Cuba, a Healthy Island
By Salim Lamrani
Havana, Aug. 9, 2012 (Taken from Rebelión)
Since the triumph of the Revolution in 1959, the development of Cuban medicine has been a government priority. The country is now a point of reference internationally, with Cuba, in fact, currently having the highest number of doctors per inhabitant in the world.
In 2012, more than 11,000 new doctors graduated, completing their six years of studies in exemplary medical schools. This is the largest graduating class in the country’s history, reflecting Cuba’s continuing commitment to health.
Among these recent graduates, 5,315 are Cuban and 5,694 from 59 other countries in Latin America, Africa and Asia – including the United States – with the majority from Bolivia (2,400), Nicaragua (429), Peruvian (453), Ecuador (308), Colombia (175) and Guatemala (170). Thus, in one year, Cuba trained almost twice the total number of doctors present in Cuba in 1959.
At the time of the Cuban Revolution, the country had only 6,286 doctors. Of these, 3,000 decided to leave the country for the United States, attracted by professional opportunities there. The Eisenhower administration’s policy of ideological warfare against the new government led by Fidel Castro, led to depleting the country’s human capital to the point of creating a serious health crisis.
Faced with this situation, Cuba undertook a massive investment in medicine, creating universal access to higher education, free of charge in all areas of advanced study.
Thus, today, there are 24 medical schools in Cuba, as compared to only one in 1959, in 13 of Cuba’s 15 provinces and the country has more than 43,00 professors of medicine. Since 1959, approximately 109,000 doctors have been trained in Cuba. Currently one doctor is available for every 148 Cubans (67.2 per 10,000 inhabitants, 78,622 in all). According to the World Health Organization, Cuba has the best ratio in the world. These medical professionals staff 161 hospitals and 452 polyclinics around the country.
For the 2011-2012 academic year, the total number of graduates in Medical Sciences, Cubans plus those from other countries, reached 32,171, including doctors, dentists, nurses, psychologists and health technology specialists.
The Latin American School of Medicine in Havana
In addition to the studies offered at 24 of the country’s medical schools, Cuba trains foreign students at the Latin American School of Medicine (ELAM) in Havana. In 1988, after Hurricane Mitch hit Central America and the Caribbean, Fidel pushed for the creation of the school, inaugurated November 15, 1999, in order to train doctors in Cuba to serve in the underdeveloped world.
“Training doctors who are prepared to go wherever they are most needed, and stay as long as necessary, has been the purpose of this school since its foundation,” said Dr. Miladys Castilla, ELAM deputy rector.
Currently, 24,000 students from 116 countries in Latin America, Africa, Asia and Oceania, as well as the U.S. (500 per cohort) are studying medicine, free of charge, in Cuba. During the period beginning with the first graduating class in 2005 and 2010, 8,594 young doctors have been trained at the school. The 2011 and 2012 graduating classes were exceptional, with close to 8,000 graduates. In all, close to 15,000 doctors were trained at ELAM, in 25 different specialties.
The World Health Organization (WHO) honored ELAM’s work in a statement, “The Latin American School of Medicine receives passionate youth from developing countries and returns them home as fully trained doctors. Its efforts are directed toward achieving equity in health care […].
“ELAM […] has made the premise of social responsibility its own. The World Health Organization defines the social responsibility of medical schools as the obligation to direct their educational and research activities toward meeting the priority medical needs of the community, region or country which they are expected to serve.
“The purpose of ELAM is principally to train doctors to work in public health services in underserved urban and rural communities, ensuring acquisition of skills in comprehensive primary care, which includes preventative care, treatment and rehabilitation. Students receive a full scholarship and a small stipend, allowing them to graduate unencumbered by debt. In exchange, they are asked to make only a non-binding commitment to work in underserved communities.
“… Preference is given to candidates from low-income families who could not otherwise cover the cost of medical studies. As a consequence, 75% of the students come from the types of communities which need doctors, in particular, from a great variety of ethnic minority and indigenous communities […].
