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.

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

August 11 – Despite objections by local Garifuna communities, Honduras’ defacto government is moving to take over the first and only Garifuna-managed hospital in the country, ousting its current staff. The facility-built by Dr. Luther Castillo, other Garifuna doctors, local architects, and the communities themselves-is located in the remote coastal municipality of Iriona.

Last week, says Dr. Castillo, the defacto ministry of health notified hospital staff that the facility was being downgraded to a health center “under new management”. “They told us that the Garifuna staff-both doctors and locally-trained nurses aides-will be fired,” he told MEDICC. “These measures would condemn to death many of our old and seriously ill people, and stop all outreach and prevention services.”

However, he said the staff is staying put, and vows to continue working, even without the small stipend the government had provided in the past and with no guarantee of medicines or vital supplies.

“We will not abandon our people,” said Dr. Castillo. “These are the poorest of the poor, the invisible poor.. They are the real victims of the coup,” he told MEDICC.”And they are the reason so many of our young people decided to become doctors in the first place.”

Some 300 representatives of local Garifuna governments gathered last week to support the hospital and its staff, and have declared they will not recognize the defacto government’s takeover move.

The Garifuna hospital officially opened in December 2007, under an agreement with the government of President Manuel Zelaya, and in accordance with an International Labor Organization covenant that supports locally-managed health services for indigenous and tribal peoples. Since then, according to Dr. Castillo, the ten Garifuna doctors staffing the hospital have treated over 175,000 cases. The physicians-all graduates of the Latin American Medical School in Havana-attend patients at outlying clinics and on regular home visits. The original government agreement permitted this medically underserved region to rely on hospital services, including birthing, surgeries, hospitalization, dental care and laboratory tests.

Since 1999, Luther Castillo 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. 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 30,000 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). Eight Cuban physicians and nurses also provide specialized services and academic training at the hospital.

A few weeks before the coup, Dr. Castillo was named director of International Cooperation in the Honduran Foreign Ministry. Since July 3rd, he has been included on a list of persons whose lives and safety were declared “at risk” by the OAS Inter-American Commission on Human Rights.

Take Action Now:

MEDICC is joining other U.S. organizations such as Global Links (www.globallinks.org) to stand with the staff and over 30,000 patients of the only Garifuna Community Hospital in Honduras.

Here’s what you can do:

1) DONATE to keep the hospital alive.  Your donation to Honduras’ First Garifuna Hospital will help pay small stipends to physicians and nurses’ aides, and help stock the hospital with essential medicines and supplies. (Donate Here)

2) SPEAK UP! Take this message to your city council, labor union, student or professional organization, asking them to pass a resolution in support of the Garifuna Indigenous Hospital in Honduras. Send these resolutions to us, and publicize them in your local media and on the web.

3) GET READY TO GO on a delegation to Honduras as a “Witness for Health” to help guarantee the safety and rights of the Garifuna hospital staff. More information coming soon..

4) Urge the US government to act: Contact the White House, the State Department and your Congressional representatives. Press them to use the US government’s influence to guarantee respect for the lives of Dr. Castillo, his colleagues and all those protesting the coup. State Department: 202-647-4000 or 1-800-877-8339. White House: Comments: 202-456-1111, Switchboard: 202-456-1414

Contact your Senators here: www.senate.gov/general/contact_information/senators_cfm.cfm

Contact your Congresspeople here: https://writerep.house.gov/writerep/welcome.shtml

5) Keep Honduras in the public eye: Circulate this alert widely. GO ON THE WEB: use your blogs, listservs and networks to get the word out.

posted by Matt Anderson, MD

Dr. Luther Castillo is a dear friend of mine… he is doing amazing things as a doctor in Honduras, and now that the world has turned it’s back, he’s trying to shed light on the situation…

He asked us to thank all of you for defending the lives of Hondurans threatened by the coup. He is spending some hours most nights attending to wounded or to families housed in temporary shelters throughout Tegucigalpa. He moves around, doesn’t sleep in one place. The streets after dark, he says, are “completely militarized”.

