I recently spent a week visiting the Frank País Orthopaedic Hospital in Havana, Cuba. The visit allowed a glimpse into the inner workings of the Cuban medical system and re-emphasized the importance of preventive medicine.
A mural outside the hospital was painted with the following quote by Che Guevara emphasizing this point: “And medicine needs to change one day…to a science that serves to prevent illness and addresses all the medical needs of the public.”
Indeed, the pride and joy of the Cuban people is its universal education and healthcare system, viewed as an undeniable right regardless of age, gender, income, and race. Access to health resources is intended to be available to all.
Each day I was at the hospital, I sensed considerable hope for the future, the country, and their patients. The young surgeons and nursing staff were eager to discuss their patients and cases, in spite of long hours, packed schedules, and busy waiting rooms. Daily reports each morning were filled with active discussion and a team that was energized to work. And work, the team did. From morning to night, each day of the week, they worked to provide the best possible care to their patients.
Yet Cuba is not without its disappointments. The promise of so much is met by the reality of a country with limited resources and economic pressures. The government-run pharmacy was perpetually low or out of certain medications, and the team quickly taught me the small list of medications able to be procured. The facilities were also lacking in technological resources for surgical procedures and rehabilitation.
Dreams and careers had changed. A barber, who previously graduated at the top of his veterinarian school class, quickly realized he could not subsist on a meager government salary. A taxi driver with a Ph.D. in literature, versed in quantum mechanics, found his car was the only way to make ends meet.
As one surgeon outlined to me, the conundrum lay not in a doctor shortage, but rather in the systemic rationing of a finite resource. Whether it was medications, medical equipment, or surgical procedures, all were in limited supply and often not to be found. The solution, he said, relied on better preventive care.
“Everybody in this waiting room will likely need a new knee or hip, but we can only offer them to so many patients,” the surgeon said.
Preventive care includes medical therapy that changes lifestyle, improves outcomes and extends quality of life as much as possible without surgical intervention. Rehabilitation, dietitian visits, physiotherapy, and in-home physician visits are used as first lines of defense to prevent illness and disease before interventional treatments were considered.
Perhaps the experience of Havana and its people can be summarized by a late-night trip to a privately run pharmacy to procure a non-government generic medication for an international patient. As the rain poured down, the pharmacist finally opened the door. After listening to my request, she said, “I’m terribly sorry, the pharmacy is closed now.” I thanked her for her time and as I turned away she said, “But our hearts are open!”
It was true. Closed or not, Cuba remains standing with an open heart.
-By Sergio Navarro, third-year medical student and research assistant with Baylor Global Initiatives