By Laurie Goering. Tribune foreign correspondent. May 7,
2001. Chicago Tribune
BOQUERONES, Cuba -- Henry Vazquez faces no shortage of challenges as the
family physician serving this scattered community of 480, tucked amid the misty
hills and hollows of Cuba's Escambray Mountains.
He has had to wave down passing trucks to get critically ill patients to the
hospital at Jibacoa, four miles away on mountain roads that twist past yucca
plantations and tobacco fields. He once made the same ride giving mouth to mouth
resuscitation to a nearly drowned 2-year-old.
"For me, it lasted an eternity," he said of the trip. The child
survived.
Vazquez has delivered babies, treated severe burns, puzzled over respiratory
infections and, most important, learned to ride Pajarito, the borrowed mule he
uses to make rounds.
"I'm self-taught," the 27-year-old medical resident with buzz-cut
hair and white lab coat joked about riding the mule. "Cubans are always
very intrepid."
Vazquez is a key component of Cuba's national health system, which has tried
to provide family doctors even to the island's most isolated residents.
The effort has paid off.
In places such as Boquerones, the Cuban equivalent of a West Virginia hill
town, grandparents remember making day-long treks to the provincial capital of
Santa Clara on horseback or in truck beds, seeking emergency help that rarely
came in time.
Infant mortality rate low
Now Cuba's infant mortality rate is the best in the Western hemisphere, 6.4
deaths per thousand compared to 60 in 1959, when Fidel Castro took power. Polio
and diphtheria have been eliminated and tuberculosis and hepatitis B radically
reduced. Cubans today can expect to live 76 years, nearly as long as Americans.
In large part that is because 98 percent of Cubans--including those in rural
places like Boquerones--have access to a free family doctor such as Vazquez,
according to Dr. Jose Jardines, a spokesman for Cuba's state-run health system.
Altogether, Cuba has 29,648 family doctors, or one for every 377 Cubans, he
said.
"The question everybody asks is: `How does a poor country do it?'"
Jardines said. The answer, he said, centers on political will, a cheaper
one-provider health system and a strong focus on preventing illness before it
creates serious problems.
That's where Vazquez comes in. His modest office, in a concrete-block
building on the edge of a cluster of modest community homes, has only the bare
necessities: A consultation room with a desk, file cabinet and a trio of shabby
chairs, a few pens, a phone, an examining table, a light box for reading X-rays,
and a set of medical tools and drugs.
Office hours are from 8 a.m. to noon each day; afternoons are for house
calls and study time.
In reality, "we work 24 hours," he said. "People know we're
here and they're knocking on the door even in the middle of the night."
Posters on the walls of his waiting room focus on prevention. One reminds
residents to put chlorine drops in their drinking water, which Vazquez explained
is contaminated with Giardia and other parasites from rainwater runoff. Another
poster encourages women to breastfeed their children as a way to prevent
diarrhea.
As in earlier decades, diarrhea and respiratory illnesses, aggravated by the
region's damp climate, remain the community's most common problems. Vazquez, who
has been at his job four years, has treated plenty of other woes as well,
including heart attacks and machete wounds.
His most memorable case, he said, was that of a 2-year-old boy found by his
mother floating in the family's water tank. She rushed the child, who had no
pulse and was not breathing, the four blocks to Vazquez's office.
Tot responds to CPR
Vazquez started CPR and got the child's heart pumping again. But the boy
couldn't breath on his own, so as family members waved down a passing jeep,
Vazquez climbed into the back seat with the boy and rode the four miles to the
local rural hospital, giving him mouth-to-mouth resuscitation throughout the
15-minute drive.
Carlos Moreno recovered with no brain damage and is nearly 4 years old. He
remains one of the doctor's favorites.
"You always feel something special because you saved his life,"
said Vazquez. "He's like a trophy to me. I love him a little more."
The doctor's strong ties to the community were evident in a walk through the
town, past mango trees, children playing on concrete front stoops, pregnant dogs
("Yes, sometimes I work with them too," he admitted).
He stopped to chat with a 17-year-old on a bicycle who has burn scars on one
arm from an effort to learn the baking trade.
"Now I just deliver the bread," the teen said.
Asked what the major causes of death have been in Boquerones during his
tenure, Vazquez smiles.
"In the four years I've been here there have been basically no causes
of death," he said.
In four years, no one has died on his watch, and no infant has died in the
community in seven years. There are about 20 births a year, he said.
Vazquez, who grew up in the Escambray foothills, where fields are still
plowed with teams of oxen and tobacco hangs in thatched drying sheds, won't stay
in Boquerones forever.
In a year or so he hopes to study emergency medicine. But a new doctor
replace him, he said, and carry on the work. | 
