Tag Archives: Health

HOW DOES CUBA MANAGE TO ACHIEVE FIRST-WORLD HEALTH STATISTICS?

The island’s medical system is envied throughout the region and is a major foreign revenue earner

ÁLVARO FUENTE; EL PAÍS, Havana 10 FEB 2017

Original Article: Cuba’s Medical System

Cuba’s healthcare system is a source of pride for its communist government. The country has well-trained, capable doctors, the sector has become an important export earner and gives Cuba valuable soft power – yet the real picture is less rosy. A lot of health infrastructure is deteriorating and there is a de facto two-tier system that favors those with money.

Cuba’s child mortality rate is on par with some of the world’s richest countries. With six deaths for every 1,000 births, according to World Bank data from 2015, Cuba is level with New Zealand. In 2015, the global average was 42.5 deaths for every 1,000 births. Despite more than half a century of a US economic embargo, Cuba’s average life expectancy matches that in the US: 79.1 years, just a few months shorter than Americans who, on average, live to 79.3 years, according to 2015 data from the World Health Organization (WHO).

Much of Cuba’s success in these areas is due to its primary healthcare system, which is one of the most proactive in the world. Cuba’s population of 11.27 million has 452 out-patient clinics and the government gives priority to disease prevention, universal coverage and access to treatment.

Cuba has also produced innovations in medical research. In 1985 the country pioneered the first and only vaccine against meningitis B. The country’s scientists developed new treatments for hepatitis B, diabetic foot, vitiligo and psoriasis. They also developed a lung cancer vaccine that is currently being tested in the United States. Cuba was also the first country on earth to eliminate the transmission of HIV and syphilis from mother to child, a feat recognized by the WHO in 2015.

In 2015, Cuba spent 10.57% of its GDP on health, slightly higher than the global average. According to the World Bank in 2014, the European average spending GDP spending was 10%, compared to 17.1% in the United States.

TWO-TIER SYSTEM

A lesser-known characteristic of Cuba’s healthcare system is the existence of special clinics, reserved for tourists, politicians and VIPs. The state reserves the best hospitals and doctors for the national elite and foreigners, while ordinary Cubans sometimes must turn to the black market or ask expatriate friends or family to send medicine.

“Cuba’s health service is divided in two: one for Cubans and the other for foreigners, who receive better quality care, while the national population has to be satisfied with dilapidated facilities and a lack of medicines and specialists, who are sent abroad to make money for Cuba,” says Dr. Julio César Alfonzo, a Cuban exile in Miami and director of the NGO Solidaridad Sin Fronteras.

In 2015, Cuba spent 10.57% of its GDP on health, slightly higher than the global average

In 1959, the country had only 6,000 doctors, half of whom emigrated after the Cuban revolution. By 2014, Cuba had 67.2 doctors for every 10,000 inhabitants, with only Qatar and Monaco ahead of it.

However, despite these impressive statistics, the quality of primary healthcare, which has been fundamental to Cuba’s success, has been declining in recent years. Between 2009 and 2014 there was a 62% fall in the number of family doctors, from 34,261 to 12,842, according to Cuba’s National Statistics Office (ONEI).

AN ARMY OF WHITE COATS

In the words of Fidel Castro, Cuba’s “army of white coats” was formed in 1960, when a medical brigade was sent to Chile after an earthquake left thousands dead. Since then, Cuba has sent more than 300,000 healthcare workers to 158 countries in Latin America, Africa and Asia, according to Cuba’s state news agency. Today, around 50,000 Cuban medical workers are present in 67 countries.

“Cuban doctors are rooted in solidarity and in the Hippocratic Oath. Our job would be unthinkable without foreign missions,” says Salvador Silva, a doctor specializing in infectious diseases who has worked in Haiti and Liberia.   “Yes, our salary is low and maybe that pushes us to go abroad, but it also makes us proud when we see our work recognized throughout the world, on top of just helping in our own country,” he adds.

Doctors are arguably Cuba’s most profitable resource and the country’s medical missions have proved to be a lucrative diplomatic tool. The healthcare industry is also one of the country’s main sources of income. In 2014, Cuban authorities estimated overseas healthcare services would bring in $8.2 billion, putting it ahead of tourism.

Cuba has a different deal with each country it works with. For example, in exchange for sending 3,500 health care workers to work in and provide training in Venezuela, a close Cuban ally, Venezuela sends oil.

With such a high demand for personnel, some suspect that the Cuban government has been reducing educational requirements to hasten students’ entry into the work force.  “They are giving doctors licenses in record time to meet the need to export them, and this has been detrimental to the quality of training and medicine, which used to be the best. This has been happening since they started the program in Venezuela, between 2003 and 2004,” says Dr Alfonzo.

Doctors are also eager to be sent abroad, not only to help the less fortunate, but also for money. Salaries are higher – depending on the location, with doctors abroad reportedly making up to $1,000 per month (minus taxes), whereas those in Cuba make around $50. On the island, it isn’t rare to find taxi drivers, shopkeepers or construction workers with medical degrees.

Juan drives a 1950s Chevrolet he bought with his brother and he uses it as a taxi from 6pm to midnight. He’s also a doctor in the clinic Hermanos Ameijeiras. “The wage is a pittance. We find ourselves obligated to make a living doing other things. I have coworkers who sell prescriptions to pharmacies, who work in unlicensed clinics or help their families in shops. It’s frustrating,” he says. “It’s like they’re pushing us to enlist in international missions, the business of Cuba.”

The country’s medical missions abroad have been an important escape route for Cubans looking to defect. Before migratory reforms were passed in January 2013 allowing Cubans with passports and visas to travel abroad, the preferred way to abandon Cuba was via Venezuela. In 2013 and 2014, more than 3,000 doctors deserted the island to go to the United States through a special visa program called Cuban Medical Professional Parole, a program started by George W. Bush to help healthcare workers who had escaped while working abroad.

Lucia Newman, a former CNN correspondent in Habana, said Cuban doctors complain that travel restrictions prevent them from attending conferences or keeping abreast of the latest medical advances. The US trade embargo on Cuba includes some textbooks, but the major problem is that Cuban doctors cannot buy medical equipment from the United States or from any US subsidiaries.

For Odalys, a young patient waiting at the Hospital Salvador Allende, “the situation is becoming unsustainable in this country and it’s not because of a lack of specialists, it’s because we have to bring everything ourselves. I just bought a light bulb for the hospital room. I’ve called home so that they can bring me bedding, towels and even toilet paper. There aren’t even stretchers, I saw a family carrying their sick son into a room. Free and universal health care, yes, but it’s a bit of a mess and very informal,” she says.

