PHM-Exch> Why Is Cuba's Health Care System the Best Model for Poor Countries?

[Claudio Schuftan]

From: gaurab roy <gaurab18 at gmail.com>
*Why Is Cuba's Health Care System the Best Model for Poor Countries?
*

> *Furious though it may be, the current debate over health care in the US
>>>> is largely irrelevant to charting a path for poor countries of Africa,
>>>> Latin America, Asia, and the Pacific Islands.  That is because the US
>>>> squanders perhaps 10 to 20 times what is needed for a good, affordable
>>>> medical system.  The waste is far more than 30% overhead by private
>>>> insurance companies.  It includes an enormous amount of over-treatment,
>>>> creation of illnesses, exposure to contagion through over-hospitalization,
>>>> disease-focused instead of prevention-focused research, and making the poor
>>>> sicker by refusing them treatment.**1*<http://mrzine.monthlyreview.org/2012/fitz071212p.html#_edn1>
>>>>
>>>> *Poor countries simply cannot afford such a health system.  Well over
>>>> 100 countries are looking to the example of Cuba, which has the same
>>>> 78-year life expectancy of the US while spending 4% per person annually of
>>>> what the US does.**2*<http://mrzine.monthlyreview.org/2012/fitz071212p.html#_edn2>
>>>>
>>>> *The most revolutionary idea of the Cuban system is doctors living in
>>>> the neighborhoods they serve.  A doctor-nurse team are part of the
>>>> community and know their patients well because they live at (or near) the
>>>> consultorio (doctor's office) where they work.  Consultorios are
>>>> backed up by policlínicos which provide services during off-hours and
>>>> offer a wide variety of specialists.  Policlínicos coordinate
>>>> community health delivery and link nationally-designed health initiatives
>>>> with their local implementation.*
>>>>
>>>> *Cubans call their system medicina general integral (MGI,
>>>> comprehensive general medicine).  Its programs focus on preventing people
>>>> from getting diseases and treating them as rapidly as possible.*
>>>>
>>>> *This has made Cuba extremely effective in control of everyday health
>>>> issues.  Having doctors' offices in every neighborhood has brought the
>>>> Cuban infant mortality rate below that of the US and less than half that of
>>>> US Blacks.**3*<http://mrzine.monthlyreview.org/2012/fitz071212p.html#_edn3>
>>>> *  Cuba has a record unmatched in dealing with chronic and infectious
>>>> diseases with amazingly limited resources.  These include (with date
>>>> eradicated): polio (1962), malaria (1967), neonatal tetanus (1972),
>>>> diphtheria (1979), congenital rubella syndrome (1989), post-mumps
>>>> meningitis (1989), measles (1993), rubella (1995), and TB meningitis (1997).
>>>> **4* <http://mrzine.monthlyreview.org/2012/fitz071212p.html#_edn4>
>>>>
>>>> *The MGI integration of neighborhood doctors' offices with area
>>>> clinics and a national hospital system also means the country responds well
>>>> to emergencies.  It has the ability to evacuate entire cities during a
>>>> hurricane largely because consultorio staff know everyone in their
>>>> neighborhood and know who to call for help getting disabled residents out
>>>> of harm's way.  At the time when New York City (roughly the same population
>>>> as Cuba) had 43,000 cases of AIDS, Cuba had 200 AIDS patients.**5*<http://mrzine.monthlyreview.org/2012/fitz071212p.html#_edn5>
>>>> *  More recent emergencies such as outbreaks of dengue fever are
>>>> quickly followed by national mobilizations.**6*<http://mrzine.monthlyreview.org/2012/fitz071212p.html#_edn6>
>>>>
>>>> *Perhaps the most amazing aspect of Cuban medicine is that, despite
>>>> its being a poor country itself, Cuba has sent over 124,000 health care
>>>> professionals to provide care to 154 countries.**7*<http://mrzine.monthlyreview.org/2012/fitz071212p.html#_edn7>
>>>> *  In addition to providing preventive medicine Cuba sends response
>>>> teams following emergencies (such as earthquakes and hurricanes) and has
>>>> over 20,000 students from other countries studying to be doctors at its
>>>> Latin American School of Medicine in Havana (ELAM, Escuela
>>>> Latinoamericana de Medicina).**8*<http://mrzine.monthlyreview.org/2012/fitz071212p.html#_edn8>
