CPHE National Network visits Cuba

By Jennifer Davis, Communications Manager, MEDICC

MEDICC organized its first Community Partnerships for Health Equity (CPHE) Network trip to Cuba from April 3-10, 2016, including participants from four CPHE sites:  Bronx, NY; Albuquerque, NM; South Los Angeles and Oakland, CA.  The purpose of the exchange was to further inform the CPHE projects already underway in these communities, inspired by Cuba’s health and community program models, and to provide the opportunity to share information and insights among the group, strengthening the broader CPHE national network.

Among its many activities and meetings, a few highlight visits included: the community project Maravillas de la Infancia, based in Matanzas province, which focuses on the needs of children and adolescents; a meeting with the Vice President of the Cuban Institute of Friendship with the Peoples (ICAP) to discuss the evolving relationship between Cuba and the United States, and; interactions with professionals and patients at the Center for Comprehensive Care for Diabetic Patients to learn more about how chronic disease is treated and managed in Cuba.
CPHE National Network2(Pictured: CPHE National Network representatives, CPHE Program Director Diane Appelbaum, Program Manager Michelle Nader, and MEDICC representative Georgina Gomez. Photograph taken in the Old Havana neighborhood of Papito the Barber.)

One particular highlight was the group’s visit with Papito the Barber, who is spearheading a movement of socially accountable microenterprises and social projects in Havana, Cuba.  His team cleaned up one of Old Havana’s most depressed neighborhoods to provide economic and cultural development for the neighbors, who contribute a percentage of their income to sustain the project.  Initiatives of the project include a barber school for at-risk youth, a children’s playground and a social program for the neighborhood Casa de Abuelos.  As well, local artists have contributed to the project by installing paintings, murals and sculpture.  This project also happens to be one of the sites visited by President Obama during his trip to Cuba in March 2016.

To learn more about CPHE, or any of MEDICC’s other programs, visit our website.

Navajo Nation visits Cuba with MEDICC, observes healthcare system firsthand

Navajo Nation
Leaders from the Navajo Nation visited Cuba last month with MEDICC’s Community Partnerships for Health Equity (CPHE) program to engage and explore the Cuban healthcare system. Along with CPHE Program Director Diane Appelbaum and Program Manager Michelle Nader, the 17 travelers included Navajo Nation healthcare professionals, community members and tribal leadership.

Working in partnership with Community Outreach Patient Empowerment (COPE) of Gallup, New Mexico, the trip program was designed with the ultimate goal of facilitating an open dialogue in which participants could identify models from the island nation’s health system which could be applied in their home community.

Over the course of the weeklong educational exchange, sponsored and hosted by MEDICC, travelers observed and experienced the Cuban healthcare system in a variety of ways: learning about programs supporting young and elderly demographics, visiting community engagement projects and centers, and engaging Cubans on the use of spirituality and herbal medicines in health care.

Highlights of the trip included a visit to Muraleando, a community arts project in which trash is transformed into art; a tour of backyard gardens in Cohimar; and a group exchange at Proyecto El Cachón, a project for environmental awareness in children and adolescents. According to Appelbaum, it was through visits and exchanges such as these that the Navajo Nation group was able to observe and keenly appreciate the strength of cultural identity and resilience that play such an important part of the Cuban approach to health care and well-being.

“Because of the receptivity of the group, and because the sites and Cuban speakers were really great, they were so well positioned to connect,” Appelbaum noted. “There was a simultaneous appreciation of [the Cuban] culture” that, combined with their own cultural pride and philosophy of self-reliance, really energized the Navajo Nation group to start finding specific ways to engage their community and children back home.

In a recent article in the Navajo-Hopi Observer, Navajo Nation Vice President Jonathan Nez summarized the trip:

“’The most gratifying part of the exchange came from direct contact with Cubans and hearing their perspectives on caring for their land and one another,’ he said.


‘Don’t forget we’re in this together. Thank you to MEDICC and COPE for their commitment to the health of the Navajo Nation and for the financial support for the Cuban cultural exchange.’” (Vice President Nez visits Cuba, observes health care system, March 9, 2016)

According to Appelbaum, the group is already building upon the ideas gained during their initial visit. A subsequent visit to Cuba is scheduled for the group this September.