English version: Alyssa McMurtry.

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CRISIS IN VENEZUELA MAKES LIFE HELL FOR CUBAN MEDICAL PROFESSIONALS

A growing number of Cuban health professionals working in Venezuela are fleeing or seeking second jobs as a result of the economic and political crisis in the South American country.

By MARIO J. PENTÓN

In Cuba Today, June 22, 2016

Original Article: Cuban Doctors in Venezuela

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Cuban Doctors in Venezuela in More Promising Times

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Tania Tamara Rodríguez never thought she would escape from the Cuban medical teams in Venezuela and become a “deserter,” now blocked by her government from returning to her country for eight years.

But the many difficulties that Cuban health professionals face in Venezuela as a result of the economic and political crisis in the South American country are leading a growing number to seek refuge in neighboring countries or obtain other jobs to make ends meet.

“Conditions for the doctors and other health professionals are horrible. You live all the time under the threat of being returned to Cuba, losing the job. You’re afraid they will take all the money – which is in Cuban government accounts – and revoke your assignment (to Venezuela) if they want to discipline you,” said Rodríguez, who now lives in Tampa.

While she worked in a medical laboratory in Venezuela as part of Cuba’s “Mission to the Neighborhood” medical aid program, the government deposited Rodríguez’s salary of 700 pesos per month (about $29) to an account in Cuba and gave her access to $280 dollars (U.S.) per month and a card for 25 percent off at the TRD shops in Cuba, which offer hard-to-find imported goods at dollar prices.

In 2014, after acknowledging that its “export of health services” was earning the island more than $8.2 billion a year, the Cuban government increased salaries in the domestic health sector. Even with the increases, which took effect after the public health sector had dismissed 109,000 employees, Cuban doctors are still not earning even close to the international median.

Rodríguez went to Venezuela in early 2015 from the eastern city of Holguín where she worked in the laboratory of the Máximo Gómez Báez. She agreed to join one of Cuba’s many medical teams in foreign countries in hopes of providing better opportunities for her 13-year-old daughter.

Cuba currently has about 28,810 medical personnel in Venezuela working in public health programs that, according to President Nicolás Maduro, represent a priority sector for his government and has cost Venezuela more than $250 billion since 1999.

The payment arrangement, essentially trading Venezuelan oil for Cuban medical personnel, has been repeatedly denounced by critics as a way for the Venezuelan government to cover up its subsidies to Cuba. Cuba then resells part of the refined oil products on the international market.

Rodríguez, who arrived in the United States after a few months in Venezuela under the U.S. government’s special parole program for Cuban medical personnel who defect, saved the money needed to buy her daughter a plane ticket to the United States from Cuba. But when her family took the girl to an Interior Ministry office to apply for a passport, she was denied because the mother was still listed as working in Venezuela.

“I don’t understand how I can be listed as working when I have been in the United States for more than a year. Someone must be pocketing the money the Venezuelan government is paying for me,” Rodríguez said.

According to the U.S. Citizenship and Immigration Service (USCIS) agency, 2,335 petitions were received in Fiscal Year 2015 under the Cuban Medical Professional Parole (CMPP) program, an initiative by the George W. Bush administration that offers visas to Cuban medical personnel “recruited by the (Cuban) government to study or work in a third country. Since its start in 2006, more than 8,000 medical professionals have been admitted under the program.  Solidarity Without Borders, a Hialeah non-profit that helps the arriving Cuban medical professionals, told el Nuevo Herald that the number of Cubans applying for the CMPP has risen in recent years. Not everyone is accepted, and 367 were rejected in fiscal year 2015, according to official data.

Rodríguez said that when she arrived in Venezuela in 2015, she was assigned to work with other Cuban medical personnel in the north central state of Falcon.

 “Everything in Venezuela is a lie,” she complained. “We were forced to throw away the reactive for CKMB (a type of blood test), a product that is scarce in Cuba. But we had to throw it away so that it would be marked in the books as having been used and Cuba could sell more. The same happened with the alcohol, bandage, medicines …  “Everything was produced in Cuba and paid for by the Venezuelan government,” Rodríguez said. “We faked lists of patients and were forced to live on nothing, while Cuba took all the money.”

During the time she worked in Venezuela, Cuban officials paid each medical professional about 3,000 bolivares (about $3) per month — an amount that has increased substantially recently because of an inflationary crisis and the relentless devaluation of the Venezuelan currency.

“Sometimes I had to do little jobs on the side to make ends meet,” she said. “Thank God that many Venezuelans take pity on the Cubans and help us.”  “Maybe what happened in my case was that when I decided to escape, I went to the municipality and told them everything about the disaster” at her clinic, she said. “And now they want to take revenge because I denounced them.”

Another Cuban doctor who works in the northeastern state of Anzoategui spoke on the condition of not being identified because of fear of being punished for speaking with a journalist.

“We started earning 3,000 bolivares and we’re now up to 15,000,” he said, or about $15 on the black market. “What’s interesting is that it makes no difference if they give us more bolivares because they are worthless in real life.”   “Our working conditions are horrible. We are salaried slaves of Cuba,” the doctor said. “They keep us in groups. Since I arrived, I live with three doctors from other parts of the island, so I have to share my room with someone I don’t know, and every day at 6 p.m. I have to ‘report’ that I am home.”

Officials of the Cuban medical teams in Venezuela justify the daily check-ins as a security measure due to the high levels of violence in the neighborhoods where they work. The doctors, however, see it as part of an effort to keep a close watch on them.

“There are many (Cuban) state security agents. Their job is to keep us from escaping,” said the doctor working in Anzoategui. “When you arrive in Venezuela, they ask you if you have relatives abroad, especially in the United States. We all say no, even if we do, because the surveillance is even worse then.”

The economy in Venezuela is so poor, he added, that returning from his last vacation in Cuba he had to carry back laundry and bathroom soap and toothpaste.

“When we first got here, this was paradise. They had everything we did not have in Cuba. Today it’s exactly the opposite,” he said. “We came thinking we would help our families, and it turns out they are the ones helping us. If it were not for the money that my brother in Miami sends me, I don’t know what I would do.”

Several other medical professionals in Venezuela also said that authorities try to hide cases when the Cubans become the victims of crimes, even when they are killed.

“You can’t avoid being robbed, because everyone gets robbed here. A stray bullet, a thug who doesn’t like you, we run all those risks,” said another Cuban doctor who also asked for anonymity. “One day I was mugged by two children, no more than 12 years old. I had to give them all my money because the pistols they were playing with were real.”

