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But health officials, working closely with family doctors and educators, are determined to curb Cuba's addiction through an aggressive new anti-smoking campaign. As part of the global anti-smoking project by the World Health Organization to reduce the number of smokers worldwide, Cuba has begun implementing new measures to convince 200,000 people to kick the habit. An aggressive education campaign in schools and the media is already in full swing and no-smoking signs are popping up in offices, universities and other public spaces in an effort to expand smoke-free areas. On October 1, cigarette packs appeared emblazoned with more strident public health messages.
Other measures already in place in accordance with the WHO's Framework Agreement for the Control of Tobacco, to which Cuba is a signatory, include prohibiting sales to anyone under 16 and the regulation of advertising and promotion of cigarettes. In practice such rules have traditionally been flaunted - much like the no-smoking signs; in Havana, teenagers are regularly seen buying cigarettes below a fun, flashy ad pushing the new cigarette. Indeed, according to a government study, teenage smoking is on the rise, nearly doubling from 6.6% in 1990 to 13% by 2001. An estimated 3.25 million Cubans - just under a third of the population - are cigarette smokers and 30% of deaths each year are caused by smoking-related diseases including cancer, heart disease and cerebrovascular problems. Experts estimate that some 5 million people die worldwide from smoking-related diseases at a cost of US$200 billion annually. For complete details on the WHO´s Framework Agreement for the Control of Tobacco, visit http://www.who.int/mediacentre/news/releases/2003/pr21/en/ Cuban Doctors Give ‘Help with Dignity’
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In the ballpark or on the bus, sometimes even in hospital lobbies, Cuban air has a distinctive, smoke-flavored quality. Indeed, anyone who has visited the island can attest that smoking is virtually everywhere. 
 Two of over 45,000 Haitian patients attended by Cuban medical staff in the wake of Tropical Storm Jeanne |
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 Hundreds of thousands were left homeless in Gonaives, complicating public health efforts |
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 Despite challenges, Cuban doctors and medical specialists continue their work in Haiti |
The Cuban ambassador in Port of Prince, Rolando González Gómez, told Medicc Review since the storm almost completely flooded Gonaives, the Cuban medical team there has attended to over 45,000 patients, free of charge. He said they have given over 3,620 vaccinations to children and pregnant women who are the most vulnerable to possible epidemics.
The Cuban medical team is not alone, but they appear to be carrying the heaviest weight. Although a flurry of international aid and personnel arrived directly after Tropical Storm Jeanne ravaged Haiti, the aftermath and long recuperation period sees much fewer aid workers. Oxfam, Catholic Relief Services, and the French Red Cross have temporarily pulled out of Gonaives because of growing violence there. Many aid workers said they didn’t want to take the risk.
The Norwegian Red Cross has set up a field hospital where two Norwegian doctors and three Canadian doctors are working side by side with 25 Cuban medical personnel. In the poor district of Raboteau there are 15 Cubans taking care of the sick and injured, whereas the rest of the Cuban team is in several areas where the homeless are concentrated.
The Cuban assistance goes beyond direct medical care, to shore up the Haitian health infrastructure and carry out general disease prevention efforts. After the storm, Cuban electromedicine engineers and technicians went to work repairing medical equipment and machinery at health facilities. And Cuban health professionals continue health education campaigns begun before the tragedy, especially important now, as the severe flooding has worsened already poor hygiene conditions. A Haitian government official who asked not to be named praised the Cuban teams: “The Cubans are giving real help with dignity and respect for the Haitian people,” she said, adding “help like this is help that lasts.”
After the arrival of another group of students last month, there are now some 600 young Haitians studying medicine on scholarship in Cuba, and the hope is that they will return home to take the place of the Cuban doctors in Haiti now. The first 128 are expected to graduate next summer.
