Archive for the 'Cuba' Category
4 Comments October 25th, 2009 by Matthew Anderson
Joanne Mae Souers, a New York State resident studying medicine at the Latin American School of Medicine (ELAM) in Havana, sent us this report on her activities:
Dr. Nelson Gonzalez on Rounds
The Hospital is Our Classroom; The Patient is Our Professor
As third year students at the Latin American School of Medicine the hospital is our classroom and the patients are our professors. We spend our days practicing patient histories and physical exams to tune and then retune our clinical skills. Students from the U.S. and several Latin American countries rotate at Hospital Salvador Allende in central Havana. Students from all over the world can be found at teaching hospitals all across Cuba.
Our first semester focuses on clinical medicine, physical exams, and the relationship built between the doctor and the patient. This is where we step out of the classroom and into the “operating” room as they might say; where medicine starts with “hello.” From the minute your patient walks in the door, you are required to take notes on what signs and symptoms they might reveal to help you develop a good differential diagnosis.
Currently, I am at the Antonio Guiteras Unit of Internal Medicine run by Dr. Nelson Gonzales, a Specialist in Internal Medicine. Every day we are tested on our knowledge of the pathological alterations in the physical exam. We see patients, go on rounds and learn first-hand how a patient is received, examined, diagnosed and treated throughout their stay.
I find our exposure to patients and first-hand clinical experience a essential counterpart to our classroom knowledge. We are constantly applying our skills and seeing new clinical cases. Recently we were addressing cases of dengue fever to control and quarantine a small outbreak in Havana and now we are focusing primarily on cases of suspected H1N1 influenza in adults with compromised health status.
If that isn’t enough patient exposure, fear not, we are on a weekly rotation at the hospital’s walk-in clinic where we see “walk-in” cases and learn from doctors making quick, accurate diagnostic calls. Some of these cases are automatically hospitalized if they come in with severe health conditions requiring admission to the intensive care unit or those who present public health risks and need to be quarantined. Examples of cases quarantined are those who present fever from areas endemic to dengue or present symptoms of an upper respiratory infection and pertain to one of the three risk groups of H1N1: pregnant women, children and/or patients with respiratory illnesses.
Medical Student Souers
I look forward to my third year at the Latin American School of Medicine in Havana, Cuba, where we learn to practice medicine on the bases of altruism, honor and sacrifice as a commitment to society. It is the patient that teaches us medicine; it is the hospital that sets the stage. Dr. Nelson Gonzales profoundly states that he is not such an altruistic being just based on character, but because of his formation as a doctor in Cuba.
Add a comment October 7th, 2009 by Matthew Anderson
Social Medicine, our open-access, online academic journal has just published its latest issue. Here is a brief summary of the articles all of which are available for free at www.socialmedicine.info and www.medicinasocial.info (in Spanish).
Children in post-Civil War Nepal singing revoutionary songs
Special Theme: Social Medicine & War
For this special theme issue on Social Medicine & War, Dr. Vic Sidel served as guest editor. His lead editorial (co-authored with Dr. Barry Levy) examines the diversion of resources to war and the preparation for war.
Quoting from their introduction to the three original research articles about war, Drs. Sidel and Levy write: ”Dr. Andrea Angulo Menasse, a researcher from Mexico City’s Autonomous University, documents the very personal story of how the violence of the Spanish Civil War affected one family. In her case study the trauma suffered by Spanish Republicans is traced through three generations and crosses the Atlantic Ocean as the family moves is exiled in Mexico. Dr. Sachin Ghimire from the Centre of Social Medicine and Community Health of the Jawaharlal Nehru University reports on his fieldwork in Rolpa, Nepal, the district from which the Nepal Civil War (also called the People’s War) originated in 1996. Based on 80 interviews, he documents the difficulties faced by health care workers as they negotiated the sometimes deadly task of remaining in communities where control alternated between Nepalese Special Forces and the Maoist rebels. Finally, Colombian researcher, Carlos Iván Pacheco Sánchez, from the University of Rosario in Bogota, brings an epidemiologist’s tools to examine the impact of the ongoing armed conflict in the border Department of Nariño. His discussion is informed by the current debate over health care in Colombia where a recent Constitutional Court decision has found that the current health care system violates the right to health.”