The personal relations of the Cuban medical personnel are also watched.

“They warn you that it can go badly for you if you have relations with Venezuelan government critics,” the female doctor said. And although intimate relations with Venezuelans are formally forbidden, “people find a way.”

During the 13 years that Cuba has been sending medical personnel to Venezuela, more than 124,000 have served in the South American country. Thousands have escaped to the United States and other countries, searching for better lives.

For many years, like Rodríguez, the medical defectors were banned from returning to Cuba for eight years. Last year, Cuba announced the defectors could return and would be guaranteed “a job similar to what they had before.”

But there was a catch: Those who returned would need a special permit to travel abroad again.

Venezuela's President Maduro speaks with Cuba's President Castro during their meeting in Havana

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Cuba: Ministerio de Salud Publica, ANUARIO ESTADISTICO DE SALUD, 2015

Below is a link to Cuba’s newly published Anuario Estadistico de Salud, a comprehensive statistical picture of Cuba’s health record.

Anuario_Estadistico de Salud, Cuba, 2015

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CUBA REPORTS FIRST CASE OF ZIKA TRANSMITTED ON THE ISLAND

By MICHAEL WEISSENSTEIN, Associated Press, March 16, 2016

zzzzz2A female Aedes aegypti mosquito in the process of acquiring a blood meal from a human host.  Photo from the Center for Disease Control and Prevention (AP)

(AP) — Cuban officials announced Tuesday night that they have detected the first case of the Zika virus transmitted inside the country, ending Cuba’s status as one of the last nations in the hemisphere without domestic cases of the disease that has been linked to birth defects.

State media said a 21-year-old Havana woman who had not traveled outside Cuba was diagnosed with the virus after suffering headaches, fatigue and other symptoms. On Monday, her blood tested positive for Zika. She remains hospitalized.

Cuba had previously reported a handful of cases of the disease in people who had traveled to countries with outbreaks of the mosquito-borne virus, particularly Venezuela, and appeared to have contracted it there.

Cuba has close ties to Venezuela, a fellow socialist country that sends hundreds of millions of dollars a year in subsidized oil in exchange for Cuban medical assistance that sees many thousands of people travel between the two countries annually.

Zika is being investigated as a possible agent in cases of microcephaly, a condition in which babies are born with unusually small heads and brain damage, and also in cases of Guillain-Barre, a rare condition that sometimes results in temporary paralysis.

Cuba has thrown more than 9,000 soldiers, police and university students into an effort to fumigate for mosquitoes, wipe out the standing water where they breed and prevent a Zika epidemic.

President Raul Castro has called on the nation to battle lax fumigation and trash collection, turning the Zika fight into a test of the communist government’s once-legendary ability to marshal the entire country behind efforts ranging from civil defense to bigger sugar harvests to disease prevention.

In recent days the streets of Havana have been crisscrossed by teams of green-clad soldiers fumigating houses with mosquito-killing fog. Residents of the capital say fumigators no longer accept excuses of allergies or requests to spray some other day, as frequently happened in the past.

Still, neighborhoods like Central Havana, where the patient in Tuesday’s case lives, are filled with decaying buildings, piles of uncollected trash and pools of standing water.

The Zika announcement comes at a moment of intense international attention on Cuba: President Barack Obama arrives on Sunday as the first sitting U.S. president to visit in nearly 90 years. The Obama administration on Tuesday announced that it was carving a series of broad new exceptions into the U.S. trade embargo on Cuba, removing limits on individual travel that experts predicted would lead to a boom in U.S. visitors.

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U.S.-CUBA NORMALIZATION AND THE ZIKA VIRUS RISK: PROBABLE IMPACTS ON CUBAN AND CARIBBEAN TOURISM

By Arch Ritter, March 14, 2016

Tourism has been the spectacular growth sector for Cuba since the beginning of the “Special Period” in 1990.  Tourist numbers have increased 10-folds in the quarter-century from 1990 to 2015, as illustrated in Chart 1.  Foreign exchange earnings from tourism have increased correspondingly.  Canada has been by far the largest source of tourists. Indeed, Cuba’s best friend throughout the “Special Period” has been the Canadian winter.

Now with full normalization of U.S. – Cuban relations “en route,” huge prospective increases in U.S. tourism will have major impacts on Canada but also perhaps on other Caribbean tourist destinations.  What might these impacts be?

Chart 1. International Tourist Arrivals, 1990-2015, Thousands. y Source: Oficina Nacional de Estadisticas, Government of Cuba, various issues, Access3ed February 23, 2016

The Coming U.S. Tourism “Tsunami” to Cuba!

Full normalization of U.S. – Cuban relations in time will bring unrestricted travel for U.S. citizens to Cuba. This will lead to a deluge of US visitors. Among the varieties of U.S. tourists would be the following:

  • Curiosity tourists. There will be a huge tourist influx of US citizens wanting to see Cuba for the first time since 1961. Relatively few US citizens appear to have broken US travel restrictions so that the pent-up demand is enormous.
  • Family Reunification tourists. When all controls are lifted on the US side for travel to Cuba, a further increase in short-term visits by Cuban-Americans for family purposes is likely to occur – following major increases already.
  • Sun, Sea and Sand tourists. Many US citizens, especially from the North Eastern and Central parts of the country will likely follow the winter-escaping Canadians to Cuban beaches for one to two week periods.
  • “Snow-bird” tourists. Some US citizens, mainly retirees, will spend several of the winter months in Cuba.
  • Retirement tourists. With normal U.S.- Cuban relations, some citizens of the northern part of the United States, especially Cuban-Americans in new Jersey, may decide to reside for half the year or so in Cuba returning to the U.S. for the other half of the year or even the whole year in Cuba, if their pensions permit it.   Permitting the purchase of time share condominiums would facilitate both snowbird and part-time retirement tourism.
  • Medical tourists. There may be some travel to Cuba for access to medical services which will likely continue to be inexpensive relative to the United States.
  • Convention tourists. Short-term visits for conventions could increase significantly.
  • Cultural and Sport tourists. One might expect more visits for purposes of interacting with and experiencing Cuban art, music, cinema, and sports.
  • Educational tourists. It is likely that American students and teachers at various levels would enroll or visit Cuban institutions of higher learning or cultural and sports centers for courses, years abroad, sabbaticals, language training etc., in much greater numbers than have been possible under the embargo.
  • March-Breaker” tourists. Students from the US are likely to try a visit to Cuba for the March Break, instead of the Maya Riviera, Florida or elsewhere.

