“I had ten brothers and sisters. We were so poor,” relates Algimiro Ortíz in the honeyed afternoon light flooding the Seniors’ Center in Cruce de los Baños. “School wasn’t an option—there wasn’t a school here—only work; I began picking coffee when I was 11. When somebody got sick, we had to carry them on our shoulders to the hospital in Contramaestre, 16 miles away,” Ortíz, now in his 70s, told MEDICC Review.
Ortiz’s story is representative of pre-1959 life in this remote rural town nestled in the Sierra Maestra—Cuba’s highest mountain range. Typified by large families coping under the triple burden of poverty, illiteracy and malnutrition, rural populations like this one were among the country’s most vulnerable and forsaken over half a century ago.
Like a tropical lullaby, the rocking chairs lay down a languid rhythm accompanied by laughter, bits of gossip, and gripes about the heat. Olga Lydia, 39, anemic, and preparing to give birth to her first child, wonders aloud what it will be like to have a son, when in her heart of hearts she wanted a daughter. Meanwhile, Loreta, 18, and expecting twins, rocks quietly alongside, a smile on her flawless face.
Just over 25 years ago, when volunteers returning from international service in Africa showed signs of a mystery illness, Cuban health authorities acted swiftly and decisively. Their response was modeled on classic infectious disease control and included an epidemiological surveillance system, contact tracing and screening of at-risk groups and blood donations, accompanied by intensive research and development. The first AIDS-related death occurred in April 1986 and a policy of mandatory treatment in sanatoria was established, thought to be the most effective way of delivering the comprehensive medical, psychological and social care needed, and limiting the spread of the disease.[1] The sanatorium policy was harshly criticized by global media, human rights advocates, and some public health specialists.
Nearly a year ago on a day like today—as people scrabbled for some charcoal to cook the evening meal, fetched their children from school, and sewed costumes for carnival—the ground began to shift. Buildings folded and houses crumbled. In the time it takes to read this paragraph, one of the most devastating earthquakes recorded in the hemisphere changed the Haitian landscape forever. Twelve months on, quake survivors struggle to live, study, work, and worship within the parameters of this new landscape. They also struggle to stay healthy.
“It’s important to be vigilant,” Dr Jorge Pérez, deputy director of Cuba’s Tropical Medicine Institute, told MEDICC Review in Port-au-Prince last March after assessing the post-quake health situation. “The epidemiological picture is going to get much more complicated.”[1] On October 21, nine months after the earthquake that killed 250,000 and left over one million homeless, his prediction was borne out when the first cases of cholera were confirmed by the National Public Health Laboratory in Port-au-Prince.[2] By November 19, the outbreak had spread to all 10 departments across the country. As of December 26, a total of 148,787 cases had been reported with 3,333 deaths, for a case fatality rate of 2.2%.[3]
“I never felt like a boy. In school I was rejected, made fun of, and mistreated… There were times I wanted to kill myself. No one chooses this,” confides Mavi Susel, protagonist of the 2010 Cuban documentary In the Wrong Body (En el cuerpo equivocado). On May 22, 1988, Mavi became the first Cuban to receive sex reassignment surgery on the island. Her tale of stigmatization, solitude and pain is not uncommon in Cuba or the world at large.
Rejecting one’s biological sex due to the discordance between an individual’s genitalia (biological sex) and their gender identity (psychological sex) is the definition of transsexuality. “This incongruity is felt profoundly by transsexual people, is permanent, and causes great anguish,” internist Dr Alberto Roque told MEDICC Review. “This anguish can result in severe mental health disorders, usually related to discrimination, stigmatization, and rejection.” In turn, victimization renders some transgender people reluctant to seek medical care or fully disclose their gender identity when they do.[1]
Natural disasters of the magnitude of the January 2010 earthquake in Haiti rend societies, exposing social inequities and laying bare weak disaster mitigation strategies. These tragic events not only test the limits of communities, families, and individuals, but also reveal the strength and mettle of survivors. Struggling to recover and rebuild, young and old stand as daily testament to human resilience. For participants in a mental health program led by Cuban health professionals in Haiti, this resilience has—at times, if only momentarily—translated into smiles, laughter, and hope.
There are dates that weigh heavy. January 12, 2010 is one of them—not only for Haitian survivors, over one million of whom are still internally displaced, but also for the 331 Cuban health professionals who were working in the Haitian public health system when the earthquake struck. Among the first responders, these doctors, nurses, and technicians serve in Cuban health cooperation programs, which have been providing care to Haitians since 1998.[1] Once the earth settled that fateful Tuesday, they were faced with an entirely new landscape, strewn with patients in urgent need of medical care.
Soon coming to their assistance were specialists from Cuba’s Henry Reeve Emergency Medical Contingent: within 24 hours, they were on the ground equipped with medicine, materials, and expertise. Many of the arriving doctors, specially-trained in disaster medicine and epidemic prevention, were veterans of disasters in Pakistan, Indonesia, Central America and elsewhere. They relieved those who had been working around the clock since the quake, setting bones, cleaning wounds, treating burns, and shrouding the dead.
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.
A ham and cheese sandwich every day. Fried chicken and pork rinds. White rice, white bread, and few leafy greens. Soft drinks with every meal. When interviewers asked a nationwide sample of Cubans what they ate on a typical day, and what they would put on a daily menu if they could choose whatever they wanted, these were among the top responses. Results of that landmark study revealed that a majority of Cubans eat too much sugar, not enough fruits and vegetables, and have an unhealthy predilection for fried food, red meat and saturated fats.