He reports that the defacto government is attempting to stop demonstrations and continued strikes by teachers and others, selectively targeting their leaders using a growing “hit list” of names that include his own. He says the attacks are being carried out by the army or by “criminals-for-hire”, reminiscent of the death squads of the 1980s. Three grassroots and labor leaders have been assassinated in the last few days alone.

Dr. Castillo has two main concerns:

ONE: the international press blackout on Honduras, with virtually all media either shut down or expelled. “We can’t let silence win; we need your voices,” he said.

TWO: the fate of the only Garifuna Hospital in Honduras, now without government support. Located in Ciriboya, the hospital is staffed by the group of young Garifuna doctors who founded it, working with volunteer Cuban physicians. Dr. Castillo reports they are down to their last supplies and medicines for 20,000 people living in the surrounding indigenous communities, settlements with no lights or running water.

“These are the poorest of the poor, the invisible poor. They are the real victims of the coup,” Dr. Castillo told MEDICC.

TAKE ACTION NOW!

Urge the US government to act: If you haven’t contacted the White House, the State Department or your Congressional representatives, DO SO NOW. Press them to use the US government’s influence to guarantee respect for the lives of Dr. Castillo, his colleagues and all those protesting the coup, and to ensure the return of Honduras’ elected government. State Department: 202-647-4000 or 1-800-877-8339. White House: Comments: 202-456-1111, Switchboard: 202-456-1414

Contact your Senators here: www.senate.gov/general/contact_information/senators_cfm.cfm

Contact your Congresspeople here:

https://writerep.house.gov/writerep/welcome.shtml

Keep Honduras in the public eye: Circulate this alert widely. GO ON THE WEB: use your blogs, listservs and networks to get the word out. Write a letter to the editor of your local newspaper.

There are also several Facebook groups that you can also join/post on:

http://www.facebook.com/group.php?gid=96870380185

http://www.facebook.com/group.php?gid=102246697300

http://www.facebook.com/againstcoup?ref=s

http://www.facebook.com/group.php?gid=95487307148

If you are a health worker or professional: ask your union, society or organization to post this alert and issue a public statement defending the rights and lives of your colleagues in Honduras.

Donate to the Garifuna Hospital: Global Links in Pittsburgh, Pennsylvania, has sent several containers of equipment and supplies already.  They will make your donation count for more.  Log on to: www.globallinks.org

Donate to MEDICC’s program to support the Garifuna medical students and graduates of the Latin American Medical School.

For more information and actions you can take, go to:

Latin America Working Group– www.lawg.org

Center for Democracy in the Americas www.democracyinamericas.org

Here is more information you can use:

Since 1999, Luther Castillo 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. After his 2005 graduation from the Latin American Medical School in Havana, Dr. Castillo returned to the Honduran coast, where he led the Foundation’s construction of Honduras’ first Garifuna Rural Hospital, now serving some 20,000 in the surrounding communities.

The hospital opened in December 2007, a few 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).

Just weeks before the coup, Dr. Castillo was named director of International Cooperation in the Honduran Foreign Ministry.

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.

–
Joanna Mae Souers
Escuela LatinoAmericana de Medicina
Carretera Panamericana
KM 3,5
Santa Fe, Playa
Ciudad de la Habana, CUBA
CP 19108

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

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.

Latin 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

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

Colombia was one of many countries in Latin American which adopted neo-liberal health reforms in the 1990′s and privatized much of the health care system. In Colombia’s case this took the form of a 1993 law known as Law 100.   Law 100 established a health insurance market with the goal of increasing efficiency through competition.  Law 100, however, was built on a two tier insurance system.  Individuals who were employed in the formal sector or had incomes two times the minimum wage were required to enroll in the Plan Obligatorio de Salud (POS), a compulsory health insurance system.  The rest of the population was placed in a State-subsidized Plan Obligatorio de Salud Subsidiado (POSS). Benefits in the subsidized plan were half those of the employee plan, but promises were made that benefits in the two programs would be equalized by 2001. These promises have yet to be kept.

