ASCP Medical Delegation to Cuba: An Educating Exchange

Written by: Dr. Nicole Brandt, ASCP Board Chairman & Executive Director & Professor Lamy Center on Drug Therapy and Aging University of Maryland, School of Pharmacy

During the week of October 2nd, I had the privilege of leading a group of professionals from various backgrounds to Cuba. Despite travel warnings and unpredictable weather, this unwavering group were trailblazers for our profession. The attendees were: Dr. Garrette Martin-Yeboah, Dr. Denise Chodnicki, Dr. Carol Morreale, Dr. Tom and Denise Genuit, Ms. Nancy Rodriguez-Weller, Thi Bay Miradoli as well as myself accompanied by my husband, Nick Brandt. (of note, one of our delegates, Dr. Sultan Yassin who lives in Puerto Rico was unable to join us and his presence was missed.) We were a small but committed delegation filling each 8-hour day with at least 2 different medical site visits. There were many exchanges during these visits and I hope that I can adequately provide highlights below.

Day 1 Monday October 2nd: Leaving the US & Arriving in Cuba

The ASCP delegation met at the Miami airport bright and early to embark upon our journey to Havana. The team from Professionals abroad, orchestrated by Thi Bay Miradoli were fantastic and alieved any concerns we had with customs or travel documents. Our arrival into Cuba was easy with no lines or delays. We were welcomed by Rita Pereira, a local tour guide as well as adjunct professor of law at University of Havana. The group started its tour of Havana by taking in the sites at El Morro castle as well as lunch at Jardin de los Milagros. Not only did we see breathtaking views, (see picture of Havana) we also enjoyed a festive dinner at San Cristobal where Michelle and Former President Barack Obama ate.

Day 2 Tuesday October 3rd: The ASCP delegation met at the Hotel Nacional de Cuba to meet with the Cuban Ministry of Health, Dr. Aldo Grandal Sosa

The talk started out highlighting that per their Constitution, “ALL Cubans have a right to health care”. The basic principles being that it is: universal, accessible (via regionalized primary care), as well as free of cost and discrimination. The health delivery system is a three-tier approach. It starts embedded within the community at the doctor’s office or at Polyclinics which offer an interprofessional team approach consisting of but not limited to: physicians; dentistry; laboratory services, and pharmacy. The next higher level of care are hospitals with about 152 throughout Cuba. The highest level are Institutes which provide specialty care such as Cardiology; Nephrology; Geriatrics (total of 13 in Cuba).

There is a strong patient and public responsibility to limit utilization in order to sustain healthcare which is about 19-20% of their gross domestic product versus 17.8% for the US. It is also important to note that they take a hard stance on issues such as childhood vaccination. For instance, if a child is not vaccinated legal actions can be taken against the family for neglect. There is also a strong emphasis on health education and promotion translating into an average life expectancy of 79 years of age.

After this overview of the healthcare system, we met with Jamile Martinez from the People to People program. One facet of this organization is to facilitate delegations. It was noted that there has been increasing scrutiny by the current US administration, which has led to the importance of programs keeping detailed schedules to ensure there are achieving their goals. Furthermore, he explained the solidarity movement as well as the impact the blockade has had on Cuba. The blockade impedes access to much needed materials such as pharmaceuticals, which is something we saw first-hand during our clinic visits.

Day 3 Wednesday October 4th: This day proved to be very interesting and was a logical follow-up to the preceding day’s discussion. We met with the Director of Pharmaceutical Services for the Ministry of Public Health, who oversees the 2153 community pharmacies. Of note, limited computer resources and inventory tracking as well as only having 802 medications available: 505 are produced in Cuba and 297 are imported. Pharmacists possess a Bachelor’s of Science in pharmaceutical sciences with it important to note that medical doctors may obtain advanced training in pharmacology as well.

In the afternoon, the delegation visited CITED, which is the institute for Geriatrics. At this site, we met with a geriatrician and a pharmacist. This team provided care to about 400 patients a year inpatient and about 1500/year outpatient. They worked together from clinical rounds to the involvement of a pharmaceuticals services committee where an important aspect is monitoring adverse drug reactions. Furthermore, they are struggling with the use of medications that may be particularly problematic in older adults (AKA Beers Medications such as cyproheptadine) as well as managing multimorbidity. Actually, we were swapping stories on tactics to improve medication safety and use in older adults. Just like us, they are also dealing with issues with transitions of care and medication management concerns.

Day 4 Thursday October 5th: By Day 4, many of us were frustrated by the limited ability to access internet so it was really impressive when we met with the Director of INFOMED. INFOMED was created in 1990 and serves as a hub for all healthcare professionals. It provides access to cutting edge information and database resources. Peer reviews are done regularly of the pages and sites by section editors as well as a Board of Advisors.

In the afternoon, we went to a University Polyclinic and then a doctor’s office embedded in the community. We were able to discuss from the front line practitioners about the needs of the community and the importance of caring for patients in their homes. This reinforced what we learned day one that healthcare is not a consumer driven industry rather a person centered approach based on a deeper understanding of their situations.

Day 5 Friday October 6th: Our final day was spent visiting an adult day care program in the morning and University of Medical Sciences in the afternoon. The Adult day program reinforced the importance of social engagement noted by the dominos and other onsite clinical programs. (e.g eye and dental care). Truly felt that the program was embedded within the community with many older adults as well as staff freely coming and going at the site. (see picture of older adults)

Our last visit was really remarkable as we met with Dr. Roberto Garcia who is the Director of the University of Medical Sciences. He explained the history of the campus and that one of the guiding principles of the University is to train practitioners to meet the needs of their communities. They use data to assess the healthcare needs which help regulate the training opportunities. (e.g. number of trainees as well as specialties). For instance, some of the newer training opportunities focus on the human genome; pharmacogenetics as well as nanomedicine. I truly believe that we will all impressed on how Cuba has been so progressive despite the impact of the blockade.

Day 6 October 7th: Leaving the Cuba & Arriving Back to the US

It may come as no surprise that with all of the unpredictable aspects of this journey that one more would face us. Hurricaine Nate was brewing close to our departure date which affected the travels of one of our delegates. Fortunately, Dr. Morreale was able to catch an earlier flight home from Miami before it hit New Orleans. Overall, our arrival back into the US was uneventful and all members made it back safely.

Our members of this delegation were able to not only learn more about the healthcare system but also experience the beauty of Havana. There were many cultural exposures from the art to the music to the antique cars, which we will all remember. Never was there a time that we felt unsafe and the locals were more than willing to share their stories. Many Cubans hope that relations with the US will improve and that the blockade will be lifted. I too hope more can be shared between our local neighbor so future exchanges can help improve the delivery of healthcare to older adults.

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