One can only guess at the future volumes of U.S. tourists to Cuba. One could imagine it quickly doubling the 2015 Canadian level (1,300,092 tourist arrivals) and then redoubling again to 5.2 million and then beyond, as Cuba’s capacity to accommodate more tourists expanded. The total number of tourists then could reach about 8 million by 2022 – or many more if tourism from other countries also increases and does not get “squeezed out.”  (However, U.S. “curiosity tourism” will peak and then subside over the next four or five years following complete normalization.)

This would perhaps lead to an increase Cuba’s total foreign exchange earnings from tourism to about $US 8.0 to 9.0 billion by 2022, up from the estimated level of $US 2.98 billion in 2015 (extrapolating from ONE’s 2014 statement of tourism earnings and 2015 total numbers of tourists.)  This would replace the foreign exchange earnings and the semi-obscured subsidization that Cuba has been receiving from Venezuela which looks totally unsustainable at this time.

The expansion of tourism is great news for Cuba, and will lead to

  • increased foreign exchange earnings for the country,
  • a construction boom in resorts and tourist facilities,
  • a major increase in incomes for the growing private sector servicing tourism (bed and breakfasts, restaurants, travel and guide services among others),
  • higher tax revenues of many sorts, and
  • generalized improvement as real incomes of citizens improve.

The downside is that success in the tourism sector may reduce the urgency of reviving the manufacturing sector which is still operating at close to 50% of the level it had achieved in 1988 before the economic meld-down.

 Will “El Cheapo” Canadian Tourism be Squeezed Out?

Will the increase in U.S. tourism to Cuba crowd out the Canadian tourists who constituted 37% of all tourists to Cuba in 2015%.  Maybe. But U.S. “curiosity tourism” will most likely focus on Havana and the historical areas of Cuba rather than the beaches so that the Canadians at the beach resorts would not be pushed out for some time, at least mot physically!

 yy Source: ONE Anuario Estadistico de Cuba, 2015 Table 15.3), Accessed February 23, 2016

 Most Canadian tourists head to the beach with a package tour – going to Havana or another city on a day’s excursion.  For this reason, they have been sometimes derided as “el cheapo” tourists who spend as little as they can in the Cuban economy.  There may be some truth in this, but most other tourists also are in similar package tours. If prices were to rise significantly with the influx of U.S. tourists, one could expect that some Canadian tourists would switch to other Caribbean destinations. This could indeed happen to some extent, especially if the winter-time “sun, sea and sand” tourism from the United States increases greatly.

Chart 3 Tourist Arrivals, Major Caribbean Countries, 1995 – 2013

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Table 1. Caribbean Tourist Arrivals and Earnings, 2010 and 2014 yyyy1

Source: United Nations World Tourism Organization, Annual Report 2014, p.6.  http://www.e-unwto.org/doi/pdf/10.18111/9789284416899, Accessed February 29, 2016

Will Other Caribbean Destinations Lose Out to Cuba?

There has been some fear that other Caribbean tourist destinations would lose when U.S. citizens start flocking to Cuba.  This indeed is a legitimate fear.

A glimpse at the past 25 years suggests that the impacts on other Caribbean destinations in general may be mixed. A glance at Chart 3 indicates that some other major destinations, including the Dominican Republic, Jamaica and the other “Caribbean Small States” in general have been able to withstand the growing competition from Cuba and have continued to expand significantly in terms of tourist arrivals over the 1995-2013 period. The expansion of tourism in the Dominican Republic is especially notewortheyPuerto Rico is the major exception along with The Bahamas.  Both have lost its shares of tourist arrivals and of revenues in the brief 2010-2014 period as indicated in Table 1.  Surprisingly, Cuba increased its share of tourists in the region, but its share of tourist revenues actually declined.

There is one reason for optimism with respect to the other Caribbean destinations.  Much of the prospective U.S. tourism to Cuba will not be of the “sun, sea and sand” variety, but will be of the other varieties especially “curiosity tourism.”  But what most of the other Caribbean Islands offer is a beach “escape-from-the-winter” holiday. They may therefore be less vulnerable to a tourism “shifting to Cuba” effect.

A small compensation will be that if Canadians are squeezed out of tourism in Cuba with the onslaught of U.S. beach resort tourists, they will likely go to other Caribbean destinations. However, there is also great affection on the part of many Canadians for Cuba as a tourism destination, and the return again and again and again!

Furthermore, international tourism generally has been growing steadily in the post-World War II period and there is little likelihood that this will cease unless the world enters a deep and prolonged recession.  Tourism in the Caribbean generally has been increasing steadily as well.  The overall expansion of tourism in the region should help compensate for any diversion of U.S. tourists from the other Caribbean islands to Cuba.

Will the Maya Riviera be hit with a diversion of U.S. tourists to Cuba?  This may well happen to some degree.  However, the Mexican Yucatan region is a highly attractive tourist waterfront destination with other major attractions. A beach holiday can be combined with archaeological tourism with a visit to the ancient Maya cities of Uxmal and Chichen Itza (both World Heritage Sites), Tulum, to less well-known but quite incredible Calakmul (another World Heritage Site) and Kohunlich and innumerable smaller sites. As well as this is the Colonial legacy in many small towns as well as Merida and Campeche (still another World Heritage site.)   In the long term, the Yucatan should certainly be able to hold its own.

 The Zika Virus Risk to Cuba’s Population and Tourism

While it is not known whether or not the  Zika Virus, linked to birth defects elsewhere in Latin America, has arrived in Cuba, there can be no doubt that it will. If, as seems increasingly certain, the Zika virus is primarily transmitted by the female Aedes aegypti, then pregnant women in Cuba would be at grave risk. This would likely have a major impact on the tourist sector and the Cuban economy generally – as well as tourism elsewhere in the Caribbean and tropical parts of the world, as suggested by the accompanying map.

Cuba has had long and reasonably successful experience in containing the dengue virus that has affected many people and also the rarer Chikungunya virus, a disease that causes fever and severe joint pain.  Both are also spread by some branches of the Aedes aegypti mosquito.  This has been achieved with frequent fumigation of homes, public and buildings and clean-up of stagnant waters that are the breeding grounds of the mosquitos.

 Map 1. Probable Occurrence of Aedes Aegypti in the Caribbean Region zika 2

Source: Wikipedia, Zika Virus, accessed February 29, 2016

Note: Global Aedes aegypti predicted distribution. The map depicts the probability of occurrence (blue=none, red=highest occurrence).