The Colombian system has been criticized for a number of reasons.  First, according to data from 2007, only 88% of the population is actually covered by this “universal” system.  And, as might be expected, it is vulnerable populations who are most likely not to have insurance. Secondly, health insurers in Colombia (like everywhere) have learned that there is more money to be made by denying services than by providing them.  So the mere fact of having insurance does not necessarily equate with access to care.  This problem, of course, is not unknown in the US and was the subject of Michael Moore’s movie, SiCKO.  Thirdly, by organizing the health care system around profit-based personal medical services, public health was neglected; the organic bond between clinical services and public health was broken.  Finally, and perhaps most significantly, Plan 100 was criticized for making health care a commodity and not a right.

The failings of the Colombian system have led people to seek redress in the court system. This is done by requesting tutelas (court-ordered protection or  supervision) to enforce their particular claims to treatment.  These claims are based on the premise that insurance company denial of treatment is a violation of their right to health.   As discussed in a recent article published in PLOS (see reference below) there were approximately 90,000 petitions to the Colombian courts for such tutelas in 2008.  The courts generally supported these petitions in cases:

(i) when there is an inextricable relationship with “fundamental rights,” including the right to life, such that if the right to health were not protected immediately it would result in the violation of these latter rights; (ii) when the case involves a person or group of people in especially vulnerable circumstances, such as children, pregnant women, or the elderly; and (iii) when the health good or service at issue is included in the POS/POSS, which the Court has taken to define a minimum core content of the right to health.

In July of 2008 Colombia’s Constitutional Court issued a landmark decision (T-760/2008) declaring the the current system had failed to guarantee the right of Colombians to health and ordering a series of remedial actions by the State. These actions were to be carried on a specific timetable that would fulfil the 1993 promise of equity between the two plans by 2010.

The decision was widely commented in Colombia. Was it really such a good idea for the Constitutional Court to be setting health policy (or telling the government exactly how and when it should go about implementing the existing policies)?  Was the decision, with its limited vision of a right to health expressed through health insurance, really a progressive one?  Would the decision actually be implemented?  If implemented, would it be enforced?

It remains to be seen whether or not the Colombian government will, in fact, carry out the Court’s orders, although it has formally accepted them.

In the meantime Colombia’s health insurance industry suffered a major public relations blow in April when the National Superintendent for Industry and Commerce cited 15 health companies for anti-competitive practices.  The Superintendent accused the companies of illegally fixing prices, conspiring to limit access to services, and falsifying or hiding information.

Commenting on this case in the Colombian edition of Le Monde Diplomatique, Carlos Ivan Pacheco S. noted wryly:

“It is, to say the least, surprising that the investigation was carried out by the Superintendent of Industry and Commerce and that the charge was anti-competitive practices.  This clearly shows the way in which Capital has come to dominate the health field.  The Superintendent of Health and the Ministry of Social Protection were notable for their absence in this case, thus  leaving the initiative to the  Superintendent of Industry and Commerce, which had recently investigated cement  and banking industries for similar practices.  And so the right to health now falls into the same category as cement production and banking.” [Our translation]

This story should sound familiar to us New Yorkers. In January our Attorney General Andrew Cuomo reached an agreement with the insurance giant United Health Care.  Quoting Attorney General Cuomo: “For the past ten years, American patients have suffered from unfair reimbursements for critical medical services due to a conflict-ridden system that has been owned, operated, and manipulated by the health insurance industry.”

The philosopher David Hume reminds us that:  “From causes which appear similar we expect similar effects.” We might, therefore, reasonably ask: Do we really expect a for-profit health insurance market to provide high-quality, equitable health for all?

Further Reading

A full copy of the 411 page Constitutional Court’s decision can be found at this link.