Learn more about MEDICC and the CPHE program on our website.

A road should have two routes, otherwise it is not a road

Translated by Mari D. González from Malmierca llega a Washington: El camino debe tener dos vías o no es camino by Ismael Francisco and Rosa Miram Elizalde, February 14, 2016

Gail Reed

Gail Reed, Executive Editor of MEDICC Review.

Gail Reed, American journalist and executive editor of MEDICC Review, is optimistic about Malmierca’s visit to the U.S., especially as it is happening soon after new measures were announced by the Department of Commerce and the Treasury in late January. She believes that this third package helps Cuba and what she is most excited about is that it could potentially benefit the health of both countries.

But a road should have two routes, otherwise it is not a road. And there are still restrictions that negatively influence achieving cooperation in health care between Cuba and the United States, a topic she and a few others know. “Other changes require congressional action,” she assured. “The most relevant prior to lifting the embargo on Cuba is the removal of the ban on exporting medicines and medical equipment to Cuba without special licenses granted by the U.S. Treasury Department.”

Reed will attend the meeting in Washington with Minister Malmierca and U.S. business owners interested in trade with Cuba and shared her expectations with Cubadebate. She is convinced that Cuban expertise in the field of health and biotechnology could benefit Americans if the existing restrictions on imports from Cuba to the United States were lifted, “in particular, those with chronic diseases such as cancer and diabetes, due to the products and innovations that Cuba has developed in this sector–therapeutic vaccines against lung cancer, head and neck cancer, and various pediatric cancers.”

“Another example, of course, is Heberprot-P for the treatment of diabetic foot lesions. In the U.S. there are more than 70,000 amputations each year from this diabetes complication, especially among minorities and the poor. This Cuban medicine has reported a decrease in the relative risk of amputation by over 70%, and these populations have no access to them due to the constraints of the current policy. Simply, it is unacceptable that diabetics and people suffering from newly treatable or preventable diseases must continue to suffer or become disabled due to the foreign policy of their government,” said Reed.

There are strategies in the health sector that contribute to the successes of the Cuban people today, even with limited resources, that the U.S. authorities and communities could take advantage of in terms of achieving greater equity in health and better outcomes for everyone. “MEDICC has proven that this is not a theory, because it has worked with about 13 communities in the U.S. who are implementing local initiatives as a result of their experiences with the national health system in Cuba,” said Reed.

Visit our website for more news and updates.

US ELAM graduate Dr. Darnna Banks begins research fellowship at Highland Hospital

By Devon Baird and Mari D. González

ELAM Graduate

From left, Devon Baird, Program Manager, Dr. Darnna Banks, and Rachel True, Director of Programs.

Latin American School of Medicine (ELAM) graduate Dr. Darnna Banks visited MEDICC’s staff last week. Dr. Banks, a Texan native, is one of five ELAM graduates accepted into a 2016 Alameda Highland Hospital Research Fellowship position in Oakland.

After graduating from ELAM in the summer of 2015, Dr. Banks entered the National Resident Matching Program (NRMP). NRMP, also called the Match, matches medical school graduates with residency programs through a lengthy application and interview process. Since the matching process began last September, ELAM graduates have been working hard to secure a residency position in Family Medicine, Internal Medicine, and Pediatrics. Dr. Banks hopes to match a residency program in Pediatrics. She and the other graduates will find out about their residency in mid-March.

Through its MD Pipeline to Community Service program, MEDICC has supported Dr. Banks during her education at ELAM with scholarships to defray the cost of the US licensing examinations and facilitation of summer clinical rotations. After matching in pediatrics, Dr. Banks hopes to join other graduates who contribute to MEDICC’s program by mentoring ELAM doctors-in-training at the school. MEDICC wishes Dr. Banks the best and looks forward to continuing to work with her in the months and years to come!

Visit our website to learn more about MD Pipeline to Community Service.

