• Submitted by: manso
• Editorial Articles
• 10 / 22 / 2010

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Thursday, 14 October 2010 16:49. Upside DownWorld, When Cuba's revolutionary government banned racially-based discrimination,it showed a dedication to social equality. [1] But unequal access to housing, education, employment and medical care can be subtle.

One of the best indicators of Cuba's genuine commitment was the rapid broadening of medical services to everyone on the island. This was quickly followed by sending Cuban doctors to Africa, Latin America and the Caribbean. Today, the thousands of students coming to study medicine in Cuba is an unparalleled happening. These students are eager to share what their experience means to them.

Beginning in 1959

Afro-Cubans comprised about 40% of the population and received vastly inferior health care at the time of the 1959 revolution. [1] Medical services were concentrated in the cities, whose residents had more money and were more light-skinned. [2]

The revolutionary goal of full medical-care-for-all benefited millions of Cubans, but especially mulattos and blacks in the
countryside. The number of rural hospitals went from 1 in 1958 to 54 in 1984. [2] Unlike the US, there are now virtually no differences in access to medical care by income or rural/urban living [3] Fully 99% of Cubans have ready access to medical services. [2]

Cuba has eliminated polio, brought malaria and dengue under control, and lowered child and maternal mortality to the same levels as rich countries. [3] The island nation currently has an HIV prevalence which is one tenth of the US and a life expectancy of 78.0 years, exactly equal to the US. [2]

What makes these accomplishments amazing is that they have occurred despite continual efforts by the US to isolate and destroy Cuba economically. Cuba continues to have an economy which is a tiny fraction of those in the West. Economic indicators suggest that Cuba is a developing country; but, by health care standards, it is a developed country. [3]

The building block of Cuban medical care is the neighborhood consultorio,which serves about 150 families. The primary health care model focuses on at-risk sectors of the population, such as the very young, the very old and those with common medical problems. It heads off medical crises before they occur.

Sanitation, potable water and immunization are essential components of Cuban health care. Since poverty creates bad health, the Cuban health system is intertwined with reducing differences in housing, income and education. [3]

Cuba proves that expensive technology is not necessary for good medical care. Its preventive and primary care system focuses on keeping people well.The vastly more costly fee-for-service system of the US focuses on sickness.This makes Cuban medicine an attractive model for poor countries of Africa and Latin America.

Beyond the borders

Cuba reached out to other countries at the same time that it was developing its own medical system. Its first health contract involved its sending a medical brigade to Algeria in 1963. [2] Cuba's international health care solidarity is perhaps best known for the doctors and paramedics it sent to the Caribbean Islands and Central America during Hurricanes Mitch and Georges in 1998, as well as the Barrio Adentro (Inside the Community) program which brought 10,000 Cuban doctors to Venezuelan in 2003-04. [4]

Less well known is the medical aid that has gone to Africa. When its soldiers went to Angola in 1975 to support the newly
independent government against the CIA-backed forces of UNITA (National Union for the Total Independence of Angola), 700 or 800 Cuban health professionals went also. Hundreds of doctors sent to Ethiopia about the same time comprised a second major African initiative. Medical aid to Mozambique followed in the 1980s. In 1978, 13% of Cuba's 12,000 doctors were working overseas. The major area to receive aid was sub-Saharan Africa. [2]

Cuba's medical assistance program was expanding so much that Fidel Castro proposed creating a medical school to bring students from around the world to Havana for their education. In 1999, the Latin American School of Medicine, ELAM (Escuela Latinoamericana de Medicina) opened its doors near Havana. With their educational costs covered by Cuba, students focus on learning how to practice medicine in underserved communities.

Just as ELAM was graduating its first class, Katrina slammed New Orleans in 2005. Castro mobilized hundreds of ELAM graduates and Cuban doctors to help. George W. Bush refused to even consider the gesture of good will.

