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<DIV><FONT face=Arial><STRONG><FONT size=5><FONT color=#800080>Salud!</FONT> A
film on Cuban Healthcare</FONT></STRONG></FONT></DIV>
<DIV><FONT face=Arial size=2><STRONG>Thursday, July 26, 6:30 pm,
</STRONG></FONT></DIV>
<DIV><FONT face=Arial size=2><STRONG>Coolidge Corner Library, 31 Pleasant
St</STRONG></FONT></DIV>
<DIV><FONT face=Arial size=2></FONT> </DIV>
<DIV><FONT face=Arial size=2>Free, Co-sponsored by Brookline PeaceWorks and
</FONT></DIV>
<DIV><FONT face=Arial size=2>the July 26th Coalition for Cuba
Solidarity</FONT></DIV>
<DIV>Light refreshments</DIV>
<DIV><FONT face=Arial size=2></FONT> </DIV>
<DIV><FONT face=Arial size=2>617 738-8029 <A
href="mailto:peace@texnology.com">peace@texnology.<WBR>com</A></FONT></DIV>
<DIV><FONT face=Arial size=2></FONT> </DIV>
<DIV><FONT face=Arial
size=2>============<WBR>=========<WBR>=========<WBR>=========<WBR>=====<A
href="http://www.saludthefilm.net/ns/study-guides.html"></A></FONT></DIV>
<DIV><FONT face=Arial size=2></FONT> </DIV>
<DIV><FONT face=Arial size=2><STRONG><EM><FONT size=3>An elaboration of
the ideas discussed in</FONT></EM></STRONG> Michael Moore’s
<STRONG>SiCKO<BR></STRONG>The main theme of the movie is that American society
needs to focus on the "we" and not the "me" in healthcare. This broad message is
an overlay for the specific criticisms of the healthcare industry - the movie
asks where the morality of the American public lies and contrasts America's
approach to health care unfavorably with other nations. <BR>Coolidge Corner
Theatre, 11:30, 2:10, 4:50, 7:30, 10:00
pm </FONT></DIV>
<DIV><FONT face=Arial size=2> <A
href="http://www.coolidge.org/">http://www.coolidge<WBR>.org/</A></FONT></DIV>
<DIV><FONT face=Arial size=2><BR> </FONT></DIV>
<DIV><FONT face=Arial size=2><FONT size=4><STRONG><EM>See SiCKO ... Then
See</EM></STRONG> </FONT></FONT></DIV>
<DIV><FONT face=Arial size=2><STRONG><FONT color=#800080
size=5>SALUD! <BR></FONT></STRONG> </FONT></DIV>
<DIV><STRONG>SALUD!</STRONG> examines the curious case of Cuba, a cash-strapped
country with what the BBC calls "one of the world's best health systems."
<STRONG>From the shores of Africa to the Mississippi Delta "Salud" hits the road
with some 28,000 Cuban health professionals serving in 68 countries, and
explores the hears and minds of international medical students in Cuba- now
numbering 30,000. Their stories bring home the complex realities confronting the
movement to make health care a human right</STRONG>. Featuring Dr. Paul Farmer
of Partners in Health, the subject of Tracey Kidder's Mountains Beyond
Mountains. </DIV>
<DIV> </DIV>
<DIV><A
href="http://www.saludthefilm.net/">http://www.saludthe<WBR>film.net/</A>
<== Interesting material on this site on Cuban healthcare and a critique of
US healthcare.</DIV>
<DIV> </DIV>
<DIV><BR>---<IMG height=220
src="mhtml:mid://00006765/!http://www.saludthefilm.net/ns/images/edu4.jpg"
width=160></DIV>
<DIV>
<DIV><STRONG>How is Cuba able to serve the medical needs of its own
people,</STRONG></DIV>
<DIV><STRONG>and at the same time send Cuban medical professionals
around</STRONG></DIV>
<DIV><STRONG>the world to work with some of the poorest people on the
planet--</STRONG></DIV>
<DIV><STRONG>who have never had health care before of any
sort?</STRONG></DIV></DIV>
<DIV> </DIV>
<DIV>From: <A
href="http://www.saludthefilm.net/ns/cuba-health-system.html">http://www.saludthefilm.net/ns/cuba-health-system.html</A></DIV>
<DIV> </DIV>
<DIV> </DIV>
<DIV>
<P class=bodytext>Analysts have explained Cuba’s health results in the face of
adversity by pointing to the following key components:</P>
<UL>
<LI class=bodytext>During the worst years of the crisis, the <STRONG>health
status of the population remained a fundamental government priority</STRONG>.
