Soaring summer temperatures, systematic urban and political violence, unreliable infrastructure—power outages, water shortages, sporadic transportation and interruption of other basic services—plus the illness, death and economic straits wrought by COVID-19, are what Haitians awake to every day. On the morning of August 14, 2021, they also woke to the earth in the throes of violent, […]
The 2020 fall semester at Havana’s Latin American School of Medicine (ELAM) began on an especially somber note: honoring 17 of its alumni felled as they battled COVID-19 in their home countries and beyond. A few were recent graduates among the 30,047 from 118 countries who received scholarships from Cuba to study medicine at ELAM. […]
Speaking remotely with US graduates of Havana’s Latin American School of Medicine (ELAM), I found them at work on hospital floors, in ICUs and health centers across the United States, putting their professional and personal commitment to the test against COVID-19. Nowhere was that more evident than in New York City, the disease’s epicenter, where […]
Meningitis, neuropathy, HIV, dengue—since the 1960s, Cuba has faced its share of epidemics. More recently, Cuban health professionals tackled domestic outbreaks of H1N1 (2009) and Zika (2016), and worked alongside colleagues from around the world to stem Ebola in West Africa; all three were categorized by WHO as public health emergencies of international concern. In […]
In 1978, the world was put on notice: health inequalities exacerbated by lack of access to essential services was a ticking time bomb threatening social and economic development everywhere. That year, over 100 countries signed on to the Declaration of Alma-Ata, which affirmed that “health . . . a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, is a fundamental human right.” To guarantee this right, governments were urged to prioritize the provision of quality, continuous, comprehensive and affordable primary care for their entire populations by the year 2000.[1]
Forty years after Alma-Ata, many countries have failed unequivocally to attain that goal. In 2017, the World Bank and WHO released sobering data that nearly half the world’s population was still without essential health services. Meanwhile, the cost of those services—when accessible—had already pushed nearly 100 million people into extreme poverty.[2]
This dire state of affairs is not limited to developing countries. According to the Association of American Medical Colleges, the USA will be short 21,000–55,000 primary care physicians by 2032[3] and recent data are not encouraging: the percentage of fourth-year medical students filling primary care positions in the 2019 US National Residency Matching program was the lowest on record.[4] Furthermore, access to a primary care physician for US patients has remained flat—76.4% in 2015 compared to 76.8% in 1996—despite evidence that “access to primary care improves health outcomes and lowers health-care costs.”[5]
From astronomical medical school tuition to inconsistent political will, numerous factors contribute to this global human rights crisis. To forge a plan towards ‘building a healthier world,’ experts and governments were invited to share data, analysis and experiences at the 2019 UN General Assembly’s first High-Level Meeting on Universal Health Coverage (UHC). Among the countries presenting findings is Cuba, a small, developing nation whose health system aimed for universal care and coverage as early as 1960, when the rights to health and education were recognized. Through that decade’s Rural Medical Service, doctors fanned out nationwide to extend health services to all Cubans, reaching universal coverage well before the Alma-Ata Declaration was adopted.
It is now widely recognized that UHC contributes to overall social and economic development. Where health care services are not universal, the most vulnerable and poorest patients are either without care altogether, or often shunted to public facilities—making public health care essentially poor people’s health care. Cuba’s global cooperation policy has been to help staff and strengthen public health institutions and systems in coordination with host governments, primarily in developing countries, rather than “setting up shop” on their own. However, early experiences revealed a daunting challenge: many of these countries’ public systems were dysfunctional, poorly run and sometimes in danger of complete collapse, aggravated in cases of natural disasters or war. Often, the health systems where Cubans served were characterized by crumbling infrastructure, health worker shortages and spatial inequality, financial and material resource scarcity, ineffective or insufficient health surveillance mechanisms, and inconsistent national health protocols. This reality begged the question: could long-term improvements in patient outcomes be achieved in such contexts and might Cuba play a larger role?
To the Editors: In MEDICC Review,[1] Natalia Orihuela presents her four-year journey at the Latin American School of Medicine (ELAM), Havana, Cuba, describing her didactic coursework and community rotations in vulnerable communities where access to healthcare is a major priority. Using a team-oriented approach, ELAM’s educational program focuses on the value of primary care, where […]
Cristian Morales, an economist by training, has dedicated his career to improving health and health equity in the Americas through his work with PAHO/WHO. This has taken him from floods and earthquakes in Haiti to PAHO’s Washington DC offices, where he was instrumental in achieving consensus on a resolution aiming for universal health—coverage plus access—approved by all governments in the Americas. Since 2015, he has served as PAHO/WHO Permanent Representative in Cuba and has recently been appointed to the analogous post in Mexico. At the end of his three years in Havana, MEDICC Review talked with Dr Morales about his experience, the Cuban health system, and the values it shares with the organization he represents. This is part one of the interview, the second part to be published in our January 2019 issue, in which we’ll talk more about the health system in Cuba itself, its achievements and also its challenges.
On the 40th anniversary of the Alma Ata Declaration that affirmed health for all a right and primary health care the route to guarantee that right, WHO and PAHO have issued a call to action to convert universal health into reality for the nearly four billion people worldwide lacking full coverage of essential health services. There is some urgency to this movement: WHO estimates the health workforce shortage of nearly 8 million could reach almost 13 million by 2035. And the USA is not exempt: medical associations and special commissions set up to investigate the shortage of primary care physicians, especially “under-represented minority” doctors, have issued report after report on this growing health care emergency. The biggest question looming is: where will the health care providers come from, especially well-trained primary care doctors who want to work for those who need them most?
Part of the answer may be found in Cuba and its Latin American School of Medicine (ELAM), which has graduated some 28,500 MDs from 103 countries since its first class of 2005—including nearly 200 from the USA. Graduates, most from low-income families, are not only admitted for their intellect and academic records, but also for their social commitment.
MEDICC Review looked to a group of these US graduates to better understand their decision to study medicine in Cuba and how they faced the resulting challenges, as well as the relevance of their Cuban education to their current practice.
