A personal blog by Jasmine Osiowy (2nd year medical student)
White sand beaches, classic cars, and salsa dancing are all images typically associated with Cuba. Perhaps more notable, however, are the things that are uniquely absent from the country. For instance, there is not a single “American” chain such as McDonalds or 7-11, and the sparsely located internet is slow and very expensive. There are countless other features of Cuba that make it different from any other country.When you really start looking, some would say that Cuba is a country of contradictions. One Cuban I spoke to phrased it succinctly and with poignancy, “in Cuba, everything is free, but we are not free.” For instance, education is free yet there are a lack of jobs and sufficient remuneration such that we met engineers driving taxis to get better pay from tourists. In addition, some students have access to computers through their university for learning purposes yet internet use is restricted. Another, better known example is that Cuba has one of the world’s lowest GDPs and yet has health outcomes comparable to North America. This statistic in particular has garnered much international attention.
Last June, I and three other UBC medical students had the privilege of learning about the Cuban health care system firsthand through a program initiated by a professor in the School of Population and Public Health at UBC and organized through the Instituto Superior de Ciencias Medicas – an international medical school in Santa Clara, Cuba. We spent three weeks shadowing doctors and nurses and speaking to medical students to learn about the organization of the Cuban health care system, the role of doctors and community health programs, and about general life in Cuba. We also had time to explore other destinations in Cuba, which were radically different from each other and deepened our understanding of a country that functions so uniquely from any other.
Cuba boasts many successes in the health sector, which have been the subject of both praise and criticism. Because it is a socialist country with universally free health care but limited resources, the Cuban health care system was fascinating to learn about. We experienced it in several different ways, from hearing mini-lectures on overall organization to touring their sterilization process. The finer details are numerous, so here, I will focus on the broader overview. The Cuban health care system is organized into three levels: consultorios (similar to a family doctor’s office), policlinics (like a mini-hospital focused on community care), and hospitals. We had the most exposure to the first two levels, which are highly focused on prevention.
Consultorios are located in every neighbourhood, allowing for easy patient access and enabling the doctor to conduct home visits. Policlinics offer services such as dentistry, obstetric consultations, physiotherapy, dermatology consultations, vaccinations, etc. The policlinics aim to catch problems before they become severe enough to warrant a visit to a hospital. Prevention and patient education are also carried out through various community programs including diabetic clinics where patients can go to learn about their disease and about proper nutrition, an exercise/health check program three times per week for elderly people, and a day care service for elderly people. We got only a brief glimpse of these programs, but they seemed to be proactive ways to involve the community members in their own health.
Comparing Cuba’s programs to other systems is quite difficult, however, as fundamentally, doctor-patient interactions are conducted in a very different manner. The biggest difference I noticed came down to confidentiality; which is essentially a non-issue. Doctors get collateral information from family members, neighbours, and acquaintances, and the next patient sometimes waits inside the consultation room. Coming from a system where patient autonomy and confidentiality are of the utmost importance, I found it interesting to consider how lack of confidentiality might contribute to health outcomes.
Lastly, I wanted to touch briefly on medical education. I was astonished to learn that the medical school that hosted us is home to students from 165 different countries around the world – many from Africa and Latin America. Just as it is for Cubans, this education is provided at no cost to the student. However, these international students must return to their home countries to practice upon graduation. We were able to gain perspectives from students from various backgrounds including students from Cuba, Africa, and Belize, as well as from the sole Canadian studying at the school. We also held a colloquium to discuss how social responsibility is taught in medical education with students from Cuban, Mexican, American, and Canadian medical schools. Please see www.medinternational.webstarts.com for more details.
By the end of the trip, I came to realize that Cuba is a truly intriguing country in many different respects. I found the disconnection from the busy, plugged-in lifestyle I am used to quite refreshing. This time spent in a country enveloped in socialism, hard-working students and passionate doctors was an amazing learning experience, and I hope that future medical students will be able to get this unique inside glimpse for many more years. Considering that major changes are on the horizon in Cuba, it will be interesting to see the evolution of health care there as the country evolves as well.
~Jasmine Osiowy