In the last few days of our week-long introduction to Cuban health care, we got several more amazing opportunities to see some unique aspects of their health care system. As mentioned previously, their system is solidly built on a “first level” system of care – i.e. full access to primary care for all centered on neighborhood-level family nurse-doctor teams that refer to more specialty-enhanced primary care “polyclinics”. The polyclinics then refer more complex cases to second-level municipal hospitals, which then refer to a set of tertiary or provincial hospitals.
We paid a visit to the William Solare Pediatric Hospital in Havana, which serves as specialty referral center for complex pediatric cases across the country, including pediatric cancers and cancer surgery; transplants (largely liver for hepatobiliary atresia); and cardiac surgery (largely for congenital malformations). It was striking to again see an amazing commitment to staff development & education, with all of the nurses being 5-year university graduates and most having advanced degrees, while working in with extremely limited resources in basic conditions that would remind any of us of conditions and equipment in the 1960-70’s.
We closed the week with a visit to the Latin American School of Medicine (Escuela Latinoamericana de Medicina, or ELAM), an amazing tribute to Cuba’s commitment to train doctors to work in underserved areas around the globe – apparently the only school of its kind in the world. As with all education in Cuba, there is no charge for attending the 6-year medical school (including approx. 30 American students/year!), and students spend the first two years at ELAM (in an old Cuban naval base) before training along other Cuban medical students in medical schools around the country. Noting that this seems like an incredibly generous use of resources in a resource-poor country, I asked our hosts there if there is any resentment from the Cuban people of this effort; they only looked at me with some amusement and said, “Of course not – this is what we do. It’s part of our commitment to health around the world, and we give from what we have, not only when we have extra”. Thus closed an amazing week!