cuban provinces. Trucking in water is a strategy for ensuring people's 'sustainable access to an improved water source,' which 91% of the population enjoyed as of 2000, according to the most recent UNDP Human Development Report . For the Ministry of Public Health, one of the most troubling possibilities posed by the drought is the re-emergence of preventable water-related diseases - eradicated long ago in Cuba. According to international guidelines, individuals need access to 250 liters of clean water a day to live healthy lives; 100 liters has been established as the absolute bare minimum. As I write this, many Cubans have access to only 20 liters of potable water a day, an alarming level of scarcity that has necessitated a proactive strategy to head off possible adverse public health effects. In order to prevent the emergence of communicable diseases and illnesses such as Hepatitis A, typhoid fever and intestinal parasites, the Ministry of Health has distributed updated hygiene guidelines for Camagüey, Las Tunas, Holguín and Havana, the provinces suffering most intensely from the water shortage. Particular stress is being placed on the selection and preparation of food and personal hygiene by workers in the public sector. Nutrition is another area of concern, with many drought-specific policies addressing the need to assure the national food supply. The newest measure is a US$2.3 million credit for small farmers (who account for 65% of all agricultural sales nationally), that helps them to stay afloat by investing in new drought-resistant crops, digging new wells or erecting more efficient irrigation systems. At present, only 17% of small farms have irrigation in place. Pesticides, which can contaminate ground water, are also being phased out. The agricultural sector has been especially devastated, with losses estimated at US$834 million. The sugar industry has been hammered: this year's sugar harvest is estimated to squeak in at 1.5 million tons - down from 2.5 million tons in 2004 - and the lowest Cuba has reaped since 1909. The drought has so hurt cane production that Cuba has been forced to import sugar to meet domestic need, while exporting the domestic crop to satisfy trade agreements. Harvests of root vegetables - a staple in the Cuba diet - are down 20% from previous years as well. In addition, hundreds of thousands of cattle have been slaughtered or moved to areas with better water accessibility. Although the UN hopes to increase by 50% the number of people worldwide who have access to safe, clean drinking water by 2015, by most accounts, that goal seems unlikely to be reached. Certainly there will be no sustainable resolution to the worldwide water crisis without international cooperation and coordination, a perennial topic of the annual UN World Environment Day, celebrated this year on June 5th. In the meantime, forecasters predict a dryer than usual June in Cuba, where rain is increasingly viewed as 'blue gold.' Cuba and Guatemala:
Some 187 Guatemalans will receive their MDs this summer in Havana. Diplomas in hand, they will be among the first 1,400 graduates of Cuba's Latin American Medical School (ELAM). Many of them come from the Central American country's significant indigenous communities, including a strong representation of young women. They began their studies with a bridging course and two years of basic sciences at the ELAM Havana campus. For nearly the next four years, they studied with Cuban medical students, rotating through clinical specialties at teaching hospitals and polyclinics, affiliated with 22 medical school campuses across the island. Like the other international students at ELAM, their medical education has differed from the regular Cuban medical school curriculum in two ways: there is a greater emphasis on health problems and diseases characterizing the epidemiological picture in their home country and more in-depth courses in disaster management are offered. However, in their last semester, Cuban and Guatemalan medical education authorities agreed to enroll 150 of the 187 in a pilot internship back in Guatemala under the guidance of Cuban professors, who are among the 294 physicians in the Cuban medical contingent serving in that country. "We believe there is no substitute for clinical experience with the communities and patients that they will be treating a year from now," emphasized Dr. Francisco Durán, Director of Higher Medical Education in Cuba's Ministry of Public Health. He was on the Cuban assessment team dispatched to Guatemala this spring, which spent 10 days visiting the remote regions where the interns are posted with their Cuban mentors. "I was impressed," he told MEDICC Review, "not only by the quality of the students' clinical skills and their commitment, but also by the great potential we can already see in how well they communicate and relate to people in these communities - because they are the sons and daughters of these populations, and so they keenly perceive their problems and belong to the culture." "This pilot experience has also placed new demands on the Cuban physicians in Guatemala," noted Dr. Juan Carrizo, who joined the team as Rector of ELAM. "They were providing services," he said, "but now they are challenged to give more of themselves - to share their scientific, technical and pedagogical expertise with these students to help them complete their medical education. I think in the end, this experience adds an element that makes for a qualitatively superior education for these young people, an education more pertinent to their medical practice environment, reinforcing the competencies they will need the most." He noted that pilot internships on a smaller scale were also organized this spring in Honduras, Haiti and Venezuela. The Guatemalan student group at the Latin American Medical School - which numbered a total of 610 in the 2004-2005 academic year - is expected to grow for 2005-2006 despite the outgoing graduates, due to unprecedented first-year enrollment for the coming year. Some 50 scholarships were originally awarded by Cuba, but the number was nearly doubled with the inclusion of another 46 in May. William Sandoval, Human Resource Director of Guatemala's Health Ministry, said his government was grateful for this additional cooperation, and called on students to take advantage of "this unique opportunity to become highly qualified (health) professionals." Central America has been the most strongly represented region in the ELAM student body, with over 650 Hondurans and another 500 Nicaraguans. Upwards of 240 more Nicaraguans begin their studies in the fall, with another 20 Hondurans as well. Contrary to the receptivity of other governments, Honduras' new Health Minister recently announced he was turning down another 25 scholarships, despite the fact that the local press reported that some 6,000 applications had been received. He argued that his government preferred to re-orient the offer towards training in the allied health professions such as laboratory and anesthesiology technicians. Total numbers in the ELAM program now surpass 10,000 from 27 countries, including students from 101 ethnic minorities (See MEDICC Review , Vol. VI, No. 1, 2004, Cuban Med Schools Open with Record Enrollment ). Most students come from low-income families. For the new school term, Guatemala and Cuba are pioneering another option to increase opportunities for qualifying students to take advantage of the Cuban scholarship program. Since ELAM dormitory space is now filled to capacity, an option for homestays with Cuban families is being offered to an additional 167 Guatemalan students for the duration of their medical studies. "The families will receive government assistance to provide students with fully adequate conditions," commented Pablo Romero, of the Cuban Embassy in Guatemala City, adding that this group of students is expected to travel to Havana by mid-July. |
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