The new global medicine.

AuthorFitz, Don
PositionLess of What We Don't Need

Cuba is remaking medicine in a remarkable diversity of cultures in Latin America, the Caribbean, Africa, Asia and Pacific Islands. Its efforts go far beyond providing medical care to other parts of the world as a Western approach might limit itself to doing. The Cuban project includes rethinking, redesigning and recreating medicine in a way that meets the needs of the world's poor.

John Kirk and Michael Erisman provide the most comprehensive documentation of the extent of this undertaking. (1) Since 1961, over 124,000 health professionals have worked in over 154 countries. When they wrote in 2009, 24% of Cuba's 70,000 doctors were participants in health care "brigades" on international "missions."

Though the majority of Cuban doctors go to this hemisphere and Africa, they have provided relief to the Ukraine after the 1986 Chernobyl meltdown, Sri Lanka following the 2004 tsunami, and Pakistan after its 2005 earthquake. Cuba is establishing medical agreements with Laos, Kiribati, the Solomon Islands, Papua New Guinea, Vanuatu and Tuvalu. By 2008, Cubans were providing medical care for over 70 million people in addition to its own 11 million. Kirk and Erisman conclude that "almost 2 million people throughout the world, many of whom were probably children when they received help, owe their very lives to the availability of Cuban medical services." (2)

Venezuela has developed closer ties with Cuba than any other country and has received the most help from it. According to Brouwer's (2011) Revolutionary Doctors, over 14,000 Cuban doctors had come to Venezuela by 2009. Brouwer goes beyond documenting the quantity of help that Cuba provides with his deep insights into social relationships that underlie medicine in both countries. (3)

As in Cuba, the Venezuelan Barrio Adentro (inside the neighborhood) program is based on doctor-nurse teams living in the neighborhoods they serve. The closeness of physicians to patients is critical for understanding problems that can afflict a community as well as individual illnesses. Brouwer describes how Cuban Dr. Thomasa discovered why women in the Venezuelan community of Monte Carmelo had more respiratory problems than men, even though they smoked less than them. Trained to peer into environmental and social causes of disease, she realized the cause was "the smoke from wood fires that women still used for cooking, often in closed rooms with low ceilings and no chimneys ..." (4)

The success of family doctors living in neighborhoods can only be realized if they are part of a larger system of (a) clinics which serve a wider area with health care specialists; and (b) hospitals and long-term care facilities. Sharing the Cuban view that improved medical care must occur as part of uplifting people from poverty and illiteracy, the Venezuelans established educational programs such as Mision Sucre. Cubans and Venezuelans likewise agree that the foundation of a new medical system is providing opportunities to thousands of students who are eager to devote their lives to improving the care of those who need it the most.

This task is not without resistance. Brouwer explains the indifference of graduates from traditional medical schools as well as the hostility of the Venezuelan Medical Federation. As Barrio Adentro unfolded, it was in direct conflict with the old medical system which focused on delivery of health care needs to the better off Right-wingers fueled a hate campaign, even encouraging violence against Cuban doctors. This reached a head in Barcelona, capital of the state of Anzoategui. In 2003, the anti-Chavez local government sent police to shut down a clinic staffed with Cubans. But 300 residents quickly showed up to support the clinic, which remained open. (5)

Just as damaging as acts of violence were the overlapping medical structures, each with an entrenched bureaucracy, which the new medical model needed to break up and replace. In order to ensure that they receive health care, Venezuelans have been active participants in building and defending their new medical system.

To date, Venezuela is the only country which has sought to replicate the Cuban model on a national scale. This article explores events in three countries which show the strengths and contradictions of Cuban participation in world medicine.

  1. After its emergency response to the 2007 earthquake in Peru, Cuban doctors set up consultorios and a policlinico based on the Cuban model, but the road was not smooth.

  2. During relief efforts following the 2010 earthquake in Haiti, Haitian patients developed very different relationships with Cuban doctors that they did with those from the US.

  3. African and African American medical students in Havana plan to use the knowledge they have gained of Ghana's health problems for a trip which aims to blend Cuban medical approaches into traditional Ghanaian healing practices.

A policlinico and consultorio in Pisco, Peru

On August 15, 2007, my daughter Rebecca Fitz and Ivan Angulo Torres were vacationing in Arequipa, Peru. She woke up with a bad feeling, which she thinks could have been a health issue or could have been a premonition that at 6:40 that evening a level 8 earthquake would hit the town of Pisco in Ica province of Peru. She went back to Lima, but Ivan had just completed his fourth year at the Latin American School of Medicine in Havana (ELAM, Escuela Latinoamericana de Medicina,) and went to Pisco to see how he could help. (6)

Soon, reports would show that over 500 Peruvians died, 1042 were injured and over 100,000 were left homeless. (7) The first international relief to arrive was the Henry Reeve Brigade from Cuba. Cuba's first response teams for international disasters are named after Reeve, an American who joined the Cuban fight for independence and was killed in battle in 1876 after becoming a brigadier general. (8) The Brigades come complete with medical equipment including autoclaves for sterilization and tents for examinations and surgery. Each Henry Reeve Brigade arrives with its own food and water so local resources can go to disaster victims.

Finding the Cuban doctors well-organized to deal with the disaster, Ivan and other ELAM medical students devoted themselves to documenting the Brigade's work. The resulting 12 1/2 minute movie, Nuestra Mision (Our Mission), shows remnants of the poorly constructed homes which crumbled from the quake and the makeshift thatched homes that replaced them. Many initial injuries were followed within a week by pneumonia deaths from the cold weather. The movie also shows the emergency tent hospital of the Cuban doctors who did 1980 operations, 30,734 diagnostic tests and 151,454 therapeutic treatments. Help only arrived from the Peruvian government when press cameras were rolling. (9)

As the response to the earthquake subsided, the Cuban doctors transformed the emergency tent hospital into the Pisco policlinico which has medical exam rooms, a birthing room, afterbirth room, and outpatient operating and recovery rooms. By far, the rooms most in demand at the policlinico are for adult and child physical therapy. Three years later people were still suffering effects of the earthquake. When I visited the Pisco policlinico in 2010, its director, Leopoldo Garcia Mejias, explained that then-President Ana Garcia did not want any more Cuban doctors coming after the quake and that they had to keep quiet in order to stay in Peru. As is typical for Cuban medical directors, Leopoldo has multiple international experiences, his first being in Honduras after Hurricane Mitch in 1998. (10)

Unlike in Cuba, health care at the policlinico is not free. It collects about 80,000 soles per year from patients, which it turns over to the Peruvian government for improvements. (One sol equals about 36 cents US.) But the improvements were not always forthcoming, forcing the clinic to confront the Alan Garcia administration. By 2010, everyone knew that 200 or so Cuban doctors were in Peru, making it possible for the polielinico to garner public support for its needs. Clearly, sustaining a health center is as much a political as a medical happening.

Backing is also likely to come from Peruvians who visit a neighborhood consultorio. Peruvian doctors trained in Cuba have set up three consultorios in Pisco, each with assistance...

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