Cuba’s Minister of Health on achieving zero mother-to-child HIV and syphilis transmission and the benefits of ending the embargo

Cuba becomes the first country to eliminate mother-to-child transmission of HIV and syphilis

By Bridget DeSimone, Burness Communications 

Moments before President Barack Obama made the official announcement that the U.S. and Cuba will reopen their respective embassies this month, Cuba’s Minister of Health shared his thoughts about what the normalization of relations would mean for health care.

“We believe in sharing what we have, and this normalization will allow us to exchange experiences and knowledge and construct projects that respond to problems we have in both countries,” said Dr. Roberto Morales. “It will also help people better understand the reality of the Cuban health system, which is free, accessible, regional, and doesn’t discriminate against anyone, no matter the color of their skin or their political beliefs.”

Dr. Morales spoke yesterday at the National Press Club in Washington, DC, just one day after the World Health Organization announcement that Cuba became the first country to eliminate mother-to-child transmission of HIV and syphilis. Morales outlined Cuba’s work to eliminate the diseases and the overall success of Cuba’s health care system which led to these achievements. Programs to combat syphilis that were ramped up the 1970’s led to the island nation’s success in effectively eliminating the disease. Morales said that the annual rate of congenital syphilis has remained between zero and 0.04 percent for births, below the original criteria set by the WHO.

Morales explained that Cuba began the request for WHO validation in 2013. An independent, international expert panel including WHO, UNAIDS, PAHO, UNICEF, and others visited Cuba in March 2015 to validate progress toward the elimination of mother-to-child transmission of HIV and syphilis. Besides visiting health centers and laboratories, the team also certified that services were provided in accordance with human rights principles.

Cuba has among the lowest rates of HIV infection globally. Morales said the annual rate of mother-to-child transmission of HIV has been at or below 2% during the last three years.

Morales also fielded questions about the impact of the 54-year US embargo against the island nation. “The effect of the economic, financial and commercial embargo against Cuba has cost us more than 60 billion dollars,” he said. “What we can’t calculate is the pain and suffering it has also caused. We hope that it can be lifted so that we can acquire the technologies that we currently can’t buy, that the Cuban people really need.”

Morales touted the high quality of the Cuban universal health coverage and public health system despite limited resources. He said that after the Cuban revolution in 1959, nearly half of island’s doctors fled to the United States. But he credited the government with prioritizing the health of the Cuban people through its investment in providing free health care for all, free medical education, and free treatments and free medication for all residents. He spoke of the nation’s booming biotech and pharmaceutical industry and of Cuba’s success in developing hundreds of medications and more than a dozen life-saving vaccines.

Cuba’s life expectancy – about 78.5 years, according to Morales – rivals that of the United States. The United Nations ranks Cuba’s HIV rate as the lowest in the Americas, and its infant mortality rate is much lower than that of the United States.

Morales said that currently 50,000 Cuban collaborators, including 25,000 doctors, provide their services in about 70 countries worldwide, and expressed hope that more countries would be able to collaborate with the island nation and follow its lead in improving health outcomes for all people.

Cuban doctor in Liberia: “I’m just an ordinary guy.”


By Dr. Ronald Hernández


Dr. Ronald Hernández in Liberia.

Dr. Ronald Hernández (left) and colleague on arrival in Liberia.

Our words were “spoken” via Facebook, which for several weeks has hosted e pictures and comments from this doctor who might do well as a journalist himself one day….

Here is the story…

Hello. I hope we can meet. Till then, take care of yourself.

Ronald: Hello. I’m here!

Hello again. I wanted to ask you a few questions, not only because the work you do is amazing but also because you’ve become the face of the group of our health professionals fighting Ebola in Africa. At least on Facebook there are Cubans searching for you to get information on how things are going over there. By the way, I am a journalist for the “Venceremos” local paper, and also a blogger in Guantánamo Province.

Ronald: I don’t think of myself as the face of our group of the Cuban collaborators…in fact, in many of the pictures I post, you see their faces, not mine. I try to keep it like that, so most of the time I’m the one taking the photos. And what I do like is keeping people updated on what’s going on in Liberia.