Closing the Gap: Where are we one year later
In August of 2009, the WHO’s Commission on the Social Determinants of Health issued a bold call to eliminate health disparities within a generation. Three articles in this issue look at what has – and has not – happened in the intervening year. Our second editorial examines the international response to the Commission’s call. José Carlos Escudero explores the meaning of the report for the WHO and underscores the report’s limitations. A detailed critique of the report, along with an alternative approach to addressing health inequities, is offered by Dr. Anne-Emanuelle Birn. Dr. Birn’s critique is especially important for offering important historical background by exploring how Europeans in the 19th century – notably Louis-René Villermé, Edwin Chadwick, and Friedrich Engels – each approached the social disparities that arose during the Industrial Revolution.
The Peckham Experiment
We are also very pleased to publish three classic texts describing the Peckham Experiment, an innovative community center built in England during the Depression. The Pioneer Health Center was designed around the idea of studying (and fostering) what makes people healthy, rather than what makes them sick. Imagine that!
Please visit the journal and explore the breadth, depth and scope of social medicine past and present. Along with some suggestions for the future.
posted by Matt Anderson, MD
Add a comment September 3rd, 2009 by Matthew Anderson
We wanted to share this press release from MEDICC:
September 2, 2009: An Amnesty International report released today recommends an end to the US embargo on Cuba, which it says has imposed severe social and economic hardship on ordinary people on the island. The report (The US Embargo against Cuba: Its Impact on Economic and Social Rights) concludes that the sanctions have endangered the health of millions and denied them access to important medicines and medical technologies.
Amnesty’s 28-page findings cite supporting evidence from UN agencies, as well as MEDICC and earlier research carried out by the American Association for World Health, which Amnesty called “still the most comprehensive study on the issue” (Denial of Food and Medicine: The Impact of the U.S. Embargo on Health & Nutrition in Cuba).
“The US embargo against Cuba is immoral and should be lifted,” said Irene Khan, Amnesty International’s Secretary General, calling on US President Barack Obama to “distance himself from the failed policies of the past” by taking immediate steps to begin dismantling its restrictions.
In a CNN interview about the report, MEDICC International Director Gail Reed commented: “…the embargo has a sweeping effect on Cuban healthcare. Over the past decades, I would say the people most affected have been cancer and HIV-AIDS patients.” She also said the embargo affects the way Cuban physicians think about the future: “Doctors in Cuba always worry that an international supplier will be bought out by a U.S. company, leaving medical equipment without replacement parts and patients without continuity of medications.”
Amnesty found that the embargo also threatens children’s health by restricting Cuba’s ability to import nutritional products for schools, hospitals and child care centers, contributing to a high prevalence of iron-deficiency anemia. And it notes that children’s health was also put at risk by a decision from US suppliers to cancel an order for three million disposable syringes made in 2007 by UNICEF’s Global Alliance for Vaccines and Immunization upon learning the units were destined for Cuba. Similar situations have affected implementation of UN programs to prevent and manage HIV/AIDS on the island.
Finally, the Amnesty report called on the US Congress to repeal US embargo legislation, a necessary step since under current law, the President’s powers to ease restrictions are limited.
3 Comments July 20th, 2009 by Matthew Anderson
We wanted to bring a new book - Community Health Care in Cuba, edited by Susan E. Mason, David L. Strug, and Joan Beder – to the attention of readers of the Social Medicine Portal.