In fact, the Cuban Parliament actually increased the health sector budget in
Cuban pesos and the share of GDP earmarked for health care at the expense of
spending for the military and state administration. At the same time, the
health sector hard currency budget was forced down by two-thirds as a result
of dropping exports. </LI></UL>
<BLOCKQUOTE><STRONG>Although scarcities abounded, they were shared</STRONG>,
prompting a report published by the UNDP in 1999 to state, “An
evaluation of 25 countries in the Americas, measuring relative inequalities in
health, revealed that Cuba is the country with the best health situation in
Latin America and the Caribbean. It is also the country which has
achieved the most effective impact with resources, although scarce, invested
in the health sector.” (<EM>Study on Human Development and Equity in
Cuba.</EM> UNDP,1999: p.103).<BR><BR></BLOCKQUOTE>
<UL>
<LI><SPAN class=bodytext><STRONG>Key medical resources were centralized and
moved to where they were most critically needed.</STRONG> In this
context, the Minister of Public Health initiated a Tuesday morning meeting of
all major health sectors to assess the exact amount of hard currency available
that week, and decide which purchases were possible and essential (often only
the life-saving ones were made). Similar weekly sessions were held in
all Cuban hospitals, to tally the medications on hand and send out an SOS for
those patients not covered by current stocks.</SPAN> <SPAN class=bodytext>A
program soliciting international donations at one point yielded some USD$20
million annually in medicines and equipment, under the consistent proviso that
international agencies could inspect end-use facilities to see their donations
were getting to the intended patients.</SPAN><BR><BR>
<LI class=bodytext><STRONG>The</STRONG> <STRONG>educational status</STRONG>
<STRONG>of the Cuban population itself worked for continued hygiene measures
and health education</STRONG>. While many of the other “social
determinants of health” spiraled downward, the average educational level of
Cubans by 2002 was ninth grade (Source: <EM>Libro Blanco 2006</EM>.
MINREX;2006, Havana, Cuba.); secondary school (through 9th grade) was
required; and over 99% of young people (ages 15-24) who graduated from
secondary school were going on to high school. (Source: <EM>Objetivos de
Desarrollo del Milenio: Cuba, Segundo Informe,</EM> July, 2005; Instituto
Nacional de Investigaciones Económicas, La Habana, p. 33). As has been
amply demonstrated in international reports, the educational level of a
population (and especially of women) augers well for health promotion and
disease prevention, and this was certainly the case in resource-scarce Cuba in
the 1990s and remains so today.<BR><BR>
<LI class=bodytext><STRONG>The</STRONG> <STRONG>dedication of Cuban health
professionals</STRONG>, working under the most stressful conditions, was
without doubt, indispensable for the Cuban population to emerge from the worst
of the crisis with their health status essentially intact. Heart
surgeons, riding to work on bicycles, would wait half an hour for their hands
to stop shaking before entering the operating room. Nephrologists were
working round-the-clock to dialyze ever-more patients on ever-fewer artificial
kidneys. Clinicians in hospitals across the island were phoning each
other, the Ministry and colleagues abroad to find life-saving antibiotics for
their patients.<BR><BR>
<LI class=bodytext><STRONG>The</STRONG> <STRONG>health status of the Cuban
population, vastly improved </STRONG>by the health care system since 1960,
provided a sound foundation which could not be easily eroded. By the
90s, Cuban children were being vaccinated against 13 childhood diseases --
more than any other country in the world, including the United States. A
host of diseases had been eradicated altogether, infectious diseases were at a
minimum, and Cubans were dying of the same chronic conditions described in the
mortality charts of industrialized countries. A significant
socio-political corollary was that the majority of Cubans trusted the health
care system to work for them.<BR><BR>
<LI class=bodytext>Perhaps the most important single catalyst determining the
positive outcome from the precarious 1990s was <STRONG>the presence of a solid
community-oriented primary care network accessible to virtually every family
in Cuba</STRONG>. The family doctor-and-nurse teams, responsible for the
health of some 150 families in a given neighborhood, concentrated their
attention on health promotion, prevention of disease, environmental cleanup,
priority attention to children and the elderly, prenatal care, and early
detection of infection and chronic disease. Most of these activities
required little in the way of material support, but they went a long way
towards keeping the levels of disease from reaching the already over-extended
