Coronary heart disease (CHD) is the main cause of death worldwide, killing 7 million annually and representing 12.2% of all global deaths.[1,2] This trend is expected to continue over the next two decades, with greater implications for low- and middle-income countries, where three-fourths of CHD deaths were already occurring by 2001.[3,4] CHD is the leading cause of death in Latin America and the Caribbean, and there, as well as in the Mideast and even sub-Saharan Africa, CHD deaths are expected to triple over the next 20 years.[4,5]
The sound of rain hitting the window may not be a transcendental event for most people, but for wide-eyed toddler and cochlear implant user María Alejandra Larred, it makes her shout at the top of her lungs, “Agua!” (Water!) eliciting a resounding cheer from all present. Unfortunately, this scene of aural awakening is out of reach for many hearing impaired children, particularly in developing countries.
Globally, in 2000, an estimated 62 million children under age 15 years had some degree of hearing loss, two-thirds of them in low- and middle-income countries.[1,2] Hearing loss is measured in decibels and categorized as mild, moderate, moderately severe, severe, and profound, according to an algorithmic scale. However, these categories may not accurately reflect real-life challenges a child faces. Severe and profound hearing loss may mean complete social isolation, limiting a child’s opportunities and quality of life.[3,4]
During the twentieth century, life expectancy rose significantly across the globe due to improvements in public health and overall living conditions.[1] By 1950, life expectancy in most of today’s developed countries had increased by an average of 20 years. In 1900, Japan’s life expectancy was 43 years; today that country boasts the highest in the world at 83. The United States entered the last century with a life expectancy of 47 years, today reaching 78,[2] the same as in Cuba, where life expectancy in the early 1900s was only 38 years.[3,4]
In Cuba, breast cancer is the most common cancer in women (excluding skin cancer) and the second cause of cancer death in women. The Ministry of Public Health recognizes breast cancer as a major public health problem, and aims to reduce mortality 15% by 2015—from the 2004 adjusted mortality rate of 14.1 per 100,000 population to 11.9.[1,2]
Programs are underway to lower mortality and improve survival through improved screening, research on risk factors and new therapies, and broader public education about the importance of early detection. Women in breast cancer support groups are also beginning to play a key role in raising awareness about the disease and about life-after-mastectomy, as well as providing emotional and practical support for each other and their families.
The first, and now largest, breast cancer support group was started in Havana in 2003 by a few surgeons and their patients who had undergone a radical or partial mastectomies. For these women and the majority diagnosed with breast cancer in Cuba, surgery is the most common shared experience with the disease, and they refer to themselves as ‘operadas’ (operated on) or ‘mastectomizadas’ (mastectomized), rather than ‘survivors’. However, the group’s name, Alas por la Vida (Wings for Life), symbolizes the spirit of hope and determination uniting these women.
Today, over 300 women, family members and doctors participate in bimonthly meetings at the Manuel Fajardo Clinical-Surgical Teaching Hospital in Havana. Inspired by this group’s experience, breast cancer survivors in other communities are forming their own, supported by the Federation of Cuban Women. MEDICC Review talked with members, physicians and families involved with three groups—in urban Havana, the semi-urban Cotorro municipality on the outskirts of the city, and the rural town of Batabanó, two hours south of the capital—about their experiences with cancer and what the group has meant for them.
Since 1995, the Cuban Sports Medicine Institute has integrated natural and traditional medicine (NTM, also known in the United States as Complementary and Alternative Medicine or CAM) into its array of prevention techniques and rehabilitation therapies for Cuban athletes. Incorporating NTM into conventional medical practice—both for the Institute and the public health system as a whole—has been a sometimes prickly process, confronting prejudice among some in the medical profession and among patients themselves.
The Sports Medicine Institute’s NTM Unit is headed by medical director Anisio Le�n and technical director Pedro Carmona, who spoke with MEDICC Review about the history, philosophy, results and challenges of their work.