Interest in the Cuban health care model has grown over the years and despite ongoing changes in Cuban society, the pride and satisfaction Cuban citizens take in their health care system suggest that it will likely prevail in post-Castro Cuba. Susan E. Mason, David L. Strug, and Joan Beder have edited this collection of essays by contributors who are respected professionals in Cuba and the United States. Community Health Care in Cuba examines the closely integrated Cuban system in which community representatives, nurses, doctors, social workers, and other health care specialists work together to meet the health care needs of all Cuba’s citizens. The collection features a first-hand look into the country’s highly successful, integrated, and prevention-oriented health care model and includes interviews with the director of Cuba’s National Medical Sciences Information Center (INFOMED) and the president of the Cuban Society of Social Workers in Health Care. Placing Cuba at the forefront as a model of international health care, this book illustrates how Cuba, despite its economic constraints, is able to deliver high-quality care to its citizens from a local to national level.
This is one of the few English-language books to provide a comprehensive view of Cuba’s community-oriented health care program. Based on observations and interviews by Cuban contributors or those who have made recent trips to Cuba, it addresses a wide variety of health care topics in social work, nursing, medicine, and public health
About the Editors:
Susan E. Mason (PhD, Columbia University; MSSW, Columbia University) is professor of social work at Yeshiva University’s Wurzweiler School of Social Work, professor of sociology, and chair of the college departments of sociology and political science. She has written many articles and book chapters on mental health, social service utilization and workforce efficacy. She is co-editor of Diagnosis Schizophrenia: A Comprehensive Resource for Patients, Families, and Professionals.
David L. Strug (PhD, Columbia University; MSW, Hunter College; MPH, University of California at Berkeley) is professor of social work at the Wurzweiler School of Social Work at Yeshiva University in New York City and is also a clinical social worker in private practice. He has traveled frequently to Cuba to do research on older persons, the development of social work, and community-oriented health care. He wrote with Jeanne Lemkau Love, Loss and Longing: The Impact of U.S. Travel Restrictions on Cuban-American Families.
Joan Beder (PhD, Yeshiva University; MSW, Adelphi University) is professor of social work at the Wurzweiler School of Social Work at Yeshiva University in New York City and maintains a clinical practice in Long Island. She is the author of Faces of Bereavement: A Casebook for Grief Counselors and Medical Social Work: The Interface of Medicine and Caring.
posted by Matt Anderson (co-author of the chapter on Medical Education in Cuba)
Add a comment July 13th, 2009 by Matthew Anderson
We have just published a new issue of Social Medicine/Medicina Social, our bilingual, online journal. It is available in both English and Spanish. Our 13th issue touches on several important issues in world health including the current economic crisis and the WHO Commission’s on the Social Determinants of Health. And, of course, the stories of activists like the young US students (shown below) studying medicine at the Latin American Medical School (ELAM) in Havana. They will be traveling in the Southwest US this summer to discuss their experiences with the American Indian community:
The Economic Crisis and Public Health
Barry S Levy, Victor Sidel
The current global economic crisis seriously threatens the health of the public. Challenges include increases in malnutrition; homelessness and inadequate housing; unemployment; substance abuse, depression, and other mental health problems; mortality; child health problems; violence; environmental and occupational health problems; and social injustice and violation of human rights; as well as decreased availability, accessibility, and affordability of quality medical and dental care. Health professionals can respond by promoting surveillance and documentation of human needs, reassessing public health priorities, educating the public and policymakers about health problems worsened by the economic crisis, advocating for sound policies and programs to address these problems, and directly providing necessary programs and services. Full Text: PDF
An Interview with Sir Michael Marmot
The Editors
In August of 2008 the WHO Commission on the Social Determinants of Health concluded its work with the publication of a report entitled: “Closing the gap in a generation: Health equity through action on the social determinants of health.” The Commission’s chair, Sir Michael Marmot, was kind enough to answer our questions about the Commission’s recommendations. This interview was conducted by email in May of this yea
Social Medicine: We congratulate the Com-mission on its excellent work in bringing attention to the social determinants of health and the Commission’s call for health equity. We appreciated the Commission’s recognition that: “Social Justice is a matter of life and death.” We were also happy that the Commission included representatives of civil society in their work. This was an important affirmation of democratic values.
