Healthcare and medicine

Medicine for the family

Cuba's accomplishments in primary care, while controversial, include several developments pertinent to family medicine. These accomplishments involve low-technology and organizational innovations such as neighborhood-based family medicine as the focus of primary care; regionalized systems of hospital services and professional training; innovative public health initiatives and epidemiologic surveillance; universal access to services without substantial barriers related to race, social class, gender, and age; and active programs in alternative or traditional treatments such as "green medicine" and "thermalism." High-technology achievements include innovations in pharmacology and biotechnology, surgical procedures, and care of patients infected by human immunodeficiency virus (HIV). Limited access to Cuban publications, impediments to presentations by Cuban health-care professionals at professional meetings, and the prohibition on importing products of Cuban biotechnology to the United States inhibit a detached, scientific appraisal of Cuba's accomplishments. Cuba's isolation from the U.S. clinical and research communities has prevented interchanges that would improve primary care services in both countries.
Key words: international health, Cuba, family medicine, primary health care, public health, community medicine.

PRIMARY CARE IN CUBA: LOW- AND HIGH-TECHNOLOGY DEVELOPMENTS PERTINENT TO FAMILY MEDICINE

Ninety miles from the United States, Cuba and its health-care system remain mysterious and controversial for many primary care practitioners. Partly because of U.S. governmental restrictions on travel and importation of journals and medical products, clinicians and researchers face difficulties in appraising critically the policies and practices that have evolved in Cuban medicine.
As members of a study seminar from the American Public Health Association who have visited Cuba in 1995 and 1996, we witnessed both problems and strengths of the health-care system that are relevant for U.S. medicine. As required under the federal restrictions which limit travel to Cuba for U.S. citizens, we traveled to Cuba with a license approved by the Treasury Department. We were able to travel freely within Cuba and to make observations in local communities, hospitals, clinics, research institutes, and the first national sanitarium for HIV patients. At several of these sites, we arrived spontaneously, without prior notification. In some instances, we entered into discussions with individuals who had opposed various aspects of Cuban governmental policies. We also conducted interviews in Spanish with officials and community leaders as part of a itinerary planned by officials of the Cuban Ministry of Public Health; we were free to deviate from this itinerary at will, did so on numerous occasions, and experienced no restrictions on our ability to pursue inquiries of interest to us, such as those that involved transportation by private automobile to provinces outside Havana. In addition, we reviewed current literature, including items identified by a Medline search using the following key words: Cuba, medicine, and health.