hospitals wards and emergency rooms. </LI></UL>
<DIV class=bodytext>
<P class=title1><FONT size=4><STRONG>Cuba & Global
Health</STRONG></FONT></P>
<P class=title1><A
href="http://www.saludthefilm.net/ns/cuba-and-global-health.html"
target=_blank>http://www.saludthefilm.net/ns/cuba-and-global-health.html</A><BR></P>
<P class=bodytext><STRONG class=title2>Cuba & the Global Health
Workforce:</STRONG><BR><STRONG class=title2>Health Professionals
Abroad</STRONG></P>
<P class=bodytext>Cuba’s contribution to the developing world’s health workforce
has been essentially a practical one, focusing on <STRONG>health care delivery
and medical education</STRONG>: since 1960, over 100,000 Cuban health
professionals have served in 101 countries, staffing public health
infrastructures; and over 21,000 students from Africa, Latin America, Asia and
the Caribbean are currently enrolled in Cuban medical schools, not counting
those in nursing and allied health professions (1)(2).</P>
<P class=bodytext>This collaboration has evolved over time. The first
Cuban medical team was sent to earthquake-devastated Chile in 1960, when the two
governments had no formal relations. Such disaster relief missions were
dispatched to another 16 countries over the next decades, but were soon
overtaken by a more long-term modality: by virtue of
government-to-government agreements, Cuban health professionals (the vast
majority physicians) began providing health care to underserved populations and
regions in Africa, Latin America, the Caribbean and Asia (3). Since the
1963 request from the Algerian government of Prime Minister Ahmed Ben Bella
(bereft of physicians at the end of French occupation) another 100 governments
have initiated pacts with Cuba for a sustained presence of Cuban health
professionals in their countries’ health care delivery programs: six in
the 1960s; 22 in the 70s; 11 in the 80s; 47 in the 90s; and 15 since 2000
(1)(4)(5). </P>
<P class=bodytext>The fact that half this cooperation began in the nineties
speaks to developments during that time in Cuba’s own health system, which made
larger numbers of physicians available for international service and also
reinforced Cuban health authorities’ <STRONG>commitment to primary care</STRONG>
as key to improving health status. In particular, by mid-decade, the
neighborhood-based family doctor-and-nurse program was in place across the
country, by 1999 covering 98.3% of Cuba’s 11 million people (6). The program
culminated a process of embedding health services deeper into communities, aimed
at more effective health promotion and disease prevention efforts. As a
result, curricula in Cuba’s 21 medical schools were revamped, and a residency
created in family medicine, ratcheting up the number of graduates annually to
cover needs at home and growing interest from other countries. By the end of the
decade, Cuba had nearly 30,000 family physicians, and a total of some 60,000
doctors, more than Sub-Saharan Africa. By 2005, the island’s physician
population had reached over 70,000. (6)(7)(8).</P>
<P class=bodytext>The other factor explaining the jump in cooperation during the
nineties was external: in 1998, Hurricanes Georges and Mitch swept Central
America and the Caribbean, leaving 2.4 million homeless. Cuban medical
teams, at first deployed on an emergency basis, stayed on at the request of
several governments under <STRONG>Cuba’s Comprehensive Health Program
(CHP)</STRONG>, created in response to the region’s crisis and later expanded to
include a total of 27 countries in Latin America, the Caribbean, Africa and
Asia. By way of example, in May, 2006, there were 448 Cuban health
professionals in Guatemala, 426 in Haiti, 113 in Belize, 347 in Honduras, 93 in
Botswana, 188 in Ghana, 109 in Mali, 134 in the Gambia, 143 in Namibia and 278
in East Timor. (9) </P>
<P class=bodytext>Under these agreements, the host country provides
accommodations and food, domestic transportation, a locale for work, and a
monthly stipend (usually US$150-$200), while Cuban personnel receive their
regular salaries, airfare and other logistical support from the Cuban health
ministry. In arrangements outside the CHP with wealthier countries
such as South Africa, the host government pays additional hard currency salary,
part of which is kept by the professionals and part of which is remitted to the
Cuban health ministry. (9)(10)</P>
<P class=bodytext>In July, 2006, 28,664 Cuban health professionals were serving
abroad in 68 countries. (5). In each country, the thrust of Cuban assistance has
been to <STRONG>bolster public health infrastructures,</STRONG> providing the
often desperately needed staff in remote areas - some in hospitals, but mainly
in primary care clinics and medical posts - regions where local governments have
been unsuccessful in attracting local physicians to the public sector. In