When thinking about health inequalities people often use the analogue of the ladder to show how the gradient of worsening health outcomes affects all people in society except (presumably) those at the very top. Thinking about the ladder leads us to pose the following question: Is making the ladder shorter (i.e. reducing inequalities) the only approach to inequalities or is it possible to imagine making the ladder disappear entirely?
Sir Michael Marmot: All societies have hier-archies. It is not conceivable, therefore, to have a society with no ladder. The conceptual framework of the Commission on Social Determinants of Health leads us to think of at least two (linked) ways to address the relation between position on the ladder and health: act at the societal level to reduce social inequalities, and break the link between position in the social hierarchy and health.
The first argues for reducing the slope of the social gradient. To see this, suppose, just for a moment, that the ladder were defined on the basis of years of education. People who had three years or fewer had life expectancy of 50 years, those who had 13 years or more had life expectancy of 80 and the rest were ranged in between in a graded way: the social gradient in health. Now if we had a societal change so that everyone had at least 10 years of education, and better health followed as a result, the magnitude of health inequity would be reduced. We have reduced inequities by making the ladder shorter. [...]Full Text: PDF
Participation and empowerment in Primary Health Care: from Alma Ata to the era of globalization
Pol De Vos, Geraldine Malaise, Wim De Ceukelaire, Denis Perez, Pierre Lefèvre, Patrick Van der Stuyft
With the 1978 Alma Ata declaration, community participation was brought to the fore as a key component of primary health care. This paper describes how the concepts of people’s participation and empowerment evolved throughout the last three decades and how these evolutions are linked with the global changing socio-economic context.
On the basis of a literature review and building on empirical experience with grass roots health programs, three key issues are identified to revive these concepts: The recognition that power, power relations and conflicts are the cornerstone of the empowerment framework; the need to go beyond the community and factor in the broader context of the society including the role of the State; and, considering that communities and society are not homogeneous entities, the importance of class analysis in any empowerment framework. Full Text:
PDFLatin American Social Medicine and the Report of the WHO Commission on Social Determinants of Health
RAFAEL GONZALEZ GUZMAN
In October 2008 the Latin American Social Medicine Association (ALAMES) organized an international workshop entitled “The Social Determinants of Health.” Representatives of ALAMES’ seven regions participated in discussions of the various consultative papers prepared by the working groups of the WHO Commission on the Social Determinants of Health as well as the Commission’s final report. The workshop considered how ALAMES should respond to the work of the Commission. In this paper we summarize the main points outlined in the position paper prepared by the Organizing Committee1 as well as a synopsis of the main contributions made by each of the workshop’s study sections. Full Text: PDF
For the full Table of Contents visit: http://journals.sfu.ca/socialmedicine/index.php/socialmedicine/issue/view/38/showToc
posted by Matt Anderson, MD
8 Comments July 11th, 2009 by Matthew Anderson
From our Friends at the People’s Health Movement: USA Circle
PHM and IPHU are pleased to announce the upcoming IPHU courses in India (September 21-30, 2009), Morocco (September 21-30, 2009) and Cuba (November 4-14, 2009). For details and registration, go to http://phmovement.org/iphu/. US health activists are encouraged to attend.
The International People’s Health University (IPHU) is one of the major programs of the People’s Health Movement. IPHU is a global university providing short courses and other resources for health activists. Courses are of a high academic standard and are documented for academic credit from established universities. IPHU short courses enable younger health activists, in particular, to make new connections, share experiences and study together. IPHU short courses strengthen the global network of people’s health activists.
Morocco – http://phmovement.org/iphu/en/morocco, in French and Arabic, Fes, Morocco
India – http://phmovement.org/iphu/en/bangalore/announcement, in English, Bangalore. This course is focused on Health and Equity.
