US Blockade on Cuba Hurts the Island's Health System

The economic, financial and trade blockade the US Government on Cuba has caused the island''s health system damages for over 2.5 billion dollars in almost 60 years, its Foreign Ministry upholds.

In its report for the upcoming 2018 session of the UN General Assembly, the Cuban government sustains the most serious damages arise from the hardships to purchase medications, instruments, spare parts for medical equipment and consumables needed for the sector's functioning.

The report is attached to a resolution Cuba will submit once again to the General Assembly to demand the end of the US hostile policy that has been condemned by the international body for the past 25 years.

It explains the hardships arise from having to make purchases in faraway markets and in many occasions through middlemen, and this causes prices to rise.

This generates suffering and desperation among patients and relatives alike for not having the proper medication for the adequate treatment of an ailment or to save a life, a human pain that is unquantifiable, the report stresses.

It mentions that MediCuba, an importing and exporting agency, sent requests during the past year to 30 US pharmacological companies to purchase medications and consumables, but only got replies from two, Agilent and Cook Medical, but both answered that according to blockade restrictions they were unable to make sales to Cuba.

Among the items MedicaCuba was trying to purchase was Temozolamide, a medication to treat malign brain tumor, or Evolucumab Repatha, designed to treat high cholesterol in high risk patients.

Next October 31 the UN General Assembly will debate and put to vote the Cuban resolution that demand the end of the blockade.

Since 1992, the initiative has been supported and voted by most of the international community. In the past three years 191 of the 193 UN member nations voted in favor of the Cuban resolution. In 2017, only the US and Israel voted against it.

  • Published in Cuba

SA needs Cuban medical model

In July, 1,000 more South African medical students who have spent five years studying medicine in Cuba will return to complete their sixth year, graduate and start practising as doctors.

If I had my way, I would send them all to the Eastern Cape, train them for their final year and employ them in the province once they graduate.

These are precisely the kinds of doctors needed throughout the province and country, because Cuba's excellent medical schools pursue a comprehensive approach that focuses equally on the four pillars of medicine - disease prevention, health promotion, treatment and rehabilitative medicine.

The Cuban system produces well-rounded specialist family physicians who are appropriately trained for South Africans' medical and health needs. They are trained to practise in diverse communities, from the cities to the deep rural areas.

The system also produces super-specialists, such as Dr Khanyisa Makamba, who was among the first cohort of South Africans to be trained in Cuba and subsequently went on to specialise in urology in SA. He is now head of urology at the Port Elizabeth Provincial Hospital. He could practise anywhere in the world but he has a strong social commitment and he chooses to use his skills in his home province to help the many public sector patients who cannot afford private medical care.

SA can and should learn from Cuba, where 80% of medical practitioners are comprehensive or specialist family physicians and only 20% are specialists in other areas of medicine or are super-specialists. In SA it is the reverse, with many in private practice or emigrating.

Cuba has eight medical practitioners per 1,000 population, while most westernised countries have two to three per 1,000. SA has 0.77 per 1,000, with 50% of the 0.77 practising in the private sector.

SA sent medical students to Cuba in the first instance because the country is simply not producing enough doctors. The Department of Health looked at the number of doctors produced by universities and realised that producing fewer than 2,000 doctors per year was not matching the rapid population growth and these numbers could never reach a ratio of two doctors per 1,000 population. The department therefore increased the number of doctors by sending many more students than in previous years to study in Cuba from 2012, as per the Nelson Mandela-Fidel Castro Medical Collaboration.

There was much resistance from us as medical academics regarding sending students to Cuba. One of the major reasons for this is that training in SA is mainly suited for practice in the West, hence graduates are able to work internationally. What is not adequately addressed is whether they are trained to meet the health needs of the majority in SA. And what does the majority require?

In developing the curriculum for the country's newest medical school, Nelson Mandela University has taken great pains to address this question. What has informed its curriculum, which also informed Health Minister Aaron Motsoaledi's decision to have our students trained in Cuba, is the need for medical students to be trained in a comprehensive manner. That is, not only with a curative or treatment emphasis, which is the main approach in SA, but with an equal emphasis on health promotion, disease prevention, treatment and rehabilitative medicine.

As a paediatric cardiologist and health sciences academic, I was sceptical about this approach until I visited Cuba in 2017 and the penny dropped regarding the appropriateness of comprehensive medical training to SA's needs. The efficiency and professionalism of their system speaks for itself in Cuba's health statistics: life expectancy in Cuba for the population is superb at about 80 years, while SA's is about 60 years; infant mortality is two per 1,000, while SA's is 30-40 per 1,000.

