How Medicine works in Cuba

There is one doctor for 153 people in Cuba.  Every neighborhood has a nurse and a doctor.  He/she lives in the neighborhood in a house that has a medical clinic downstairs and home upstairs.  Patients are encouraged to visit anytime.  Above is one of the neighborhood doctor's houses.  Since people don’t move—they live in the family house for generation after generation—and the doctors and nurses know their patients and are expected to visit them at home twice a year.  All medical care and medicine are free and patients are also free to go to the polyclinic which is in the bigger towns or the hospital if they want.   After the revolution, 70% of Cuba’s doctors left for the US and the government gave doctors and other professionals the mansions that were vacated temporarily—most people expected to return to Cuba in 6 months or so.  It’s now been 50 years!  The Ministry of Public Health was created after the revolution.  Private doctors were difficult to access and not all medical services were available.  In his book, History Will Absolve Me, written in prison prior to overthrowing Batista, Fidel laid out his plan for Cuban health care starting with immunizations for all children and adults.  The 1970s saw the increase in medical school, 1980s the family MDs was moved into the neighborhood and prevention was stressed.  The 1990s was a major crisis when the support of the Soviet Union disappeared with the dissolution of the Soviet bloc.  The 2000s saw high tech entering medicine and now Cuba is researching and producing pharmaceuticals.

Cuba also has 39,000 doctors in 110 countries.  Most doctors and nurses serve a 2 year stint as a volunteer in another developing country prior to starting practice in Cuba.  I don’t know how many Cuban doctors have defected to the US. 

Briefly the medical Structure is:

1.        Ministry of Heath that oversees all health care.

2.        13 Research Institutes

3.       Hospitals and 452 polyclinics with doctors according to the population

4.       142 Maternity houses where hi risk, chronic disease, underweight or adverse social situations live full time.

5.       Infant mortality is 4.6 for newborn and 3.5/ 1000 for children under 5 (in 180 it was 27 and 33)

6.       1 RN for 117 people and one dentist for 887 people

7.       36,000 primary care physicians living in the community with the population

8.       26 blood banks

9.       There are medical Brigades that are basically disaster relief team that go to other countries in time of national disasters.  In fact, Cuban disaster teams were the first into Haiti.

10.   Through the Latin American School of Medicine, since 1999 American students can work towards US credentialing

The leading causes of death are the same as ours

1.       heart disease  197/1000

2.       tumors             193/1000

3.       strokes              76/1000

4.       accidents,  pneumonia, and injuries  

All patients are grouped by the doctor and the nurse into

1.        Group one –no disease

2.       Group 2—some risk factors or bad habits

3.       Group 3--- Disease like hypertension or diabetes

4.       Group 4—Post cancer, disability, recovering from an accident

We’ve been to several doctor’s office, polyclinics and hospitals and even though the staff seems well educated and knowledgeable, there is a gross lack of all supplies and equipment.  Most of the places we’ve been predate my nursing career which started in 1971!  Two of our group has been to the international clinic for foreigners for basically the same type of GI disturbance.  One thought they had good care and the other got scolded by the doctor who told her, “you shouldn’t have come to Cuba without medicines”, and acted like she was taking away from Cuban people's limited supply of medications.