Archive for the 'Cuba' Category

Cuba Leads the World in Lowest Patient per Doctor Ratio; How do they do it?

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by Joanna Mae Souers

*Paraguayan 5th year student participating in primary care in Havana, Cuba. (2011,by Joanna Mae Souers)

In early 2007, I began studying medicine at the Latin American School of Medicine in Havana, Cuba.  I entered the program not knowing much about the Cuban healthcare system, other than that it was universal and free.  “Now that’s a system I want to learn from,” I thought to myself, “It’s a system we could all learn from.”  Five years later, what have I learned?

There are many subtle and not so subtle differences between the Cuban and the U.S. health care systems which have allowed the Cubans to equal the U.S. with respect to their health statistics, but at a much lower cost and with better preventative and primary care.  In this paper I analyze just one of the reasons for the differences between the two systems; Cuba produces more primary care practitioners per capita.  How do they do it? Medical education in Cuba is free, all doctors interested in specializing must first serve two years working in primary care, and graduating doctors are not driven to specialize by salary incentives.  This socialist approach towards medicine and medical education assures the human resources necessary to provide universal and preventative healthcare to all.

People marvel at how Cuba has “accomplished so much with so little.”  And they marvel with good reason.  According to the World Health Organization, Cuba spent only $503 per capita on healthcare in 2009, the U.S. spent almost 15 times that sum.  In fact we in the US spent $421 per person just on the administration of the private healthcare insurance system, almost enough to fund the Cuban system. [1] [2] Despite dramatically lower costs, Cuba has some of the best health statistics and health indicators of any country around the world.

Although people like to compare and contrast the health statistics of the U.S. and Cuba, I think this a bit preposterous.  Cuba, a small island in the Caribbean, is being compared to one of the largest countries in the Americas with a very different history.  So in the table below, I have shown some health statistics on Cuba and the U.S. as well as the Dominican Republic and Haiti.  The Dominican Republic and Haiti are Cuba’s Caribbean neighbors; similar in size, history and geographic location.

*Statistical information provided by the World Health Statistics 2011 Report by the World Health Organization.

From this table, we can see that Cuba’s health indicators are more like those of the “first world” in the U.S. than its neighbors in the “third world.”  The life expectancy of the U.S. and Cuba is almost identical.  Cuba supersedes the U.S. in the categories highlighted.  So we continue to ask, “How do they do it?”  Could it have something to do with their philosophy that people need doctors?  Hence, their solution is to offer a free medical education to develop young, quality doctors dedicated to serving those in need.

Per capita Cuba graduates roughly three times the number of doctors as the U.S.   In 2005 Cuba had 70,594 doctors.  Before the revolution in 1959, there were only an estimated 6,000 doctors; somewhere around half left the country after 1959.  This means they must have graduated an average of 1,469 Cuban doctors per year, not including the some 5,000 international students who graduate each year from Cuban medical schools. [3]  When we later compare these numbers to the U.S. we see that Cuba graduates 3 times the number of doctors per capita, and the U.S. must import graduating doctors from other countries just to fill the primary care residency positions.

Critics of the “Obama Plan” say that there will not be enough doctors in the U.S. to take care of all the patients if everyone has healthcare coverage.  Obama encouraged the Association of American Medical Colleges to increase the number of graduating doctors by 30% in 2010.  Ever since 1980, U.S. Medical schools have graduated 16,000 doctors a year.  Meanwhile, the population of the U.S. has grown 50 million during the same period.[4]  A 30% increase would have meant we should have graduated 20,800 medical students in 2010, but we only graduated 16,838 according to the Kaiser Family Foundation.[5]  The number of residency programs at teaching hospitals in the U.S. has been frozen since 1997, funded by Medicare.  There were 29,890 residency slots filled in 2009,positions not filled by American graduates are filled by International Medical Graduates. [4]   This means we can estimate more than 1/3 of students in U.S. residency programs are International Medical Graduates (IMGs), students from another country or a U.S. citizen, like me, who studied in another country.

