CUBANET ... CUBANEWS

April 5, 2001



Public-health experts high on Cuba's medical degrees

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."

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Salud pública cubana: otro perfil
Salud pública cubana:
otro perfil


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