Cuba’s Emphasis on Preventive Medicine

Ray Suarez continues his series from Havana with a report on the Cuban health care system's emphasis on preventive medicine.

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    Next: medical care in Cuba, where many ounces of prevention are considered worth a pound of cure.

    Here is the second of Ray Suarez's reports.


    One of Cuba's greatest prides is its health care system.Cuba's government promotes the country's free and universal medical care from the moment a baby is born as the cornerstone of its communist state.

    And, according to the World Health Organization, the country has much to boast about.The average Cuban lives to the age of 78.That's slightly longer than the life span of the average American.The cost of health care in Cuba is less than $400 a year per person.In the U.S., the annual tab is almost 20 times higher.

    And there are twice as many doctors per person in Cuba than in the United States.In fact, it's the highest doctor-patient ratio in the world.

    How can one of the poorest countries in the Western Hemisphere provide free care and achieve such impressive health outcomes?

    GAIL REED, editor, "MEDICC Review":Prevention, prevention and more prevention.


    Gail Reed is American-born and living in Cuba. She edits a journal that studies Cuban medicine called "MEDICC."


    Having access to family doctors and nurses I think has been a key to Cuban success, even when there wasn't much medicine in the medicine cabinet.The preventive approach, having health care workers accessible to people, doing home visits, is a critical part of the success.


    Unlike the rest of the developing world, there's no doctor shortage in Cuba, which means the health care system here can push doctors and nurses down to the smallest rural communities, providing a kind of care that's both personal and persistent.

    Here, in rural Moncada, Dr. Orisloriam Morales spends every afternoon making home visits. She reaches about six homes a day. After she finished medical school, free of cost for all Cuban doctors, Dr. Morales was assigned to work in Moncada. All new doctors must work where the government assigns them.

    Like everything in Cuba, the government keeps a close eye on medical employment, ensuring that all Cubans have access to care and that each doctor has no more than 1,100 patients.

    On this day, Dr. Morales is following up on an 86-year-old patient who suffered a hip fracture.But Morales says her exam doesn't only check the patient.She's on the lookout for other health threats.

  • DR. ORISLORIAM MORALES, Cuba (through translator):

    The objective is not just to see the sick person in the home, but also to prevent illness.We do a physical exam of everyone in the home and inspect the living conditions.


    It's aggressive preventive medicine.Homes are investigated, water quality checked, electrical plugs checked.All the other people in the household also get a checkup.

    Dr. Jorge Delgado is with the Cuban Ministry of Public Health.

    DR. JORGE DELGADO, Cuban Ministry of Public Health (through translator):Preventative medicine in Cuba is a premise.There is a saying:It's better to avoid someone falling off a cliff than to pick him up after he's destroyed on the ground.In Cuba, preventative health care is a victory of our revolution.


    In such a poor country, however, it's not always easy to treat illness.

  • JULIO ALFONSO, Solidaridad Sin Fronteras (through translator):

    When a Cuban patient goes to a hospital, he must rely on the resources available at that moment.Sometimes, a simple urinary infection can't be treated because they don't have the right antibiotics or some of the basic medications to treat chronic illnesses.


    Julio Alfonso is a doctor who fled Cuba in the early '90s, when the country was in severe economic crisis.Alfonso became frustrated with the limited financial resources given to Cuban doctors.

    His Miami organization, Solidaridad Sin Fronteras, Solidarity Without Borders, gives scholarships to nurses and doctors who defect from Cuba and want to retrain and get board-certified in the U.S.

  • DR. JULIO ALFONSO (through translator):

    Cuba looks abroad to supply the Cuban people.Every Cuban has a family member abroad to send medicines.Plus, there are organizations like ours that send medical supplies.


    But Gail Reed says one of the biggest problems remains the embargo of medicine from U.S. pharmaceutical companies.


    There are serious restrictions on patented medicines.The latest cancer drugs, for example, have patents that are 20 years, and now the pharmaceutical companies are asking for more time for their patents.So, these are inaccessible to Cuba in regular commercial terms.


    Because of the U.S. government's trade embargo, Cuba has created its own biotech industry.Some of its strongest successes have come in preventive medicine, like vaccines, including one for hepatitis B, now virtually eliminated from the country.

    Manuel Raices Perez-Castaneda is an executive for Cuba's Center for Genetic Engineering and Biotechnology.

    MANUEL RAICES PEREZ-CASTANEDA, Center for Genetic Engineering and Biotechnology (through translator):In the sense that it created a great need, yes.It created great suffering, but, at the same time, the embargo created the challenge of trying to resolve our own problems.And we developed an industry capable of producing the very latest medicines.


    According to Raices, the Cuban biotech sectored has garnered 230 international patents and is marketing its products in 57 countries.It's now the third largest industry in Cuba.

    Still, some ask if living to the age of 78 is worth it, if it means living in persistent economic hardship.

    Carlos Castaneda, a Cuban-trained physician who left the island in 1995, says there's more to living than staying healthy.After arriving in the United States, he took odd jobs for 16 years and is now in the process of getting his physician's assistant's license.

    CARLOS CASTANEDA, Cuban-Trained physician:I had to do everything, anything.I had to work in the beach as a bellman, logging — I mean, carrying luggage to — everything.I was a valet parking.I did it.You name it.I did everything.But I was happy, because I was working and I was making money.And I always thought that I would — I had a light at the end of the tunnel.


    But, in Cuba, the rewards for doctors are often talked about in philosophical, not financial, terms.Free medical care is considered a basic right.Preventing illness is considered a state priority.And doctors who provide those services are considered foot soldiers in Cuba's social revolution.

  • DR. JORGE DELGADO (through translator):

    Education here in Cuba is free.So, providing good medical staff for Cubans is practically a duty.But it is also considered an honor.


    In an era when countries are struggling to do more for less with limited health care dollars, Cuba's successes in prevention are likely to be closely watched.


    Tomorrow, Ray and the Global Health Unit will report on one of Cuba's choice exports: doctors.