Peace, Hugs, and Purrs,
Carolyn Rose Goyda
Missouri, USA
rosegojda@aol.com
rosegojda2@aol.com
'awaken and shaken the sheople'
Americans Are Learning Medicine the Cuban Way
By Julia Landau, East Bay Express
Posted on February 5, 2010
http://www.alternet
Health professionals 938 Of those, Haitian ELAM grads 280 Persons treated 50,000 Surgeries 3,400 Complex surgeries 1.500 Births 280 (including 183 C-sections)
Sources: Granma, Juventud Rebelde, AIN, PL, Trabajadores.
January 24, 2010
A team of 64 environmental control specialists—including epidemiologists, vector control experts, and entomologists-
Dr. Mirta Roses, Director of the Pan American Health Organization, visited the Cuban medical contingent today in Port-au-Prince, praising the health professionals' work in Haiti. "We were already aware of their organizational capacity, their experience in disaster management; and it has been an enormous advantage that they were already here (before the quake). They know the situation, the health ministry, the Haitian people and they were already working with PAHO. Theirs is an enormous contribution."
Today, Cuban Foreign Minister Bruno Rodriguez proposed to member governments of ALBA (Alianza Bolivariana para las Americas) that they permit medical students from their countries to form a multinational contingent with Cuban and Cuban-trained Haitian doctors to help staff the Haitian public health system, as it recovers from the January 12th earthquake. At a meeting of ALBA ministers in Caracas, he also proposed that ALBA resources be dedicated to building and rebuilding health facilities in Haiti, from primary care clinics to hospitals.
University student organizations throughout Cuba have begun a voluntary blood drive for Haiti, with some 50 donations a day reported at one University of Havana campus. Cuba's Ministry of Public Health collects the donations and also tests them for safety before shipment.
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Social Activism is not a hobby: it's a Lifelong Commitment.
www.blackeducator.
Feb 6, 2010
[MedicalConspiracies] take a look at this medical approach - serious very interesting and short read
this is needed in the USA
don't be turned off because it is CUBA - it is a system with better results than ours
and a saner approach than the AMA and med schools here
"....The Cuban experience also may provide important lessons for our current health-care crisis. With a fifth of our per capita GDP, Cuba has health statistics comparable to those of industrialized nations.
In the shabby, eroding, and commodity-deprived neighborhoods of Old Havana, Cubans also enjoy a better doctor-patient ratio than Americans: 59 doctors per 10,000 people compared to 26 for us.
Cuban life expectancy also matches that of the United States, its Infant mortality rate is lower, and the island's HIV/AIDS transmission is among the lowest worldwide. Cuba's aggressive health-care delivery system also costs much less — around $200 per capita annually, compared to our $7,000.
And it provides timely and primary care for every citizen — near universal accessibility. To the Cuban government, health care is a right...."
there offer to help in the aftermath of Katrina was refused but their help in Haiti has been vital and timely
the point is not the socialism = politics and labels are not the issue - but rather it is the saner approach and the lack of strangle hold by the AMA and the corporate drug pushers and for profit hospitals; and the indoctrination of US doctors who start out in debt and have to focus on ROI and loan repayments rather than health care - and where our doctors get kick backs from drug mfg's and our US Doctors too often turn to assembly line medicine to maximize profits and see preventive medicine as not profitable to THEM - or their lifestyle
Sadly - the AMA guild and the multinational pharmaceutical conglomerates and their lobbyists have fashioned a profitable medical a system that thrives on drugs and getting chronic patients and life long meds and costly intervention and very few very very few med school teach anything but the minimum on nutrition and environmental factors in illness and health care -
simply put
there is no money in it if patients don't become dependent
read the Cuban approach below .. and just imagine that kind of doctor ratio here and that effort to promote prevention rather than drugs and surgery and costly testing and their side effects and our dehumanization of health care
Melissa Rose Mitchell was discouraged. After taking the Medical College Admission Test, she was uneasy about applying to medical schools. In prep courses for the exams, she had glimpsed her future as a doctor, and she didn't like the environment she saw. "People were like, 'What kind of doctor do you want to be?' and it was all based on how much money you make," the Oakland resident recalled. "It was a really scary moment, because this thing that all my life I had wanted to do without question, all of a sudden I'm thinking, 'I don't know if I want to do this.'"
Mitchell had scraped together the money to prepare for and take the med-school admissions test, but even as she studied, she had begun to waver. "It had taken me over a year to save the $1,400 for the test and prep course and they said, 'We recommend that you apply to no less than twenty schools,' at about $200 each." And there were still the costs of plane tickets and a proper suit to interview at schools. She did well on the exams, but Mitchell was spending a lot of money to fulfill her goal of serving the poor.
