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

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.

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

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.

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

But what is the reform law enacted as Chapter 58 of the Acts of 2006 that Mr. Brown has inherited anyways? Is it really the “universal coverage” it was promised to be?  The short answer is “no”.

The momentum for reform in Massachusetts in 2006 was spurred by the Bush Administration, who was insisting that the state reduce block funding of indigent care through the state’s free care pool or lose $385 million of Federal Medicaid funds. The state has an Uncompensated Care Pool that provides funds to hospitals and community health centers that deliver care to those without insurance coverage.  This pool is funded by assessments on hospitals, health insurance premium taxes, and federal matching funds. As the number of uninsured people rose significantly in 2006, the financing for the pool became fragile and the Bush Administration threatened their federal funds if Massachusetts failed to reduce the money spent on “free care”.

So, with 657,000 uninsured residents, or 10.4% of the population, the Massachusetts Health Care Reform Act was born.  At its center is The Connector, an independent state agency offering a “menu” of private insurance plans and assisting individuals obtain their insurance. For residents at or below 300% of the Federal Poverty Level (FPL), The Connector offers “Commonwealth Care”, where “customers” can choose a subsidized health plan based on a sliding scale.  So this should expand people’s health care choices, right? Wrong. Not if your employer offers insurance. If so, you are not eligible for these subsidized plans.  For all other residents above 300% PFL, and for small employers, The Connector offers “Commonwealth Choice”, a series of regulated, non-subsidized private plan options.  Truly American, “Commonwealth Choice” allows you to choose from the Gold, Silver, Bronze, or Young Adult plans, so-rated depending on how comprehensive they are. But the bottom line is: you get what you pay for.

By way of example, the cheapest plan available to a middle-income 56-year-old now costs $4,872 annually in premiums.  However, if the policy holder becomes sick, he or she must pay an additional $2,000 deductible before the insurance kicks in.  Thereafter, the policy holder pays 20% co-insurance, (20% of all medical bills) up to a maximum of $3,000 annually.  This totals to $9,972 dollars, if heaven forbid, the policy holder becomes ill. And we haven’t even begun to talk about “uncovered services”, that “affordable” policies Massachusetts-style are full of. For those, you are on your own, as you were before.

The plan also includes an “employer mandate”, that is, employers have some obligation to contribute to the cost of insurance, in 2008 an employer could opt out by paying $295 per employee and an individual could opt out by paying $912 yearly – as a fine. These surcharges were predicted to yield $45 million dollars annually, but totaled only $5 million in the first year of the program.   In addition, individuals can apply to be excluded from the program, for “hardship waivers”, if they can prove at a court of law that there is no affordable option available to them. In 2009, 79,000 residents applied and were “exempted” based on these grounds. Or, in plain English, 79,000 individuals remained uninsured.

The financing for this reform comes from the fines mentioned above and funds diverted from the state “free care pool”, that is, from appropriations originally invested on safety net facilities for those without insurance.

Since 2006, the outcome from the Massachusetts reform has been costly and still has yet to address the issue of access to health care. Because, it is important to remember, health insurance is not health care, but rather a means to it. And whether insurance will or will not improve access to medically necessary care depends of course on what type of coverage it offers. In Massachusetts, as explained above, coverage depends on how much you pay, from “Cadillac” plans (if you have the money) to bare-bones plans, if you belong to the so-called generation of “invincibles” (the young, often cash-strapped).

In 2008 the cost of the program for the state, to pay the subsidies and administrative costs to run the program, was 1.1 billion dollars, and rose again in 2009 reaching 1.3 billion. More expensive than expected, the Connector itself adds an addition 4.5% administrative cost to each policy it brokers. To reduce the price for the state, even if not for patients, insurers have increased premiums and co-pays.  As mentioned above, last year, as premiums rose 9.4% in 2009, 79,000 people who were not eligible for the subsidized Commonwealth plans were able to prove that they could not afford any other plan.

The Massachusetts reform does not change the cost of purchasing health insurance. In addition, the funding for these new insurance policies has replaced the “free care” system that included safety net clinics where low-income residents could receive care.  Now these residents are required to pay co-pays at the clinics due to the elimination of state funding, and they simply can’t afford to do so.  Therefore, this mandate to purchase a private product doesn’t achieve universal access to health care nor does it reduce the financial burden of disease on low- or middle-income families.

Steffie Woolhander, a professor of medicine at Hardvard, calls private insurance a defective product, one that leads people to bankruptcy and at the same time doesn’t provide the health care they need.  She explains, “Once failure to buy health insurance is a federal offense, what’s next? A Ford Pinto in every garage? Lead-painted toys for every child? Melamine-laced chow for every puppy?”  The idea here she’s exaggerating is that forcing residents to buy a flawed product they can’t afford, and that doesn’t provide what’s it’s supposed to, i.e. relief the “financial burden of disease”, is not a way to provide health care. Further, this mandate to buy a faulty product is no way to deliver “universal coverage” and Massachusetts should provide ample evidence for this.

But then, one does not need the over 2000 pages of legislation produced either by Congress or the Senate to realize why this is so. A much briefer paper of only 15 pages, written back in 2003, by four prestigious Princeton economists explains it very clearly. They studied why it is that the United States spends more than any other industrialized nation on health expenditures for the same amount of care, and concluded that “It’s the prices, stupid!” We may want to add to these extraordinary prices the close to 400 billion dollars in administrative waste generated by an extraordinary system built upon the idea of avoiding to pay for the costs of health care: private insurance policies.

