headlines in cuban health

Cuba’s Response to Katrina Disaster

By Conner Gorry

Physician volunteer: “We’re ready to go wherever we are most needed.”

As we went to press with this issue, Hurricane Katrina was a catastrophic fait accompli, leaving large swaths of the Gulf Coast in ruins and a wake of destruction reminiscent of a war zone. Although the number of lives lost was incalculable at press time, the hurricane’s aftermath posed serious public health concerns, with the potential to spark widespread epidemics. Indeed, unsanitary conditions in hospitals and shelters, contaminated drinking water, lack of medicines for the chronically ill and other disaster-related health problems had already manifested just days after the storm struck.

Tetanus, dengue, E. coli, cholera, malaria and other water- and vector-borne diseases are among the health risks following an event of this scale. Psychological trauma, particularly for the more than 250,000 displaced children affected by this disaster, is a longer term and often more difficult public health challenge now facing the U.S. How to effectively and efficiently address such challenges in the atmosphere of despair, loss, violence and confusion that gripped the U.S. South after Katrina, takes a specialist health workforce trained to recognize pathologies and deliver health care in disaster scenarios.

On August 30, Cuba - recognized by the UN, Oxfam and other international organizations as a leader in disaster response ( International Voices Weathering the Storm: Lessons in Risk Reduction from Cuba) - paired its condolences to the devastated families with an unconditional offer to send over 1,000 Cuban doctors to the disaster zone at its own expense. On September 4 th, the number was raised to 1,586, with another 300 in reserve. The volunteers from across the island were concentrated in Havana preparing to travel if needed, along with scores of recently graduated Latin American Medical School MDs who also volunteered. ( Top Story Where There Were No Doctors: First MDs Graduate from Latin American Medical School). The medical teams, which the Cuban government pledged to have on the ground in the areas worst hit, have been named the Henry Reeve Brigade, in honor of the U.S. hero who joined the fight for Cuban independence from Spain.

Waiting for Washington: Cuban medical team assembled in Havana.

Specialists in family medicine, cardiology, pediatrics, epidemiology and other fields, and trained in disaster response and the health risks engendered by such events, the health professionals were outfitted with two backpacks each, filled with 24 kilograms (52.8 pounds) of essential medicines. Resources carefully selected to provide maximum coverage for such a disaster, the backpacks contained re-hydration therapies, insulin, hypertension medications, treatments for systemic and topical infections, and minor surgical instruments, among others. With their packs on their backs and an average of 10 years clinical experience, these physicians were prepared to provide an experienced, mobile team able to move where health care was most needed. This flexibility would be enhanced by diagnostic kits carried by the doctors working alone or in pairs, for on-site patient evaluation in either English or Spanish.

The team as a whole already has considerable international experience, collectively having worked in 43 countries. They committed to stay in the disaster zone as long as necessary, as have many Cuban emergency medical teams before them (see Table 1).

Table 1: Examples of Cuban International Disaster Relief Missions (1960-2000)

Over 50 countries offered aid to the U.S., many from the comparatively resource-scarce Global South, including Venezuela, Sri Lanka, South Korea and Guatemala. U.S. Secretary of State Condoleeza Rice stated that no offer from foreign governments would be turned down, although Cuba was still awaiting an official response when this issue of MEDICC Review went to print in early September. Meanwhile, the 1,586 Cuban medical professionals remained on-call in Havana, ready to fly to the U.S. at a moment’s notice.

The following are some vital statistics of the Cuban emergency medical team prepared to carry 36 tons of medical aid and their own clinical skills to victims of Hurricane Katrina:

• 857 are women; 729 are men.
• 699 have previously worked overseas.
• Average age is 32 years old.
• Average clinical experience is 10 years.
• 1,097 are specialists in family medicine.
• 72 physicians have two or more specializations.
• All have disaster-preparedness training.

Most significantly perhaps, they were prepared to go to the most isolated, hardest hit and poorest regions---clearly an important disposition, given the social composition of the victims left behind when the hurricane struck. Analysis of census data by the Associated Press of Katrina victims in the three dozen hardest-hit communities in Mississippi, Alabama and Louisiana revealed:

• Some 60% were minorities.
• 2 out of 10 households had no car – double the national average.
• Almost 25% live under the poverty line – about double the national average.
• 1 of 100 homes did not have adequate plumbing – double the national average [1].