several countries, such as Honduras, Haiti, Guatemala, Mali, South Africa and
the Gambia, there are whole regions where the Cubans have been the first bearers
of local physician services to rural, indigenous and other marginalized
communities. They also bear the Cuban philosophy of <STRONG>combining
population-based public health principles and prevention with clinical
medicine</STRONG>. </P>
<P class=bodytext>On other levels, Cuban medical scientists and advisors have
participated in design of public health departments and systems, and in
<STRONG>epidemiological research and campaigns</STRONG> tackling specific health
problems (malaria in several African countries, dengue in El Salvador and
Honduras, cholera in South Africa, etc.). They have also worked with
health ministries to devise <STRONG>more reliable statistical record-keeping and
information systems</STRONG> in many countries, especially in those with the
heretofore weakest infrastructures (11).</P>
<P class=bodytext>Health professionals on the ground participate and often lead
local courses for <STRONG>midwives and other community-based health personnel
</STRONG>and participate in more formal<STRONG> training for paramedical and
allied health professionals. </STRONG>Most recently, Cuban<STRONG> biomedical
engineers </STRONG>and technical support have been increasingly in demand,
repairing nearly 55,000 pieces of medical equipment since 1999. (5) </P>
<P class=bodytext>Cuban coverage has resulted in an increase in patient care
levels in poor communities, according to statistics kept by the medical
teams. For the 22 countries in the CHP by 2004, from November, 1999
through February, 2004, this translated into: 36.7 million doctor’s
visits, 917,381 surgeries, 397,636 deliveries, 11.9 million health promotion
activities, and medical education courses for 910,120 local health personnel,
including midwives (12). <STRONG>Health status</STRONG> has also improved
in areas where Cuban doctors serve: in Guatemala, the infant mortality rate in
these regions dropped from 45 to 16.8 deaths per 1,000 live births; in the
Gambia, from 121 to 61; and in Haiti from 59.4 to 33, from 1999 through May,
2003 (13).</P>
<P class=bodytext>Recently, Cuba has taken a more pro-active role in initiating
<STRONG>trilateral collaboration, </STRONG>in which a third country or agency
donates resources for health programs developed between Cuba and another
nation. This was the case of the 2001-2002 vaccination drive in Haiti,
when Cuban epidemiologists and family doctors teamed up with Haitian health
authorities to immunize 800,000 children against five childhood diseases.
Funds from the French government and 2 million doses of vaccines from the
Japanese government completed the triangle. The German government
contributed to Cuban projects with Niger and Honduras; the South African
government donated US$1 million for Cuban medical cooperation with Mali; and the
WHO has supported Cuban collaboration in the Gambia and elsewhere (14).
According to the Cuban government, 95 non-governmental organizations worldwide
contributed to CHP projects between 1999 and 2004. (13)</P>
<P class=bodytext>Since 2000, Cuba has launched <STRONG>four special cooperation
initiatives</STRONG>: one <STRONG>focuses on HIV-AIDS in 19
countries</STRONG>, through joint projects in prevention and treatment
(Botswana, Honduras, Mali, and Haiti among them); and in 2001, Cuban officials
offered African countries 4,000 doctors and other health professionals, medical
school professors, a stock of anti-retroviral drugs and diagnostic equipment to
help combat the epidemic (15).</P>
<P class=bodytext>The second, begun in 2003, makes a major <STRONG>commitment to
Venezuela</STRONG>, a country with one of the greatest discrepancies between
rich and poor in South America.(16) The Venezuelan government’s “Barrio
Adentro” program relies on some 20,000 Cuban family doctors to provide health
services and health education in medically underserved communities ranging from
the shantytowns of Caracas to the jungle riverbanks of Amazonas State. The
agreement falls under the ALBA accords (Bolivarian Alternative for the
Americas), offered as a South-South alternative to the FTAA, in which several
Latin American and Caribbean countries now participate—the principle being that
each brings to the table the resources at its disposal to be used for social
programs bilaterally and throughout the region. Thus, in Cuba and Venezuela’s
case, the arrangement is often boiled down in the international press to “oil
for doctors”.</P>
<P class=bodytext>The third initiative is a <STRONG>vision restoration
program</STRONG>, begun in mid-2004, which addresses the condition of the
estimated six million persons in Latin America and the Caribbean who have
reversible blindness or vision loss due to cataracts and other conditions—but