In the current scheme of things, International Medical Graduates are continuously brought in to the U.S. to meet the needs of the growing patient population.  Unfortunately nothing bridges the gap, because there just are not enough residency positions and/or funding for teaching hospitals to produce enough doctors to satisfy the entire U.S. population.  Taking International Medical Graduates to meet the needs of the U.S. population only adds to the “brain drain” of developing countries around the world.  So as we produce fewer doctors, introduce more doctors from other countries; U.S. doctors work harder for less to meet the needs in the U.S. and a lot of the world remains catastrophically underserved.

Cuba leads the world with the lowest patient to doctor ratio, 155:1, while the U.S. trails way behind at 396:1.[6]  With a surplus of Cuban doctors, Cuba is able to help ailing nations around the world.  They have medical missions in over 75 different countries lead by nearly 40,000 health professionals, almost half of them are doctors.[7]  The United States by contrast imports doctors from poorer countries, further contributing to the brain drain of professionals from poorer countries to rich ones.

In Cuba education is free.  Room and board, books and amenities are included.  Doctors are not burdened by student loans and live comfortably though not extravagantly.  Harvard Medical School states in their admissions statement that an “un-married first year medical student” will spend approximately $73,000 for the 2011-2012 academic year.  This includes tuition, room and board, books, etc.[8]  Now times that by four and you have a whopping $292,000 to shell out to become a Harvard doctor.  With interest rates, loan deferments and default charges, you might end up like Michelle Bisutti.  She graduated medical school in 2003 with a $250,000 debt, in which by 2010 had increased to $555,000.[9] This may be an extreme case, but the Association of American Medical Colleges projected in their 2007 report that in 2033, students on a 10-year repayment program will only see half of their after-taxes salaries, the rest going to loan repayment.[10]

The cost of medical education in the U.S. causes more and more medical school graduates to turn to higher paying specialties and subspecialties rather than primary care or family medicine.  Dr. Thomas Bodenheimer writing for the New England Journal of Medicine, stated that “between 1997 and 2005, the number of U.S. graduates entering family practice residencies dropped by 50 percent,” based on data from the National Resident Matching Program. [11]  In the U.S. specialists predominate at a ratio of 2:1 (the reverse of other Western countries) while half of all outpatient visits are made by primary care physicians. [12]   This deficit of primary care physicians decreases people’s access to primary care and preventative medicine, causing increases in health disparities and healthcare costs.  This is because preventative medicine benefits the patient as well as reduces the number of Emergency Department visits and hospital stays.  If there are no primary care physicians to provide preventative care to the population, we see the population suffer as costs continue to rise.

* Family Medicine Residency Positions and Number Filled by U.S. Medical School Graduates. From the American Academy of Family Physicians, based on data from the National Resident Matching Program. [11]

According to a survey in 2008 by the American Academy of Family Physicians, family medicine graduates with less than 7 years of experience earn, on average, a yearly salary of $145,000.[13]  The difference in earnings between primary care physicians and specialists differed by only 30 percent in 1980, and dramatically rose up to 300 percent for some narrowly defined specialists by 2009.  In the graph below, we show the dramatic difference between median compensation for selected specialties compared to that of primary care.[14,15]

*Median Compensation for Selected Medical Specialties.
Data are from the Medical Group Management Association Physician Compensation and Production Survey, 1998 and 2005. [15]

When working in the U.S., almost every primary care physician I talk to has the same complaint, “Too many patients, and too little time.”  They are forced to see 20 to 30 patients a day just to meet pay-incentives and “keep their doors open.”  General/Family Practice physicians spend an average of 16.1 minutes with each patient per visit. [16]   Meanwhile, 18%, or roughly 48.2 million of the U.S. population under the age of 64 is without healthcare insurance.  They have no access to most GP’s or family practice physicians. [17]

We need to follow our Cuban role model, we need to be held socially accountable and produce more primary care physicians.  This can be accomplished by providing an education at full scholarship to those interested in primary care, or by increasing the number of medical students going into primary care by closing the compensation gap between primary care and the higher paid specialties.  These measures would ensure the population better access to quality primary care and preventative medicine.  It would bring down the cost of healthcare while allowing primary care physicians to practice under less stressful conditions leading to quality affordable healthcare for all.