There’s a lot of misinformation about what’s going on here. Also, it’s a real boost to receive thanks from friends and relatives who I’m about to provide news about.

Exactly. That’s why I wanted to interview you. Is it possible?

Ronald: Sure, you’re already doing it!

So, here’s the first question. Who are you? Where were you born? What did you study? How old are you? What’s your job in Cuba?

Ronald: I’m just an ordinary 45-years-old Cuban guy. I’m a specialist in family medicine. I have two children, three brothers. My parents are still alive, thank God. I am from Banes in the province of Holguin but I’ve always worked in Sagua de Tánamo. Right now, I live in Las Tunas Province and I work in the primary care section of the provincial health department.

I was born in Tacajo on May 4, 1969. I went to s school like any Cuban and graduated from medical school in Holguin in 1992.

I worked as a family doctor for two years as part of the Plan Turquino in Sagua (a program for rural and mountainous areas —Eds.) Three years later, I finished my residency in family medicine. Since then I’ve also headed teams at different levels, in Cuba and in both stints I did abroad: in Honduras and Venezuela.

Are you a leader of the team in Liberia?

Ronald: Here, I’m just a doctor.

Do you hold a degree in epidemiology? Do you have any experience in epidemiological situations requiring such a high level of care and training?

Ronald: I was the deputy director and director of the Municipal Hygiene Unit in Sagua over four years. I’ve taken courses in tropical diseases, medical emergencies and management.
As for experience, I’ve worked in emergencies involving cholera, dengue, malaria and TB. But nothing like Ebola.

How did you make it into the brigade? What was that process? I guess you know that some media are saying it was ‘mandatory’, that you were forced to go…

Ronald: Our disposition to go was the first thing required. Over here, we are just a portion of the ones who wanted to come. There were many more getting ready to do so. But there weren’t enough spaces, which frustrated a lot of the ones left behind. There is nothing ‘mandatory’ about it. I offered to come from the start. My boss didn’t let me go in the first group but I got lucky and he let me come in the second one.

I just said ‘Yes’. I filled out the form and made it to Havana with the rest of the doctors from Las Tunas for a month of training. Then we left for Africa. A lot was explained to us in Cuba before we left.

Did anybody drop out at the last minute?

Ronald: We all had to have a thorough medical check-up—tests of all kinds at the Hermanos Ameijeiras Hospital, and some people turned out not fit to go. The only dropouts in my group were due to medical conditions, by decision of the medical commission.

Rumor has it that you were told that if you got infected with Ebola you couldn’t return to Cuba in five years and in case of death, your bodies wouldn’t be brought back home. Is that true?

10838225_812770345431539_7909124340872962672_oRonald: Look, the fact is that a cadaver infected with Ebola is the most contagious element. Contact with cadavers explains many of the deaths here, too. But, first of all, we’re not going to die here. And second of all, if that were ‘my destiny’, then my body shouldn’t be transported back home to infect you all. That’s the way I think.

My apologies for talking about death. I know a doctor always works surrounded by it, but this time you have it closer than ever. Aren’t you afraid?

Ronald: No, I’m not. For over three months, I’ve been conscientiously preparing myself. Besides, there are situations that remind me that I’m a health professional and I must act as one and save lives. Yesterday, in the ward of confirmed Ebola cases, there was a 10-year-old girl who had lost her entire family to Ebola… and I mean the whole family… looking at her makes you feel like crying. But our job is not to cry; our job is to save her. That’s what we came here for.

That’s hard…

Ronald: Living it is harder, a lot harder…

It must be heartbreaking to see the Ebola patients…

Ronald: It’s the hardest thing…and I’ve seen quite a few. First, the fever, the headache, muscle and joint pains; abdominal pain, diarrhea, vomiting, dehydration and bleeding at every possible level.

Nobody doubts the Cubans’ courage. But taking a look at the images, the number of deaths… many people here on the island look up to you but at the same time think you’re all ‘crazy’… in a good sense… but ‘crazy’ after all.

