Cuban doctors give Swiss a lesson in true grit
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.
Hospital infections
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.
Geneva model
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.
Medical students at Geneva University finish off their third year of study with an internship of 4-6 weeks either within or outside Switzerland. This is to enable them to tackle a community health problem in its entire biopsychosocial complexity.
This year about 70% of the students decided to go abroad. The countries they chose included Bolivia, Argentina, Brazil, Peru, Costa Rica, Nicaragua, the US, Canada, Sweden, Romania, Armenia, Mali, Cameroon, Nepal, India, the Philippines, Thailand, Japan, Mongolia and Australia.
Often this experience can be the beginning of an enduring relationship of physicians with poor countries through projects which are a part of the humanitarian commitment of Geneva University.
The island’s socialist system guarantees the 11 million inhabitants free medical care. Because of difficulties of supply, there are quality gaps in the services provided.
Yet Cuba shows comparable health indicators with industrialised countries.
Given a mortality rate of 4.9 out of 1000 live births Cuba has (with Canada) the lowest infant mortality in the Americas.
With local manufacturing Cuba is able to cover about 70% of its need for basic medicines, and imports the remainder. Some medicines may often be in short supply.
The island nation works with about 70 countries in health care, whether it is by sending Cuban medical staff or training foreign doctors on the island.
Countries with adequate financial resources like Venezuela or Angola pay for these services.
Sale of medical services to other countries is one of the most important sources of income for the country.
(Source: WHO and Cuban government)
(Translated by Terence MacNamee)
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