Gerontovida 2004 Conference:
Health Care for Seniors
From October 4 th to 9th, Havana hosted “Gerontovida 2004,” which included the 3rd Central American and Caribbean Congress of Gerontology and Geriatrics, the 6 th National Congress of Gerontology and Geriatrics, the 12 th International Seminar on Attention to the Elderly, the 2 nd Ibero-American Meeting on Geriatric Nursing and the 4 th International Meeting of Elderly persons.
“ Cuba is one of the few countries in the world with a comprehensive, integral program of attention for the elderly” |
Professor of Medicine, President of the Cuban Society of Geriatrics and Gerontology ( http://www.sld.cu/instituciones/gericuba/socgg ) , and President of the Organizing Committee , Doctor Osvaldo Prieto Ramos spoke with MEDICC Review following the Congress. In his opinion the “most important and fundamental aspect of the Congress was the broad exchange of ideas and in-depth discussions amongst the specialists in attendance, specifically in relation to the comparative study of aging in different countries and the factors linked to social and/or economic context and each country’s respective health care system.”
Over 500 delegates from countries including Mexico, Portugal, Venezuela, Panama, Nicaragua, Chile, Peru, El Salvador, Uruguay and others, were in attendance. Topics covered during the 5-day event included the Aging Process in Latin American Populations, Satisfactory Longevity and the Cuban Program for Older Adults ( Programa Cubano de Atención al Adulto Mayor; http://www.sld.cu/instituciones/gericuba/paamc/ ).
Cuba is one of the few countries in the world with a comprehensive, integral program of attention for the elderly, thanks to the particularities of it’s health care system and, especially the family doctor and nurse program and the newly renovated polyclinics with their rehabilitation services. This approach to primary care has enabled Cuba to attend to the elderly in their communities allowing them to retain higher levels of dignity, independence and psychological health. Only 0.5% of Cuba’s elderly are hospitalized and/or institutionalized which is not only positive for the elder individual, but is less costly to society as well.
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Free, accessible services for the elderly are in the communities where they live | |
Community-based health promotion services and diagnosis and treatment when needed are all easily accessible and available near the seniors’ homes. Most seniors greatly prefer living at home with family, in neighborhoods they know.
Currently in Cuba, some 1,600,000 people (14%-15% of the population) are over 60 years of age, a figure which is steadily increasing. Life expectancy has risen notably, and many even urgent care needs are now met in the local/municipal intensive care units, located in or near the neighborhood polyclinic.
Dr. Prieto also told MR that the current medical school curriculum has added course material on geriatrics and that slowly, but surely, consciousness in relation to the special characteristics of old age and aging is growing.
Cuba also presented it’s innovative pilot program currently being tried in several provinces, whereby seniors who live alone - 11% to 13% of the over-60 population - are visited regularly and provided with assistance throughout the week. “More than 96,000 elders have benefited from the policy of home hospitalization and/or regular home visits made possible by the presence of community-based medical personnel and social work programs,” according to Dr. Prieto.
Cuba boasts over 14,000 “senior clubs” and 174 live-in facilities for the elderly. However, there is a strong cultural norm in Cuba about taking care of one’s elders, which is far more comfortable for the senior citizen. Geriatric and gerontology clinics are growing steadily throughout Cuba, with specialized rehabilitation and physical therapy services offered to those who wish to stay active.
Cuban Health Care Saves British Boy
“Blake’s salvation was coming to Cuba for vacation!” averred Dr. Josefa Mar González, pediatric neurologist at the “Octavio de la Concepción y de la Pedraja” Pediatric Hospital in the capitol city of the eastern province of Holguín. Speaking outside the Intensive Care Unit where Blake was hospitalized, Dr Mar went on to describe the medical situation of the young British boy whose life was saved last month while on vacation in Cuba.
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Dr. Josefa Mar González, chief neurologist at the Octavio de la Concepción y de la Pedraja Pediatric Hospital in Holguín |
Eight-year old Blake traveled to Cuba with his parents and two brothers for a family vacation at the Guardalavaca resort in Holguín province. On the way to the hotel from the airport, Blake went into severe convulsions and lost consciousness. He was rushed first to the emergency room and then the ICU of the pediatric hospital.
