Except for the people living with the disease, no others have so immersed themselves in Cuba’s world of HIV/AIDS as Dr Jorge Pérez. It is a world of Cuban returnees from Angola’s war against apartheid South Africa, gay and bisexual men, housewives, transactional sex workers, rebellious teenagers, and infected surgeons and scientists—a cultural kaleidoscope reflecting all the faces of AIDS. To more than one international author, he is simply “Cuba’s AIDS doctor.” Speaking to his patients at the Pedro Kourí Tropical Medicine Institute in Havana, it is easy to see why, but also to appreciate the courage, compassion, and persistent search for new knowledge that characterize the Institute’s staff as a whole. Dr Pérez’s story—now told in two books based on his diaries—is not his alone.
MEDICC Review held two interview sessions with Jorge Pérez just days apart at the beginning of April: one before and one after his designation as the new Director of the Tropical Medicine Institute, where he previously served as Deputy Director and Chief of Hospital Services. More than strictly medical matters, the conversation turned to the human dimension of HIV/AIDS, the depth to which it has touched many directly and affected Cuban society as a whole, and the challenges ahead for Cuba’s flagship institution for research and treatment of infectious diseases.
Dual specialties in epidemiology and labor medicine, as well as an advanced degree in public health, gave Dr José Blanch expertise on disabilities in Cuba from a population health perspective. However, when he began losing his sight due to a diabetic retinopathy while serving in Africa, he also began a difficult journey that would transform his life and career, giving him new personal and professional perspectives on disability and the potential of disabled persons. Active for the past several years in the National Association of Blind Persons (ANCI, its Spanish acronym), in 2010 Dr Blanch was elected President of the non-governmental organization. He spoke with MEDICC Review about ANCI’s role and challenges in the context of Cuba today.
When Cuba was hit by a neuropathy epidemic two decades ago, Dr Rosaralis Santiesteban was one of the Cuban health professionals who played a key role in its management, as reflected in a recent issue of Seminars in Ophthalmology.[1] She was well prepared for her part: trained in medicine at the University of Havana before completing a residency in ophthalmology and eventually a doctorate in medical sciences, she has received multiple honors for her research, publishing and teaching. In 2007, she was named Distinguished Researcher by the Cuban Ministry of Science, Technology and the Environment. She has headed the Department of Neuro-ophthalmology at Cuba’s Neurology and Neurosurgery Institute since 1977.
Now called Cuban Epidemic Neuropathy, the 1990s epidemic that affected over 50,000 Cubans is the largest and best-documented of its kind in history. As researchers pressed to unravel the mystery of its etiology to hasten the epidemic’s end, Dr Santiesteban recognized that similar outbreaks had occurred during Cuba’s wars of independence in the late 1800s—described in her book, Epidemias y Endemias de neuropatía en Cuba.[2] In the proverbial eye of the storm during the 1990s epidemic, she shares her reflections below on the context, causes, evolution and lessons learned from the challenge that put Cuba’s health system to the test.
Regenerative medicine has emerged over the last two decades as one of the most rapidly developing fields in medical science, demonstrating unprecedented potential to restore severely damaged or destroyed tissue and even “grow” new tissue in its place. Although the most advanced research, both laboratory and clinical, is taking place in well-financed high-tech settings—including centers in China, India and Brazil—Cuba is one of a handful of other developing countries—along with Argentina, South Africa, Egypt, Iran, and Malaysia—producing regenerative therapies suited to the needs and capacity of their health care systems.[1]
Dr Porfirio Hernández has been at the forefront of the field in Cuba, helping pioneer stem cell research at the Hematology and Immunology Institute in Havana, where he has worked in internal medicine and hematology as clinician and researcher since the 1970s. In this interview with MEDICC Review, he discusses Cuba’s regenerative medicine program, particularly development of a simplified method of obtaining adult mononuclear stem cells using existing resources at moderate cost to the national public health system.
Niviola Cabrera is from Santa Isabel de las Lajas, a small town in central Cuba with a mystique all its own as the birthplace of the island’s legendary crooner, Benny Moré. Dr Cabrera studied medicine in her home province of Cienfuegos before completing a residency in epidemiology in 1981 and working at the provincial hygiene and epidemiology center. Her move to Havana came with an appointment as Deputy Director for Research at the National Institute for Workers Health; in 1996, she transferred to the Ministry of Public Health’s Science and Technology Division, which she has directed for the last five years.
Most recently, she headed the Cuban organizing committee for the Global Forum for Health Research’s 2009 meeting, Innovating for the Health of All, held in Havana.
José Juan Ortiz assumed the post of UNICEF Representative in Cuba in 2006 with nearly three decades of international cooperation experience. A native of Spain and social anthropologist by training, Ortiz came to Cuba with comprehensive disaster response experience, serving as chief of UNICEF relief missions to Albania (1999) and Peru (2001). He also worked for six years at the Spanish Red Cross, where he headed their international emergencies division, among other duties.
Ortiz brings a variety of intersectoral work to his position in Cuba, including periods as Education Director for Development and Peace in Tibetan refugee camps in Nepal and India, and International Red Cross representative for conflict resolution. Ortiz spoke with MEDICC Review about the Convention on the Rights of the Child and UNICEF’s support of this and other initiatives related to the health and well-being of Cuban children and youth.
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.