 On February 23, a public program was announced to deal with the potential problem. This involves:

  • using the army to expedite fumigation spraying,
  • calling on the somewhat moribund neighborhood associations – the Comites por la Defensa de la Revolucion – to promote public education,
  • a general clean-up of the streets and stagnant waters and
  • improved garbage disposal arrangements.

Judging from recent reports from Cuba these programs have been implemented quickly and people are already adjusting their behavior to eliminate the mosquito vector of the disease and in their normal living arrangements (using mosquito nets at night for example.)

Cuba’s public health system is very strong and its actions already seem to be determined and serious.  Cuba will probably be able to deal with the mosquito and the disease very effectively. Obviously effective action is imperative to protect Cuba’s people and future generations.

What will be the effect on Cuba’s tourism and its tourism-dependent economy?  Already there are concerns on the part of young women and especially of course pregnant women regarding travel to Cuba. This will undoubtedly have an impact, very minor one hopes, on Cuba as well as on the rest of the countries in the region.  But it is probable that Cuba’s public health system will minimize and hopefully eliminate the problem. If so, tourism will not be affected that seriously.

 Conclusion

In summary, if managed wisely, Cuba can look forward to greatly expanded and economically beneficial tourist boom with full normalization of relations with the United States. This may generate some collateral damage for Canadian tourists who may face a crowding out and pricing out effect, but this will likely be modest and would likely benefit other Caribbean countries. Within the Caribbean region, some countries may feel pressure from the diversion of U.S. beach resort tourists, but most of the bigger destinations have held their own in the last few decades and will continue to do so.

A question mark and potential risk for the tourist sector – and more importantly for the whole population and for future generations in Cuba and many tropical regions is the Zika virus. This will likely hit Cuba in time if it has not already. But resolute policy, education and action have begun to deal with Zika.  Cuba’s past successful programs for controlling the dengue virus should facilitate rapid and effective action against Zika.

With respect to tourism in summary, the positive economic impacts of the coming U.S. tourism tsunami should far outweigh any possible effects of the Zika virus, which will likely be successfully controlled.

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Cuba’s Best Friend of the 1990s: The Canadian Winter

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Cuba’s Best Friend of the 2016 Onward: The Curious American Tourist !

> on February 26, 2015 in Havana, Cuba.

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CUBA CONFRONTS THE ZIKA VIRUS

CUBA ANNOUNCES FIRST CASE OF ZIKA, IMPORTED FROM VENEZUELA

By Michael Weissenstein, Associated Press

HAVANA — Mar 2, 2016,

Original Article: First Zika Case

Cuba announced Wednesday that it had detected the first case of the Zika virus on the island, which had been one of the last nations in the Western Hemisphere free of the disease.

The Ministry of Health said in state media that a 28-year-old Venezuelan post-doctoral student in gastroenterology arrived in the country Feb. 21 and a day later came down a high fever and rash. The government says the woman was under medical quarantine in Artemisa province outside Havana with other newly arrived doctors when her symptoms were detected.

An initial test for Zika was negative but a second test on Feb. 28 was positive, health officials said. The woman remains hospitalized in good condition at Cuba’s main tropical disease hospital in Havana, officials said. The woman’s husband and brother-in-law had both come down with Zika in Venezuela in recent weeks. The medical professionals who had entered Cuba alongside the sick woman remain in quarantine with no sign of Zika, officials said.

The Health Ministry made no mention of any case of Zika transmitted inside Cuba.

President Raul Castro announced Feb. 22 that the country was militarizing its fight to kill disease-carrying mosquitos, assigning 9,000 soldiers to spray for the insects nationwide. Since then, soldiers, police and health workers have launched an intense door-to-door effort to fumigate for mosquitos.

Gaps had been increasingly obvious in the effort to spray homes and businesses for the Aedes aegypti mosquito, which has infected thousands of Cubans with the dengue virus and dozens with chikungunya, a disease that causes fever and severe joint pain. Cubans frequently claimed allergies or asthma to put off fumigation crews composed of public health workers and teenagers completing obligatory military service.

Those days appear to be ending as troops deployed across the country with hand-held foggers are now armed with the threat of fines for anyone who resists fumigation and fog-spraying trucks and small airplanes are blanketing the capital and other cities with white clouds of pesticide.

In Cuba’s airports and cruise ship terminals, crews of white-clad doctors are monitoring incoming travelers for high temperatures or other signs of illness. Medical officials said the fight against Zika had taken on increasing urgency as Cuba’s hot, humid spring and summer draw near.

Cuba earns billions of dollars a year from programs that dispatch doctors to allied countries like Venezuela and Brazil and bring medical students to Cuba. Wednesday’s report appeared to imply that those medical professionals were now being quarantined on return.

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ZIKA VIRUS: PREGNANT WOMEN WARNED AGAINST TRAVEL TO AFFECTED AREAS

The Guardian, Sarah Boseley, Tuesday 1 March 2016 19.26 GMT

Original Article: ZIKA Virus

Pregnant women or those hoping to become so should stay away from Brazil and other regions of Latin America affected by the Zika virus, according to revised government advice.

The weight of evidence that Zika is to blame for the surge in babies with brain damage in Brazil has now tipped the balance, Public Health England (PHE) feels.

The previous guidance advised pregnant women to consider staying at home, consult their doctor if they intended to travel and take precautions against mosquito bites. Now it advises them not to go.

“It is recommended that pregnant women should postpone non-essential travel to areas with active Zika transmission until after pregnancy,” says the advice.

The update may cause some women who had hoped to travel to the Olympics in Rio de Janeiro in the summer to abandon their plans – even though the Aedes aegypti mosquito, which has been blamed for transmission of the virus, does not breed or bite in the summer.

Prof Paul Cosford, director for health protection and medical director at PHE, said: “As our knowledge of the Zika virus, and the evidence linking microcephaly to Zika infection, becomes clearer, a more precautionary approach is warranted. This advice will be kept under review and updated as more information becomes available.”

The decision to upgrade the advice follows the emergence of an increasing amount of evidence linking the Zika virus to microcephaly – the small heads in babies growing in the womb that can cause brain damage.

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CUBA THROWS SOLDIERS INTO BATTLE AGAINST ZIKA VIRUS

Yahoo: Cuba Throws Soldiers…. against Zika

By ANDREA RODRIGUEZ February 24, 2016 10:23 AM

HAVANA (AP) — Olive-clad soldiers are going door-to-door across Cuba, filling houses with mosquito-killing fog in a nationwide mobilization to keep the Zika virus out of one of the last countries in the hemisphere without it.