A multidisciplinary team of medical experts diagnosed the neurological disorder afflicting young Blake and were able to save his life. The boy required emergency surgery to alleviate a cerebral obstruction impeding the proper drainage of cerebral spinal fluid.
The team of experienced doctors diagnosed the condition which had been the cause of similar convulsive crises previously, but considered a mystery by the family’s health care providers in Britain.
 Blake and his mother in the intensive care unit of the Holguín Pediatric Hospital, after Blake’s surgery. |
Brian Murton and his wife, Karol Mary said they had taken Blake twice for medical consultation in South Humberside in England because he suffered repeated “attacks” or “crises” involving uncontrollable trembling, involuntary hand movements and occasional mild ataxia.
The medical recommendations they were given was to ensure that Blake went to the bathroom frequently, until the condition disappeared on it’s own.
Both parents have expressed their deepest appreciation and gratitude for the dedicated and expert care received by Blake and indeed the whole family. Blake’s father, Brian has said that he will return to Cuba whenever any member of his family has a health problem, and re-iterated his satisfaction with the way in which his son’s case was handled.
This article was compiled from the following sources:
Holguín Weekly, Ahora , October 2, 2004.
Granma International, September 28, 2004.
Televisión Cubana in Holguín, www.aldia.cu.
Radio Angulo, September 30, www.radioangulo.cu.
MEDICC at National Summit on Cuba:
Embargo Harms US People, Too
The ‘collateral damage’ of Washington’s 43-year-old embargo on Cuba is none other than the health of ordinary American citizens. So argued Dr. Peter G. Bourne, MEDICC Board Chair, in his plenary presentation to the National Summit on Cuba, held in Tampa, October 8 th.
“Now Cuba has important (medical) products to offer the world,” he said. “And where previously the victims of the embargo were the Cuban people and to some extent US pharmaceutical and agro-business interests, now the victims are also the American people who are denied access to the products derived from Cuba’s medical breakthroughs.”
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Americans are denied access to Cuban medical breakthroughs. |
The best known example of Cuba’s contribution to global health, he said, was their development, in the mid-eighties, of the world’s first effective vaccine against meningitis B. “This resulted in the virtual elimination of the disease in Cuba, while several hundred young people a year were, and still are, dying of the disease in the USA,” noted Dr. Bourne. An agreement was struck in July 1999 between Havana’s Carlos Finlay Institute and Britain’s SmithKline Beecham, giving the latter worldwide rights to sell the vaccine after clinical trials - some of which depended on labs owned by US subsidiaries, hence requiring US government blessing. Although the US Treasury Department initially denied the license request, two years of perseverance and negotiations finally won approval, with a catch: the clinical trials could only be held in the USA after they are completed in Europe and elsewhere - further delaying the vaccine to US children.
“…the loosening of the embargo on food sales was never applied to the sale of medical equipment, medications or hospital supplies…law still requires a (licensing) process so full of red tape that manufacturers have laughed it off as a waste of time and money.” |
Such delays are also caused, said Dr. Bourne, by the US embargo provision that prevents Cuban institutions from participating in clinical trials for US-made drugs. Such was the case, he charged, in recent clinical tests on a drug for sickle cell anemia patients. Test designers estimated that Cuban participation in the trial would have brought the medication to market at least a year sooner, since they could have drawn on the island’s national registry of all sickle cell patients (which the US does not have). “In the end,” he said, “the losers again are ordinary American citizens.”
The day-long Summit heard from a bevy of pubic figures and analysts, including U.S. Congressmen William Delahunt (D-MA) and Jeff Flake (R-AZ); (Ret) General John Sheehan, former NATO Commander; Wayne Smith, former Chief of the US Interests Section in Havana; Kirby Jones of Alamar Associates; Alfredo Duran, Cuban Committee for Democracy; Marvin Lehrer of the USA Rice Federation; Emily Morris of the Economist Intelligence Unit; and Pete Peterson, former US Ambassador to Vietnam.