>>>>
>>>> *In a recent Monthly Review article, I gave in-depth descriptions of
>>>> ELAM students participating in Cuban medical efforts in Haiti, Ghana, and
>>>> Peru.**9* <http://mrzine.monthlyreview.org/2012/fitz071212p.html#_edn9>
>>>> *  What follows are 10 generalizations from Cuba's extensive
>>>> experience in developing medical science and sharing its approach with poor
>>>> countries throughout the world.  The concepts form the basis of the New
>>>> Global Medicine and summarize what many authors have observed in dozens of
>>>> articles and books.*
>>>>
>>>> *First, it is not necessary to focus on expensive technology as the
>>>> initial approach to medical care.  Cuban doctors use machines that are
>>>> available, but they have an amazing ability to treat disaster victims with
>>>> field surgery.  They are very aware that most lives are saved through
>>>> preventive medicine such as nutrition and hygiene and that traditional
>>>> cultures have their own healing wisdom.  This is in direct contrast to
>>>> Western medicine, especially as is dominant in the US, which uses costly
>>>> diagnostic and treatment techniques as the first approach and is
>>>> contemptuous of natural and alternative approaches.*
>>>>
>>>> *Second, doctors must be part of the communities where they are
>>>> working.  This could mean living in the same neighborhood as a Peruvian
>>>> consultorio.  It could mean living in a Venezuelan community that is
>>>> much more violent than a Cuban one.  Or it could mean living in emergency
>>>> tents adjacent to where victims are housed as Cuban medical brigades did
>>>> after the 2010 earthquake in Haiti.  Or staying in a village guesthouse in
>>>> Ghana.  Cuban-trained doctors know their patients by knowing their
>>>> patients' communities.  In this they differ sharply from US doctors, who
>>>> receive zero training on how to assess homes of their patients.*
>>>>
>>>> *Third, the MGI model outlines relationships between people that go
>>>> beyond a set of facts.  Instead of memorizing mountains of information
>>>> unlikely to be used in community health, which US students must do to pass
>>>> medical board exams, Cuban students learn what is necessary to relate to
>>>> people in consultorios, polyclínicos, field hospitals, and remote
>>>> villages.  Far from being nuisance courses, studies in how people are
>>>> bio-psycho-social beings are critical for the everyday practice of Cuban
>>>> medicine.*
>>>>
>>>> *Fourth, the MGI model is not static but is evolving and unique for
>>>> each community.  Western medicine searches for the correct pill for a given
>>>> disease.  In its rigid approach, a major reason for research is to discover
>>>> a new pill after "side effects" of the first pill surface.  Since
>>>> traditional medicine is based on the culture where it has existed for
>>>> centuries, the MGI model avoids the futility of seeking to impose a Western
>>>> mindset on other societies.*
>>>>
>>>> *Fifth, it is necessary to adapt medical aid to the political climate
>>>> of the host country.  This means using whatever resources the host
>>>> government is able and willing to offer and living with restrictions.
>>>> Those hosting a Cuban medical brigade may be friendly as in Venezuela and
>>>> Ghana, be hostile as is the Brazilian Medical Association, become
>>>> increasingly hostile as occurred after the 2009 coup in Honduras, or change
>>>> from hostile to friendly as occurred in Peru with the 2011 election of
>>>> Ollanta Humala.  This is quite different from US medical aid which, like
>>>> its food aid, is part of an overall effort to dominate the receiving
>>>> country and push it into adopting a Western model.*
>>>>
>>>> *Sixth, the MGI model creates the basis for dramatic health effects.
>>>> Preventive community health training, a desire to understand traditional
>>>> healers, the ability to respond quickly to emergencies, and an appreciation
>>>> of political limitations give Cuban medical teams astounding success.
>>>> During the first 18 months of Cuba's work in Honduras following Hurricane
>>>> Mitch, infant mortality dropped from 80.3 to 30.9 per 1,000 live births.