President Raul Castro announced this week that he was throwing 9,000 military personnel and hundreds of police into what he called Cuba’s “inadequate” fight against the mosquito that carries the virus linked to birth defects and paralysis elsewhere in Latin America.

“Our people will know how to demonstrate their ability to organize and maintain the public health achievements of the revolution and prevent our families from suffering,” Castro declared. “We must be more disciplined and demanding than ever before.”

Castro’s call to action included an unusual admission of deficiencies in Cuba’s vaunted free neighborhood-level health-care system, which has suffered in recent years from lack of equipment, short-staffing and low morale among poorly paid state health workers. It was also a test of the communist government’s once-legendary ability to marshal the entire country behind efforts ranging from civil defense to bigger sugar harvests to disease prevention.

The government announced Tuesday that it was activating the Committees for the Defense of the Revolution, a neighborhood watch organization that enforced government dictates for decades but has lost importance in recent years. The government said that committees across the country would distribute anti-Zika information to every Cuban and inspect at-risk sites for mosquitoes in coming days.

Gaps have been increasingly obvious in the effort to spray homes and businesses for the Aedes aegypti mosquito, which has infected thousands of Cubans with the dengue virus and dozens with chikungunya, a disease that causes fever and severe joint pain. Cubans frequently claim allergies or asthma to put off fumigation crews composed of public health workers and teenagers completing obligatory military service. Unwilling to force homeowners to let them in, the crews often mark the residence as fumigated and move on to the next house or apartment.

Those days appear to be ending as troops deployed across the country with hand-held foggers are now armed with the threat of fines for anyone who resists fumigation.

“Cuba has a series of advantages: It’s an island, it has a homogenous population and a health infrastructure that generally reaches every street corner,” said Jaime Torres, director of tropical medicine at the Central University of Venezuela. “And its political system allows it to take measures, including imposing punishments, that are harder to impose in other places.”

Cuba Zika

Soldiers carrying a fumigating machine leave a home after spraying for mosquitos in Havana, Cuba,

In Cuba’s airports and cruise ship terminals, crews of white-clad doctors are monitoring incoming travelers for high temperatures or other signs of illness. Medical officials said the fight against Zika had taken on increasing urgency as Cuba’s hot, humid spring and summer draw near.

“The objective is to diminish the adult mosquito population ahead of the coming critical months,” said Reinaldo Garcia, head of anti-mosquito efforts for a neighborhood health clinic in Havana.

As soldiers fumigated Wednesday, medical students were knocking on doors alerting homeowners to watch for symptoms such as fever and conjunctivitis. State-run television and radio featured a constant stream of educational messages about Zika, which has been linked to the birth defect microcephaly.

“Although there is no sign of that disease, we want to eliminate the transmitter, eliminate the chain, so if it enters the country there is no way to transmit it,” Dr. Osvaldo Mendoza of the Public Health Ministry said as he supervised a crew of military fumigators.

Medical workers were ready to move into any area where a possible Zika case is detected, quarantining and testing anyone who lives within 500 meters, said public health official Dr. Lorenzo Somarriba.

“Everyone’s talking about it,” said Suset Valdes, a 19-year-old Havana resident who is six months pregnant. She said pregnant women in her maternity ward were protecting themselves with repellent-soaked mosquito nets.

Carlos Espinal, director of the global health program at Florida International University in Miami, said that while it was virtually certain that Zika would arrive in Cuba, he was hopeful the island’s health system would prevent the virus spreading as it has elsewhere in Latin America.  “It’s inevitable, but the Cuban disease-monitoring system is sure to greatly mitigate the negative impact in the community,” he said.

Valdes’ mother, Dolores Hernandez, 51, said she felt better with her daughter off the streets of their Old Havana neighborhood, where garbage had been piling up for weeks or months without any government reaction.  “It’s horrible how people threw trash in Old Havana,” she said. But now “they’re picking it up, running around, unclogging their drains. Now, they’re really getting going.”

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FIFTY YEARS OF CUBA’S MEDICAL DIPLOMACY: FROM IDEALISM TO PRAGMATISM

Julie M. Feinsilver

Cuban Studies, Volume 41, 2010, pp. 85-104

Complete Article here: Feinsilver – Fifty Years of Cuba’s Medical Diplomacy

ABSTRACT

Medical diplomacy, the collaboration between countries to simultaneously produce health benefits and improve relations, has been a cornerstone of Cuban foreign policy since the outset of the revolution fifty years ago. It has helped Cuba garner symbolic capital (goodwill, influence, and prestige) well beyond what would have been possible for a small, developing country, and it has contributed to making Cuba a player on the world stage. In recent years, medical diplomacy has been instrumental in providing considerable material capital (aid, credit, and trade), as the oil-for-doctors deals with Venezuela demonstrates. This has helped keep the revolution afloat in trying economic times. What began as the implementation of the one of the core values of the revolution, namely health as a basic human right for all peoples, has continued as both an idealistic and a pragmatic pursuit. This article examines the factors that enabled Cuba to conduct medical diplomacy over the past fifty years, the rationale behind the conduct of this type of soft power politics, the results of that effort, and the mix of idealism and pragmatism that has characterized the experience. Moreover, it presents a typology of medical diplomacy that Cuba has used over the past fifty years.

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10-03-2014Cuban_Ebola

Conclusion

Medical diplomacy has been a cornerstone of Cuban foreign policy since the outset of the revolution fifty years ago. It has been an integral part of almost all bilateral relations agreements that Cuba has made with other developing countries. As a result, Cuba has positively affected the lives of millions of people per year through the provision of medical aid, as well as tens of thousands of foreign students who receive full scholarships to study medicine either in Cuba or in their own countries under Cuban professors. At the same time, Cuba’s conduct of medical diplomacy with countries whose governments had not been sympathetic to the revolution, such as Pakistan, Guatemala, Honduras, and El Salvador, to name only a few, has led to improved relations with those countries. Medical diplomacy has helped Cuba garner symbolic capital (goodwill, influence, and prestige) well beyond what would have been possible for a small, developing country, and it has contributed to making Cuba a player on the world stage. In recent years, medical diplomacy has been instrumental in providing considerable material capital (aid, credit, and trade), as the oil-for doctors deals with Venezuela demonstrates. This has helped keep the revolution afloat in trying economic times.

