Cubas health care: A continuing success story

Health care Cuban style has many admirers. One reason is favorable statistical measures of health outcome vying with those of wealthy nations. Preventative strategies, health education, and universal access through a unique primary care system all contribute.

This writer, a pediatrician, has long followed the country’s improved infant mortality rates. In Cuba that measure — a sensitive marker of social support within a society — has remained for two years at a low 5.3 babies dying in their first year out of 1,000 births. The most recent U.S. infant mortality rate is 6.3, with the added twist that African American babies die at twice that rate. The worldwide infant mortality rate is 52, that for the rest of Latin America is 26.

Cuban health care has also been applauded because of its international outreach. The most recent class of new doctors graduating Aug. 2 from the Latin American School of made for a four-year total of 5,960 young people from 27 nations completing a free six-year course of medical study. Currently 21,000 foreign medical students are studying in Cuba. Two years ago, 28,664 Cuban doctors were serving in 68 countries.

But the development of capabilities to deliver specialty care for complicated illnesses is just as noteworthy. In fact, Cuba long ago became a referral center for Latin America and elsewhere. In a survey of Cuban health care published in the New England Journal of Medicine in 1983, Robert Ubell wrote, “For some of these nations, it is not Boston, Mass., but Havana, Cuba that is the center of the medical world.”

That aspect of Cuban health care has gained new visibility. Cuba has developed facilities and a multidisciplinary team to carry out pediatric liver transplants. The Ministry of Public Health arranged for the training of specialists and devised referral networks and systems of follow-up care. Since 2006, Havana’s William Solar Pediatric Teaching Hospital has performed 14 pediatric liver transplants. The government covers costs for these complicated operations — up to $200,000 each — and for immunosuppressive therapy costing $20,000 annually per patient.

A Havana friend told me about her granddaughter afflicted with biliary atresia, a birth defect preventing bile from draining into the small intestine. The infant would have died from liver failure had not she and her mother been sent by Cuba’s health ministry, along with other affected babies, to the La Paz Children’s Hospital in Madrid for a new liver. Mother and child spent a year in Spain, courtesy of the Spanish hospital and the Cuban government.

That new program, which began in 2002, called for Cuban surgeons to receive training in Spain enabling them to perform the operation in Cuba. The report on the medicc.org web site emphasizes the important contribution to the program provided in the community through the family doctor system and polyclinics. Another success story derives from experience in Cuba with HIV infection, summarized in an Oxfam report timed with the recent 17th International AIDS conference in Mexico City. Cuba boasts by far the lowest prevalence of HIV infection in the Americas.

Planning for surveillance, diagnosis, treatment programs, ongoing care and nutritional support began in 1983, two years before Cuba’s first patient with AIDS appeared. Since then, Cuba has developed sex education programs for all aimed at prevention.

The prevalence of HIV infection in Cuba is 52 per 100,000 adults. Comparable figures are: 456 for Argentina, 508 for the U.S., 1,236 for Barbados and 3,377 for Haiti. In Cuba, the annual mortality rate for AIDS patients fell from 24 percent in 2000 to 6 percent in 2007, a drop attributed to availability at no cost of seven anti-retroviral drugs produced in Cuba since 2001. Virtually all those afflicted with AIDS there receive treatment. Worldwide, 70 percent of HIV infected persons needing treatment — 10 million people — receive none.

Factors contributing to the Cuban AIDS success story, according to Oxfam, include dedication to health care as a human right, a continuum of health care from community to specialists, respect for the civil rights of persons living with HIV and availability of nutritional, counseling and educational services in patients’ communities.

The International Journal of Cuban Health and Medicine, HYPERLINK http://www.medicc.org www.medicc.org, features more information on medical care in Cuba.

atwhit @roadrunner.com