The Colombian Supreme Court’s decision is discussed in an article written by Alicia Ely Yamin and Oscar Parra-Vera entitled How Do Courts Set Health Policy? The Case of the Colombian Constitutional Court and published in February 2009 in PLOS.  Those who read Spanish may want to look at Carlos Ivan Pacheco’s complete article in the Colombian edition of Le Monde Diplomatique entitled El derecho fundamental de la salud para los colombianos. This article adopts a critical view of the Court’s decision.  A critical analysis of the Colombian Law 100 is provided in Colombia and Cuba, contrasting models in Latin America’s health sector reform written by Pol De Vos, Wim De Ceukelaire and Patrick Van der Stuyft and published in Tropical Medicine and International Health in 2006.

Dr. Torres has agreed to share with the Portal’s readers a recent presentation reviewing the Colombian Health Situation in a time of crisis and pandemic illness.

posted by Matt Anderson, MD

According to the president, “the vast majority” of Americans get coverage from their jobs, and presumably are satisfied with it.

Another interesting accompanying headline is “Health Industry Says Obama Overstated Pledge to Cut Costs” (surprise surprise!). It looks like, after all, companies “never agreed to specific yearly cuts, but only vague voluntary goals”.

For both clips, click here.

Obama Questioned on Single Payer

At a town hall-style event in Rio Rancho, New Mexico, Thursday, local resident Linda Allison asked President Obama why the White House and the Democratic-led Congress have ruled out single payer.

Linda Allison: “My question is, so many people go bankrupt using their credit cards to pay for healthcare. Why have they taken single payer off the plate? And why is Senator Baucus on the Finance Committee discussing healthcare, when he has received so much money from the pharmaceutical companies? Isn’t it a conflict of interest?”

President Obama: “If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense. That’s the kind of system that you have in most industrialized countries around the world. The only problem is that we’re not starting from scratch. We have historically a tradition of employer-based healthcare. And although there are a lot of people who are not satisfied with their healthcare, the truth is, is that the vast majority of people currently get healthcare from their employers, and you’ve got this system that’s already in place. We don’t want a huge disruption as we go into healthcare reform, where suddenly we’re trying to completely reinvent one-sixth of the economy.”

Obama did not address the second part of Linda Allison’s question about Democratic Senator Max Baucus, who has excluded single-payer advocates from Senate Finance Committee hearings. Allison says she was partly inspired to ask the question after viewing Democracy Now!‘s coverage on Wednesday of single-payer advocates who disrupted Baucus’s hearing.

It is important to begin this story with 1958 Cuba where there was only 1 doctor for each 1,051 Cubans.  This statistic actually hid very large geographical disparities.  Most of Cuba’s doctors were concentrated in the towns and particularly Havana.  There were very few doctors in rural areas.  In the years immediately following the Revolution this situation only grew worse.  Many doctors emigrated, including much of Havana Medical School’s faculty.  By 1967 there was only 1 doctor for every 2,000 Cubans.  The health care system had, quite literally, to be rebuilt from scratch.

In a way this provided the Cubans with the opportunity to create an entirely different type of medical system, one established on principles of primary care and equal access to all.  By the mid-80′s the country had adopted a system of Comprehensive General Medicine (Family Medicine in US terms) based on doctor/nurse teams who served (and lived in) a neighborhood, typically of 800 people.  By 2007 there were 3 Cuban generalists per 1000 population as compared to 0.7 in the United States.  Many people attribute Cuba’s excellent health statistics to this commitment to primary care and equality of access.

However, developments on the island of Cuba are only half of this story.  Cuba had sent physicians on missions of medical solidarity since the early 1960′s.  This solidarity has accelerated notably in the past 10 years.  The 1998 Programa de Salud Integral (Comprehensive Health Program) sent brigades of Cuban doctors to Haiti, Guatemala and Honduras in the wake of Hurricanes George and Mitch.  These brigades led to semi-permanent Cuban health presences in these countries, particularly in the countryside.  Brouwer also examines the crucial role of Cuba in the Barrio Adentro program in Venezuela.

Sadly, the response of the Bush Administration has been the Cuban Medical Professional Parole Program,  an attempt to lure Cuban medical personnel to the US.  The existence of such a program is a backhanded compliment to the quality of Cuban medical personnel.  And a statement of the threat they posed to the Bush Administration.