Isn’t it time for U.S. policymakers to stop doing the same thing and expecting different results? Yet for for some odd reason, our President and many in Congress are “urging common ground” to go exactly in the same direction. Change we can believe in? Hardly.

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.]

Cuban Medical Assistance in Haiti

There are currently about 400 Cuban-trained Haitian doctors working in 120 communities around Haiti, including Port-au-Prince.  As graduates of the Latin American Medical School in Havana (ELAM) these doctors typically come from the poorest regions of Haiti and have studied medicine to serve Haiti, not to emigrate to the US (where the majority of Haitian-trained doctors work).  They are accompanied by a 370-person Cuban medical mission which has been working in Haiti for several years.

The work of the Cubans and Haitians in the past week is described in these video feeds from CNN’s Shasta Darlington and Steve Kastenbaum. To quote from the Kastenbaum report:

“There are so few places where ordinary Haitians can turn to when they are in need of urgent medical care in the center of the city.  We came across one: La Paz hospital. It is now being administered by Cuban medical personnel here in Haiti alongside crews from Spain and Latin America. And it is amazing to see.  They are giving medical attention—quality medial care—to severely injured people, six to seven hundred patients a day, several dozen surgeries a day. They have three theaters going around the clock, 24-7, and it is one of the only places deep in the city where Haitians can go and be treated and have a reasonable expectation of surviving.

We saw so many traumatic injuries there. I can’t even say how many amputations we saw, compound fractures, traumatic flesh wounds.  Yet, these overwhelmed medical teams were finding ways to take care of all of them, despite being very low on critical supplies—sutures, oxygen, anesthetics, water—they need all these things. Their supply lines stretch all the way back to Spain, and it’s being sent in. And it is being done in a remarkably orderly fashion.”

[The Portal has provided information about US students studying at ELAM who have also agreed to return to medically disadvantaged areas in the US.]

Providing support through MEDICC & Global Links

MEDICC, the Medical Education Cooperation with Cuba, has paired up with Global Links to organize a recovery and long-term medical assistance program for ELAM-trained Haitian doctors. Both organizations have decades of experience in regional material aid cooperation, and with Cuba and Haiti in particular. They will be working with representatives of the Haitian graduates to identify needs for medicines, medical supplies, and equipment. And they will get these supplies directly to them.

While US law does not allow Cuban doctors in Haiti to receive these essential medical materials–the US embargo is taking its toll post-disaster–MEDICC and Global Links will ensure distribution to the young Haitian physicians working in public hospitals and clinics alongside the Cuban team, seeing hundreds of patients daily.

To quote from MEDICC”s appeal:

We need your help to raise the funds for this joint effort–and to raise the policy bar by replacing hostility towards Cuba with cooperation when it comes to the health of the hemisphere–Haiti deserves nothing less. And Haiti’s young doctors need your support now.

For more information, see www.medicc.org, where you can also donate online to the HAITI EARTHQUAKE APPEAL. Or send your check to:  MEDICC, PO Box 361449, Decatur, Georgia, 30036.  Note at bottom: HAITI APPEAL.

MEDICC (Medical Education Cooperation with Cuba) is a 501 (c) (3), not-for-profit organization; your donation is tax-deductible.

Here is a direct link to donate.

The Political Economics of Public Health

Much has been made of the disastrous health and social conditions in Haiti.  It is important to keep in mind that these conditions did not develop in a vacuum.  Paul Farmer, in an April 8, 2004 article published in the New England Journal of Medicine, documented the links between political violence and the public health in Haiti.

This political violence was often the result of outside interference, most prominently by the US.  Commondreams.org has published several articles discussing this from which we quote the following (written by Peter Hallward):

The noble “international community” which is currently scrambling to send its “humanitarian aid” to Haiti is largely responsible for the extent of the suffering it now aims to reduce. Ever since the US invaded and occupied the country in 1915, every serious political attempt to allow Haiti’s people to move (in former president Jean-Bertrand Aristide’s phrase) “from absolute misery to a dignified poverty” has been violently and deliberately blocked by the US government and some of its allies.

Aristide’s own government (elected by some 75% of the electorate) was the latest victim of such interference, when it was overthrown by an internationally sponsored coup in 2004 that killed several thousand people and left much of the population smouldering in resentment. The UN has subsequently maintained a large and enormously expensive stabilisation and pacification force in the country.

Haiti is now a country where, according to the best available study, around 75% of the population “lives on less than $2 per day, and 56% – four and a half million people – live on less than $1 per day”. Decades of neoliberal “adjustment” and neo-imperial intervention have robbed its government of any significant capacity to invest in its people or to regulate its economy. Punitive international trade and financial arrangements ensure that such destitution and impotence will remain a structural fact of Haitian life for the foreseeable future.

it should be noted that the 2004 coup was the second overthrow of Aristide by international forces.

A different perspective on Haiti, can be found at the Institute for Justice and Democracy in Haiti, the Haiti Information Project and – for those who read French – Haiti Liberte & Haiti Progres.

Finally, one long-lasting step towards Haitian reconstruction would be cancellation of its foreign debt (click here to sign a petition asking for this).  In fact, one of Aristide’s many political sins was calling for the French to return the money that Haiti had been forced to pay the ex-slaveowners in order to gain recognition by France.  For another twist on this story, see Bill Quigley’s “Why the US owes Haiti Billions: The Briefest History.”

Matt Anderson, MD

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.

Starting at the end of July, twelve ELAM students went on a two week tour of the Southwest United States. Their intent was to publicize the school, work as volunteers and make contacts in the health community.  The blog – which contains information about the students and the school  -  is located at: http://saludswexchange.org/

posted by Matt Anderson

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