But then her boyfriend saw a blurb in a church newsletter that appeared to assuage her growing worries. It was a unique offer to study in Cuba, the impoverished nation 90 miles from Florida that is internationally known for its training and use of doctors. She applied through the Interreligious Foundation for Community Organization in New York, a group whose mission is to "increase minority participation in medicine" and therefore increase the doctor-patient ratio for underserved areas.
Cuba began educating American medical students after members of the Congressional Black Caucus met with Fidel Castro in 2000. Congressman Bennie Thompson of Mississippi told Castro about areas in his district that suffer from extreme doctor shortages. The Cuban president responded by promising scholarships for 500 Americans to attend medical school in Cuba, under the umbrella of the Latin America School of Medicine. To qualify, the students would have to show aptitude and a commitment to work in underserved communities in the United States. Since then, 34 have graduated, and more than 160 are currently enrolled.
The Bay Area, it turns out, is something of a hub for the Cuba school of thought, where Cuba-trained students, unencumbered by the massive debt that plagues grads from US medical schools, have the luxury to do the kind of medicine that Cuba instructs — family medicine. The island's medical schools focus on nutrition and other preventative approaches. Cuba also is well known for its focus on the "social determinants of health."
The Cuban experience also may provide important lessons for our current health-care crisis. With a fifth of our per capita GDP, Cuba has health statistics comparable to those of industrialized nations. In the shabby, eroding, and commodity-deprived neighborhoods of Old Havana, Cubans also enjoy a better doctor-patient ratio than Americans: 59 doctors per 10,000 people compared to 26 for us.
Cuban life expectancy also matches that of the United States, its infant mortality rate is lower, and the island's HIV/AIDS transmission is among the lowest worldwide. Cuba's aggressive health-care delivery system also costs much less — around $200 per capita annually, compared to our $7,000. And it provides timely and primary care for every citizen — near universal accessibility. To the Cuban government, health care is a right.
This fact highlights a gap in the health-care reform initiative proposed by Congress and President Obama. Those currently without insurance, who will receive coverage with the bill, will feel the lack of family practitioners as basic care continues to be undervalued in favor of more profitable types of medicine.
At a White House forum early last year, the president spelled out the problem bluntly: "We're not producing enough primary-care physicians," he said, pointing to a daunting chain of obstacles. "The costs of medical education are so high that people feel that they've got to specialize."
According to the Association of American Medical Colleges, the average debt for a US medical school graduate in 2008 was $154,607. American doctors, as a result, feel forced to take up specialized practice, because ultimately the higher pay will ease their enormous student debt. Yet without enough primary care doctors, experts say, health-care costs grow exorbitant, end-stage care increases, and thousands of family practice residence positions go unfilled every year.
Doctors graduating in Cuba have no such excuse to specialize, and the island does not graduate members of an elite profession. Instead, it's a veritable doctor-producing machine with more than 70,000 physicians for a population of just 11 million.
And after medical school in Havana, Mitchell would return to the United States debt free.
Many students enter American medical schools wanting to do family care but get discouraged, said Dr. Richard Quint, retired faculty at UC San Francisco and a medical consultant to the Oakland nonprofit group Medical Education Cooperation with Cuba. American medical schools deem primary care as having secondary import, he contends. "The overall structure of our 'non-health system' is fragmented and skewed toward specialty practices," he said. "Faculty in medical schools make comments suggesting you shouldn't go into primary care because it's not stimulating or high-achieving enough." It also no secret that physicians are reimbursed highly for procedures and surgeries rather than for preventive medicine and diagnoses. And the need for primary care in underserved areas often doesn't make it into the textbooks or the classroom.
When it comes to preventative care, the shortcomings in American medical education mirror the failings in our health-care system as a whole. "There's nothing the Cubans are doing that people couldn't think of here — it's just they are looking upstream" at prevention, explained Dr. Lynn Berry, chronic disease program manager at Oakland's Highland Hospital, who has conducted research in Cuba.
Berry pointed out that Alameda County has "pretty strong" community health care. "We have La Clínica de La Raza, the Ethnic Health Institute, Native American Health Services," which emphasize prevention and education to avoid the costs, medical and financial, of end-stage care. But "ours is a market system," Berry said, a system "organized around insurance and payer source, not necessarily the long-term health of the patient."
