What's New at MEDICC
MEDICC Launches New CAM Elective
By Diane Appelbaum, RN, FNP, MS, U.S. Director

n February-March of 2003, MEDICC offered its first Clinical Elective in Natural and Traditional Medicine (NTM)  (Complementary/Alternative Medicine, or CAM).   During the 5-week pilot elective, nine students rotated among  sites in Havana, Camagüey and Santiago de Cuba provinces.  They hailed from medical schools at the University of Minnesota, NYU, Albany, UCLA, University of Pittsburgh, Baylor, Ohio State and the University of Wisconsin. 

Dr. Romulo Rodríguez, Rector of Camagüey’s Provincial Medical School, is the director of Cuba’s national Master’s Degree program in NTM, and his contribution to developing the MEDICC elective was especially important.  Dr. Leoncio Padrón, Director of the Ministry of Health’s  Department of Natural and Traditional Medicine, offered students an overview of how natural and traditional medicine has been incorporated into primary and secondary medical care in Cuba, and into medical education. 

CAM Elective students observing cataract surgery, with acupuncture used for anesthesia (see inset).

Students then observed a range of approaches in clinical practice, including acupuncture, electro-acupuncture, homeopathy, magnetic therapy, herbal therapy and massage therapy.  The group also visited gardens producing medicinal plants, and  observed cataract surgeries with acupuncture anesthesia only.  The involvement of the Cuban medical students in Camagüey and Santiago de Cuba contributed to make this a wonderfully successful MEDICC elective.   I served as the group facilitator and evaluator of the elective for the entire five weeks, and witnessed the academic expertise and attentive efforts on the part of Cuban professors.  In addition to Dr. Romulo Rodríguez, special thanks to the  Dean, Dr. Carmen Labrada, and to Dr. Machado and Lic. Maria de Luz Fernandez (Marilú) who coordinated the academic program in Camagüey.   In Santiago, our thanks to Dr. Carolina Placencia, and in Havana Lic. Grisell Perez and Lic, Michel Alpizar, both faculty at the National School of Public Health. 

CAM Elective students with Deepak Chopra, MEDICC U.S. Director Diane Appelbaum, and faculty from the Carlos J. Finlay Medical School, Camaguey, Cuba: Dr. Sosa, orthopedic specialist (far left) and Dr. Romulo Rodriguez, Rector (4th from left). On the far right is Dr. Marlén Rodriguez, internist and specialist in NTM at the Joaquín Albarran Teaching Hospital, Havana.

Here’s several comments from students who completed this elective:

I have a better knowledge base on which I can rely in telling my patients about these modalities.  It has also sparked an interest in learning more back in the U.S. about how practitioners integrate healing practices into allopathic medicine.

I was impressed at how integrative medicine in Cuba is for all… and also the degree of acceptance and practice by many physicians.

I acquired insight into how powerful certain non-invasive techniques can be to help chronic conditions (specifically meditation, yoga, and auricular therapy)

During the last weekend of the MEDICC CAM Elective, their program included several sessions of a Conference in Havana sponsored by Cross Cultural Journeys.  The Conference, entitled “Journey Into Healing:  Training in Mind Body Medicine and Ayurveda,”, was offered by Deepak Chropra, M.D and David Simon, M.D.  Conference participants also included several of the key  faculty from Havana and Camagüey who taught in the MEDICC Elective.

As a result of the success of this pilot elective, MEDICC is pleased to announce that the Clinical Elective in Natural and Traditional Medicine (NTM)  will be offered on a regular basis, beginning in 2004 (February 1 through March 6, 2004—hold those dates!).

PAHO Awards fro Cuban Academic Council Members 

Two Cuban members of MEDICC’s Academic Council—Professors Alejandro García Gutiérrez and Ernesto de la Torre-- have been honored with the “Public Health Distinction” by the Pan American Health Organization.  The distinction, awarded on the PAHO centennial, was bestowed citing their “scientific and social contribution to Cuban public health”.  The 24 Cuban health professionals who received the distinction also included such prestigious figures as Dr. Rubén Rodríguez Gavaldá, Dr. Francisco Rojas Ochoa, Dr. José A. Gutiérrez Muñíz and Dr. Eugenio Selman.  Our congratulations!

	At left, Eileen Lake and Linda Aiken join Marla Salmon (center) and Maricela Torres (right) for a photo with nursing staff at the Puentes Grandes Community Polyclinic in Havana.

Emory Dean of Nursing Joins MEDICC Seminar

Marla Salmon, ScD, RN, FAAN, Dean of Emory University’s Nell Hodgson Woodruff School of Nursing, worked with MEDICC to organize a Seminar in Nursing Education, which brought Dr. Salmon and two colleagues to Cuba earlier this year--Eileen Lake, PhD, MSN, BS, Assistant Professor, School of Nursing, University of Pennsylvania, and Linda H. Aiken, PhD, Professor of Nursing and Sociology, also of the University of Pennsylvania.  They presented on several topics of interest to Cuban nursing faculty, practicing nurses and other health professionals, including Perspectives on Post-Graduate Education for Nurses, Organization of Work and Nurses’ Job Satisfaction: Results of a Study in Five Countries and Results of a Study on Care for Patients with HIV/AIDS in 30 U.S. Hospitals. The seminar, organized on the Cuban end by the National School of Public Health and its Nursing Leadership Department, offered the U.S. faculty an overview of nursing’s role at all levels of the Cuban health system, and the development of new post-graduate opportunities for nurses. 

