Sunday, January 2, 2011

Cuban medics in Haiti put the world to shame

http://www.independent.co.uk/life-style/health-and-families/health-news/cuban-medics-in-haiti-put-the-world-to-shame-2169415.html

Cuban medics in Haiti put the world to shame

"Cuba's contribution in Haiti is like the world's greatest secret. They are
barely mentioned, even though they are doing much of the heavy lifting."

By Nina Lakhani
The Independent/UK: 25 December, 2010

They are the real heroes of the Haitian earthquake disaster, the human
catastrophe on America's doorstep which Barack Obama pledged a monumental US
humanitarian mission to alleviate. Except these heroes are from America's
arch-enemy Cuba, whose doctors and nurses have put US efforts to shame.

A medical brigade of 1,200 Cubans is operating all over earthquake-torn and
cholera-infected Haiti, as part of Fidel Castro's international medical
mission which has won the socialist state many friends, but little
international recognition.

Observers of the Haiti earthquake could be forgiven for thinking
international aid agencies were alone in tackling the devastation that
killed 250,000 people and left nearly 1.5 million homeless. In fact, Cuban
healthcare workers have been in Haiti since 1998, so when the earthquake
struck the 350-strong team jumped into action. And amid the fanfare and
publicity surrounding the arrival of help from the US and the UK, hundreds
more Cuban doctors, nurses and therapists arrived with barely a mention.
Most countries were gone within two months, again leaving the Cubans and
Médecins Sans Frontières as the principal healthcare providers for the
impoverished Caribbean island.

Figures released last week show that Cuban medical personnel, working in 40
centres across Haiti, have treated more than 30,000 cholera patients since
October. They are the largest foreign contingent, treating around 40 per
cent of all cholera patients. Another batch of medics from the Cuban Henry
Reeve Brigade, a disaster and emergency specialist team, arrived recently as
it became clear that Haiti was struggling to cope with the epidemic that has
already killed hundreds.

Since 1998, Cuba has trained 550 Haitian doctors for free at the Escuela
Latinoamericana de Medicina en Cuba (Elam), one of the country's most
radical medical ventures. Another 400 are currently being trained at the
school, which offers free education - including free books and a little
spending money - to anyone sufficiently qualified who cannot afford to study
medicine in their own country.

John Kirk is a professor of Latin American studies at Dalhousie University
in Canada who researches Cuba's international medical teams. He said:
"Cuba's contribution in Haiti is like the world's greatest secret. They are
barely mentioned, even though they are doing much of the heavy lifting."

This tradition can be traced back to 1960, when Cuba sent a handful of
doctors to Chile, hit by a powerful earthquake, followed by a team of 50 to
Algeria in 1963. This was four years after the revolution, which saw nearly
half the country's 7,000 doctors voting with their feet and leaving for the
US.

The travelling doctors have served as an extremely useful arm of the
government's foreign and economic policy, winning them friends and favours
across the globe. The best-known programme is Operation Miracle, which began
with ophthalmologists treating cataract sufferers in impoverished Venezuelan
villages in exchange for oil. This initiative has restored the eyesight of
1.8 million people in 35 countries, including that of Mario Teran, the
Bolivian sergeant who killed Che Guevara in 1967.

The Henry Reeve Brigade, rebuffed by the Americans after Hurricane Katrina,
was the first team to arrive in Pakistan after the 2005 earthquake, and the
last to leave six months later.

Cuba's constitution lays out an obligation to help the worst-off countries
when possible, but international solidarity isn't the only reason, according
to Professor Kirk. "It allows Cuban doctors, who are frightfully underpaid,
to earn extra money abroad and learn about diseases and conditions they have
only read about. It is also an obsession of Fidel's and it wins him votes in
the UN."

A third of Cuba's 75,000 doctors, along with 10,000 other health workers,
are currently working in 77 poor countries, including El Salvador, Mali and
East Timor. This still leaves one doctor for every 220 people at home, one
of the highest ratios in the world, compared with one for every 370 in
England.

Wherever they are invited, Cubans implement their prevention-focused
holistic model, visiting families at home, proactively monitoring maternal
and child health. This has produced "stunning results" in parts of El
Salvador, Honduras and Guatemala, lowering infant and maternal mortality
rates, reducing infectious diseases and leaving behind better trained local
health workers, according to Professor Kirk's research.