Ronald: We are crazy–about doing our job. Thinking we’re not going to do it? Now that would be really crazy…

I think people think that way because they wouldn’t have done what you all did, were they in your place. In the beginning you said you were just an ordinary guy but, actually an ordinary person wouldn’t go to another country to save lives putting his own at risk.

Ronald: There’s nothing extraordinary about it. We’re common and ordinary people who’ve been educated based on principles of humanism, altruism and internationalism. That’s our ‘destiny,’ and to fulfill it, we have to do it right.

How did your family take it?

Ronald: Hard. At the beginning it was a mess, no one understood my decision, especially my youngest boy. Then little by little, they grew used to the idea and now they’re more accepting. However, my mom’s birthday was last week and they couldn’t even make a cake for her: she said there’ll be no party until I get back home.

J: I guess that cake will deserve a Guinness Record Award by then…

Ronald: That’s right, maybe so.

How often do you communicate with your family and how does it go when you do?

Ronald: Through email, several times a day. We exchange messages and I call them on the phone. No problems in that sense.

Do you feel safe?

Ronald: Very safe. We have good living conditions, nutrition and protection gear.

What is the work like that you do in Liberia?

Ronald: I already shared that on Facebook, so I’ll copy the text from there and paste it here, not to abuse my fingers that are already hurting, since I’m writing on a cell phone…

It goes like this:

To answer questions I’ve received from a number of people, I’ll explain how the biosafety procedures work, essential for maintaining the good health of all personnel working here. First, the suits are impermeable. As you can see, they cover the whole body including the head that gets covered with a hood that it is part of the suit. We wear rubber boots, masks, glasses and two pairs of gloves.

In between patients we must wash our hands with hypochlorite at 0.5% and change the gloves. We always work in pairs or trios, making sure that each others’ suits are perfectly fit. Not one bit of the skin can be exposed.

The hospitalization of patients is subdivided into three groups: suspected, presumed and confirmed cases. The rounds start with patient one and continue until all have been seen. The flux is always in one direction; there is no coming back to the previous case.

During rounds, there is no use of personal items of any sort, not even pens. Everything is written on an information board: treatments, vital signs, temperature and pulse.10830088_812774718764435_3183339605326629285_o

The most important thing is choosing a suit with the accurate size. And the greatest danger comes when you take off the suit, which might be contaminated with fluids or vomit from the patients.

On our way out, we get help from the epidemiologists. They are the soul of this mission. They guide us through all the steps for taking off the suits. They also give us psychological support, because after wearing the suit for two hours straight, we’re anxious to take it off and drink water, but we have to keep calm.

First, we get showered with hypochlorite at 0.5% all over the body and then slowly, we start shedding our protection…washing our hands… Anyway, it is a long, complicated and highly professional process that keeps problems from arising.

Another thing–if someone is working in the “red area” [where confirmed cases are hospitalized//Eds.] and starts feeling bad, becomes too thirsty or requires relief from a physiological need, the work stops right there and then, and the person is guided outside by their partner. After this is done, the person then gets supplied with oral rehydration salts and water.

We have set times to rest. The work is carried out in six-hour shifts, but we work in the “red area” for only two hours.

I hope this answers your question.

From a cell phone? My apologies. Just two more questions. How were you received by people in Liberia? Have you received encouragement through social networks? What do they say, the people who contact you?

Ronald: These are almost two questions… hahhaha. We never thought we would be received with so much public affection. The people who work with us every day are even speaking some Spanish. Every now and then, they tell us how grateful they that we’re here. It’s become like a second home to us.

Well… two questions, three questions… I know you have spent just a short time there, but I’m sure you already dream about coming back to the things you love. Your return to Cuba–because I’m sure you’ll come back–how do you imagine it?

Ronald: When I get back to Cuba, the first thing I want to do is see my family. Then, have a nice Cuban meal and then go back to work, which is my thing.

If you ever decide to leave medicine, you’d sure do well in journalism. You write well and clearly… anyway, thanks so much for sharing with me some of your Sunday time.

Ronald: A pleasure, my friend… and thanks but I would rather stay doing my thing.  Abrazos to all.

