More on Cuba’s moral medicine

I would have written something lighter or something funny for today, but moral medicine is necessary if we are to solve the shameful inadequacy of our medical system. Giving a few rooms for poor patients in big hospitals is not enough. These are palliatives and will never solve the problem.  An entire system has to be changed with new values and principles.

Let us hear from the poor countries that adopted the Cuban way and why it works. 

“When I heard the Cubans were participating, I expected something quite different – a form of supervision or control by them,’ one Salvadorian health promoter said. I did not expect a team in which we were all fully integrated, working side by side as we went door-to-door together advising people about the means of eradicating dengue.’

We do not have a system that would cultivate such at attitudes and work habits. What is the key to Cuba’s success?  “The system is based upon medical training in which ethical considerations and the responsibilities of professionals are emphasized far more than in medical schools of the industrialized world.”

“Cuban medical personnel serving abroad go where the need is greatest, and where the host government assigns them responsibilities. The result is that the Cuban system has developed a cost-effective, pragmatic, highly ethical and sustainable system of public healthcare. It is this basic framework which is shared with the host country, and which has been remarkably successful for decades.”

Cubans have shown what it means to offer “relief before politics.”

Cuba’s medical internationalism program gained its reputation when the country offered to send 1,500 medical professionals to support the disaster relief effort after Hurricane Katrina pounded New Orleans in 2005. But US President George W Bush rejected the offer.

Other countries saw the virtues of what the authors called “moral medicine” and what they could gain from it. Little by little it came to be known that Cuba has been sending medical teams abroad since 1960, when an earthquake occurred in Chile. This was followed by a large medical delegation sent to Algeria in 1963 to help the construction of the national healthcare program following its independence from France.

Paradoxically it was at the time of its greatest need that Cuba’s moral medicine came about.

“The revolutionary government headed by Fidel Castro came to power on 1 January 1959 after the authoritarian Batista regime was overthrown. By 1961 almost half of Cuba’s medical personnel had fled, most to Miami; approximately 3,000 were left. Yet despite the pressing situation in Cuba, the government saw the need to provide internationalist support. Since then, medical contingents have been sent around the globe to help in emergency situations – regardless of ideological differences with the host country.”

Several hundred Cuban medical personnel are working in Honduras, for example, despite Havana’s protests against the coup which overthrew democratically elected president Zelaya in 2009. Likewise, while Havana condemned the removal of President Fernando Lugo in Paraguay in June 2012, Cuban doctors remain there. Perhaps no greater enemy of the Cuban revolutionary process in the region was Nicaragua’s Anastasio Somoza. Yet when a massive earthquake occurred in Managua in 1972, the Cuban contingent was among the first to arrive. In 1998 the disastrous impact of Hurricane Mitch in Central America (over 20,000 were either killed or declared missing) led to a number of missions. Significantly, Cuba did not have diplomatic relations with the countries that were worst affected, yet did not hesitate in sending large delegations to the affected areas (424 specialists arrived within days, peaking at 2,000).

Humanitarian considerations rather than political sympathies remain key to Cuba’s approach.

A major initiative came from Cuba’s role in Central America – the foundation in 1999 of the world’s largest medical university, the Latin American School of Medicine (ELAM), in Havana. The national naval academy was converted into a medical school, principally for students from the regions devastated by Hurricane Mitch. The idea was simple – to provide enough medical personnel for the region.

Students were generally selected from impoverished backgrounds, as it was thought that they would have more ‘buy in’ to their local under-served communities than their wealthier peers, and would want to assist after graduation. The plan was to develop a policy of ‘brain gain’ rather than ‘brain drain’, and to have medical support where it was needed. There is, however, a basic stipulation: students make a moral commitment to work with the underprivileged and those most in need of medical care after graduation.

From this significant contribution a variety of other medical education initiatives has grown. The largest is in Venezuela, where over 25,000 students are being trained as doctors by Cuban medical professors. The first graduating class of some 8,000 ‘comprehensive community doctors’ (77 percent of whom are women) finished their training in February 2012. Cuban professors have helped to found medical schools in Yemen, Guyana, Ethiopia, Uganda, Ghana, Gambia, Equatorial Guinea, Haiti, Guinea Bissau and Timor-Leste.

Sam Loewenberg a journalist who covers the intersection of global health, business, government and politics asks if Cuban medicine can help solve American inequality? His website is www.samloewenberg.com.

American doctors may have the expertise but its system addresses the needs of patients with money or insurance. The example of Cuba was developed for poor folk. It was not focused on expertise but primary care. 

Nearly a hundred Americans are studying medicine at Cuba’s Latin American School of Medicine (ELAM), where they are taught preventive medicine to treat the underserved.

Globally, the need for doctors is urgent. We will need some seven million doctors, nurses, and other health care workers in developing countries – and that number is expected to nearly double in the next 20 years. The WHO warns that the United Nation’s Sustainable Development Goals, like reducing maternal and infant mortality, will not happen without more health care workers.

Just a few days after the PAGCOR board approved the building of more health care centers, a group of Chinese businessmen (not taipans) and doctors came forward to offer their help. Like the Cuban model, their work will concentrate on primary care to reach as many rural communities. Their approach, they told us, would be on preventive rather than curative medicine. With them were trainers for the program. It could be a good start of moral medicine, the Cuban way in the Philippines.

I was finishing this column when I received a text from Louie Sarmiento of Philippine Mines Safety and Environment Group asking for volunteers for the Leyte quake disaster. We can start making the list for studying primary care in ELAM.