By Tim Collie. South Florida Sun-Sentinel. April 05, 2001
How good is a Cuban medical education?
If the world's public-health experts are to be believed, a medical degree
from Fidel Castro's small island nation can be hung proudly next to diplomas
from Harvard or Stanford.
Especially in the field of global public health, Cuban-educated doctors draw
raves around the world.
Cubans have propped up a collapsed health system in Haiti, provided care in
hurricane-ravaged Honduras and prompted a much-lauded AIDS prevention campaign
in Uganda.
After cigars and rum, one might say medical care is the country's leading
export. In recent years, Cuba has sent an estimated 20,000 doctors abroad to
work in rural areas throughout Africa and Latin America.
And that has bought Castro valuable friends among leaders in such developing
regions as Central America and sub-Saharan Africa. Building on a medical
establishment that was well regarded before he came to power, Castro has used
medical care in much the same way the United States buys friends through
programs like USAID.
"I wouldn't hesitate to work with a doctor educated there," said
Dr. Anthony Kirkpatrick, a professor at the University of South Florida's
college of medicine who has worked extensively in Cuba.
Best outcomes, least resources
"In fact, these students who go to school there are going to learn
something they can't learn in the United States, and that's how to get the best
outcomes with the least amount of resources."
Not everyone is impressed. Exile leaders say Cuba's medical reputation is
vastly overrated, a propaganda tool bandied by leftist sympathizers in the U.S.
and around the world. They point to recent examples of Cuban doctors attempting
to flee assignments in Africa, where they often are forced to work in dangerous
conditions.
Joe Garcia, executive director of the Cuban American National Foundation,
ridiculed the notion that the U.S. students soon to be educated in Cuba would
ever be able to practice medicine in the United States. Foreign-trained doctors,
many Cuban, never get a chance to practice medicine in this country because they
are unable to pass required exams, he said.
Garcia said the Cuban doctors working around the world are nothing but
slaves of the Castro government. "These are not people who do it out of
dedication," he said. "These are people who are ordered to do it."
But many doctors who work in international health point to Cuba's vital
statistics. It has one of the best infant-mortality rates in Latin America and
has curtailed the spread of the AIDS epidemic hitting other Caribbean countries.
Thanks to aggressive vaccination campaigns, Cuba has eradicated many common
diseases, including measles, mumps, polio, diphtheria and tuberculosis. Life
expectancy is 75 years, only a year less than that of the United States.
Advanced care
"In many cases, they've actually built a better mousetrap in terms of
medical care," said Kirkpatrick, a specialist in anesthesiology and an
outspoken critic of the U.S. embargo of Cuba. "And they do it by learning
to save resources."
A Cuban medical education is far ahead of the much-maligned Caribbean
medical schools often attended by American students whose grades are not up to
snuff. Some aspects of Cuban medical care are highly advanced. Surgeons at the
Ameijeiras Brothers Hospital, for example, have performed numerous heart
transplants in the past 10 years. Researchers have done pioneering vaccine
research for meningitis C and cholera, and UN experts say Cuba has the
capability to cheaply copy expensive AIDS drugs.
As an example, Kirkpatrick cited a novel approach the Cubans have developed
that places intensive care units in hospitals next to surgery wings. In U.S.
hospitals, ICUs often are well away from the surgery area, often on separate
floors.
"One of the high-risk times is when you have to move a patient from
intensive care back to surgery," he said. "By combining the two areas,
they provide safer and more effective care."
In the past four decades, Cuba has been isolated by the U.S. embargo and
diplomatically tied to communist and Third World nations that are often poor.
The country lost thousands of doctors after Castro took power, and it was forced
to radically modify a top-notch medical program for Third World conditions.
The result is an expertise at what might be called global triage: adapting
quickly and efficiently to conditions where there is little equipment and even
less medicine.
Global triage
In Haiti, a small army of Cuban doctors, often alone and rarely paid,
stitched together a national health-care system decimated by multiple coups, a
U.S. invasion and an economic collapse.
"Eight hundred Cubans--that's who is doing the outreach in Haiti,"
said Dr. Peggy McEvoy, the recently retired head of the Joint United Nations
Program on HIV/AIDS (UNAIDS).
In Honduras, 121 Cuban doctors who arrived after Hurricane Mitch in 1998
have treated an estimated 1.2 million patients. The doctors have made such an
impact that Honduran doctors recently demanded the Cubans be sent home because
of their effect on local medical practices. The president of Honduran Medical
College was quoted in news accounts as saying he was worried the government was
trying to replace Honduran doctors with Cubans.
Cuban officials have been quoted as saying they have a surplus of medical
professionals despite profound shortages in cancer drugs and other medicine.
Cuba has 60,000 physicians--one for every 136 people.
Still, despite a shortage of doctors in rural areas and inner cities in the
United States, few experts think Cuba will make an impact in the U.S. similar to
its impact on Honduras. At best, Castro's latest move seems to be a well-crafted
propaganda tool.
"The problem, of course, is that they're not going to train large
numbers of American medical students for a long time and pay the tab themselves,"
said William LeoGrande, a professor and Cuba watcher at American University in
Washington.
"The point from the Cuban side is to highlight the income inequalities
in the United States." |