Trading white coats for Ebola protection suits: Cuban volunteers gear up to fight Ebola

Pierre M. LaRaméeBy Pierre M. LaRamée PhD and Gail ReedGail Reed MS in Havana

Dr. Jorge Pérez, director of Havana’s Pedro Kourí Tropical Medicine Institute, provided an update to a MEDICC group in Havana on preparations for Cuban medical volunteers to leave for West Africa in the next few days, providing critically needed medical assistance to African countries impacted by the Ebola epidemic.

Dr. Jorge Pérez--The first Cuban Ebola team will leave for Africa within days.

Dr. Jorge Pérez

The first team of the 461 health professionals will be dispatched to Freetown, Sierra Leone, and later to Liberia and Guinea if requested of those governments and the World Health Organization (WHO), he said. The Cubans will be working under the umbrella of the WHO, whose Director Margaret Chan has said that trained human resources are the missing link in the fight against Ebola, and has praised Cuba for sending the largest contingent of any country. The epidemic has already taken 3,000 lives and infected more than 6,500 people.
Dr. Pérez noted that 15,000 Cuban health workers have volunteered to go from which the 461 candidates have been initially selected, based on their prior experience in treating patients in epidemic and disaster situations. He strongly emphasized the voluntary nature of their commitment and described the rigorous training being received to master new state-of- the-art sanitary procedures, including the correct use of protective suits and the proper handling of patients as well as medical waste.

Suiting Up To Tackle Ebola

Suiting up in Havana for Ebola in Africa( Photo: Courtesy of Tropical Medicine Institute, Havana)

MEDICC CEO Pierre LaRamée and MEDICC Research Director Gail Reed had the opportunity to visit the mock field hospital set up on the grounds of the Institute, where they examined the layout of the tent-wards and briefly experienced the extreme conditions under which these volunteers will be toiling. Even without the suits, the tents are unbearably hot under the intense tropical sun. Part of the training has involved limiting the permissible suit-wearing shifts to a maximum of three hours.

Dr. Pérez declared prevention as “the most important measure”, and emphasized that the Cuban health workers have received extensive training from Cuban professors and foreign experts from WHO and the Pan American Health Organization (PAHO). He said “we will cooperate with professionals from any country, including the United States.” In fact, the preparations already involve three US specialists contracted by PAHO as well as one each from Italy and Brazil.

Cuba’s track record of offering disaster responders to other countries dates back six decades, to the brigade sent to post-earthquake Chile in 1960. Most recently, medical personnel has been dispatched to the Caribbean and Central America (1998 Hurricanes George and Mitch), Pakistan (2005 earthquake) and Haiti (2010 earthquake). The island’s ongoing international medical cooperation is carried out with personnel staffing public health facilities in underserved areas in in 66 countries, and also includes training nearly 25,000 doctors from over 120 countries since 2005, graduates of Havana’s Latin American Medical School.

MEDICC's Dr. Pierre LaRamée inside mock field hospital in Havana

MEDICC’s Dr. Pierre LaRamée inside mock field hospital in Havana

Emphasizing the urgency and severity of the crisis to the Security Council, UN Secretary-General Ban Ki-moon declared, “The Ebola crisis has evolved into a complex emergency, with significant political, social, economic,
humanitarian and security dimensions. The suffering and spillover effects in the region and beyond demand the attention of the entire world. Ebola matters to us all. The outbreak is the largest the world has ever seen. The number of cases is doubling every three weeks.”

Dr. Pérez told the MEDICC group—in Cuba on a People-to-People educational exchange—that the first measures taken back in March were designed to protect the island nation’s own population. He said that as early as last March, his Institute began training local personnel working at Cuban ports of entry on how to look for Ebola symptoms, and began preparing an isolation ward at the Institute’s hospital.

Tropical Medicine Institute Ebola Trainer Dr. Madelín Garcés with Volunteers copy

Tropical Medicine Institute Ebola Trainer Dr. Madelín Garcés with Volunteers

No cases of Ebola have entered the country thus far, he said. The first case to enter the USA on a passenger plane was reported yesterday in the USA, a patient now being treated in Dallas after a flight from Liberia.