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Other Health Care Systems

Project: US Health Care System
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The Federation of Cuban Women (Federacion de Mujeres Cubanas, FMC) is founded to promote gender equality and the full integration of women into the economic, political, social, and cultural life of Cuba. (Partido Comunista de Cuba 7/29/2006; Cuban Education Tours 7/29/2006) The FMC, a non-governmental organization, will liaison with the Cuban government through the People’s Health Commissions to promote women’s health. (Feinsilver 1993, pp. 32) Some of the organization’s members will serve as brigadistas sanitarias (health brigade members), helping polyclinic (see 1964 and after) nurses provide women with first aid, injections, and general health information. They are also responsible for seeing that all women in their district regularly have pap smears, and that all pregnant women do not skip any of their prenatal exams or check-ups. When Cuba implements its Family Doctor Program (see 1984) many of the brigadistas sanitarias’ responsibilities will be taken over by the family physician-nurse teams. The role of the brigadistas sanitarias will focus mainly on health education. They will also occasionally assist family doctors and nurses. (Feinsilver 1993, pp. 66)

Cuba transforms its health centers into “polyclinics.” Each of the polyclinics administers health services to a specific geographical region comprised of between 25,000 and 30,000 people and serves as the point-of-entry for most patients. (Feinsilver 1993, pp. 35) In addition to treating patients, the clinics educate patients by holding daily lectures on health care in clinics’ waiting rooms. (Feinsilver 1993, pp. 67) The region served by a polyclinic is further divided into health sectors. Within these sectors, all people are seen by the same medical teams, which after 1976 are mostly comprised of a physician and nurse trained in the same specialty. So for example, within a health sector, all children have the same pediatrician and all women have the same gynecologist. The polyclinic medical teams operate according to a paradigm known as “medicine in the community” which aims to treat patients as a biopsycho-social being in their respective unique environments. The medicine-in-the-community model is also designed to focus on disease prevention by identifying risks present in the environment before they become health problems. By the 1980s, it is apparent that something more needs to be done to achieve these objectives. The polyclinic medical teams fail to establish close relationships with their patients and have little time for prevention. This shortcoming leads to the creation of Cuba’s Family Doctor Program in 1984 (see 1984). (Feinsilver 1993, pp. 35-40)

The Cuban government takes over the last remaining private medical clinics in the country. (Feinsilver 1993, pp. 33)

Cuba’s Ministry of Public Health establishes rules and standards on health care for women, infants, and young children. The rules make infant health and the reproductive health of women the country’s top health priorities. The ministry’s rules specify the minimum number of prenatal examinations and consultations for pregnant women and require that all pregnant women receive education on hygiene, health during pregnancy, childbirth, and child care. They are also to receive psychological counseling and instruction in birth exercises. When women miss appointments or educational lectures, doctors are instructed to go to their homes. Additionally, the ministry’s rules state that all childbirth must take place in hospitals, where women and their new babies will typically stay for four or five days. By the mid-1980s, prenatal care provided to Cuban women will far exceed the medical norms of most industrialized countries. (Feinsilver 1993, pp. 48-49) The ministry also issues specifications for the care of infants and children, requiring that doctors conduct a certain number of check-ups every year. By 1989, the average number of well-baby visits per year will be 11. (Feinsilver 1993, pp. 53) Author Julie Feinsilver notes that Cuba’s commitment to prenatal and infant care is cost-effective in the long-term. “These children experience less illness, require less curative medical care, and possess greater potential for development and educational achievement, which lead to greater work capacity and higher productivity.” (Feinsilver 1993, pp. 51)

Cuba’s public health ministry launches an education campaign promoting physical fitness as part of an effort to combat negative health conditions associated with sedentary lifestyles. (Feinsilver 1993, pp. 71)