What began as the implementation of one of the core values of the revolution, namely health as a basic human right for all peoples, has continued as both an idealistic and a pragmatic pursuit. As early as 1978, Fidel Castro argued that there were insufficient doctors to meet demand in the developing world, despite the requesting countries’ ability to pay hard currency for their services. Because Cuba charged less than other countries, with the exception at that time of China, it appeared that it would win contracts on a competitive basis. In fact, during the following decade (1980s), Cuba’s medical contracts and grant aid increased. In most cases, aid led to trade, if not to considerable income. With the debt crises and the International Monetary Fund’s structural adjustment programs of the 1980s, grant aid predominated. In 1990, Cuban medical aid began to dwindle as neither the host countries nor Cuba could afford the costs, the former because of structural adjustment–mandated cuts in social expenditures and the latter because of the collapse of its preferential trade relationships following the demise of the Soviet Union. As Cuba’s ability to provide bilateral medical aid diminished, its provision of medical aid through multilateral sources (contracts) increased.56 Cuba’s medical diplomacy continued, albeit on a smaller scale during the 1990s, until the rise of Hugo Chavez in Venezuela.

With medical services leading economic growth in the twenty-first century, it seems unlikely that even the more pragmatic Raul Castro will change direction now. In contrast, dependency on one major benefactor and/or trade partner can be perilous, as the Cubans have seen more than once. If Chavez either loses power or drastically reduces foreign aid in an effort to cope with Venezuela’s own deteriorating economic conditions and political opposition,

Cuba could experience an economic collapse similar to that of the Special Period in the early 1990s. In fact, the global financial and economic crisis has compounded existing problems. In an effort to avert that type of collapse, Raul Castro has been trying to further diversify Cuba’s commercial partners.57 In July 2009, Cuba received a new US$150 million credit line from Russia to facilitate technical assistance from that country, and companies from both countries signed various agreements, including four related to oil exploration.

Furthermore, Raul Castro made clear in his August 1, 2009, speech before the National Assembly of People’s Power, that Cuba could not spend more than it made. He asserted that it was imperative to prioritize activities and expenditures to achieve results, overall greater efficiency, and to rationalize state subsidies to the population. Despite a little help from its Venezuelan friend, the Cuban government has had to embark on austerity measures that hark back to the worst of times right after the collapse of the former Soviet Union.60 With two budget cuts already this year, restrictions on electricity distribution, and a 20 percent decrease in imports, it is likely that the Cuban government will attempt to increase its medical exports to countries that can afford to pay for them. In fact, in August 2009, Raul Castro indicated that Cuba would need to increase the production of services that earn hard currency.62 Pragmatism clearly dictates this course of action even if it also is imbued with strong revolutionary idealism about humanitarian assistance.

Economic and political benefits of medical diplomacy aside, Fidel, both when he was president and today as an elder statesman and blogger, most sincerely cares about health for all, not just for Cubans. His long-term constant involvement in the evolution both of the domestic health system and of medical diplomacy has been clear through both his public pronouncements and actions, and the observations and commentary of his subordinates and external observers.  Today, this concern for health is part of the social agenda of ALBA, through which, for example, additional Cuban medical aid to Haiti post-2010 earthquake is being conducted.

Unable to offer financial support, Cuba provides what it excels at and what is easily available, its medical human resources. International recognition for Cuba’s health expertise has made medical diplomacy an important foreign policy tool that other, richer countries would do well to emulate. After all, what country could refuse humanitarian aid that for all intents and purposes appears to be truly altruistic?

Julie F.

Dr. Julie Feinsilver

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FRENCH GROUP TRUMPETS CUBAN DRUGS INNOVATION

Financial Times, May 26, 2015

Andrew Ward, Pharmaceuticals Correspondent

Original here: Cuban Drugs Innovation

Cuba has the potential to become a force in the life science industry as its economy gradually reopens to the world, according to Abivax, a French company that has licensed a hepatitis B treatment from Cuban researchers.

Abivax is planning an initial public offering in Paris to finance clinical trials of the ABX203 therapeutic vaccine developed by the Center for Genetic Engineering and Biotech in Havana.

Hartmut Ehrlich, Abivax chief executive, said that Cuba had world-class medical science ready to be tapped as the country re-engages with the US and the broader global economy.

He highlighted the 500 products developed by 40 pharmaceuticals companies during past decades when Cuba’s isolation made it difficult to access some foreign drugs.

“They have a strong public health system and a strong science base because [Fidel] Castro decided in the 80s that in order to fulfil the medical needs of the population they needed to develop their own medicines,” said Mr Ehrlich.

Abivax was among the French companies that accompanied President François Hollande on a visit to Cuba this month — highlighting growing international interest in the commercial opportunities created by Cuba’s economic reforms. The Paris company owns the rights to ABX203 in 80 countries across Europe, Asia and Africa and will share revenues with its Cuban partners should the treatment reach market. Late-stage trials of the vaccine started in February.

Cuban products are still barred from the US, the world’s biggest pharmaceuticals market, by a trade embargo but the chances of this being lifted appear to be rising as talks continue about resuming diplomatic relations severed since the cold war.

Mr Ehrlich said that Abivax would be interested in US rights to ABX203 should the market open. European companies hope they will have a head start in Cuba over US rivals held back by the embargo.

“It takes time to build trust with our partners in Cuba and we believe we have achieved that trust,” said Mr Ehrlich. “We have found the Cubans to be very collaborative. For us it has been a real pleasure to work with them.”

ABX203 is a first-in-class immunotherapy that aims to provide longer-lasting suppression of the virus than existing treatments — and potentially a cure. An estimated 350m people worldwide have the chronic form of hepatitis B, which kills more than 1m people every year.

Analysts say that both ABX203 and a separate HIV treatment being developed by Abivax in France have lots of potential if trials prove successful. Mr Ehrlich said that the company was open to a partnership with a larger pharmaceuticals group to help reach market. He would not say how much money would be raised in the IPO, announced last week, but Abivax was on course to burn €20m of cash this year and €30m next year.  fbb5f4388c59ee22ea6925023b66b419PPG: Cuba’s Wonder Heart Drug, (also Cuba’s Viagra)

CUBA-INSTITUTO DE INGENIERIA GENETICA-CARTERInstitute of Genetic Engineering and Biotechnology, Havana

 

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CUBA’S HAD A LUNG CANCER VACCINE FOR YEARS, AND NOW IT’S COMING TO THE U.S.

The Huffington Post | By Erin Schumaker

 Posted: 05/14/2015

Original here: Cuba’s Cancer Vaccine

 When New York Governor Andrew Cuomo (D) headed to Havana on a historic trade mission in April, he returned with the promise of an important commodity: a Cuban-developed lung cancer vaccine.