Cuba – http://www.phmovement.org/iphu/en/CubaAnnounce, in Spanish and English, Havana
Add a comment July 9th, 2009 by Matthew Anderson
We have been asked by our friends at MEDICC to pass on this action alert regarding Dr. Luther Castillo, a Honduran physician who has been threatened with arrest in the wake of the recent coup. Dr. Castillo, a member of Honduras’ Garifuna community, was one of the first graduates from the Latin American School of Medicine (ELAM). After receiving his MD degree he returned home and constructed the first Garifuni rural hospital. Dr. Castillo was featured in the film Salud and you can read an interview with him in English at this link.
July 7, 2009—The life of Dr. Luther Castillo, indigenous Garifuna physician in Honduras, is in imminent danger. MEDICC has learned that the Honduran army has orders to capture Dr. Castillo, and if he resists, to shoot him. He was already included on a list of persons whose lives and personal integrity were declared “at risk” by a July 3rd communiqué from the OAS Inter-American Commission on Human Rights.
We have been able to verify that Dr. Castillo’s cellphone communications have been cut. The last conversation with him took place at approximately 2:30pm today, in which he reported on continued demonstrations demanding the return of elected President Manuel Zelaya, despite security forces’ repression.
Just weeks ago, Dr. Castillo was named director of International Cooperation in the Honduran Foreign Ministry. Since 1999, he has directed the Luaga Hatuadi Waduheñu Foundation (“For the Health of our People” in Garifuna), dedicated to bringing vital health services to isolated indigenous coastal communities.
TAKE ACTION NOW!
Call the White House and the State Department, urging the US government demand:
- safety for Dr. Castillo, his colleagues, and all persons protesting the coup,
- an end to the repression, and
- the unconditional return of constitutional President Manuel Zelaya.
State Department: 202-647-4000 or 1-800-877-8339
White House: Comments: 202-456-1111, Switchboard: 202-456-1414
More Background
After his 2005 graduation from the Latin American Medical School in Havana, Dr. Castillo returned to the Honduran coast, where he led construction of Honduras’ first Garifuna Rural Hospital, now serving some 20,000 in the surrounding communities. The hospital opened in December 2007, just months after Dr. Castillo was named “Honduran Doctor of the Year” by Rotary International’s Tegucigalpa chapter. “Thank you for inspiring me,” said California Lieutenant Governor John Garamendi, speaking at the hospital’s opening ceremony.
The hospital and its community health outreach are supported by a number of U.S. and other international organizations, including the Sacramento, California Central Labor Council, Global Links, The Birthing Project, and MEDICC. Several US medical schools also have cooperative arrangements with the Garifuna hospital, including Johns Hopkins, Emory, Charles Drew and University of California (SF).
Dr. Castillo is featured in ¡Salud! (www.saludthefilm.net), a documentary film that received the Council on Foundations Henry Hampton Award for Excellence in Film & Digital Media (USA). MEDICC (Medical Education Cooperation with Cuba), www.medicc.org, is a US non-governmental organization working to enhance cooperation among the U.S., Cuban and global health communities aimed at better health outcomes.
posted by Matt Anderson, MD
7 Comments June 23rd, 2009 by Matthew Anderson
Here is the latest update from from Joanna Mae Souers, one of the US students studying medicine on scholarship in Cuba:
June 2009
Today there are 148 American students studying medicine at the Latin American School of Medicine in Havana. They study within Cuba’s world-renowned system of universal health care. Despite Cuba being a “poor” country, the World Health Organization (WHO) ranks the Cuban system among the top 10 in the world. They study thanks to a scholarship provided within the same system of humanitarian medical solidarity that has placed more than 21,000 Cuban doctors in poor third-world countries.
The 148 students originate from some of America’s poorest and most medically under-served communities. After graduating they plan, in line with the encouragement of the Cuban Government and our own Congressional Black Caucus, to serve the very same under-served communities from which they came.
As students attending ELAM we, have been given an opportunity to do something that has never been done before. On July 26, 2009, 12 American students from ELAM will board an RV for a road-trip of the Southwestern United States. Together we will spend two weeks as humble guests visiting Native American reservations, neighboring communities, hospitals and colleges to spread the word about our medical school opportunity and foster an exchange of information between all participating groups.
