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 days are long and arduous, with endless patients to attend, often in a foreign language, always on foreign shores. Far from family and the familiar. Sleep is fitful at best for health professionals serving in emergency situations—when sickness obeys no clock and patients’ pain haunts even the quiet moments. The crisis scenario varies: post-earthquake, […]
This MEDICC Review roundtable gathers some of Cuba’s top researchers in the fields of vaccines and biotechnology, all of whom work in institutions belonging to BioCubaFarma, the umbrella company of Cuban biotech and pharmaceutical R&D, production, distribution and export. Founded in 2012, the company is comprised of 34 enterprises with 61 lines of production and […]
In El Salvador, chronic kidney disease had reached epidemic proportions towards the end of this century’s first decade. In 2011–2012, the Ministry of Health reported it was the leading cause of hospital deaths in men, the fifth in women, and the third overall in adult hospital fatalities. Farming was the most common occupation among men in dialysis (50.7%). By 2017, chronic kidney disease admissions had overwhelmed hospital capacity. In 2009, El Salvador’s Ministry of Health, Cuba’s Ministry of Public Health and PAHO launched a cooperative effort to comprehensively tackle the epidemic. The joint investigations revealed a total prevalence of chronic kidney disease in the adult population of farming communities higher than that reported internationally (18% vs.11%–14.8%), higher in men than in women (23.9% vs 13.9%) and higher in men who were farmers/farmworkers than in men who were not (31.3% vs. 14.8%). The disease was also detected in children. An association was found between chronic kidney disease and exposure to agrochemicals (OR 1.4–2.5). In 51.9% of all chronic kidney disease cases, traditional causes (diabetes, hypertension, glomerulopathies, obstructive nephropathies and cystic diseases) were ruled out and the existence of a particular form of chronic kidney disease of nontraditional etiology was confirmed (whose initial cases were reported as early as 2002). In the patients studied, functional alterations and histopathologic diagnosis confirmed a chronic tubulointerstitial nephritis; most presented with neurosensory hearing loss, altered tendon reflexes and tibial artery damage. The main results of this cooperation were the epidemiologic, physiopathologic, clinical and histopathologic characterization of chronic kidney disease of nontraditional etiology. This characterization facilitated case definition for the epidemic and led to the hypothesis of systemic toxicity from agrochemicals (e.g., paraquat, glyphosate), which particularly affect the kidneys and to which farmers/farmworkers (who may also become dehydrated in the fields) are most exposed. The research thus also laid the foundations for design of comprehensive intersectoral government actions to reduce cases and put an end to the epidemic. KEYWORDS Chronic kidney disease, chronic renal failure, tubulointerstitial nephritis, epidemiology, histopathology, international cooperation, agrochemicals, environmental pollutants, noxae, and pesticides, occupational health, PAHO; El Salvador, Cuba
Helena J. Chapman MD MPH PhD, Luisa A. Armas-Pérez MD MS, Michael Lauzardo MDMS,
Edilberto R. González-Ochoa MD PhD
Global efforts to eliminate tuberculosis by 2050 continue to challenge health systems. In countries with low reported tuberculosis incidence, such as the USA (3.1/100,000 population) and Cuba (6.9/100,000), differences in classification by income level and health systems’ overall organizational structure are evident. However, the two countries’ low tuberculosis incidence, geographic proximity, robust research capacity and shared health priority for tuberculosis elimination provide fertile territory to strengthen collaboration for tuberculosis control in clinical, laboratory and community settings. Two tuberculosis symposia in Cuba—one at the Cuba Salud Convention in 2015 and the other at the International Forum on Hygiene and Epidemiology in 2016—were instrumental in stimulating dialogue on continued efforts towards eliminating tuberculosis by 2050. In this article, we describe tuberculosis burden in the USA and Cuba, critically analyze strengths and challenges experienced in areas of low tuberculosis incidence and provide recommendations for future institutional collaboration to support tuberculosis elimination and improved population health.
KEYWORDS Tuberculosis/epidemiology, Mycobacterium tuberculosis, prevention, communicable disease control, disease eradication, disease elimination, international cooperation, Cuba, USA
Erratum
Page 60, Table 1, rows 9 and 10: row labels “New cases (%)” and “Previously treated cases (%)” should be indented, to make clear that they are subsets of MDR-TB cases.
From 1991 to 1993, an epidemic of optic and peripheral neuropathy—the largest of the century—broke out in Cuba, affecting more than 50,000 people. Initially the main clinical features were decreased visual acuity, central and cecocentral scotomas, impaired color vision and absence of the papillomacular bundle. Later, peripheral and mixed optic–peripheral forms began to appear. Due to the magnitude of the epidemic, the Cuban government requested help from the international community at the 46th World Health Assembly in 1993. PAHO and WHO immediately responded by sending a mission of international experts. Several hypotheses regarding the pathogenesis of Cuban epidemic neuropathy were put forward including: toxic, nutritional, genetic and infectious. The authors refer to extensive studies by researchers sponsored by the Cuban government and PAHO/WHO, joined by scientists from several other countries, including the USA. This paper describes their multidisciplinary work, particularly devoted to investigating the hypothesis of a primary toxic–nutritional cause of the epidemic. Clinical aspects, such as case definition and clinical description, were vital issues from the start. Cuban physicians who first examined patients received a clear impression of its toxic–nutritional origin, later confirmed by international experts. Research then focused on the mechanisms contributing to damage under the toxic–nutritional hypothesis. These included injuries to the mitochondrial oxidative phosphorylation pathway, nutritional deficiencies, excitotoxicity, formate toxicity and dysfunction of the blood–brain barrier. It was expected that the results of such international collaboration into this major health problem would also shed more light on mechanisms underlying other nutritional or tropical myeloneuropathies.
KEYWORDS Optic neuritis, optic neuropathy, peripheral neuropathy, neurotoxicity syndromes, disease outbreaks, international cooperation, Cuba
Erratum:
Page 30, first complete paragraph, line 7, “Two models were developed independently by Cuban researchers” should read “Two models were developed independently by AAS and AGQ.”
Scientific research cooperation between Cuba and the USA has a long history that dates back to the 19th century. For the past 200 years, the two countries’ relationship has been subject to complex economic, political and social forces. In the second half of the 20th century, the Cuban revolution and the subsequent escalation of the US government embargo impacted every aspect of Cuban life. While science was no exception, scientific interactions never ceased. Over the past decade, scientific cooperation—led and facilitated by scientific organizations such as the Cuban Academy of Sciences, the American Association for the Advancement of Science and others—has steadily increased to address ever more critical issues facing both countries. Science and global health diplomacy were key to reestablishing a trusting and productive relationship of mutual and global benefit after the USA and Cuba restored diplomatic relations in 2015. However, recent changes in Cuba policy by the new US administration are jeopardizing these opportunities for increased scientific cooperation, which are in the best interests of people in both countries.
KEYWORDS International cooperation, academies and institutes, Cuba, USA
This article analyzes the entrepreneurial cooperation between Cuba and Brazil in health biotechnology. It looks at the strategies applied and the main impacts. The respective government/political wills and the corresponding South-South collaboration policies are discussed, as well as the steps taken to materialize collaboration programs, including joint production of a meningitis vaccine for Africa. This cooperation is a good example of how South-South collaboration can be a useful tool to promote capacity building and provide cost-effective health solutions for developing countries.
KEYWORDS: Biomedical technology, technology transfer, technology, pharmaceutical, international cooperation, Brazil, Cuba