How did they get it right? Through their comprehensive healthcare system, based on the four levels of care, everyone in the health system focuses on advancing health rather than only on treating disease.

Home-based care and local clinics are efficiently aligned to polyclinics, or what are called community health centres in SA. Every polyclinic has a section of complementary medicine - including acupuncture, homeopathy and traditional medicine - and each patient is advised on the relative merits.

Every polyclinic has as a basic minimum a comprehensive or specialist family physician-nurse team and a range of health professionals, as well as necessary equipment, including X-ray machines, certain laboratory facilities and ultrasound.

These are efficiently matched with secondary hospitals (district, regional and tertiary hospitals in SA) and national institutes that specialise in specific diseases, such as neurological diseases and oncology.

There are similarities between the structure of the Cuban public health system and SA's system, but there are also stark differences, notably in Cuba's far superior level of efficiency, professionalism, staffing, equipment and national emphasis on the four levels of care.

To cover all four levels, the entire health team plays a key role, starting at the community level where it is the role of community health workers to visit every individual in their area and to ensure that every individual goes for a medical check-up at least once a year, and to identify any health issues and why, for example, they have not gone to the clinic for their regular check-up.

The Cuban community health workers know each individual personally; one community health worker looks after about 50 people in his or her community, and they know every person's health status, disease status, medication, the names of the pills, and whether they are running out of medication. They educate the patients about their health, their disease condition and the medication they are taking.

They work with a team of health professionals, from doctors and physiotherapists to psychologists and dieticians to focus on all four levels of care.

In SA, with National Health Insurance in the wings, the country has to look at new health system models, such as Cuba's. While SA is well recognised for training world-class healthcare practitioners and it is important to maintain the country's high standards, it should also introduce new populationwide approaches to health. This includes increasing taxes on substances that can undermine health, such as tobacco, alcohol and sugar.

Cuba's health system model is working. The death rate in that country is seven per 1,000. Brazil implemented the Cuban system in the early 2000s and its death rate dropped from 9.5 per 1,000 to six per 1,000 in one year (from 2002 to 2003). It now has a better life rate than the UK and the US (nine deaths per 1,000). SA's death rate is 17 per 1,000, except for the 16% of its population on private medical aids, whose life expectancy is comparable to the West.

Cuba is spending about $500 per capita per year on health, while SA spends $1,000 per capita per year. The US spend is 3,000 per capita and other First World countries are spending $1,000-3,000.

In terms of GDP, most countries spend 10%-15% on health, with the US at 15%. SA spends 8% and only half of this is spent on the 84% of the population that is without private medical aid.

The private medical aid industry has a R160bn turnover per year in SA, and this is spent on only 16% of the population.

As a nation SA has to start looking after the health of the 84% of the population in far more comprehensive, holistic ways and the four pillar system is the best population-wide and budget spend approach.

SA should therefore embrace the medical students when they return from Cuba and ensure they get the best possible reintegration assistance into medical schools throughout SA.

There is so much more SA can do to improve population health, quality of life and length of life, and these students can help the country to achieve it.

  • Published in Cuba

Cuba Contributes to Renewing Global Medicine, Said Neuro-Scientist

Cuban health system can make substantial contributions to new health trends worldwide, like precision medicine, said Professor Pedro Valdes, Deputy Director of the island''s Neuro Sciences Center.

Precision medicine represents a change of paradigm, as it is based on assessment, rules and algorithms to study the persons during all their lives and provide them with personalized care, the neuro-scientiest said at a presentation.

In his remarks, Valdes said that despite the trend gaining ground in the world, there's a big gap between rich and poor as in the developed nations it is exclusively benefiting high income people thus not turning into a major public health coverage.

However, Cuba is ideally located to serve as the intermediary between where the money is for research and those who need this kind of medicine, the doctor said.

Cuba has the experience of the family doctor and the prevention medicine approach centered on primary care, he explained, adding the island has been working for decades focused on precision medicine.

Therefore, the country has the experience to boost such medical trend and contribute to world public health, Valdes highlighted.

In his presentation, the doctor talked over Cuba's recent breakthroughs in international cooperation on connections of brain regions involved in cognitive and emotional functions and their repercussion in the diagnosis of degenerative, brain-vascular and psychiatric diseases.

He added the islands's main partners on this matter are China and Canada. The three nations are working to create a big data bases, which will contribute to boost precision medicine in a just manner.

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