Their call was unanimous for an end to the US government’s ban on American travel to the island, and they had particularly harsh words for President Bush’s June measures, which in addition to further restricting academic travel (see MEDICC press release at www.medicc.org), limit the rights of Cuban-Americans to visit their families in Cuba and send family remittances to loved ones. “This is the most counterproductive and illogical policy to date,” charged Dr. Wayne Smith, “These measures won’t bring down the Cuban government, but they are punishing Cuban-American communities, and they have virtually eliminated academic travel.”
Dr. Bourne and many other speakers addressing the 240 people gathered at the University of Tampa Grand Salon called for normalization of trade relations between the two countries, and a total lifting of embargo sanctions. “The policy of embargo is wrong and unnecessary,” said Gen. Sheehan, “and as someone who has walked the fence lines (at Guantánamo Naval Base)…I can say I think it’s time we rethink what we do. It’s time to take down that wall.”
The wall has only been partially taken down since a Clinton Administration decision permitted food sales to Cuba, which have amounted to $890 million to date, according to Chris Aberle, FC Stone, Minneapolis. Today, Cuba is the USA’s 3 rd largest market for rice, and whereas Cuba once ranked dead last in US imports, the country now ranks 23 rd overall as a market for US foodstuffs. Speakers at the conference estimated that each one billion dollars in exports to Cuba creates 19,000 jobs for Americans back home.
However, the wall is still standing, argued Dr. Bourne, when it comes to medical exports. “Contrary to the popular view,” he said, “the loosening of the embargo on food sales was never applied to the sale of medical equipment, medications or hospital supplies. Not one iota of language was changed in the law that still requires a (licensing) process so full of red tape that manufacturers have laughed it off as a waste of time and money.”
“In fact,” said Dr. Bourne, “Washington bans free trade in medicine and pharmaceutical supplies. And Cuba goes elsewhere - to U.S. competitors. For Cuba this is a problem since it has little or no access to cutting-edge US technology that literally saves lives. There are US companies that manufacture generic drugs at very competitive prices. Cuba is an obvious and not insubstantial market. The same is true for top-of-the-line cancer drugs, certain drugs for HIV/AIDS and the latest antibiotics.”
Emily Morris of the Economist Intelligence Unit presented economic data, showing that despite the embargo, “Cuba’s performance since 1993 has been better than Latin America’s, and has arrived at the same end point as the transition economies (of Europe).” She continued that “the forecast for Cuba in the context of Latin America is at the top end, among the stronger performers in the region.”
South African Med Students
Hit the Ground Running
By Gail Reed
Thirty-three South African medical students returned to their country in October to begin internships early next year in hospitals and communities of their home provinces. They received their first five years of medical training in Cuba, under a 1997 agreement between the two countries, and are expected to graduate in December, 2005, after their year as interns.
The accord specifically provides South African government scholarships to students from previously under-served communities in both rural and urban South Africa. The 33 interns come from Gauteng, KwaZulu-Natal, Mpumalanga, Limpopo and North West provinces, joining others from the Eastern Cape.
In Cuba, 333 South African students are located on two medical school campuses: in the provinces of Cienfuegos and Villa Clara. They spend their first year in Spanish language, computer sciences and pre-med studies, and then are integrated with Cuban students for both their basic sciences and clinical years. Eight have become MDs after a sixth year in South Africa; and 18 more are slated to write their exams this December.