Cuba redesigned its medical system out of financial necessity following the collapse of the Soviet Union. Faced with a supply crisis brought on by the lack of Soviet funding, Cuba revamped its medical education system towards primary care. By the mid-Nineties, they had established a comprehensive neighborhood-based family medicine standard: a consultario (neighborhood clinic) in every locale, and a revised medical school curriculum to embed family care into the model.
The island's health care starts with a top-down mandate for a "bottom-up" approach to health care. Too poor to rely on high-tech equipment or expensive, invasive procedures, the Cuban model stresses prevention and spreads health-care responsibility beyond doctors — into schools, work sites, and neighborhoods. A national network of polyclinics ensures the mandate. People in all walks of life are expected to cooperate in health publicity campaigns and other measures to prevent disease.
The United States' fifty-year-old embargo on goods to the island also has played a role in shaping Cuba's medical care system. The embargo prohibits or restricts the sale of some medical equipment and punishes other countries that deliver essential cargo. Drugs and medical supplies are sporadic, especially in Cuba's rural areas, where clinics work with outdated X-ray machines. And because US pharmaceutical companies develop most major new drugs, Cuban physicians don't have access to many new medicines on the world market. Countries like Spain and Venezuela donate, but routine medical supplies remain scarce or absent from some Cuban clinics.
Still, Dr. Davida Flattery, an internist at Highland Hospital, was struck by Cuba's "bottom-up" approach when she observed their health system last year. "What really impressed me about Cuba was their focus on the non-medical determinants of health," she said. It's standard in Cuba, she added, to engage the psycho-social factors of a patient — level of sanitation, presence of abuse or addiction, and food habits. Doctors and nurses, in fact, make home visits to evaluate these things personally.
Americans trained in Cuba see firsthand the glaring differences between the two medical education systems. Melissa Rose Mitchell learned, for example, that Cuba highlights rural medicine. "In lots of situations the professor will ask, 'What's the best test?' We'll say 'CT scan, ultrasound.' They'll say 'Well you don't have ultrasound, you're in the middle of nowhere, in the mountains, you have no electricity or phone. ... What are you going to do?'"
Many past and current students of the Latin American School of Medicine in Havana, where Mitchell attended, had lived or worked in poor and underserved neighborhoods in the United States, and were chosen to study in Cuba so they could take what they learned back home. And their Cuban education equipped them to deal with health problems of the poorest communities in the United States far better than if they had gone to Harvard.
Havana medical students, for example, are trained to stabilize people in places with no electricity or potable water. One might think those skills irrelevant in the wealthy United States, but a number of poor American communities have come to resemble sections of Third World countries — especially after a disaster (see Hurricane Katrina).
The lack of doctors in America's neediest communities is exactly what the Interreligious Foundation for Community Organization wanted to remedy as they began recruiting for the Cuban scholarships. The resulting program also is quite diverse — far more diverse group than any US med school. The majority of students in Latin American School of Medicine in Havana are African Americans from New York or California, 85 percent are minorities, and 73 percent are women.
And most of the students are trained as "médicos de la familia," or family practitioners. But, as the students saw, medical supply shortages plague the system, and despite diabetes intervention and screening programs in schools and workplaces across the country, the Cuban national diet remains high in fat and sugar. Like the US poor, Cubans don't have easy access to fresh fruits and vegetables — or the habit of eating them — and this hinders their health. Cuba's food distribution system from the countryside to the cities is substandard. The nation imports more than 50 percent of its food.
Mitchell said the training and experience suited her. "They train us just like they train Cubans," she said. "Every Cuban, regardless of specialty, has to do two years of family medicine. Until you can deal with basic, vital situations, you are not allowed to mess with other parts of the body."
After graduating last summer, Mitchell settled in Oakland to work and prepare for the boards, but she says her calling is rural medicine. She used her summer breaks from medical school, in fact, to work in a mobile health-care clinic serving rural populations outside of Birmingham, Alabama, a conservative city with stark wealth disparities. "Every two weeks or once a month, this clinic on wheels visited parts of the state where some of the houses did not have electricity or indoor plumbing. Not because it couldn't be gotten, but because people didn't have the money to invest in it." When asked if the poverty compared to that of rural Cuba, she responded: "The poverty was more intense" in some areas of rural Alabama than in rural Cuba, she said, "because there were no social services."
Yet back home Mitchell faced disapproval — even hostility — for deciding on a nonspecialized practice. "My first experience going home, my aunt and I had a heated argument — me saying I didn't want to specialize and if I did it would be family medicine or rural medicine. Her argument was anybody who had any sense would become a neurosurgeon or a cardiologist. But my image of a doctor is someone who can handle any situation that comes up."