President Fidel Castro stressed that the Cuban government and medical team assembled were “waiting patiently” for a response from Washington, but noted critical hours had already passed during which the doctors could already have been on the ground.

To learn more about Cuba’s disaster preparedness strategy, see MEDICC Review’s issue dedicated to the theme “Disaster Management in Cuba: Reducing the Risks”.

References

1. Bass, Frank. “Katrina’s Victims Poorer than National Average,” Associated Press, September 4, 2005.

Seeing is Believing:
Sight-Saving Extended for Region’s Poor

By Gail A. Reed

Some six million low-income patients from the region will be offered sight-saving care over the next 10 years in Cuban and Venezuelan medical facilities, according to an August announcement in Havana. Presidents Fidel Castro and Hugo Chávez, who attended the graduation ceremonies of the Latin American Medical School August 20th, reported that 50,403 Venezuelan patients and over 1,000 from Caribbean countries have already received surgery and other ophthalmological therapies in Cuba under the plan that foresees treatment for 100,000 in 2005. Many of these people were blind or near blind before treatment.

An estimated four million poor in Latin America and the Caribbean are afflicted annually with disorders affecting eyesight, and “over half a million lose their sight each year, many times without ever having been examined by a doctor,” President Castro said in his commencement address.

With the remodeling of more Cuban hospitals, an airplane soon to be pressed into service by Venezuela, and the incorporation of other Venezuelan medical facilities, the program has enhanced its capabilities to screen for and treat such conditions as cataracts, retractile disorders, corneal leucoma, myopias, and strabismus. According to the Cuban President, services for treating glaucoma are also expected to be included in the plan.

In the immediate future, 100,000 Venezuelan, 100,000 Cuban, 120,000 Central and South American, and 25,000 Caribbean visually-impaired persons will be eligible for the free program, staffed primarily with Cuban ophthalmologists and related specialists.

In Antigua and Barbuda, one of the countries whose people have benefited thus far, the local Antigua Sun newspaper called the program a “worthwhile lesson in the way CARICOM (the Caribbean Community) can operate by pooling the resources that exist right here in the region,” and praised such South-South cooperation for expanding access to vital health services.

Cuban Treatment for Diabetic Foot
Enters Phase III Trials

By Conner Gorry

Diabetes is one of the greatest disease burdens to public health worldwide: according to the Centers for Disease Control and Prevention, one third of children born in the US in 2000 will develop diabetes (translating to 45 to 50 million by 2050). Meanwhile, WHO warns of a more than 100% increase in general diabetes prevalence globally, from 140 million to 300 million, by 2025, most in the developing South. Of these, up to 15% - or 45 million people worldwide - will have a toe, foot or leg amputated due to diabetes.

For these people, a new Cuban treatment using recombinant human growth factor offers hope.

“Diabetic foot,” whereby a neuropathic or ischemic foot ulceration incapable of self-repair leads to lower extremity amputation (LEA), affects between 5% and 15% of diabetics and is the number one cause of non-traumatic amputations. Furthermore, life expectancy following amputation is only five years. Reports have shown that surgical and pharmacological treatment cannot entirely obviate LEA, while education and prevention can only limit the occurrence of non self-repairing foot ulcers. Into this clinical picture steps the Cuban product called Citoprot-P, developed by the Center for Genetic Engineering and Biotechnology (CIGB) in Havana.

Based on the human epidermal growth factor (rHuEGF), Citoprot-P helps stimulate scar tissue growth in third- and fourth-stage non-healing ischemic ulcers; the lyophilized injections – administered three times weekly over five to eight weeks - successfully regenerated epithelial tissue in 85% of the 41 patients participating in Phase II trials, according to Dr Calixto Valdés of the National Institute of Angiology and Vascular Surgery. In the second half of 2005, the treatment will enter Phase III clinical trials in angiology departments in Cuban hospitals nationwide. In Cuba, 50% of amputations (about 3,000) each year, are caused by diabetic foot.

Although surgical interventions for diabetics with non-healing foot ulcers caused by osteomyelitis (bone inflammation) exist, there is no pharmaceutical therapy on the market similar to Citoprot-P. “This is science providing an answer for an important health problem not only in Cuba, but also in many countries of the First World,” said Dr Luis Herrera, director of CIGB. Clearly, prevention of diabetes remains the ideal, but in the meantime, proper intervention with surgical procedures or pharmacological therapy with products such as Citoprot-P, offer hope for diabetic foot sufferers.