The intertwined history of Cuba and Guatemala goes back almost five centuries. In 1536, Friar Bartolomé de las Casas sailed from Cuba to Guatemala with material for his book, A Brief Account of the Destruction of the Indies, seared upon his conscience. Documenting atrocities against Cuba’s indigenous populations, the book persuaded Guatemala’s colonial powers to rewrite abusive labor laws that were killing the Maya; the book also earned De las Casas the nickname ‘apostle of the Indians.’ Over 300 years later, the apostle of Cuban independence, José Martí, cut his journalistic teeth in Guatemala, while Cuban poet José Joaquín Palma authored Guatemala’s national anthem. More recently, in the 1950s, Dr Ernesto (‘Che’) Guevara’s time in the country solidified his belief in the need for radical social change a few years before he would join Fidel Castro’s Rebel Army.
And in 1998, Guatemala, like Cuba so many times before and since, was struck by a fierce, fatal hurricane, opening in its wake a new chapter in the countries’ shared history. Hurricane Mitch took over 30,000 lives in Central America and is widely considered the deadliest hurricane to hit the Western Hemisphere in 200 years. The storm made landfall in Guatemala on October 26, 1998 killing 268 people and displacing 106,000. Losses were estimated at US$750 million, with 6,000 homes completely destroyed and another 20,000 damaged. Seven health centers and 48 rural health stations serving 50,000 people were affected.[1] Within days, a team of 19 Cuban doctors landed in Puerto San José in the southern department of Escuintla to provide medical assistance. Working alongside Spanish, US, and Guatemalan relief workers, the Cuban contingent set broken bones, treated some 900 cases of cholera[2] and 14,000 of malaria,[3] evacuated pregnant women, and delivered babies. Implementing vector control, safeguarding food supplies, and providing potable water were other measures taken by the Cuban volunteers, who drew on their own experiences in hurricane recovery.
“Even if I don’t finish, we need others to continue. It’s got to keep going without me,”[1] said Terry Fox as he ran across Canada. Little did the young athlete know that nearly 30 years after uttering these determined words, the world would continue, unflaggingly, to run, walk, cycle, and skate to raise money for cancer research. Ultimately, Terry didn’t finish, forced to abandon his “Marathon of Hope” when the cancer that took most of his right leg spread to his lungs. But the heroic amputee had already run a marathon a day—over 3,300 miles—and reached his goal of collecting a dollar for every Canadian to fight cancer. That initial CAD$24 million has ballooned to more than $400 million and keeps on growing thanks to the Terry Fox Run for Cancer Research. First held in 1991, the Run is the world’s largest single-day cancer research fundraiser. And the single largest participant country in that event is Cuba.
The 10-90 gap, double burden of disease, lack of infrastructure, resource scarcity: developing countries face a series of circumstances and determinants which inhibit progress in population health. Add to this constellation of challenges another set related to knowledge sharing, including the “know-do” gap and the digital divide, and the barriers to health in the Global South loom larger still. Whereas there’s no silver bullet for rebuilding crumbling health systems, information sharing holds possibilities for improving health care and services, especially in resource-scarce settings.
In 1986, Cuba made public health history — and headlines, largely unfavorable[1-3] — when health authorities on the island implemented a quarantine policy for people evidencing symptoms of AIDS. The unprecedented ‘sanatoria’ policy sparked a turbulent international debate when it was initiated, but received scant attention when it was amended in 1993 and later repealed. Controversy aside, this and subsequent modifications to Cuba’s national HIV/AIDS prevention and control program have helped keep prevalence on the island to 0.1%, the lowest rate in the Americas.[4] With just 31 cases of mother-to-child HIV transmission since 1986, and infection through blood and hemoderivatives virtually eliminated,[5] the Cuban response to HIV/AIDS may provide useful strategies to other countries, especially in the Global South.
The need for practical, sustainable HIV programs in developing countries, where the disease burden is greatest, is urgent. Of the estimated 33.2 million people with HIV in 2007, 22.5 million were from sub-Saharan Africa, where the adult prevalence rate is 5.0%. Figures for other parts of the Global South are similarly sobering, including the Caribbean, where the 1.0% adult prevalence rate is the world’s second highest.[6] Although indicators have stabilized and even improved in some countries (eg Barbados, Trinidad & Tobago, Cuba), AIDS-related mortality remains a leading cause of death among 25-44 year olds in the region.[7] More than any other indicator, AIDS mortality reflects the great divide between north and south: in 2007, 32,000 people from North America, and Western and Central Europe died of AIDS-related causes, compared to over 1.9 million in Latin America, South and Southeast Asia, and sub-Saharan Africa.[6]
Cuba 1963: a nation grappling with the legacy of inequities between rich and poor, city and country. In 1959, Cuba’s new government inherited a land in which 89% of families in the countryside didn’t have milk to drink,[1] 45% of school-age children didn’t attend school,[2] and the vast majority of families in the remote and mountainous regions had no health care at all.
If you’re reading this, you’re not one of the 121 million people worldwide[1] suffering from blindness or vision loss caused by cataracts, diabetic retinopathy and other reversible or preventable conditions causing visual impairment. Or perhaps you’ve benefited from vision restoration surgery. If so, you know how straightforward many of these procedures are when performed by trained specialists, using the latest technology and techniques.
Cuba has been building a national strategy using information and communication technologies (ICTs) for health since the establishment of the National Medical Sciences Information Center (CNICM) in 1965. Back then, vital statistics and health data – considered a cornerstone of the country’s new universal health system – were transmitted by hand or over the phone. As technology grew more sophisticated over the next 30 years, microprocessors and computers were integrated into the process. In 1992, reeling from economic crisis, Cuba founded the national health telematics network known as INFOMED (www.sld.cu), betting on the strategy that ICTs could be used to improve population health at low cost. From these initial efforts until today, the country has followed a policy to build and strengthen a virtual health information infrastructure.[1]