And having witnessed the obstacles facing Cuba, the returning American doctors are scandalized with the state of health care at home. Mitchell works as a part-time medical assistant at a Bay Area clinic and doesn't have insurance herself. "There have definitely been a couple of times I've been sick and couldn't afford to see a doctor," she said.
"A friend did me a favor by seeing me, but I had to pay $60 for antibiotics — that was with the clinic's discount."
Before moving to Oakland as a teen, Pasha Jackson saw firsthand on the streets of South Central Los Angeles the power of nonmedical, psychosocial factors to spread disease — both physical and mental. Violence, joblessness, and addiction merge with poverty to leave many residents out of the health-care system. "What does primary care mean for the people around me?" he said. "It's self-medication. Junk and drinking. These people really need attention, and insurance will deny them for a list of reasons."
But Jackson didn't know he wanted to study medicine until he sustained a football injury. Recruited from City College of San Francisco by the University of Oklahoma, he went on to play for the San Francisco 49ers and Oakland Raiders. But academic advisors throughout high school and college, he said, actively discouraged his interest in science. "They said it was too hard," and that his best chances were with football.
Reassigned by the Raiders to NFL Europe, Jackson tore his left pectoral — "a huge injury for a linebacker," he noted. "Once I left the NFL my health care ended, and to go to Cuba I needed shots and checkups to travel internationally. I couldn't believe what I had to go through. After calling around to public clinics, I had to wait for weeks and miss a day of work to see a doctor that didn't want to see me."
Jackson spent a year recuperating and getting physical therapy. And during that time, the effects of Hurricane Katrina reminded him of the deep connection between poverty and disease. "I knew I didn't want to play football anymore," Jackson said. "In the NFL there's so much waste, the playing with the money and power. I saw how much a part it was of the capitalist system."
Disgusted with professional football, Jackson went to the Interreligious Foundation for Community Organization's web site and applied. The Cuba program "had me in Cuba, where I could learn Spanish; covered me financially; and got me back to science."
On summer break from his studies in Cuba, Jackson and more than a dozen other students from the Latin American School of Medicine visited deprived American communities to deliver basic health services and expand their own cultural competency. Los Angeles' Skid Row, a place with "ridiculous numbers of homeless people," was one stop on the trip, Jackson recalled. "Mora County [New Mexico] has hardly any doctors." They stopped at Pajarito Mesa, "where the Pueblo Indians live, with no potable water and no electricity. It shows you," Jackson said. "There's the Third World — right here. There are no national boundaries."
"When the earthquake hit in Haiti, over 400 Cuban medical personnel were already there - they've been there for years," said Dr. Nelson Valdez, Professor Emeritus of Sociology at the University of New Mexico and Director of Cuba-L, which monitors news related to Cuba. According to Medical Education Cooperation with Cuba, some 700 Haitian medical students in Cuba study at the Santiago de Cuba campus of the Latin American Medical School. Cuba is sending doctors and students in droves to treat tens of thousands Haitians lying wounded in hospitals with zero or few doctors. "No one is reporting on the Cuban presence in Haiti," commented Valdez, though he said he wasn't surprised. "The additional doctors being sent are part of the same team that was offered to the United States by Cuba when hurricane Katrina hit." The assistance was refused. Valdez also said the Cuban doctors, solidly trained in disaster medicine, provide psychological as well as physical attention to victims.
The State Department announced that U.S. aid workers would cooperate with Cubans on the ground in Haiti. Those who've observed what we can learn from the Cuban medical approach -- scholars and physicians, new and veteran -- all agree that cooperation and conversation with Cuba, at least in this respect, might bring us all some relief.
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View this story online at: http://www.alternet.org/story/145523
================================== Sources: Agencia Cubana de Noticias, Granma, Juventud Rebelde. =========================
UPDATES:
Cuban-Haitian Medical Teams in Haiti
February 2, 2010—Cuban and Cuban-trained Haitian doctors—already the largest contingent of medical relief workers in Haiti since the January 12th earthquake—are being joined by graduates of Cuba's Latin American Medical School (ELAM) from a score of countries. Among the first to arrive this week will be several US physicians who studied at ELAM.
Of the 938 health care providers in the teams on the ground thus far, 280 are young Haitian doctors, and at least 60 more are Haitian medical students enrolled at the school. Over the next few weeks, they will receive reinforcements of their peers in a number of Latin American, African and Caribbean countries.
Like the Cubans, they are planning to stay in Haiti to rebuild the public health system: "We're working to provide comprehensive care over the long term," said Dr. Carlos Alberto Garcia, one of the teams' coordinators. He noted that the immediate need for surgeries for fractures and polytraumas has now given way to rehabilitation efforts, treatment of people with diarrhea and respiratory infections, and campaigns to prevent serious disease outbreaks in the aftermath of the quake.
