The University of Alabama College of Community Health Sciences hosted two physicians from Cuba as part of UA’s Cuba Week.

Dr. Nancy de la C. Milián Melero, the municipal director of health for Old Havana, and Dr. José de Jesús Portilla García, professor of general surgery and international medicine, visited UA and the College and discussed health care topics with faculty, staff, medical students and resident physicians.

Hosted by UA’s Cuba Center, Cuba Week, which was held Oct. 24-28, was a gathering of more than 20 Cuban artists, musicians, writers, doctors and scholars, joined by UA faculty and staff for a series of panel presentations, readings, lectures, exhibitions and discussions sharing collaborative and individual work.

Throughout the week, in which the College offered a tour of DCH Regional Medical Center, an Interprofessional Research Breakfast focused on geriatric care, a visit to rural Greensboro, Alabama, and a community reception culminating the week’s activities, Dr. Richard Streiffer, dean of CCHS, emphasized that there were many lessons that Alabama and the US could learn from the Cuban approach to health care.

“We are a resource-poor state, and they are a resource-poor country. Though we are resource poor, we do have more money. Yet, they have better outcomes. What can we learn from them?” Streiffer said to CCHS faculty, staff, residents and students.

The presentations made by Portilla García and Milián Melero throughout the week focused on prevention and health promotion in communities, and programs that offered care for the elderly and maternity care. It is through Cuba’s emphasis on prevention and health promotion, Portilla García and Milián Melero said, that Cuba is able to have greater health outcomes than other third world countries.

The University of Alabama has had a relationship with Cuba for several years, but it wasn’t until about three years ago that the College started its own initiative. Streiffer and other CCHS faculty visited Cuba to learn about its healthcare system and approach to medical education.

 

At an opening reception on Monday, Oct. 24, Dr. Stuart Bell welcomed the Cubans, saying Cuba Week enables “colleagues from different cultures and backgrounds to come together and find common ground to educate students and work together.”

Portilla García and Milián Melero then joined the College on a tour of DCH Regional Medical Center, followed by a visit to the Capstone College of Nursing, where they saw the patient simulation laboratory for nursing students.

 

Caring for the elderly was the topic of the UA Interprofessional Research Breakfast, which was held on Tuesday, Oct. 25, at Capstone Village, and hosted by the College. Milián Melero spoke about aging in Cuba and the programs available to the elderly.

She said Cubans aged 60 and older currently comprise 18 percent of the population, and that is expected to rise to 30 percent by 2030. With a goal of keeping this population healthy and active, the Cuban government has created programs that enable the elderly to come together for care and for activities such as exercise and social programs. “Programs are designed so that a person can confront aging in a positive way. They are designed to help the elderly age healthfully and youthfully,” Milián Melero said.

There are Grandparents’ Houses in communities throughout the country for elderly who need meals and help with daily activities. They come to the Grandfather Houses during the day, and return home at night when their families are back from work. There are also institutions for those who need round-the-clock care.

“The government likes to provide services locally, since the goal is to keep people in their communities and in contact with the places and the people they know,” Milián Melero said. “The elderly live a quality life in their communities.”

 

Portilla García and Milián Melero then presented a two-part Lunch and Learn series for CCHS faculty, medical students and residents. The first hour-long segment was an overview of the accomplishments of the Cuban healthcare system since the revolution in 1959 and was presented by Portilla García.

He said the facilities of the national healthcare system now include 451 neighborhood clinics, 152 hospitals, 110 dental clinics, 136 maternity homes and 165 homes for the elderly. The health care workforce is now comprised of 12,883 family medicine physicians,  79,297 nurses and 15,600 dentists. Vaccinations have eradicated polio, malaria, neonatal tetanus, measles, diphtheria and pertussis.

“We are not a rich country, but the results are very good,” Portilla García said.

The second portion was specifically for residents. Portilla García and Milián Melero discussed the importance of touching a patient and having personal interactions with them over the use of technology.

“You are using high tech, and that’s good. But to give a very good physical exam, to touch the patient, is so important,” said Portilla García.

 

On Wednesday, Oct. 26, the College presented its portion of the official UA Cuba Week panel presentations at the Bryant-Jordan Performing Arts Center. The first segment, “Achievements of the Cuban National Healthcare System: 1950s to the Present” was presented by Portilla García, with Dr. Debra Whisenant, assistant professor at the Capstone College of Nursing, serving as the discussant.