 

  1. World Health Organization (WHO 2011); Countries. [www.who.int/countries/en]
  2.  “Healthcare Marketplace Project, Trends and Indicators in the Changing Marketplace (Exhibit 6.11: Private Health Insurance Admin Cost per Person Covered, 1986-2003),” Kaiser Family Foundation, Publication Number: 7031.  [http://www.kff.org/insurance/7031/print-sec6.cfm]
  3.  “Cuba and the Global Health Workforce: Training Human Resources.” Salud! (Source Vice Ministery for Medical Education and Research, Ministry of Public Health) [http://www.saludthefilm.net/ns/elam.html]
  4. Sullivan, Paul.  “Discomfort at U.S. Medical Schools.” The New York Times; April 29, 2009.
  5.  “Total Number of Medical School Graduates, 2010.”  The Kaiser Family Foundation.  [http://www.statehealthfacts.org/comparemaptable.jsp?ind=434&cat=8]
  6.  “World Health Statistics 2011,” World Health Organization; WHO Press, Switzerland.
  7. Brouwer, Steve.  “The Cuban Revolutionary Doctor: The Ultimate Weapon of Solidarity,” Monthly Review, 2009, vol 60, issue 8 (January).
  8. Harvard Medical School Admissions, “Costs (Updated: 7/21/2011).”  [http://hms.harvard.edu/admissions/default.asp?page=costs]
  9. Pilon, Mary.  “The $555,000 Student Loan Burden,” The Wall Street Journal, February 13, 2010.
  10. Fuchs, Elissa.  “With Debt on the Rise, Students Face an Uphill Battle.” The Association of American Medical Colleges, January 2008.
  11. Bodenheimer, Dr. Thomas,“Primary Care – Will it Survive?” New England Journal of Medicine, vol 355;9. Pg 861-862.
  12. Alper, Philip R. “Primary Care’s Dim Prognosis,” Hoover Institution, Stanford University, Policy Review No. 158 (December 1, 2009).
  13. American Academy of Family Physicians, Income (2011).      [http://www.aafp.org/online/en/home/publications/otherpubs/debtmgmt/graduation/income.html]
  14. Alper, Philip R. “The Decline of the Family Doctor,” Hoover Institution, Stanford University, Policy Review No. 124 (April 1, 2004).
  15. Woo, Dr. Beverly.  “Primary Care – The Best Job in Medicine?” New England Journal of Medicine, vol 355;9. Pgs 864-866.
  16.  “Healthcare Marketplace Project , Trends and Indicators in Changing Healthcare Marketplace (Exhibit 6.5: Mean Time Spent with Physicians (in Minutes), 1989 – 2002),”  Kaiser Family Foundation, Publication Number: 7031, Information Updated: 4/11/05.      [http://www.kff.org/insurance/7031/print-sec6.cfm]
  17.  “2010 National Health Interview Survey (Tables 1.1A-B, 1.2 B)”, Center for Disease Control.  [http://www.cdc.gov/nchs/fastats/hinsure.htm]

 

Door-to-Door; Dengue Fever

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Medical Students and community members participate in dengue fever prevention efforts in Havana, Cuba (photographer, Joanna Mae Souers)

January, classes were suspended for medical students throughout Havana.  The dengue epidemic had reached its height and health officials decided it was time students joined the prevention efforts; door-to-door.  It is not the first time.  Medical students in Cuba have frequently been called upon for their volunteer services and solidarity to the community during epidemics and medical emergencies including Hurricane Katrina and the Chernobyl Disaster, political campaigns including “Bringing Home Emilio” and “Free the Cuban Five” and interests of state like harvesting potatoes and planting citrus trees.

When we first hit the streets we were armed with knowledge of disease prevention and assigned individually or in pairs to a city block.  We were oriented to visit each household daily, talk to each family about dengue prevention, teach signs and symptoms, and remit anyone in the home with fever to their local health center.  We were also given instructions to enter the homes, revise water tanks, and dispose of any items that could serve as fresh water containers where mosquitoes deposit their eggs.

On my own city block I had seen several issues solved and few to be addressed.  For example, I successfully mapped out the community and spoke face-to-face with at least one member of every household.   People were very cooperative and happy to receive us in their homes.  It was most important to see if anyone had come down with a fever or noticed any problems in the community concerning vector control and focal points where water was collecting and mosquitoes could be potentially breeding.

