Health News from Cuba
PAHO: Cuba Proposed as Site for Regional Fight Against Dengue
n
recognition of Cuba’s 72-day successful battle last year against dengue
fever and its Aedes aegypti mosquito vector, PAHO’s representative in
Havana has proposed that the country be the site of a WHO/PAHO Regional
Collaborating Center on Dengue. The proposal from Dr. Patricio
Yépez was made at a national scientific gathering to commemorate one
year of “dengue-free” Cuba, after Havana and several other provinces affected
were rid of new cases, the result of a monumental effort that initially
involved 11,000 health workers and eventually grew to over 300,000 health
professionals
(with family doctors and nurses leading the way), students, journalists,
community health promoters, firemen and health inspectors. Dr. Yépez
noted that this experience deserved to be shared with other countries
of Latin America and the Caribbean, in the tradition of Cuba’s international
commitment in health.
Aedes aegypti, the culprit identified by Cuba’s own Dr. Carlos J. Finlay as the vector of yellow fever (in a classic scientific dispute with Dr. Walter Reed), has brought both dengue and hemorrhagic dengue to 50 million people worldwide, with over two-fifths of the world’s population at risk—making it no longer a “tropical disease”, but rather an “emerging disease” in international health parlance.
Last
year’s bout with the mosquito and dengue fever in Havana and a few outlying
provinces began on January 11th, when Havana registered infestation
of .6%. Door-to-door teams went to work, beginning in the most heavily
affected neighborhoods, inspecting homes for the kind of clean, standing-water
environment the larvae thrive in; fumigation of buildings and streets
was immediately begun on a systematic basis; television and radio spots
went on the air, reminding their audiences to do everything from turn
over the buckets on their back porches to change the “spiritual waters”
in their homes. Students—junior high school, high school, medical and
social work students in particular—played a key role in community education
and inspection.
By the end of February, no new cases were being reported in metropolitan Havana, Havana countryside, Pinar del Rio, Las Tunas, Santiago de Cuba or Guantanamo provinces, where dengue had been detected. By the end of March, 2002, the infestation rate dropped dramatically: today it stands at .02% for Havana, and .04% for the country as a whole.
The secret, of course, is to keep it that way. Dr. Elia Rosa Lemus of the Council of State, a family doctor with significant experience in the fight against dengue from her days in El Salvador, and a leader of the Cuban campaign, said that now Cuba must begin the real battle: to keep the country free of the mosquito and free of the disease over time. This challenges us, she said, to expand our notion of “guardians of health”—to prevent in the broadest sense, and to be protectors of life.
National Survey of Disabled Persons Under Way
Cuban health professionals are carrying out a national survey of physically disabled persons, which should be completed in the next few months, and which is designed to serve as the basis to provide them with improved and more consistent attention to their specific needs. Family doctor-and- nurse teams, geneticists and other specialists, local government and community organizations are involved.
Included in the program is a study of cases of mental retardation in each municipality in the country, and the pattern of causal factors, including environmental problems, alcoholism, consumption of alcohol during pregnancy; intermarriage of close relatives, and difficulties during labor. The clinical genetic disorders studied include Usher’s Syndrome, Norris disease, congenital cataracts, congenital glaucoma, rubellic embriopathy and others.
Sweeping Changes in Cuban Health Care: Moving Key Services Closer to Home
Cuba’s 444 community-based polyclinics have traditionally provided the main primary care services referred by neighborhood family doctors—with pediatricians, ob-gyn’s, internists, psychologists and other primary care specialists on staff.
In line with major efforts to bring other services closer to patients’ homes, a number of these clinics in each municipality are being equipped to take on more responsibilities: emergency services, with physicians on call 24 hours a day (including capabilities to handle cardiovascular emergencies with Cuban-produced drugs such as recombinant streptokinase); more sophisticated clinical laboratories capable of diagnosing specific allergies; orthopedic services; minor surgery; radiology and ultrasound; endoscopy; optometry and ophthalmology services, among others. In addition, by the end of this year, all 444 polyclinics are expected to be outfitted with electrocardiography capabilities and to offer physical therapy and rehabilitation services.Sophisticated services are also being brought closer to chronically ill patients as well: steps are being taken to establish 19 new hemodialysis services for patients with chronic renal insufficiency.
Steps are being taken to set up new dental services, and also to improve the resources and quality of existing dental clinics.
Four new important centers for cardiovascular surgery for adults are being set up in Santiago de Cuba, Villa Clara and the City of Havana, and new diagnostic centers in the 14 provinces.
Post-graduate courses for primary care physicians and nurses are being offered in 373 subjects, with the participation of 23,733 doctors and 10,718 nurses. The courses are taught by medical school professors and other specialists. The aim is to more fully prepare these health professionals to prevent, treat and solve a greater number of health problems at the community level.
2nd Forum on HIV-AIDS in Latin America and the Caribbean
The 2nd Forum on HIV-AIDS in Latin America and the Caribbean took place in Cuba on April 8-12, with over 1,300 delegates. Dr. Peter Piot, Executive Director of UNAIDS and Deputy Secretary General of United Nations, opened the gathering with his lecture From Planning to Implementation: Facing AIDS in the Americas.
In his address, Dr. Damodar Peña, Minister of Public Health of Cuba, explained how Cuba has been able to maintain the lowest prevalence in America of persons living with HIV: 0.05% of the population between 15 and 49 years old. He also referred to the alternatives offered to patients, including both out-patient and sanatorial care; and the fact that Cuba has begun producing antirretroviral drugs, allowing the health system to provide treatment for all AIDS patients at no cost to them. From 1986—when the first case of HIV was diagnosed in Cuba--until April 4, 2003, 4,699 seropositive persons have been diagnosed with HIV, of which 2,097 have developed AIDS and 1,063 have died.
Dr. Peña referred to the experience accumulated over the years by Cuban health professionals and scientists, and Cuba’s offer to cooperate in the struggle against AIDS in Africa and the Caribbean, providing human resources in the hopes that economically powerful nations and organizations would be able to provide financing for medications and other needs. He reported that, since 1963, over 52,000 Cuban health workers have served in 92 countries; and currently 4,423 are working in 64 nations.
Polio Vaccination Campaign
From
February 21 to 27, 2003, Cuban health authorities carried out the 42nd
National Polio Vaccination Campaign. Approximately half a million children
younger that 3 years (from 30 days old to 2 years, 11 months and 29 days)
were vaccinated simultaneously across the island.
These campaigns have been carried out in Cuba for the last 40 years. In 1962, Cuba was declared free of polio. Today, polio is one of 13 childhood diseases against which Cuban children are immunized.
