Cuba-trained medical student examines Peruvian child, Lima, Peru, December 2010. Photo by Don Fitz.
[Read more about Cuba's health-care system and its international health-care solidarity HERE.]
8, 2012 – Links International Journal of
Socialist Renewal -- Furious though it may be, the current debate over
health care in the US is largely irrelevant to charting a path for the 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 the 30% overhead by private insurance companies.
It includes an enormous amount of over-treatment, making the poor sicker by refusing
them treatment, exorbitant over-pricing of medications and medical procedures, creation
of illnesses, exposure to contagion through over-hospitalisation, and
disease-focused instead of prevention-focused research.
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.
revolutionary idea of the Cuban system is doctors living in the neighbourhoods
they serve. A doctor-nurse team is part of the community and know their
patients well because they live at (or near) the consultorio (doctors’ 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
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
integration of neighbourhood 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 disabled residents out of
City (roughly the 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 mobilisations.
María Concepción Paredes Huacoto & Johnny Carrillo Prada, Peruvian doctors trained in Cuba, at Consultorio No.2 in Pisco, Peru, December 2010. Photo by Don Fitz.
the most amazing aspect of Cuban medicine it that, despite its being a poor
country itself, Cuba has sent more than 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 more than 20,000 students from other countries studying to be doctors
at its Latin American School of Medicine in Havana (ELAM, Escuela Latinoamericana de Medicina).
recent Links International Journal of
Socialist Renewal article, I gave in-depth descriptions of ELAM students participating
in Cuban medical efforts in Haiti, Ghana and Peru.[9, see also http://links.org.au/node/1984] What follows are 10 generalisations
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 summarise what many authors have observed in
dozens of articles and books.
Acupuncture is a part of Cuban medical training: patient at Polyclinic of
Natural and Traditional Medicine, Havana, Cuba, May 2012. Photo by Don
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 neighbourhood 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
it could mean staying in a village guesthouse in Ghana. Cuba-trained doctors
know their patients by knowing their patients’ communities. This differs
sharply from US doctors, who receive zero training on how to assess homes of
Third, the MGI model outlines relationships between
people that go beyond a set of facts. Instead of memorising
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.
Use of herbs is a part of Cuban medical training: 4 Caminos University
Polyclinic in rural area outside of Havana, Cuba, May 2012. Photo by Don
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, 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.
Cuba is a leader in eradicating diseases: Pedro Kouri Institute of Topical Medicine, Havana, Cuba, May 2012. Photo by Don Fitz.
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 1000
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.”
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 that 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 communitaria,
comprehensive community medicine), which builds upon, but is distinct from,
Cuban MGI. 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-conceptualise how healing systems can meet the needs of a country’s
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
utilising 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.
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 organisations wring their
hands over the high infant mortality rates and lack of resources to cope with
natural disasters in much of the world.
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.
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.
[A version of this article was also posted at MRZine. Don Fitz (firstname.lastname@example.org) is editor
of Synthesis/Regeneration: A Magazine of
Green Social Thought. He is co-coordinator of the Green Party of St. Louis
and produces Green Time in
conjunction with KNLC-TV 24.]
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9, 2010). Eight reasons US healthcare costs 96% more than Cuba’s—With the same
2. Dresang, L.T., Brebick,
L., Murray, D., Shallue, A. & Sullivan-Vedder, L. (July-August, 2005).
Family medicine in Cuba: Community-Oriented Primary Care and Complementary and
Alternative Medicine, Journal of the American
Board of Family Medicine 18 no. 4: 297-303.
3. Cooper, R.S., Kennelly, J.F. &
Orduñez-Garcia, P. (2006). Health in Cuba, International
Journal of Epidemiology, 35: 817–824.
4. Pérez, J. (May 15,
2012). Gender and HIV Prevention. Slide presentation at the Pedro Kouri
Institute of Topical Medicine, Havana, Cuba.
5. Whiteford, L.M.
& Branch, L.G. (2008). Primary Health
Care in Cuba: The Other Revolution. Lanham: Rowman & Littlefield Publishers,
6. Fitz, D. (February
8, 2012). How Cuba mobilises to defeat public health emergencies. http://links.org.au/node/2736
7. Kirk, J.M. &
Erisman, M.H. (2009). Cuban Medical
Internationalism: Origins, Evolution and Goals. New York: Palgrave Macmillan.
8. Fitz, D. (March,
2011). The Latin American School of Medicine Today: ELAM. Monthly Review 62 no. 10: 50–62.
9. Fitz, D.
(September, 2012). Cuba: The New Global Medicine. Monthly Review 64 no. 4: 37–46.
10. Brouwer, S.
(2011). Revolutionary Doctors: How
Venezuela and Cuba are Changing the World’s Conceptualization of Health Care. New
York, Monthly Review Press.