Global Community Health Education: Perspectivas Cubanas

Article excerpt

CUBA IS A COUNTRY OF CONTRADICTIONS. The beautiful tropical scenery contrasts with abject poverty and a decaying infrastructure. The Cuban people, vibrant and gregarious, are confined by a restrictive socialist regime and their despondent economic status. IN A PLACE WHERE EVERY DAILY TASK IS EQUATED WITH LA LUCHA (THE STRUGGLE). HOW IS IT POSSIBLE THAT CUBA HAS ONE OF THE BEST PRIMARY HEALTH CARE MODELS IN THE WORLD? Despite a lack of resources, Cuba's system of free and equal access for all citizens demonstrates its value in the shadow of the United States, just 90 miles to the north.

One of the crowning achievements of the 1959 Cuban Revolution, the Cuban health system changed in a relatively short period of time from a fragmented, urban, and elite-driven system into a high quality, preventive-care-oriented system that guarantees access to all (1). The embargo placed on Cuba by the United States for more than 40 years has had numerous effects on Cuba's economy. The current dynamic of the US-Cuban relationship not only negatively affects Cuba's ability to prosper and care for its citizens, but also prevents American citizens from benefiting from the many aspects of culture that Cuba has to offer.

The travel ban that exists as part of the embargo restricts Americans from visiting Cuba. Moreover, under the Trading with the Enemy Act of 1917, it is illegal to spend American money in Cuba, which further restricts travel. Specific licenses granted by the US Treasury Department do allow for travel by members of certain disciplines--science, education, and journalism, for example--but recently, many exchanges have not been allowed because US policies have become more restrictive.

I was able to travel to Cuba in June and July 2004 as part of a program that held one of these licenses prior to the recent tightening of the embargo. Medical Education in Cooperation with Cuba, an exchange program based at Emory University in Atlanta, Georgia, has facilitated global education over the last 10 years by providing students of various health disciplines with a variety of courses of study in Cuba. I participated in a medical school elective focusing on public health, a one-month program highlighting primary care in Cuba. Traveling to both urban sites in Havana and rural areas in the Villa Clara province, I was able to experience firsthand a distinct manner of health care delivery.

In Santa Clara, capital of the Villa Clara province and home to the Che Guevara memorial, I witnessed one of Cuba's most impressive examples of primary/preventive care. The Consultorio Medico de la Familia (CMF), or family doctor's office, is a cornerstone of the Cuban health system. Designed to serve approximately 50 families, nearly every neighborhood in Cuba has a CMF. The primary functions of these facilities include well visits, maternal-newborn care, home visits, long-term case management, and referral services for more complicated health issues. Each CMF employs a doctor-nurse team that provides basic care to the immediate community. There is no appointment book; patients simply arrive with their problems and are seen on a first-come, first-served basis.

The intimacy of this setting is apparent in the manner in which the doctor-nurse team interacts with patients. Not only do they personally know each patient, they also live in the same neighborhood. In fact, the doctor's house is usually directly above or adjacent to the office. This creates an ideal environment for carrying out primary care in a country where preventive medicine is the gold standard.

Witnessing maternal care strategies in Cuba was a highlight of my trip. In addition to regular visits to the CMF, pregnant women are given extra rations both during pregnancy and the postnatal period. (All Cubans have ration cards available to them.) A visit to the Crezca la Vida (Let Life Grow) facility in Ranchuelo, Villa Clara, demonstrated health promotion strategies involving education as well as intervention. …