who are too poor to pay for the surgeries in their own countries. Since the
program began through July, 2006, 317,489 patients had been treated from 27
countries (including 69,000 Cubans). Ophthalmology centers have also been
opened in Ecuador, Bolivia and Mali under this program, which receives support
from local governments as well as the ALBA. (17)(18)</P>
<P class=bodytext>The <STRONG>fourth new initiative</STRONG> is the Henry Reeve
Disaster Response Contingent, originally some 1500 physicians offered to the USA
in the wake of Hurricane Katrina. When the Bush administration turned down
the offer, the contingent was established as a permanent volunteer corps and
given special training, ready to be dispatched to disaster areas within 24
hours. Their first mission came in October 2005, when 2500 traveled with
32 field hospitals to earthquake-stricken Pakistan, where they remained for five
months. Since then, the contingent has also been dispatched to Guatemala,
Indonesia and Bolivia. The Contingent builds upon earlier Cuban
cooperation in disaster relief since the 1960 earthquake in Chile, which took
Cuban health professionals to Nicaragua, Honduras, and several other countries
thereafter. The treatment in Cuba of over 17,000 children of the Chernobyl
nuclear disaster is also part of this history. (5)(19)</P>
<P class=bodytext>Over time, Cuba’s South-South cooperation has faced endless
challenges: the political and social instability besetting many developing
countries; the sheer size of the effort and resources needed to make a dent in
the poorest countries’ health status, sometimes straining domestic health
facilities; barriers to access and treatment found in the various health systems
staffed by Cubans; initial concerns from in-country medical associations fearful
of job displacement; the need to expand the skill set of Cuban physicians
serving abroad, who confront circumstances and infectious diseases long absent
from the Cuban health picture; and unabating effects of the US embargo which
continue to generate barriers for Cuban health care at home and abroad. </P>
<H2 class=title2>References</H2>
<OL class=style1>
<LI>Memo to Gail Reed from Dr. Ricardo Bagarotti, Unidad de Colaboración
Médica, Ministry of Public Health, Havana, June 26, 2006.
<LI>Data from the Comprehensive Health Program and International Cooperation
Vice Ministry, Ministry of Foreign Relations, Havana and the Vice Ministry for
Medical Education, Office of Foreign Student Enrollment, December, 2006.
<LI>Memo to Gail Reed from Dr. R. Bagarotti, Unidad de Colaboración Médica,
Ministry of Public Health, Havana, March, 2004.
<LI>Speech by Ahmed Maamar, Algerian Ambassador to Cuba, May 24, 2003, Astral
Theater, Havana (40th anniversary of Cuban medical team’s arrival in Algiers).
<LI>“Mirando al futuro desde la Cooperación Internacional”, Power Point
presentation by Dr. Yiliam Jiménez, 26 June 2006, Havana.
<LI>Reed, GA. Challenges for Cuba’s Family Doctor-and-Nurse
Program. In <EM>MEDICC Review</EM>, Vol 11 No 3, 2000.
<LI>Castro, F. Speech at national medical school graduation ceremonies,
August 13, 2003. Unpublished transcript.
<LI><EM>Health Human Resources Trends in the Americas: Evidence for
Action,</EM> Pan American Health Organization Human Resources for Health Unit,
September 2006, Washington DC., p. 6.
<LI>Memo to Gail Reed from Dr. Nestor Marimón Torres, Director of
International Relations, Ministry of Public Health, July 4, 2006.
<LI>Author’s interview with Dr. Jaime Davis, head of the Cuban medical team in
South Africa, July 17, 2003, Johannesburg, South Africa.
<LI>Country reports from Cuban medical teams, Unidad de Colaboración Médica,
Ministry of Public Health, Havana, 2003.
<LI>Comprehensive Health Program Database, Departamento de Cooperación
Internacional, Ministry of Foreign Relations, Havana, Cuba, March 15, 2004.
<LI><EM>Globalizando la solidaridad.</EM> Programa Integral de Salud.
Ministerio de Relaciones Exteriores, p. 7.
<LI>Reed GA. Interview with Dr. Yiliam Jiménez, Director, Comprehensive Health
Program, October 17, 2003, Havana.
<LI>Speech by Cuban Vice President Carlos Lage Davila, UN Meeting on AIDS,
June 25, 2001.
<LI><EM>Informe Sobre Desarrollo Humano, 2003</EM>. UNDP.
Mundi-Prensa, 2003. pp. 282. Difference between incomes of top 10%
and lowest 10% is a factor of 44, surpassed only by Brazil and Paraguay.
<LI><EM>Acumulado Operación Milagro (hasta 27 junio 2006), </EM>International
Cooperation Vice Ministry, Ministry of Foreign Relations, Havana.
<LI>Reed GA. Interview with Dr. Marcelino Río, Director, Instituto de
Oftalmología Pando Ferrer, Ciudad Habana, 17 November, 2006.
<LI>Vice Minister for International Cooperation, Ministry of Foreign
Relations, Havana, 2006. </LI></OL>
<P><SPAN class=source>©<A
href="http://www.medicc.org/"><STRONG>MEDICC</STRONG></A>, 2007</SPAN></P></DIV>
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