Cuba: Family Doctor Clinics and Polyclinics Form the Backbone of National Public Health System

Cuba_flagThe anticipated easing of restrictions between the U.S. and Cuba may pave the way for increased public health collaborations between the two countries.

Arachu Castro, Samuel Z. Stone Chair of Public Health in Latin America, has decades of experience working in Cuba. Three years ago she relaunched the school’s Public Health in Cuba course, with about a dozen students participating each summer since. The course, taught in Cuba at the National School of Public Health (NSPH) and at sites around the country, examines the Cuban health system within its economic and political context, and shows how the island country has approached universal health coverage.

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Doctoral student Hannah Kaufman translates from Spanish to English while SPHTM students visit a family doctor clinic in rural Northwest Cuba.

The School of Public Health and Tropical Medicine previously offered a Cuba summer course but it was put on hold in 2004 when travel restrictions were expanded by the U.S. Before she was even officially installed at the school, Castro (no relation to the current or former president of Cuba) was invited to join a delegation of academic leaders from Tulane, including Dean Pierre Buekens, to visit and meet with officials in Cuba. Restarting the course was one of the key objectives of the trip. “The course is completely a collaboration with the National School of Public Health,” says Castro. While the NSPH in Havana organizes courses for other universities, those programs don’t vary a lot from school to school. “It’s different for Tulane,” she says. “They cater to what we discuss with them that could be important to our students.”

HIV prevention poster at a Cuban AIDS sanatorium.

HIV prevention poster at a Cuban AIDS sanatorium.

The course starts in Havana, with a combination of lectures at the school of public health and field trips to “Family Doctor Clinics” and Polyclinics, which are the backbone of the Cuban primary health system and the entry point for most Cubans who seek any kind of medical care. These community-based clinics are located within neighborhoods throughout Cuba. The doctor and nurses staffing the family doctor clinics typically live in the neighborhood, sometimes in the same building as the clinic.

Later, the students visit the same type of clinics and polyclinics in rural areas. Students see that the rural clinics look the same as the larger clinics in Havana. “That’s the point,” says Castro. All Cubans get the same standard of healthcare no matter where they live.

Cuba’s system of primary health care is very unique, she says, adding that it “attends about 85% of the healthcare conditions people present.”

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Field trips are a big part of the Public Health in Cuba summer course, including a visit to the Molecular Immunology Center in Havana.

For those who need care not provided by the clinics, the primary healthcare system is supported by a strong referral network. Specialists from tertiary hospitals come to the polyclinics to treat patients, or the doctor can refer patients to specialists available in those hospitals. Patients are referred back to the clinic when the specialist no longer needs to directly monitor a case.

Although individual patients receive a high standard of care from both primary and specialist physicians, the care facilities are sometimes limited in the technology and diagnostic tools they can offer, a direct result from 50 years of U.S. economic and travel sanctions. While Cuba has not had direct access to American advances in medical technology, the Cuban government has invested in specialty institutes where physicians and scientists have come together to develop the country’s own diagnostic tools, medicines, and vaccines. As a result, Cuba has developed some medical technology, drugs, and vaccines that aren’t available anywhere else in the world.

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Summer 2015: Students in Dr. Arachu Castro’s summer course learned about public health in Cuba from faculty at the Escuela Nacional de Salud Publica (ENSAP), the National School of Public Health in Cuba. Dr. Castro is pictured in the back row, second from right.

Researchers in Cuba and the U.S. have been largely kept apart for half a century. Restoring relations could provide an unparalleled opportunity for collaboration. Castro is excited about the prospect and has been working on a Memorandum The Memorandum of
Understanding of Understanding (MOU) between Tulane and the National School of Public Health that will facilitate joint research programs between the two institutions and collaboration in teaching.

She hopes the MOU, together with relaxed travel restrictions, might allow some students to stay on in Cuba after the travel course to work on practica. Up until now the travel regulations and Cuban visa restrictions made such opportunities complicated.

The MOU was signed at a joint gathering at Tulane SPHTM in early November. A month later, Castro will be back in Cuba with a group of American health professionals including Dr. Richard Oberhelman, chair of the Department of Global Community Health and Behavioral Sciences. The delegation, organized by the group Medical Education in Cooperation with Cuba (MEDICC) will be in Cuba to discuss opportunities for collaboration.

Read about the Memorandum of Understanding.

— Madeline Vann

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About Tulane University SPHTM

Tulane's School of Public Health and Tropical Medicine is the oldest school of public health in the country and the only American school of tropical medicine. Our mission is to advance public health knowledge, promote health and well-being, and prevent disease, disability, and premature mortality. This is accomplished through academic excellence in education of public health professionals, rigorous scientific research of public health problems, creative partnerships to advance the practice of public health, and innovative service to the local, national, and international public health community.
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