>>>> When Cuban health professionals intervened in Gambia, malaria decreased
>>>> from 600,000 cases in 2002 to 200,000 two years later.  And
>>>> Cuban-Venezuelan collaboration resulted in 1.5 million vision corrections
>>>> by 2009.  Kirk and Erisman conclude that "almost 2 million people
>>>> throughout the world . . . owe their very lives to the availability of
>>>> Cuban medical services."**10*<http://mrzine.monthlyreview.org/2012/fitz071212p.html#_edn10>
>>>>
>>>> *Seventh, the New Global Medicine can become reality only if medical
>>>> staff put healing above personal wealth.  In Cuba, being a doctor, nurse,
>>>> or support staff and going on a mission to another country is one of the
>>>> most fulfilling activities a person can do.  The program continues to find
>>>> an increasing number of volunteers despite the low salaries that Cuban
>>>> health professionals earn.  There is definitely a minority of US doctors
>>>> who focus their practice in low-income communities which have the greatest
>>>> need.  But there is no US political leadership which makes a concerted
>>>> effort to get physicians to do anything other than follow the money.*
>>>>
>>>> *Eighth, dedication to the New Global Medicine is now being
>>>> transferred to the next generation.  When students at Cuban schools learn
>>>> to be doctors, dentists, or nurses their instructors tell them of their own
>>>> participation in health brigades in Angola, Peru, Haiti, Honduras, and
>>>> dozens of other countries.  Venezuela has already developed its own
>>>> approach of MIC (medicina integral comunitaria, comprehensive
>>>> community medicine) which builds upon, but is distinct from, Cuban MGI.
>>>> **11* <http://mrzine.monthlyreview.org/2012/fitz071212p.html#_edn11>*
>>>> Many ELAM students who work in Ghana as the Yaa Asantewaa Brigade are from
>>>> the US.  They learn approaches of traditional healers so they can
>>>> compliment Ghanaian techniques with Cuban medical knowledge.*
>>>>
>>>> *Ninth, the Cuban model is remaking medicine across the globe.  Though
>>>> best-known for its successes in Latin America, Africa, and the Caribbean,
>>>> Cuba has also provided assistance in Asia and the Pacific Islands.  Cuba
>>>> provided relief to the Ukraine after the 1986 Chernobyl meltdown, Sri Lanka
>>>> following the 2004 tsunami, and Pakistan after its 2005 earthquake.  Many
>>>> of the countries hosting Cuban medical brigades are eager for them to help
>>>> redesign their own health care systems.  Rather than attempting to make
>>>> expensive Western techniques available to everyone, the Cuban MGI model
>>>> helps re-conceptualize how healing systems can meet the needs of a
>>>> country's poor.*
>>>>
>>>> *Tenth, the New Global Medicine is a microcosm of how a few thousand
>>>> revolutionaries can change the world.  They do not need vast riches,
>>>> expensive technology, or a massive increase in personal possessions to
>>>> improve the quality of people's lives.  If dedicated to helping people
>>>> while learning from those they help, they can prefigure a new world by
>>>> carefully utilizing the resources in front of them.  Such revolutionary
>>>> activity helps show a world facing acute climate change that it can resolve
>>>> many basic human needs without pouring more CO2 into the atmosphere.*
>>>>
>>>> *Discussions of global health in the West typically bemoan the
>>>> indisputable fact that poor countries still suffer from chronic and
>>>> infectious diseases that rich countries have controlled for decades.
>>>> International health organizations wring their hands over the high infant
>>>> mortality rates and lack of resources to cope with natural disasters in
>>>> much of the world.**12*<http://mrzine.monthlyreview.org/2012/fitz071212p.html#_edn12>
>>>>
>>>> *But they ignore the one health system that actually functions in a
>>>> poor country, providing health care to all of its citizens as well as
>>>> millions of others around the world.  The conspiracy of silence surrounding
>>>> the resounding success of Cuba's health system proves the unconcern by
>>>> those who piously claim to be the most concerned.*
>>>>
>>>> *How should progressives respond to this feigned ignorance of a
>>>> meaningful solution to global health problems?  A rational response must
>>>> begin with spreading the word of Cuba's New Global Medicine through every
>>>> source of alternative media available.  The message needs to be: Good
>>>> health care is not more expensive -- revolutionary medicine is far more
>>>> cost-effective than corporate-controlled medicine.*
>>>>
>>>> *URL for Video interview
>>>> http://www.youtube.com/watch?feature=player_embedded&v=uJrOOHnOLRk#t=0s
>>>> *
>>>>
>>>> *by Don Fitz *
>>>>
>>>>
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