In January,  MEDICC  also sponsored a Seminar in Public Health and Clinical Medical Practice at the initiative of Dr. C. William Keck, Associate Dean for Community Health Sciences at the Northeastern Ohio Universities College of Medicine (NEOUCOM), and member of MEDICC’s Academic Council.  Dr. Robert Blacklow, outgoing Dean, several faculty and one student joined the Seminar, which included a wide range of site visits and opportunities for dialogue, intended to illustrate the integration of clinical medicine and public health principles in Cuban medical practice.   

	Emory nursing student presents book donation to Dr. Esther Baez, Director, Women’s Health Studies, and to Dean Cristobal Mesa, Matanzas Provincial Medical School.

MEDICC Practicums: Harvard and Emory Universities

In January,  MEDICC offered Practicums to students and faculty from the Emory School of Nursing and Harvard School of Public Health.  This was the second MEDICC course for each school,  and further fortified MEDICC’s collaborative programs with both.  The Emory group spent one week at health facilities in Havana and Matanzas Province.  At the Matanzas Provincial Medical School—hit last year by Hurricane Michelle—the group presented a donation of medical textbooks to help replenish the stacks destroyed in the storm.  But perhaps what students enjoyed most was the special program, offering them a chance to dialogue with Cuban nursing students at the Julio Trigo School of Medical Sciences.  

The three-week Harvard program  offered theoretical background and observational learning experiences on public health practices and programs in Havana and in Villa Clara Province.  Harvard students rated highly their case conferences with health professionals in the mountainous community of Jibacoa.   Some student insights after the practicum:

“It was impressive to the integration of the health system with other sectors of society—education, agriculture, culture, women’s federation, etc.”

“Limited resources need not limit patient care.”

“I believe there are elements of the Cuban health care system that could be practiced in developed countries and it might be useful to experiment with these through local pilot projects in underserved communities.”

	Harvard students and faculty with Cuban medical students in Villa Clara Province.

In March, MEDICC greeted  students and faculty from Rollins School of Public Health, Emory University, whose Practicum included a seminar and conference with Cuban doctors who have served in developing countries, and site visits to clinical and public health facilities in Havana and Matanzas Province.  Participants were enthusiastic about their experiences and offered ideas on how to apply what they had learned in Cuba:

The Cuban health care system has shown me the importance of prevention and also the benefit of good patient-doctor communications.  An insight I have gained is the method used to inform the public of public health issues at an early age; providing this information in elementary school.

My belief in health as a right has been reaffirmed.  I will strive to keep the human solidarity as a focus as I continue my work in public health.

MEDICC Practicums: Michigan State, Wisconsin Medical Schools

Seventeen medical students and a faculty member from Michigan State University School of Human Medicine participated in a MEDICC Practicum in March.   This first trip for Michigan State students was organized  by Heather Costello, a medical student “MEDICC alumnus” from the 2001 program jointly organized with the American Medical Student Association (AMSA).  The group gave high marks to the time they spent in Cuba’s primary care facilities:  polyclinics and family doctor’s offices, and in seeing the integration of natural and traditional medicine into Cuba’s public health care system. 

University of Wisconsin medical students join in exercises at the 10 de Octubre Hospital Pain Clinic.

In late March, sixteen students and faculty from University of Wisconsin Medical School-Madison,  participated in a Practicum with MEDICC.  This was the second year that Lynne Cleeland, MS has organized a program with MEDICC.   This spring, two other faculty members accompanied the group: Dr. Javier Nieto and Dr. Ann Behrmann.  The Wisconsin group had a full program in its short week in Cuba, including  a field experience in Camagüey Province.  Some of their insights:

I found especially helpful the chance to observe and exchange with health providers in Cuba, especially going to the family doctor’s “consultorio” in Camaguey.

I have learned many things that I can integrate into my future practice as a physician.  I learned about the importance of active patient education (e.g., creation of murals at the maternity home), the inclusion of natural and traditional medicine in the care of a patient and the importance of preventive medicine.  The experience in Cuba has given me many ideas as to how I can treat my patients and develop strong relationships with them.

Residency Rotations

During the first half of 2003, 14 residents have rotated through several specialties, including Family and Internal Medicine, Pediatrics, Obstetrics, Psychiatry  and Emergency Medicine.  During our individualized academic rotations, residents are able to work closely with Cuban physicians in the community.  MEDICC’s collaboration with Yale University Family Medicine Residency Program is expanding, and providing a model for cooperative arrangements with other schools throughout the country.

New Nursing Elective in 2004…

MEDICC will be offering a four-week Community Nursing Elective in the summer  of 2004 (June 20-July 17, 2004).  Maricella Torres, RN, MPH, Director of MEDICC programs at the National School of Public Heath, is collaborating with MEDICC in developing the curriculum.  MEDICC is fortunate to have a broad base of expertise to draw upon, from Dean Salmon at the Emory School of Nursing, and from other members of the Seminar in Nursing Education (see above).   We anticipate accepting up to 15 undergraduate and graduate nursing students from U.S. Schools of Nursing for this pilot elective.  Write to me if you are interested: dappelb@emory.edu.  More will be posted on the website soon!