Rolando Camacho was born in Pinar del Río-Cuba’s westernmost province and, ironically enough, home to the country’s richest tobacco-producing farmlands. He was about to leave for an engineering scholarship abroad when he accompanied a friend to medical school on the first day of classes in Havana, a bus ride that changed his life. Since completing his oncology residency in 1985, Dr Camacho has served as director of Pinar del Río’s Cancer Control Program, chair of the National Cancer Control Program, director of the National Oncology and Radiobiology Institute (INOR), and today, chair of the National Oncology Group. The Group advises the Ministry of Public Health through its National Cancer Control Unit on questions of cancer control policy, planning and development of human resources for cancer care, structure of services, material resource planning and cancer research. Since 1988, breast cancer has been a particular focus for Dr Camacho’s research, practice and teaching.
MEDICC Review spoke with Dr. Camacho for his views on the problem of cancer in Cuba, and the prospects for more effective control.
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.
The Sports Medicine Institute (abbreviated in Spanish as IMD) in Havana is a hub of energy concentrated on the health and training of the nation’s top athletes. While fencing teams, wrestlers and judokas work out in one building, a multidisciplinary staff keeps office hours next door for athletes, retired athletes, their families and others referred to their services. And not just “office” hours: everyone at the IMD, including doctors, seem to put physical activity into practice, moving in and out of hallways, up and down stairs, and along pathways between buildings and outdoor training areas, as if keeping pace with the young athletes in the lead.
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.
Immunologist by training, Dr Fernández Yero began his career in medical technology at the National Center for Scientific Research in Havana, working at the behest of several hospitals to develop the first Cuban alpha-fetoprotein test. It was the 1970s, a time when a single public health system was taking shape in Cuba and many of the main poverty-related social determinants of health had been tackled. “We were looking for technologies of the future,” he says, “to see what we could do that could be applied throughout a national public health system.” Sixteen generations of equipment later, Dr Fernández Yero heads the 21-year-old Immunoassay Center, a leader in the field of medical technology for population health. The road traveled has not been an easy one, lack of resources threatening delays and detours along the way. He shares his thoughts with MEDICC Review on his work, the meaning of appropriate technology and the challenges he foresees ahead.
In 2008, the Global Health Education Consortium (GHEC) created the Training for Health Equity Network (THEnet), bringing together schools in different parts of the world that share a core mission: to recruit students from, and produce physicians for, underserved communities. In determining the competencies such physicians will need, these schools also share an approach to medical education that looks beyond the traditional curriculum and seeks the involvement of communities and other stakeholders. Their input helps define the knowledge, skills, and attitudes around which new curriculum is built, and helps guide the selection of educational methodologies, taking into account context and resource constraints.
The nascent THEnet now has a nucleus of eight member schools, each dedicated to fulfilling a strong social accountability mandate. The network is designed to assist them by providing a collaborative platform conducive to experimentation; dialogue; and creation and sharing of tools, experiences and evidence. It will also support systematic outcome evaluations, innovation, and joint research to strengthen the knowledge base on successful strategies for increasing the number and quality of doctors in neglected communities. By bringing these schools together, developing synergy among them and publishing their results, THEnet hopes to more broadly promote the transformation of medical education and medical practice into more socially accountable endeavors that improve health system equity and performance.
Leaders from six of these innovative medical schools spoke with the Guest Editors of this issue of MEDICC Review, a conversation we bring you below. They are: Dr Juan Carrizo, Rector of the Latin American Medical School (ELAM), Cuba; Dr Fortunato L. Cristobal, founding Dean of the School of Medicine at Ateneo de Zamboanga University (AZU), the Philippines; Dr Pedro D�az, member of the National Academic Coordinating Committee of the National Training Program for Comprehensive Community Physicians (NTPCCP), Venezuela; Dr Richard Murray, Dean and Head of the School of Medicine and Dentistry, James Cook University (JCU), Australia; Dr Roger Strasser, founding Dean of Northern Ontario School of Medicine (NOSM), Canada; and Dr Paul Worley, Dean of Flinders University School of Medicine (FUSM), Australia.
The following erratum has been corrected in all versions of this article.
The correct website for the Ateneo de Zamboanga University School of Medicine in the Philippines is: http://som.adzu.edu.ph
The year 2005 was a watershed for disaster management worldwide and also in Cuba. Representatives of every continent met in Japan, hammering out the Hyogo Framework for Action (2005-2015), an international blueprint for risk reduction strategies and a guide for developing national platforms. In Cuba, a spate of devastating hurricanes the year before led to a reassessment of how the country was managing disasters, and to the 2005 comprehensive overhaul of national, provincial, and municipal disaster
This May, when the earthquake’s death toll passed 60,000 and another 30,000 poured into hospitals in Southwest China’s Sichuan province, Cuba responded to the call for medical assistance with a team of 35 health professionals. At their helm: Dr José Jorge Rodríguez, who arrived on May 23, less than a week after our interview in Havana. At press time, the team was working at the province’s largest public hospital, treating victims of the massive quake and its aftershocks.
Pedro Valdés spent his childhood in Chicago, Illinois, USA, where he says his love of science began. After his family returned to Cuba in 1961, he studied medicine, received his PhD in biological sciences, and in 1990 at the age of 40, founded the Cuban Neuroscience Center with a group of young scientists that included his brother Mitchell, now the Center’s Director. Since then, the Center has accumulated an impressive record developing patented neuroimaging diagnostic equipment for national use and export, a nationwide infant screening program for hearing loss, and the Cuban Brain Mapping Project, among other pioneering efforts. The Center’s recruitment of new graduates keeps the median age of its professionals at 28, and its scientists are the island’s most widely published outside of Cuba.