Most Cubans are well educated on the signs and symptoms of dengue and the methods of prevention.  Even before we speak to them, they have already heard the information from their local nurses, doctors, door-to-door inspectors, schools, community meetings, television, radio, and newspapers.  We may not have any new information to transmit to them, but we are able to bring to their awareness the severity of the epidemic and the importance of their continued cooperation in further prevention efforts by creating a presence in the streets.

The student efforts were so important because specialists were concerned that if the numbers did not return to a record low by the time the rains came in March, the epidemic would be out of control and cost many more lives.  Thanks to the students and the cooperation of the community our prevention efforts made a difference and progress was made just by going door-to-door.  The number of cases around the city steadily declined as cases were reported and prevention efforts were enforced.  The campaign lasted just a month, and in February with the epidemiologists satisfied and the community safe from dengue, we were on our way back to classes.

Fundraiser for Book on Chinese-Cubans in Havana

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YOU ARE INVITED TO A FUNDRAISER

———————————————— 

Please come and support my research project/book on
Chinese-Cuban Elderly Men
SATURDAY, NOVEMBER 5, 2011
8:00 pm – 10:00 pm
Enjoy old-school Hip Hop and R&B
BOB BAR
235 Elridge Street (Between Houston & Stanton)
** Cash Bar **
Joyce Wong, CSW

 

Our colleague Ms. Joyce Wong is planning to return to Cuba later this year to continue her research on elderly Chinese men living in El Barrio Chino de la Habana en Calle Zanja  (See SMP 2/9/2011).  She is preparing a book on this community in collaboration with Professor Eric Tang, University of Texas.Ms. Wong’s  work grew out of semi-structured interviews done in Havana in 2007 and 2008.

Some of her work was published in the book Community Health Care in Cuba (Lyceum Books, 2010).   Through her interviews Ms. Wong explores the difficulties faced by a group of (now elderly) Chinese immigrants as they sought “to preserve their physical and mental health, maintain their sense of self, and find a place in the context of the Cuban health-care system and Cuban society.”
See you on Saturday.
posted by: Matt Anderson

Steve Brouwer, author of Revolutionary Doctors, will discuss health care in Venezuela and Cuba on 9/2/11 in NYC.

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Steve Brouwer

Readers of the Portal may be interested in a talk this Friday (9/2/2011) at the CUNY Graduate School.  Steve Brouwer, author of the blog Venezuela Notes, will be speaking about his new book, Revolutionary Doctors published by Monthly Review Press.   He will be accompanied by the Honorable Jorge Valero Briceño, Permanent Representative of the Bolivarian Republic of Venezuela to the United Nations.  The talk will take place at 7PM at the Elebash Recital Hall, The Graduate Center, CUNY, 365 Fifth Avenue, New York, NY 10016.  Click here for a flyer.

Brouwer’s book begins with a discussion about the Cuban medical system and its programs of medical internationalism (either providing medical care directly overseas or training foreign doctors).  It goes on to consider how Cuba assisted Venezuela to create a new public health care system, known as Barrio Adentro.  Finally, Brouwer looks at the backlash against the Cuban model on the part of the US as well as the development of revolutionary medicine as part of the creation of a socialist society.  It is always mind opening to read about serious attempts to construct socialist societies; there are real alternatives to our current social structure.

Brouwer notes that medicina integral (comprehensive or whole medicine) is built on Che Guevara’s idea that “individuals can liberate and develop themselves more fully when they are devoted to the full and revolutionary development of their communities and societies…”   This conception of human development stands in stark contrast to current US political discourse where we are told that individuals develop most fully when they are disconnect from the broader social good and pursue their own selfish ends.

Readers who want some background on Venezuela prior to the talk may want to look at several articles published in our journal Social Medicine.  Rebecca Trotsky-Sirr described her experiences with Barrio Adentro in Adentro Barrio Adentro: An American Medical Student in Venezuela and Carlos Muntaner and colleagues discussed the evolution of  Barrio Adentro in Venezuela’s Barrio Adentro: participatory democracy, south-south cooperation and health care for all.

Finally, it is always worth remembering that Cuba’s medical internationalism extends to the US as we have discussed in prior postings about free medical education for US citizens in Cuba.