Dr Yamila de Armas has occupied an array of posts since finishing her residency in family medicine in her home province of Cienfuegos in 1992. She has served as a family doctor; polyclinic, municipal and provincial health director; medical school dean; and twice vice minister of public health. But few would doubt her toughest job is the one she has now: deputy director of the Havana City Provincial Health Department, in charge of medical services for the 2.2 million people living in Cuba’s complex, sprawling capital. It was here in 2002-2003 that the program was launched to repair, refurbish and expand the country’s nearly 500 community polyclinics. Key to the effort was equipping these facilities with a broader range of new and upgraded medical technology. Dr de Armas offers MEDICC Review her reflections on the results five years later.
In 2004, the final death toll in Haiti from Tropical Storm Jeanne was recorded at 3,006; of these, 2,826 in Gonaïves, a city floating in ruins. The road to Gonaïves was washed out, leaving the city and the department of Artibonite cut off for days from the rest of the country. Dr Juan Carlos Chávez, who headed the Cuban medical team in Haiti at the time, recalls that 17 Cuban health professionals were working in the area when the storm barrelled through, among the 400 already serving in the country. They were later joined by another 72 doctors, nurses, technicians and engineers sent directly from Cuba.
In December 2007, Cuba’s National Health Science Prizes were awarded for outstanding contributions to basic science, clinical medicine, and population health. The prizes, first bestowed in 1976, are sponsored by Cuba’s Ministry of Public Health and the National Council of Scientific Societies. Works are selected based on excellence, scientific rigor, and relevance. In 2007, one Grand Prize, 13 additional prizes, and 11 special mentions were awarded from among 244 entries forwarded from the provincial level.
Jacinto Duverger received his Bachelor’s Degree in Economic Cybernetics from the University of Donetsk, Ukraine in 1988 and his Master’s Degree in Information and Communications in 2007 from a joint program between the University of Las Villas and Guant�namo University. Since 1994 he has worked almost exclusively on the development of the Health Trends Analysis Units (Unidad de An�lisis de Tendencias en la Salud, UATS) throughout Cuba, participating in their conceptual design, installing their first computer network, and more. Born in the country’s easternmost province, Guant�namo, his fascination with programming and Prospective Methodology led him to create health software that helps provincial UATS track and forecast health events and to engage in proactive strategic health planning. Most recently, Duverger developed a software package to study the financial sustainability of Mexico’s new catastrophic illness coverage program. Duverger sat down with MEDICC Review to talk about software development, strategic health planning methodologies, and training the new generation of Cuban public health leaders.
Dr Pedro Ordúñez, a leading public health expert and internist, is Director of the Cienfuegos Provincial Teaching Hospital and Associate Professor at the National School of Public Health in Havana. Dr Ordúñez has published extensively in Cuban and international peer-reviewed journals, most recently in the American Journal of Epidemiology, as co-author of Impact of Energy Intake, Physical Activity, and Population-wide Weight Loss on Cardiovascular Disease and Diabetes Mortality in Cuba, 1980–2005.[1] In 1994, he was selected as a Pan American Health Organization (PAHO) post-graduate fellow at Johns Hopkins University School of Public Health. Thereafter, he obtained a Doctorate in Health Sciences from Cuba’s National School of Public Health. Dr Ordúñez has traveled throughout the Americas as a chronic disease consultant for PAHO and has served locally in the PAHO-coordinated CARMEN Network, which focuses on the integrated prevention of chronic non-communicable diseases and their risk factors. He is a member of the Cuban Academy of Sciences and has received the nationalhealth award on several occasions.
Dr Ordúñez sat down with MEDICC Review for an exclusive interview to discuss his insights into the complex relation between poverty, development, and chronic disease.
The world’s 1,691 medical schools and 5,492 nursing schools are not producing enough graduates to cover the massive global deficit of doctors, nurses, and midwives, reports the World Health Organization (WHO).[1] One scaling-up initiative addressing these critical shortages is Cuba’s Latin American Medical School (ELAM).