In May 1981 dengue fever appears in the Cuban population, becoming an epidemic by mid-June 1981. It is not known how the disease was introduced to the island, but in his annual speech on July 26, Fidel Castro suggests that the Cuban population was intentionally infected by the US. He will later claim in 1984 that some “counterrevolutionaries confessed to having carried out biological operations against Cuba at that time.” To combat the illness, the Ministry of Public Health launches a country-wide campaign to clean up all potential breeding places for the Aedes aegypti mosquito, the carrier of the disease. Everyone is asked to participate in the effort. The last case of dengue fever is reported on October 10, 1981. During the five-month outbreak, a total of 344,203 cases were reported. Of those, only 158 were fatal. More than 116,000 people were hospitalized. “No government in the Third World and few in the developed countries could have achieved as much as rapidly as the Cubans did, because most lack this national capacity to mobilize,” writes author Julie M. Feinsilver. (Feinsilver 1993, pp. 85-90)

Cuba opens its 950-bed, 24-story, state-of-the-art Hermanos Ameijeiras Hospital. The building cost 60 million pesos to build and houses USD $62 million worth of medical and nonmedical equipment. The hospital will provide the latest technology and procedures available in the most developed countries and will also serve as a major research facility with computer and telex links to international research institutions. Five years later, a top Pan American Health Organization official will say that the hospital’s staff “conduct research and use technology at the international cutting edge in the medical specialties in which services are rendered.” (Feinsilver 1993, pp. 61-62)

A study prepared for the Congressional Joint Economic Committee acknowledges Cuba’s successes in education and health care. “[T]he Cuban revolution has managed social achievements, especially in education and health care, that are highly respected in the Third World…. [These include] establishment of a national health care program that is superior in the Third World and rivals that of numerous developed countries,” the report says. (US Congress 3/22/1982, pp. 5; Feinsilver 1993, pp. 81-5)

Sergio Diaz-Briquets, in his book The Health Revolution in Cuba, concludes that universal health care access, along with the narrowing of the gap between mortality rates in urban and rural populations “appears to be the main causative factor behind Cuba’s impressive gain in life expectancy.” (Diaz-Briquets 1983, pp. 113; Feinsilver 1993, pp. 92)

Cuba launches its Family Doctor Program. This new system is designed to make up for the shortcomings of the “medicine in the community” model (see 1964 and after) which did not create the intended close relationships between physicians and patients and which had failed in the area of preventative care. Under the new system, Cuba aims to put a physician and nurse team on every city block and in the remotest rural communities. The plan calls for the creation of 25,000 such teams by the year 2000, 5,000 of which would be assigned to factories, schools, ships, and homes for the elderly. The teams are charged with providing comprehensive medical attention to everyone in their districts, both healthy and sick. Each district consists of between 120 and 150 families. Special emphasis is placed on prevention and people are encouraged to exercise, eat well, and avoid unhealthy lifestyle habits such as smoking. (Feinsilver 1993, pp. 35, 40-42) Implementing the system also requires corresponding changes in the country’s medical schools. All medical graduates except surgeons, nonclinical specialists, and future medical school professors are now required to complete a residency in family medicine before completing a second residency in a specialty area. (Feinsilver 1993, pp. 30) After the Family Doctor Program is implemented, medical costs begin to drop. The reduced costs are attributed to decreased hospitalization and emergency room use, better health monitoring, improved patient fitness, and more effective prevention. (Feinsilver 1993, pp. 35, 45)

Cuba’s Ministry of Public Health conducts 8 million HIV tests discovering 449 positive cases. Most of the infected individuals are quarantined by the Cuban government to prevent an epidemic. They are housed in a sanitarium, luxurious by Cuban standards, and they are exempted from work requirements. Though they are not prohibited from seeing family members and friends, any visits are restricted and monitored. Health officials from both developed and developing countries later request assistance from Cuba in establishing their own AIDS sanitariums. (Feinsilver 1993, pp. 82-85)

By this date, Cuba has 6.0 medical assistance beds per 1,000 inhabitants and 1.3 social assistance beds per 1,000 people. The island boasts a total of 263 hospitals, 420 polyclinics (see 1964 and after), 163 dental clinics, 229 dispensaries, 3 medicinal spas, 148 maternity homes, 23 blood banks, 11 medical research institutes, 153 homes for the elderly, and 23 homes for the physically and mentally impaired. These facilities are distributed relatively evenly across Cuba, though there is a slightly higher concentration of beds in those provinces that serve as regional health centers. The Havana province also has a larger number of beds per capita because it is a national referral center. (Feinsilver 1993, pp. 58-59)

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