The talk is presented by  Monthly Review Press; Bolivarian Circle Alberto Lovera; Cuba Solidarity New York; TheIndypendent; July 26 Coalition; Casa de las Americas; The Center for the Humanities at The Graduate Center, CUNY; IFCO-Pastors for Peace; The Center for Place, Culture and Politics, CUNY; and others.

posted by: Matt Anderson

Updates from Medical Education Cooperation with Cuba (MEDICC) and a touch of Cuban rap music

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US Medical Students at ELAM in Havana

Our colleagues at MEDICC, Medical Education Cooperation with Cuba, have been very busy over the past several months and it seemed time for an update about their activities:

Nineteen US students graduate from ELAM (The Latin American School of Medicine)

This July 19 US students graduated from the Medical University of Havana’s Dr Salvador Allende Health Sciences Faculty.  They were a part of nearly 1400 international medical students who got their MD degrees in Cuba last month.  (See our previous post on How US students can get a free medical education in Cuba). MEDICC has posted pictures of some of the happy graduates on its website.

Chicago graduate Dr. Mena Ramos

This year is the 7th in which US students have graduated from ELAM; Dr. Cedric Edwards was the first US graduate in 2005.  Readers who would like to know more about ELAM should consult Don Fitz’s article published in the March Monthly Review entitled The Latin American School of Medicine Today.  This article goes over both the strengths and challenges of study in Cuba.

MEDICC support for US students studying at ELAM

The process of picking US students for scholarships is managed by IFCo/Pastors for Peace.  MEDICC, through its MD Pipeline to Community Service program has been playing a key role in helping these students make their transition back to clinical practice in the US.  This has involved financial assistance in the form of form of MNISI fellowships that allow students to prepare for and take their US licensing board examinations.  The fellowships are vital to make sure that ELAM graduates get positions in US residency programs and do well in those positions.  But MEDICC has also developed a mentorship program to give ELAM students practice working in US clinical settings.

If you would be interested in donating, $100 will  defray the costs of US exam fees and prep courses; $250 will allow students to prepare for their US board exams with 1,000 online practice questions; and $750 will  pay the full cost of one US Medical Licensing Exam.

Donate Now Button

Would you like to become a mentor?

MEDICC is looking for US health care professionals who would be willing to mentor ELAM students. I personally have mentored several and found them to be a bright and highly motivated group anxious to demonstrate their history and physical examination skills (in fluent Spanish).  MEDICC’s Rachel True is responsible for the mentorship program and writes:  “As the cohort of US ELAM students continues to grow, so does our need for mentors all over the country.  We are currently looking for more mentors in the following areas of the country:  Atlanta, Washington, D.C., Texas, Southern states (AL, MS, LA), Chicago, Los Angeles, and the Midwest (MN, ND, MI).  If you have any colleagues or friends who might be interested, please let them know about our program and put them in touch with me.  If you would like me to provide you with a brief description of the program, I would be happy to do so.”

Achieving Universal Health Care: A New Issue of MEDICC/Review

 MEDICC Review, the International Journal of Cuban Health and Medicine, published its most recent issue in July; the issue is entitled Achieving Universal Health Care and contains articles from Colombia, Brazil, Ecuador, Cuba, Vietnam, Ethiopia, and Nigeria.  The full table of contents is given below.  I was particularly interested in an update on medical schools who were seeking to be socially accountable (i.e. to train graduates who met the health needs of their countries, Roundtable: Revisiting Innovative Leaders in Medical Education) and a brief description of changes to the Ecuadorean health system (Sumak Kawsay: Ecuador Builds a New Health Paradigm). Following a new 2008 constitution health in Ecuador has been declared a right and discussion is underway about how build a care system built on sumak kawsay, a Quecha phrase translated as collective well-being.   This idea has been related to the concept of sustainable development as well as the Brazilian formulation of collective health (the Brazilian form of social medicine).

Finally, some collective well-being captured on the streets of Havana

For those of you who don’t speak Spanish, these are the “rappers of the third age”, i.e. geriatric rappers. The lead singer informs us that she has” five children, 11 grandchildren, five great-grandchildren and nothing stops me from singing and dancing.”