As we approach the one month mark in our countdown to departure we are motivated, poised, and excited about the road ahead us. We are busy preparing for the exchange; writing up the material we hope to present, learning about the different communities we plan to visit and organizing our curriculum of exchange with guidance from our community liaisons. So far we hope to visit with the following communities and organizations:
- The Oakland Health Fair, California
- Bay Area Native American Health Center, California
- California Consortium for Urban Health
- La Clinica de la Raza, Oakland, California
- California City College
- University of California at Berkley
- Fresno Clinic, California
- Fresno City College, California
- Los Angeles Indian Health Services, California
- Arizona Indian Health Services
- Windowrock, Arizona
- Gallup, New Mexico
- One Hope Clinic, Albuquerque, New Mexico
- Acoma Pueblo, New Mexico
- Pueblo Indian Cultural Center, New Mexico
- Pajarito Mesa, South Valley, New Mexico
- Santo Domingo Pueblo, New Mexico
- Shiprock, New Mexico
As students, we want to thank the following individuals and organizations for all of their support and guidance during the process of organizing this exchange.
We extend a special thank you to all of our donors and supporters for making this exchange possible, and we want to encourage further support. We are just short of meeting our proposed budget and we hope to make that happen to make this tour possible! We need your support, please check out our link (http://www.medicc.org/ns/index.php?s=30&p=4) and donate now!
Visit our website www.saludswexchange.org for more information on the exchange!
sent in by Joanna Mae Souers
Escuela LatinoAmericana de Medicina
Carretera Panamericana
KM 3,5
Santa Fe, Playa
Ciudad de la Habana, CUBA
CP 19108
1 Comment April 28th, 2009 by Matthew Anderson
Our thanks to Diane Appelbaum of MEDICC for sharing this link to an interview with former NFL player Pasha Jackson. Pasha is one of approximately 100 US students studying medicine on full scholarship in Cuba at the Latin American Medical School (ELAM).
Here is a link to the program The World According to Gary. The specific interview is entitled: Gary chats with NFL Player Leaving Football to Study Medicine in Cuba.
For other information about ELAM on the Portal, see this link.
posted by Matt Anderson, MD
1 Comment April 23rd, 2009 by Matthew Anderson
We recently received the following letter from Joanna Mae Souers, one of the US students studying medicine at the Latin American Medical School (ELAM) in Havana:
It is my pleasure to introduce to you a project we have been working on since December.
Inspired by the MEDICC Conference, we put our minds together to manifest the ¡Salud! Southwest Tour:
July 28th, 2009, 12 American students from the Escuela Latinoamericana de Medicina (ELAM – Latin American School of Medicine) in Havana, Cuba will board a Recreational Vehicle (RV) for two weeks to travel across the Southwest region of the United States visiting a number of tribal settlements of American Indian Nations, community colleges and universities.
While at the various sites the students will share their personal experiences of what it’s like to study at ELAM while promoting the availability of full scholarships for students, volunteer their services while learning about some of the more significant health concerns affecting American Indian populations and to build personal and professional relationships with health care practitioners and members of Native American communities.
These 12 students are among the 104 Americans on full scholarships currently studying medicine in Cuba alongside their peers from 27 different countries across the world. They represent not only some of the brightest and most courageous medical school students this country has to offer, but also originate from some of the toughest and poorest communities in the U.S. The settlements they plan to visit represent one example of the type of historically underserved communities where all the U.S. ELAM students have pledged to work upon graduation.
We are seeking funding support and medical donations that will provide the substance with which lifelong alliances will be built between future American physicians dedicated to underserved communities and our national predecessors.
For those interested in making a donation please visit the MEDICC Website (http://www.medicc.org/ns/index.php?s=30&p=4), or under ¨programs¨you´ll find ¨ELAM Students Southwest Tour¨ or email our communications director, Tasha Rassuli, at saludswtour@gmail.com or directly at tjrassuli@gmail.com
posted by: Matt Anderson, MD