The Henry Reeve Emergency Medical Contingent—as the Cuban-led teams are known, named after a US veteran of Cuba's independence war against Spain—is now working in three hospitals, four field hospitals, five Comprehensive Diagnostic Centers (clinics) and numerous open-air sites in Port-au-Prince and throughout Haiti. The latest field hospital was opened January 26 in Croix des Bouquets on the outskirts of the capital.
In addition, the contingent will open its ninth rehabilitation center this week in Port-au-Prince, staffed by nearly 70 Cuban physical therapists and rehab specialists, in addition to the Haitian medical personnel. Another 64 Cuban epidemiologists and nurses are working in teams with the Haitian medical students to provide health education, vector control and vaccinations in some 40 makeshift settlements around Port-au-Prince.
"Post-quake epidemics are a real concern of course," noted Dr. Garcia, reporting that the teams have thus far vaccinated some 20,000 Haitians and international volunteers with 400,000 tetanus vaccines donated by Cuba and additional vaccines donated by the Pan American Health Organization (PAHO) against whooping cough, rubella, measles and diphtheria.
The Cuban-led contingent in numbers, through February 1, 2010:
Cuban-Haitian Medical Teams in Haiti-arrived this morning in Port-au-Prince, who will work in several vector-control and fumigation brigades to prevent outbreaks of dengue, malaria and other illnesses. They are joined in preventive efforts by 30 four-person teams of Cuban physicians and Haitian medical students from Cuba's Latin American Medical School, who are in the field vaccinating against tetanus and providing health and hygiene public education. Some 400,000 doses of the vaccine were donated by Cuba.
Through January 22, the Cuban-Haitian teams--made up of Cuban health professionals, Cuban-trained Haitian physicians, and 5th-year Haitian medical students studying in Cuba—had treated over 20,000 patients and carried out 1,054 surgeries. In the next few days, Cuba is also expected to send physical therapists and nurses specializing in rehabilitation. Through January 22nd, over 4,000 patients treated by Cuban medical personnel suffered fractured limbs, and nearly 3,000 others suffered polytraumas.
In the capital of Port-au-Prince, the teams are currently working in three hospitals (Renaissance, OFATMA and La Paz University Hospital), as well as attending to patients in public parks and other outdoor locations. On the capital's outskirts, they have set up a field hospital in Leogane, and are also working in the towns of Arcahaie and Carrefour (where a second field hospital is being mounted), on the island of La Gonave, and in Comprehensive Diagnostic Centers (CDIs, new built with Venezuelan aid) in Grand Goave, Petit Goave and Thomazeau. In other departments, they have established a field hospital in the city of Jacmel, and are serving in CDIs and other health centers in Mirebalais, Anse-a-Veau, Raboteau, Aquin, Les Cayes, Cap-Haitien, Port de Paix, Nippes and Grande Anse.
Days ago, the UN shipped some 1,500 patients to Grande Anse to alleviate saturation of Port-au-Prince facilities. In all, the Cuban-Haitian medical contingent is staffing 14 operating rooms with 16 surgical teams. See photos
www.medicc.org/ns/index.php?s=106
PAHO Director Visits Cuban Medical Teams in Haiti
Dr. Roses visited the La Paz University Hospital, where a large contingent of Cuban and Cuban-trained Haitian doctors are working with specialists from dozens of countries, and where she also met with Dr. Yiliam Jimenez, head of the Cuban effort in Haiti. The PAHO director noted that organization and coordination is key to recovery, and warned that the many volunteers who are attempting to reach Haiti with no infrastructure in place can in fact become 'displaced persons' themselves, competing for food, water and logistical support intended for the Haitian people. She emphasized that needs will be changing over the next period, and the recovery effort must take this shift into account to be effective. See photos
Dr. Roses emphasized the need to renew programs against TB, HIV/AIDS, and malaria, and noted that vaccination campaigns are already being initiated to avoid major epidemics in the disaster which has already cost over 110,000 lives.
IN RELATED NEWS:
Cuba Proposes Long-term Multinational Medical Staffing for Haiti
Cuban University Students Begin Blood Drive for Haiti
January 20, 2010
In the last 48 hours the rush of patients was reported on the increase, and the UN has sent some 1500 patients to Grand Anse where other Cuban medical teams are working.
Before the quake, Cuban medical personnel were already working in 127 of 137 of the country's municipalities (communes).
--------------------------------------- s. e. anderson is author of "The Black Holocaust for Beginners"org
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