Portilla García noted that prior to the 1959 revolution, there was only one school of medicine in Cuba, 6,000 doctors, and of every 1,000 children born each year 60 died in infancy. Today, there 25 schools of medicine, 78,000 plus physicians and the average life expectancy is 78 years. “Health is now guaranteed in Cuba by the constitution,” he said. “The Ministry of Health has the responsibility to keep the country’s people healthy.”

The Cuban healthcare system is free of charge, accessible to everyone, comprehensive and regionalized, Portilla García said. Cubans are cared for by a team that includes a doctor and nurse and has these goals: knowledge of the patients they care for, including how they live, their hygiene and  number of family members; and health prevention and promotion, which involves administering vaccinations, teaching people to boil water so that it is safe to drink, and teaching people to eat more fruits and vegetables, limit saturated fats and exercise.

Whisenant said in Cuba there is a culture of health. “Prevention and health is a way of life there,” she said. “In the US and Alabama, it’s fix me when I get sick.”

Milián Melero then presented “Training Physicians for Cuba and the World,” and Dr. Richard Streiffer, dean of CCHS, was the discussant.

In Cuba, students enter medical school, which lasts six years, right after high school. They complete four rotations – in  family medicine, pediatrics, internal medicine and obstetrics and gynecology – and  then take their state exam. After that, they complete a three-year family medicine residency. Education and training are free.

“The majority of our graduates are specialists in family medicine,” Milián Melero said, adding that a small group of students do specialize in surgery and OB/GYN.

She said medical student education, including studies and training, takes place in community clinics, or poly clinics. “It starts with the introduction to clinical medicine and the relationship between patient and doctor. It’s important to us that the relationship between the patient and the doctor is effective.”

Streiffer noted that in the US, most patient care is given in communities, but most medical education and training takes place in hospitals. He also pointed out that, unlike in the US, medical education and training in Cuba is based on prevention and is socially responsible.

“This is incredible training they get. We have so much that we can learn from Cuba’s medical education,” Streiffer said. “The Deep South needs these kinds of doctors.”

Then, Milián Melero concluded the morning presentations with “Mother and Child Care Program in Cuba.”

“This is one of the priorities in Cuba’s health programs,” said Milián Melero. Around the time of the Cuban revolution, the country had high infant mortality rates, said Milián Melero. Many deaths were due to curable diseases. So the country developed a program for mothers and their children as well as an immunization program.

In Cuba, pregnant women have at least 12 visits with a physician during their pregnancy, and they are screened for congenital anomalies and diseases. They are also offered access to maternal homes, if needed. After the baby is born, the physician follows the mother and the child after the birth and through the child’s development. Cuba was named the best Latin American country in maternity by Save the Children, an international organization that supports children’s rights.

Dr. Daniel Avery, professor of Community and Rural Medicine at the College and retired obstetrician, said that in the US, the Health Department stopped prenatal care in the 1980s. Rural hospitals have closed, and as a result labor and delivery units in rural areas close.

“Patients in rural, underserved areas have to travel a long way to get prenatal care and even longer to deliver their baby at a hospital,” he said. “We’re going in the wrong direction.”

 

On Thursday, Oct. 27, the College took Portilla García and Milián Melero on a tour of Greensboro, Alabama.

The first stop was the Project Horseshoe Farm Community Clubhouse, where lunch was provided and Dr. John Dorsey, a psychiatrist and executive director of the program, gave an outline of Project Horseshoe Farm’s objectives.

Project Horseshoe Farms provides youth programs for Greensboro schools in tutoring, mentoring and enrichment designed to help students improve in math and reading and promote character development. It also offers affordable housing for women over 50 who are in need and could benefit from a supportive family-style home environment. The Project also offers fellowships for recent college graduates. Fellows facilitate the youth programs, participate in community outreach and learn to be leaders in health care and education.

In addition to learning about the projects and visiting Horseshoe Farms, the tour also stopped at Whatley Health Services in Greensboro, a federally-funded health care clinic.

Deborah H. Tucker, CEO of Whatley Health Services, called the center “state of the art” and said it provides primary medical care and primary dental care to its community. The building was constructed thanks to stimulus funding.

On Friday, Oct. 28, the week concluded with a community event held at the Tuscaloosa River Market. In  his talk, “Achievements of Cuban Healthcare Professionals Around the World,” Portilla García spoke about the health collaborations around the world, and instances of when Cuba has sent health care providers and relief to areas in the world that are in need.

“There is something different about the values, training and orientation in the Cuban healthcare system that we can learn from,” Streiffer said. “And as Cuba comes out of the Third World, they will be interested in our technology. We hope to bring more Cuban health care professionals to Alabama and ex-change our trainees with them and see where this can go.”