 South African medical students at the Higher Institute of Medical Sciences, Villa Clara Province, Cuba. Nontambeko Sweetness Kunene second from left. |
Nontambeko Sweetness Kunene, who spent five years in Villa Clara, is now back in the Eastern Cape. Before she left for home, she told me why she decided to study medicine in Cuba: “As a child, I saw glamour in the white coat. And then again, I was sick many times growing up, so I began to get used to seeing doctors. In school, I began to like science and medicine. But I also realized that there was only one doctor for our whole region. People had to go very far to see him, stand in long lines - sometimes even sleep on the clinic doorstep. In my family, I lost two brothers to meningitis, yet they could have been saved if we had been able to get them immediate medical attention. But the doctor was too far away. So, most of all, I realized that our people need doctors.”
On graduation, the new doctors must work in the South African public health sector for as many years as they studied in Cuba, which Sweetness Kunene says is all right with her. “We signed a contract to that effect. And what’s more, we’re willing to work where we are most needed. It’s about serving the community. I think being a doctor is not just a profession, after all - it’s more like a calling, and so you go where you are needed.”
That’s part of what she says she has learned in Cuba. “The most important thing is that health care should be based on the patient, not just on the disease,” she said. “So, what I have learned here in Cuba is to see the patient as a person first, in a holistic sense. And the training here is very good, very hands-on; I feel very well prepared.”
Doctors Save Severely Burned
Pregnant Woman and Baby
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New mother Yurelis, with burn specialist and ob-gyn at Holguín’s Lenin Hospital, Cuba |
Holguín Province , Cuba - Here in Eastern Cuba, Yurelis Cáceres Torres is recovering from her brush with death when a household accident left severe burns over 75% of her body. At the time - August 9 th - she was 37 weeks pregnant. Under these conditions, saving mother and child is a rare occurrence, even in today´s high-tech medical world, but this November, Yurelis celebrates her daughter´s third month and the Cuban physicians at the Lenin Hospital in Holguín are rightfully proud.
After initial treatments for Yurelis’ burns, an emergency Caesarian section was performed since fetal heart distress was already detected. The newborn - named Clarinellis - initially presented some of the usual complications in such cases, but reacted positively to treatment and is now at home and in perfect health, according to her doctors.
The hospital’s burn team worked intensely to save the mother’s life, first assuring rehydration, and then seeing her through various surgeries, including five skin grafts.
 Baby Clarinellis with her neonatology nurse just before going home |
The international literature indicates that burns sustained during pregnancy increase mortality and morbidity for both mother and infant. Unfortunately, studies of such cases are relatively rare, as is follow-up of surviving infants. Obstetrics textbooks do not generally deal with burns in pregnancy, nor is the topic considered in most books devoted to burn treatment.
However, medical scientists agree that successful treatment for both mother and the fetus is extremely difficult, because of the triple coincidence of the following factors:
- The gravity of sustaining severe burns over a high percentage of total body surface area (TBSA).
- Pregnancy itself, with all its physiological implications.
- The negative effects of burn lesions on fetal well-being.
Studies published in the Annals of Burns and Fire Disasters, official publication of The Mediterranean Council for Burns and Fire Disasters (MBC) ( http://www.medbc.com/ ), WHO Collaborating Centre for Prevention and Treatment of Burns and Fire Disasters, refer to improvement in maternal and fetal survival over the decades, but reiterate that both maternal and fetal mortality increase with the burn size and the presence of inhalation injuries. (1, 2)
Yurelis’ case in Cuba is one of the few reported worldwide – and one of fewer still where burns were sustained over 75% of total body surface area - with a happy ending.
References
- Still J.M., Law E.J., Gooding J. et al., Effect of Burns on Maternal and Foetal Outcome in Pregnancy.Annals of Burns and Fire Disasters , June 2004;17 (2) (http://www.medbc.com/annals/review/vol_17/num_2/text/vol17n2p73.asp)
- Napoli B., D'Arpa N., Masellis M. et al., Burns in Pregnancy. Annals of Burns and Fire Disasters , March 2000; 13(1) (http://www.medbc.com/annals/review/vol_13/num_1/text/vol13n1p18.htm)
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