MEDICC Review, July 2011 Table of Contents

Editorial

Equity Matters

Interview

Roundtable: Revisiting Innovative Leaders in Medical Education

André-Jacques Neusy MD DTM&H and Bjorg Palsdottir MPA

Feature

Cuban Maternity Homes: A Model to Address At-Risk Pregnancy

Conner Gorry MA

Special Article

Global Pharmaceutical Development and Access: Critical Issues of Ethics and Equity

Agustin Lage MD PhD

Original Research

Intentional Injury in Young People in Vietnam: Prevalence and Social Correlates

Linh Cu Le MD MSc PhD and Robert W. Blum MD MPH PhD

Cuba’s Strategy for Childhood Tuberculosis Control, 1995–2005
Gladys Abreu MD MS PhD, et al.

Perspective

Raising the Profile of Participatory Action Research at the 2010 Global Symposium on Health Systems Research

Rene Loewenson PhD(Med) MScCHDC, et al.

Population-Level Approaches to Universal Health Coverage in Resource-Poor Settings: Lessons from Tobacco Control Policy in Vietnam

Hideki Higashi MPH MSc, et al.

Health Systems in an Interconnected World: A View from Nigeria

Seye Abimbola MD MPhil

Ethiopia’s Health Extension Program: Improving Health through Community Involvement
Hailom Banteyerga PhD

Making the Right to Health a Reality for Brazil’s Indigenous Peoples:

Innovation, Decentralization and Equity

Vera Coelho PhD and Alex Shankland DPhil

Impact of Court Rulings on Health Care Coverage: The Case of HIV/AIDS in Colombia

Ana Cristina González MD MA and Juanita Durán LLB

Abstracts

Cuban Research in Current International Journals

Viewpoint

Sumak Kawsay: Ecuador Builds a New Health Paradigm

César Hermida MD MS

 

posted by Matt Anderson, MD

 

Opportunity to Study Healthy Aging In Cuba: May 1-8, 2011

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Our colleagues at MEDICC passed on this announcement of a Marazul sponsored trip to study healthy aging in Cuba:

Marazul Charters, Inc.

www.marazul.com

Greetings,

Marazul Charters, in consultation with MEDICC (Medical Education Cooperation with Cuba) is pleased to advise you of an exciting research opportunity in Cuba, focusing on Healthy Aging. The week-long research program is scheduled for the week of May 1 – 8, 2011. We are sending this announcement to health professionals and policy-makers dedicated to preserving and optimizing the health of older adults.  Participants will be drawn from university centers for healthy aging, gerontology departments and associations, national organizations on aging; and senior councils on active aging.

The graying of the global population is occurring rapidly, most significantly in developing countries.  According to the United Nations Population Fund, Cuba will head the list of Latin American and Caribbean countries with the most elderly population by 2025.  Citizens of Cuba are not only living healthier and longer, but they have a higher level of education than 40 years ago.  Addressing the needs of a highly educated aging population presents new challenges, requiring innovative programs.  In response, Cuba has developed a comprehensive national program for older adults – unique in the developing world.  This research experience will offer US participants the chance to observe first-hand Cuba’s low-cost working models and determine if these models have relevance in their own work settings.  Research objectives will include the following:

1.  To examine Cuba’s national programs aimed at healthy aging, including the Comprehensive Care Program for Cuban Elders, the Research Center on Longevity, Aging and Health, and the Cuban Society of Geriatrics and Gerontology.  Family doctor-nurse teams serve every community, and all policlinics have a multidisciplinary Gerontology Care Team comprised of a doctor, social worker, nurse, and psychologist.

2.  To examine Cuba’s community programs, including “Grandparents’ Circles” which engage elders in social events, Tai Chi in parks and sports activities.

3.  To examine Cuba’s Seniors University, an innovative program in which older adults play an active role in defining the aging process, and in proposing solutions to the challenges of aging.

Full time health professionals conducting research in Cuba are allowed to do so under the US Treasury Department’s general license for professional research.  Participants make arrangements directly with Marazul Charters, as we are an agency licensed to make all program and travel arrangements to/from and within Cuba (marazulhealth@gmail.com or 1 800 223-5334, ext 16.)   The cost for a one-week program including roundtrip air from Miami to Havana, Cuban visa, accommodations, meals and full research program in Cuba averages $2,200.  This is in addition to the cost of a domestic flight to Miami.  MEDICC (www.medicc.org) serves as a program consultant to Marazul, and in some cases may be able to provide partial fellowships.

