Cuban hospitals have to cope with poor hygiene and a lack of supplies, in part due to the United States embargo. Swiss medical interns are learning first-hand how such struggles can lead to creative coping strategies and doctors’ tenacity.
Three Swiss medical students have been experiencing the Cuban health care system at one of the main hospitals in Havana. They are some of the 100 or so Geneva medical students doing internships in 30 countries around the world.
"I am fascinated by the Cubans’ flair for getting by and coping with the everyday challenges of a life that is never easy," says 23-year-old Sofia Merlo, who along with two other students based at Hermanos Almeijeiras hospital as part of a programme of social awareness for physicians in training.
Cuba has one of the best health systems in Latin America, but poor hygiene is still a problem that can have catastrophic consequences: seven in every 100 patients get infected during their hospital stay because of lack of proper hand-washing by staff - and 30 per cent of them are in the intensive care unit.
Among the key causes of infection is inadequate hygiene among staff handling intravascular catheters and ventilating machines.
But it is also a consequence of the economic embargo by the United States. This embargo, as the United Nations has warned over 20 times, restricts the resources of an economically vulnerable country.
"There is a lack of Latex gloves, surgical masks and spare parts needed for medical equipment. When they auscultate a patient the doctors have to cover their mouth with their white cap," notes Wanders.
"The embargo is not a topic that we particularly want to dwell on, but it is our everyday reality," says Nora Lim, a doctor in the intensive care unit. "After Washington stepped up the blockade in the 1990s, the doors closed for us as regards importing equipment and spare parts. The US threatens companies with sanctions if they deal with us. So importing equipment is much more costly for us than for other countries."
In spite of scarcities it is the goal of the Cuban health care system "to keep disease to a minimum. But faced with the embargo we have to adjust our aims to the situation we are actually dealing with," says Lim.
Through the non-governmental organisation MediCuba, Switzerland is one of the countries trying to help Cuba overcome the limitations of its health care system. In the last 20 years MediCuba has funded projects worth over SFr5 million ($5.1 million).
For example, Almeijeiras hospital recently took delivery of 250 catheters for lung cleansing and a spare part for one of the ventilators. This equipment is crucial for avoiding pneumonia in critical care patients needing to be ventilated.
"MediCuba funds basic ingredients for local manufacture of medicines and organises fundraising campaigns together with its European sister organisations to buy things like cancer drugs for children," explains Nélido Gónzales, the deputy director of the National Institute for Oncology and Radiobiology (INOR) and the intermediary for Swiss and Cuban medical staff.
Beyond the comfort zone
The Swiss students say that they have become used to the glaring material shortages they have to deal with at Almeijeiras hospital. At the same time they have met some outstanding clinicians, says Merlo.
"Even if they have less in the way of technology and resources available, you can tell that they are more humane and intuitive and take an interest in the patient’s living environment. Working in Cuba has made it possible for me to get beyond my comfort zone, to learn from others and mature." This, she says, will make a big difference in her later career.
"This determination not to be discouraged by problems and to give your best as a professional is something we will take back with us to Switzerland", concludes Stefani.