But Cuba's neighbor, Haiti, has had no trouble being one of the largest recipients of Cuba medical aid. There are 567 Haitian students in ELAM,which has graduated 550 Haitian doctors. Cuban efforts in Haiti have meant a greater than 50%
decrease in infant mortality, maternal mortality and child mortality and an increase in life expectancy from 54 to 61 years of age between 1999 and 2007. Haitian President René Preval said, "You did not have to wait for an earthquake to help us." [5]

Cuban doctors provided more medical care than any other country during the first three days after the 2010 earthquake. In addition to ELAM graduates already in Haiti, 184 Haitian students from ELAM (along with US ELAM graduates) came to assist. At the time that the US had 550 medical personnel in Haiti, there were 1500 from Cuba. They had treated 227,143 patients when the US had treated 871. [5] Within a few weeks, most non-military Americans departed and Haiti was out of the headlines. Just as they were present before the disaster, Cubans stayed afterwards "not only to treat patients but to help build a new health care system."

The new medical leadership

The thousands of international students who have graduated from ELAM do more than add another doctor to their countries.

Returning home with a concept of preventive and community health, they have mastered an approach very different from that taught in Western schools.

ELAM has 9675 students from 100 countries in the Havana area. The 7777 students from 15 Latin American countries account for over 80%. But Africa has the largest number of countries (36) represented. They are from Angola,Benin, Burkina Faso, Cameroon, Cape Verde, Chad, Congo, Djibouti, Equatorial Guinea, Ethiopia, Gabon, Ghana, Guinea Republic, Guinea-Bissau, Kenya,Lesotho, Madagascar, Malawi, Mali, Mauritania, Mozambique, Namibia, Niger,Nigeria, Sao Tome Principe, Sarhawi Arab Democratic Republic, Seychelles,Sierra Leone, South Africa, Swaziland, Tanzania, Togo, Tunisia, Uganda,Zambia and Zimbabwe.

African students are 9.1% of those at ELAM, followed by the Caribbean with 7.3%. A much smaller portion of the student body is made up of those from Asia (0.7%), Europe (0.1%), the Middle East (0.5%), Canada/US (1.2%), and the Pacific Islands (0.7%).

During three trips to Havana in 2009 and 2010, I spoke with administrators,professors and students at ELAM.

Notes:

The author would like to thank ELAM Rector Juan Carrizo, Director of International Relations Nancy Remón, General Secretary of Project ELAM Wuilmaris Pérez Torres, and Assistant Professor of MGI Dr. Raul Jorge Miranda for explanations of the Cuban medical system, data on ELAM, and help with contacting students.

Discussions with students Amanda Louis, Lorine Auma, Yell Eric, Keitumetse Joyce Letsiela, Dennis Pratt, Ketia Brown and
Omavi Bailey occurred May 26  June 2, 2010 on the ELAM campus.

1. Sweig, Julia. (2009). Cuba: What everyone needs to know. New York: Oxford University Press, pp. 53.54.
2. Kirk, John M. & Erisman, H. Michael. (2009). Cuban medical internationalism: Origins, evolution and goals. New York:

Palgrave Macmillan, pp. 7, 25.34, 45, 72.75.
3. Whiteford, Linda M. & Branch, Laurence G. (2008). Primary health care in Cuba: The other revolution. Lanham: Rowman &

Littlefield Publishers, Inc.,pp. 2, 7-10, 59, 83.
4. Brouwer, Steve. (January, 2009). The Cuban revolutionary doctor: The ultimate weapon of solidarity. Monthly Review, 60 (8), 28-42.
5. Kirk, Emily J. & Kirk, John M. (Fall, 2010). Cuban medical aide to Haiti: One of the world's best kept secrets.

Synthesis/Regeneration: A Magazine of Green Social Thought. No. 53.
6. Information on the YAB was obtained from the interview with Ketia Brown and the document provided by Omavi Bailey: Yaa Asantewaa Brigade. (August 15 September 5, 2010). African Medical Corps and Ghana Proposal. Latin American School of Medicine, Carretera Panamericana 3 KM, Santa Fe, Playa, La Habana, Cuba CP 19142. For information on the Organization of African Doctors, see www.africanmedicalcorps.com. Donations can be made to the Ghana Project at www.birthingprojectusa.org.

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Source: http://groups.yahoo.com/group/CubaNews/message/118609