If you think you may be interested in participating in this opportunity, the first step is to please email marazulhealth@gmail.com by Friday, February 11, 2011, and we will send further information. We look forward to hearing from you.

Sincerely,

Bob Guild

Vice President

Marazul Charters, Inc.- In consultation with MEDICC

4100 Park Avenue, Weehawken, NJ 07086

800-223-5334 ext 16 / 201-319-1054 ext 16

201-319-8970 fax

marazulhealth@gmail.com

Barriers to Accessing Health Care for Asians: From the Bronx to Cuba

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For 20 years Joyce Wong, a friend and colleague, has worked as a licensed clinical social worker  with the Cambodian and Vietnamese refugee community in the Bronx.  We wanted to share with readers of the Portal some of her recent work examining immigrant health care both in the Bronx and in Cuba.

Throughout the years she has been involved in training medical residents and students on refugee mental health in addition to organizing with the Committee Against Anti-Asian Violence (now called Organizing Asian Communities)  in the area of language rights for the Southeast Asian community. She contributed a chapter, on the mental health and resiliency of elderly Chinese  men in Cuba, to the book Community Health Care in Cuba. She is a native New Yorker who grew up in Washington Heights to parents from Puerto Rico and China.

Accessing Health Care: From the Bronx to Cuba

In 2010, Ms. Wong was interviewed for Asia-Pacific Forum, a program on New York radio  station WBAI.  The interview (available at this link) examined barriers to health care access for two different Asian immigrant communities. The first was the Southeast Asian refugee community in the Bronx who have faced challenges to obtaining language access and quality health/mental health care.  (See our prior posts on the Justice is Healing campaign). She then turned to Cuba where she shared her research on health access for the Chinese-Cuban elderly male population in Havana.

La Magia de Cuba

During her visits to Cuba for the book chapter, Ms. Wong produced a short photo-video documentary entitled La Magia de Cuba, for a course on global mental health at the Harvard Program in Refugee Trauma on healing environments. It needs no commentary or introduction. Enjoy:

Ms. Wong is planning to return to Cuba this year to expand her research on elderly Chinese men with a plan to publish a book with Professor Eric Tang, University of Texas.  A fundraising event will take place  later this spring and we will keep readers informed.  She can be reached via email.

posted by Matt Anderson

ELAM Students & Graduates Work with Cuban Doctors in Haiti

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I requested a year off from school to go to Haiti and work with the Cuban doctors after completing my 2nd semester of 3rd year at ELAM (the Latin American School of Medicine). I am one of 120 American citizens studying medicine in Cuba free of charge, with plans to practice medicine upon graduation in underserved communities of the United States and around the world.

When I arrived, I found several international ELAM graduates (http://elamedicosinternacionalistas.wordpress.com), including 7 United States graduates (http://www.michaelmoore.com/words/mike-friends-blog/cuban-trained-us-docs-complete-haiti-mission), and a number of Haitian medical students working alongside the Cuban doctors. We were stationed at a field hospital set up by the Henry Reeve Brigade of Cuban doctors on January 28th in a small central park of Croix des Bouquet, just outside Puerto Prince. Together we served displaced earthquake victims and patients suffering from inadequate health care services.

In the first six months the hospital was established, we addressed the needs of more than 70,312 patients; 53,588 at the hospital and 16,723 in the field. We performed a total of 2,506 operations on-site, with 786 major surgeries; including emergency caesarean sections, ectopic pregnancies, thyroidectomy, hernias, hydroceles, hysterectomies of uterine fibroids, orthopedic surgeries and more. We assisted 116 natural births. We diagnosed 3,533 patients with our on-site laboratory and diagnostics center. We saw 3,192 patients for x-rays and ultrasounds. We treated 8,778 patients with physical therapy, and we hospitalized 2,053 patients on-site (Information provided by the Henry Reeve Brigade of Croix des Bouquet Statistical Report, June 2010).

When you stepped out of the hospitals and into the streets the only question that came to mind had to be, “where is the aid?” It was obvious, even six months after the earthquake that little progress had been made, with little to no evidence of monetary support. Hundreds of thousands of people were still living displaced in make-shift tent cities. The city still resembled a disaster zone with buildings teetering above cracked foundations, while corpses remain beneath the rubble. The doctors seemed to be the only relief effort making a difference.

