CUBA SHOWS THE WAY
Don Fitz
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.
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.
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 policlinicos which provide services during off-hours and offer a wide variety of specialists. Policlinicos 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. 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).
The MGI integration of neighbor-hood 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 neighbourhood and know who to call for help getting disab same population as Cuba) had 43,000 cases of AIDS, Cuba had 200 AIDS patients. More recent emergencies such as outbreaks of dengue fever are quickly followed by national mobilizations.
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. 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).
For one thing 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.
(Frontier: Vol. 45, No. 28, January 20-26, 2013)
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