The article closes with a discussion of Cuban medical training.  Brouwer highlights the Latin American Medical School (ELAM) as well as Cuban training in Venezuela and Yemen.   Brouwer notes that:

Cubans, with the help of Venezuela, are currently educating more doctors, about 70,000 in all, than all the medical schools in the United States, which typically have somewhere between 64,000 to 68,000 students enrolled in their programs. The U.S. students emerge from their four years of study burdened with an average of $140,000 of debt. So it’s not surprising that they have a desire to earn high salaries, either to pay that debt or simply enjoy the upper-middle-class lifestyle to which most first world physicians are accustomed. Consequently, very few U.S. medical school graduates go into residencies in family practice, the lowest paying specialty.

Interested readers are encouraged to consult the full text of the article which is available free online.

Further reading

One of the best English sources for current news about health and  medicine in Cuba is the MEDICC Review, publication of Medical Education Cooperation with Cuba.  Those who read Spanish may also want to visit the official Cuban Health Portal.

Our online journal, Social Medicine, has published articles on Barrio Adentro, the Latin American Medical School and the experience of a US student working in a Barrio Adentro clinic in rural Venezuela.

This Portal contains numerous postings about Cuba and the ELAM school.  Readers should note that Cuba still has several hundred  full scholarships for US students to attend the 6 year medical school in Havana.

posted by Matt Anderson, MD

November 30th 2008, commenced the 4-day conference, “Medical Education for the 21st Century: Teaching for Health Equity,” at the National Hotel of Cuba.  The conference brought together health professionals, educators, administrators and researchers from around the world to exchange the latest in socially “accountable” health education.

The opening night included an inaugural address by Dr. Roberto Gonzalez, the Vice Minister of Public Health in Cuba, and a lecture by Dr. Charles Boelen, an international consultant on health care and ex-coordinator of the World Health Organization’s (WHO) Program for Human Resources.

The turnout was impressive with 230 presenters from 29 different countries including Cuba, the Philippines, the United States, Canada, Belgium, Honduras, Chile, Ethiopia, Columbia, Iran, Egypt, Ecuador, Argentina, South Africa, Mexico, Brazil, Spain, Great Britain, Greece, Germany, Ecuador, Belgium, Switzerland, Puerto Rico, Hungary, Tanzania, Australia, Pakistan, and New Zealand.

I was amazed that 54 of the 230 presenters came from the United States, representing a plethora of institutions including the American Association of Medical Colleges (AAMC), UCSF-UC Berkley, Albert Einstein College of Medicine, Boston University, The Jay Weiss Center for Social Medicine and Health Equity of the Leonard Miller School of Medicine, George Washington University, the University of Wisconsin, and the list goes on.

As representative students of the Latin American School of Medicine (ELAM), we were very pleased to be invited as guests of the non-profit organization, MEDICC (Medical Education Cooperation with Cuba).  MEDICC, one of the many sponsors, has worked closely with Cuba over the years to bring awareness to the international community the highly qualified human resources they have developed to meet the needs of the Cuban people and others around the world.

It was a wonderful opportunity for students to meet and share their experience with health care educators from around the world.  Educators were mostly impressed with the student’s humanistic ideals and their well-established set stride ahead of the curve on Social Health Care.

Most of the U.S. students chose the Latin American School of Medicine not only as their first choice, but they chose it as their only choice for the program’s social, humanistic and altruistic ideals embedded in its history and carried out in its curriculum.

As a student of the Latin American School of Medicine, I am proud to represent Cuba’s thought provoking, innovative ways of approaching health education in the 21st Century.  It was amazing to see so many people come together to share their ideas and show an interest in our experience.  I hope that people will be further inspired to mark their experience with positive thinking and practical change.

Joanna Mae Souers
Escuela LatinoAmericana de Medicina
Carretera Panamericana
KM 3,5
Santa Fe, Playa
Ciudad de la Habana, CUBA
CP 19108
jsouers@gmail.com <mailto:jsouers@gmail.com>