The Cuban doctors were accomplishing more than what the international community was willing to recognize. Croix des Bouquet was just one of several field hospitals established by the Henry Reeve Brigade to serve communities in and around Puerto Prince free of charge. CNN even had to apologize after interviewing one of the Cuban doctors and crediting him as Spaniard. Fortunately, Cuban doctors aren’t looking for recognition; they are out to save lives and continue to do so all over the world.

The Henry Reeve Brigade has since moved on to other emergencies, like the fires plaguing Russia. Other Cuban doctors have replaced them to continue serving the Haitian community free of charge. Brazil and Cuba have signed a trilateral accord with the Haitian Health Minister to establish three hospitals staffed by Cuban doctors located in communities surrounding Puerto Prince where health services are limited to non-existent. Cuba has been dedicated to sending doctors to Haiti for 11 years. Amidst the unfortunate circumstances of the earthquake, they continue to fulfill their commitment to the Haitian community by sending doctors. With the success of the students working alongside the doctors, they now have plans to send more students in the years to come.

Note: Article written by Joanna Mae Souers. Photograph titled, “Joanna Mae Souers on Wound Care” was taken by Cuban photographer, Juvenal Balán. The other photographs were taken by Joanna Mae Souers.

Cuban Medical Students in New York City: April 12-14, 2010

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Yenaivis Fuentes Ascencio

Yenaivis Fuentes Ascencio, 23, a medical student from Guantánamo, Cuba and Aníbal Ramos Socarrás, 30, a surgery resident from Manzanillo,  Cuba are currently on a tour of the US.  We understand that they have been in Atlanta, the Twin Cities and Chicago and will be traveling to Washington before arriving in New York City on Saturday.  They will be visiting and talking in New York on April 12 (at the Schomberg Center) on April 13th (at Rutgers University) and on April 14th (at Hofstra in the morning and Hunter College in the evening) before leaving for the West Coast on Thursday.

It is not often that we have a chance to have a face-to-face discussion with Cubans from the island in the United States.  We understand that US students who have studied at ELAM (the Latin American Medical school) will be speaking at the Schomberg Center event. For more information call: Nellie Bailey 646-812-5188 or Tom Baumann 646-256-0992.  A fairly complete list of their engagements can be found at this link.

Anibal Ramos Socarrás

For more posts about health in Cuba, click on our Cuba category in the blog roll. For information about getting a free medical education in Cuba (yes, free), please consult ifco and see some of our posting about the Latin American School of Medicine and its students.

posted by Matt Anderson, MD

Kingston New York Hospital Helps out US medical students in Cuba

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Joanna Mae Souers, an American studying medicine at the Latin American School of Medicine (ELAM) has written several times on the portal (see here).  She asked us to post the following thank you note:

David Lundquist, President and CEO of Kingston Hospital, of upstate New York, made efforts to organize supplies to donate to the students of the Latin American School of Medicine in Havana Cuba.  Supplies included masks, gloves, scrubs, and several other useful items that the students can use during their time in Cuba.  Because of the U.S. embargo against Cuba, supplies are limited and students are expected to bring their own.  It is very helpful when hospitals can help students out by donating supplies to alleviate them from these costs.

Kingston is where I grew up, and it is wonderful to get such positive support from local hospitals.  Many health care professionals don’t know about the program to study medicine in Cuba, but when they hear about the opportunity, in spite of political propaganda, they think it’s great and they look forward to anything they can do to support the students.  Cuba is well renowned for their public health care and international relief efforts, but what is little known is that there are over 100 U.S. students studying medicine in Cuba for free, with one catch, the promise to return to the U.S. upon graduation and practice in underserved communities.  Is that really a catch?  This is a gift from the Cuban government to the American people.

I want to thank Kingston Hospital for their generous donation and I want to encourage other hospitals to donate what they can.  If you would like to make a donation of medical supplies or books to the students of ELAM, please contact IFCO & Pastors for Peace via their website www.ifconews.org.

Thank you Kingston Hospital for your support!

[Editor’s note: For more information about this program, readers should visit prior postings on this topic.]




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