Medical training in Cuba lasts six years - a year longer than in the UK -
after which every graduate works as a family doctor for three years minimum.
Working alongside a nurse, the family doctor looks after 150 to 200 families
in the community in which they live.

This model has helped Cuba to achieve some of the world's most enviable
health improvements, despite spending only $400 (£260) per person last year
compared with $3,000 (£1,950) in the UK and $7,500 (£4,900) in the US,
according to Organisation for Economic Co-operation and Development figures.

Infant mortality rates, one of the most reliable measures of a nation's
healthcare, are 4.8 per 1,000 live births - comparable with Britain and
lower than the US. Only 5 per cent of babies are born with a low birth
weight, a crucial factor in long-term health, and maternal mortality is the
lowest in Latin America, World Health Organisation figures show. Cuba's
polyclinics, open 24 hours a day for emergencies and specialist care, are a
step up from the family doctors. Each provides for 15,000 to 35,000 patients
via a group of full-time consultants as well as visiting doctors, ensuring
that most medical care is provided in the community.

Imti Choonara, a paediatrician from Derby, leads a delegation of
international health professionals at annual workshops in Cuba's third city,
Camaguey. "Healthcare in Cuba is phenomenal, and the key is the family
doctor, who is much more proactive, and whose focus is on prevention ... The
irony is that Cubans came to the UK after the revolution to see how the NHS
worked. They took back what they saw, refined it and developed it further;
meanwhile we are moving towards the US model," Professor Choonara said.

Politics, inevitably, penetrates many aspects of Cuban healthcare. Every
year hospitals produce a list of drugs and equipment they have been unable
to access because of the American embargo which prevents many US companies
from trading with Cuba, and persuades other countries to follow suit. The
2009/10 report includes drugs for childhood cancers, HIV and arthritis, some
anaesthetics, as well as chemicals needed to diagnose infections and store
organs. Pharmacies in Cuba are characterised by long queues and sparsely
stacked shelves, though in part this is because they stock only generic
brands.

Antonio Fernandez, from the Ministry of Public Health, said: "We make 80 per
cent of the drugs we use. The rest we import from China, former Soviet
countries, Europe - anyone who will sell to us - but this makes it very
expensive because of the distances."

On the whole, Cubans are immensely proud and supportive of their
contribution in Haiti and other poor countries, delighted to be punching
above their weight on the international scene. However, some people complain
of longer waits to see their doctor because so many are working abroad. And,
like all commodities in Cuba, medicines are available on the black market
for those willing to risk large fines if caught buying or selling.

International travel is beyond the reach of most Cubans, but qualified
nurses and doctors are among those forbidden from leaving the country for
five years after graduation, unless as part of an official medical team.

Like everyone else, health professionals earn paltry salaries of around $20
(£13) a month. So, contrary to official accounts, bribery exists in the
hospital system, which means some doctors, and even hospitals, are
off-limits unless patients can offer a little something, maybe lunch or a
few pesos, for preferential treatment.

Cuba's international ventures in healthcare are becoming increasingly
strategic. Last month, officials held talks with Brazil about developing
Haiti's public health system, which Brazil and Venezuela have both agreed to
help finance.

Medical training is another example. There are currently 8,281 students from
more than 30 countries enrolled at Elam, which last month celebrated its
11th anniversary. The government hopes to inculcate a sense of social
responsibly into the students in the hope that they will work within their
own poor communities for at least five years.

Damien Joel Suarez, 27, a second year from New Jersey, is one of 171
American students; 47 have already graduated. He dismisses allegations that
Elam is part of the Cuban propaganda machine. "Of course, Che is a hero here
but he isn't forced down your neck."

Another 49,000 students are enrolled in the El Nuevo Programa de Formacion
de Medicos Latinoamericanos, the brainchild of Fidel Castro and Hugo Chavez,
who pledged in 2005 to train 100,000 doctors for the continent. The course
is much more hands-on, and critics question the quality of the training.

Professor Kirk disagrees: "The hi-tech approach to health needed in London
and Toronto is irrelevant for millions of people in the Third World who are
living in poverty. It is easy to stand on the sidelines and criticise the
quality, but if you were living somewhere with no doctors, then you'd be
happy to get anyone."

There are nine million Haitians who would probably agree.

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