“The new doctors work for the most part in the Americas, including the United States, several African countries and many English-speaking Caribbean nations.
“Schools like ELAM represent an example to medical studies authorities around the world, challenging them to take on a greater social commitment. As Charles Boelen, former Human Resources Coordinator for WHO, said, “The idea of social responsibility deserves the attention of all, even traditional medical circles… the world urgently needs people committed to generating new paradigms in medical training.”
Within the framework of its international collaboration programs, Cuba additionally trains close to 29,000 students every year in three areas: medicine, nursing and health technology, in eight other countries, Venezuela, Bolivia, Angola, Tanzania, Guinea Bissau, Equatorial Guinea, and Timor Leste.
Since 1963, when Cuba sent its first international medical mission to Algeria, Cuba has been committed to providing health care to the planet’s poor, in the name of international solidarity and the seven principles of Cuban medicine: equity, no cost, solidarity, accessibility, universality, shared responsibility and justice. Cuba’s humanitarian missions are unique and have reached four continents. In fact, no other country in the world, even the most developed, has created such a network of humanitarian cooperation around the planet. Since its inception, close to 132,000 doctors and other medical personnel have voluntarily worked in 102 countries. In all, Cuban doctors have treated 85 million people around the world and saved 615,000 lives. Currently 31,000 collaborating doctors offer their services in 69 Third World countries.
According to the United Nations Development Program (UNDP), “One of the most successful examples of Cuban cooperation with the Third World is the Comprehensive Health Program for Central America, the Caribbean and Africa.”
Within the framework of the Bolivarian Alliance for the Peoples of Our America, ALBA, in July of 2004, Cuba and Venezuela decided to launch a broad humanitarian campaign named Operación Milagro (Operation Miracle), offering surgery free of charge to those suffering cataracts, and other operable eye ailments, who cannot afford the $5,000 to $10,000 price tag of such an operation. This humanitarian effort has been extended to other regions in Africa and Asia and has established 49 ophthalmology clinics in 15 Central American and Caribbean countries. In 2011, more than two million people in 35 countries recovered their eyesight as a result of the mission’s work.
As for disaster medicine, there is doubt as to the efficiency of the Cuban system, according to Wayne S. Smith, former diplomat at the U.S. Interests Section in Havana and a senior fellow at the Center for International Policyin Washington. He states in a report, “Only a few Cubans have lost their lives during the 16 most devastating hurricanes which hit Cuba over the last 10 years and the likelihood of losing your life during a hurricane in the United States is 15 times greater than in Cuba.”
The report adds that, as opposed to the situation in the United States, “disaster medicine is an integral part of medical training and education of the population as to how to react begins in elementary school.” Even the youngest children participate in preparedness exercises and learn first aid and survival techniques, often through cartoons, as well as how to find medicinal plants and food in the event of a natural disaster. The result is a strong culture of prevention and an unequalled level of readiness.
A HIGH LEVEL OF HUMAN DEVELOPMENT
This investment in health, 10% of the national budget, has allowed Cuba to achieve exceptional results. Thanks especially to the preventative focus, the country has an infant mortality rate of 4.9 deaths per 1,000 live births, (as compared to 60 per 1,000 in 1959), the lowest in the Americas, better than that in Canada or the U.S. and throughout the Third World. Likewise, life expectancy, 78.8 years of age (as compared to 60 in 1959), is similar to that in the most developed countries.
Important international institutions have praised Cuba’s human and social development. The UNDP states that Cuba “adopted very advanced social programs 50 years ago which have allowed the country to reach social and demographic indicators comparable to those in developed countries.” The UNDP adds, “Cuba provides evidence which supports the conclusion that the limitations of developing economies do not necessarily constitute an insurmountable obstacle to improvements in heath, demographic change and well-being.”
Cuba continues to serve as a reference point internationally in the area of health care, particularly for Third World countries, showing that it is possible to reach a high level of social development, despite limited resources and the severe economic blockade imposed by the U.S. for over 50 years, when human beings are placed at the center of policy making decisions in society.