The vaccine, called CimaVax, has been researched in Cuba for 25 years and became available for free to the Cuban public in 2011. The country’s Center for Molecular Immunology signed an agreement last month with Roswell Park Cancer Institute in Buffalo, New York to import CimaVax and begin clinical trials in the United States.

“We’re still at the very early stages of assessing the promise of this vaccine, but the evidence so far from clinical trials in Cuba and Europe has been striking,” Dr. Kelvin Lee, Jacobs Family Chair in Immunology and co-leader of the Tumor Immunology and Immunotherapy Program at Roswell Park, told The Huffington Post.

When President Obama loosened the United States’ 55-year long trade embargo against the island nation in December, he allowed for such joint research deals to be finalized. Similar programs might have been impossible just a few years ago.

Cuba has long been known for its high-quality cigars, and lung cancer is a major public health problem and the fourth-leading cause of death in the country. A 2007 study of patients with stages IIIB and IV lung cancer, published in the Journal of Clinical Oncology, confirmed the safety of the CimaVax and showed an increase in tumor-reducing antibody production in more than half of cases. It proved particularly effective for increased survival if the study participant was younger than 60.

So far, 5,000 patients worldwide have been treated with CimaVax, including 1,000 patients in Cuba. Lee said the latest Cuban study of 405 patients, which has not yet been published, confirms earlier findings about the safety and efficacy of the vaccine. What’s more, the shot is cheap — it costs the Cuban government just $1, Wired reported. And studies have found there are no significant side effects.

“We think it may be an effective way to prevent cancer from developing or recurring, so that’s where a lot of our team’s excitement comes in,” Lee said. “There’s good reason to believe that this vaccine may be effective in both treating and preventing several types of cancer, including not only lung but breast, colorectal, head-and-neck, prostate and ovarian cancers, so the potential positive impact of this approach could be enormous.”

Preclinical investigations of CimaVax at Roswell Park and the unpublished findings of the 405-patient Cuban study are promising, according to Lee. CimaVax works by blocking a hormone that causes lung cancer tumors to grow, a method which has also been shown to be effective in treating colon cancer. That fuels researchers’ hope that the vaccine will be an effective treatment for other types of cancer as well.

Still, he acknowledged that the vaccine needs rigorous testing in each of these different disease areas to know whether or not the drug will work as well as the scientists at Roswell Park hope. To be clear, the CimaVax doesn’t cure cancer. It’s a therapeutic vaccine that works by targeting the tumor itself, specifically going after the proteins that allow a tumor to keep growing. (And as PBS points out, a person can’t just take a shot of CimaVax and continue to smoke without fear of lung cancer.)

“We hope to determine in the next few years whether giving CimaVax to patients who’ve had a lung cancer removed, or maybe even to people at high risk of developing lung or head-and-neck cancers because of a history of heavy smoking, may be beneficial and may spare those people from having a cancer diagnosis or recurrence,” Lee said.

The United States is currently at work developing two lung cancer vaccines of its own, GVAX and BLP 25, though neither has been studied for as long as CimaVax.

How does a tiny island nation with limited economic resources pioneer a powerhouse cancer vaccine? “They’ve had to do more with less,” Candace Johnson, CEO of Roswell Park, told Wired. “So they’ve had to be even more innovative with how they approach things. For over 40 years, they have had a preeminent immunology community.”

Despite decades of economic problems and the U.S. trade embargo, Cuba has been a model of public health. According the New York Times, life expectancy for Cubans is 79 years, on par with the United States, despite the fact that its economy per person is eight times smaller. While many drugs and even anesthesia have been hard to come by over the years, Cuba has one of the best doctor to patient ratios in the world. Moreover, the Cuban government’s investment in primary care for residents and preventative health measures like public education, housing and nutrition have paid huge dividends in the health of citizens, especially relative to similarly poor countries.

Looking forward, ongoing research collaborations between the two nations are almost certainly on the horizon as relations between Cuba and the U.S. continue to thaw. For now, Lee says the researchers at Roswell Park have their eyes trained on about 20 cancer treatment and prevention technologies in Cuba — including another lung cancer vaccine called racotumomab that the group hopes to study in clinical trials at Roswell. Cuba - CIMCentro de Inmunología Molecular – Cuba

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CUBA’S EXTRAORDINARY GLOBAL MEDICAL RECORD SHAMES THE US BLOCKADE; From Ebola to earthquakes, Havana’s doctors have saved millions. Obama must lift this embargo.

cuba ebola B Seumas Milne, The Guardian, Wednesday 3 December 2014 20.07 GMT

Original article here: CUBA’S GLOBAL MEDICAL RECORD

Four months into the internationally declared Ebola emergency that has devastated west Africa, Cuba leads the world in direct medical support to fight the epidemic. The US and Britain have sent thousands of troops and, along with other countries, promised aid – most of which has yet to materialise. But, as the World Health Organisation has insisted, what’s most urgently needed are health workers. The Caribbean island, with a population of just 11m and official per capita income of $6,000 (£3,824), answered that call before it was made. It was first on the Ebola frontline and has sent the largest contingent of doctors and nurses – 256 are already in the field, with another 200 volunteers on their way.

While western media interest has faded with the receding threat of global infection, hundreds of British health service workers have volunteered to join them. The first 30 arrived in Sierra Leone last week, while troops have been building clinics. But the Cuban doctors have been on the ground in force since October and are there for the long haul.

The need could not be greater. More than 6,000 people have already died. So shaming has the Cuban operation been that British and US politicians have felt obliged to offer congratulations. John Kerry described the contribution of the state the US has been trying to overthrow for half a century “impressive”. The first Cuban doctor to contract Ebola has been treated by British medics, and US officials promised they would “collaborate” with Cuba to fight Ebola.

But it’s not the first time that Cuba has provided the lion’s share of medical relief following a humanitarian disaster. Four years ago, after the devastating earthquake in impoverished Haiti, Cuba sent the largest medical contingent and cared for 40% of the victims. In the aftermath of the Kashmir earthquake of 2005, Cuba sent 2,400 medical workers to Pakistan and treated more than 70% of those affected; they also left behind 32 field hospitals and donated a thousand medical scholarships.

That tradition of emergency relief goes back to the first years of the Cuban revolution. But it is only one part of an extraordinary and mushrooming global medical internationalism. There are now 50,000 Cuban doctors and nurses working in 60 developing countries. As Canadian professor John Kirk puts it: “Cuban medical internationalism has saved millions of lives.” But this unparalleled solidarity has barely registered in the western media.

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Cuban doctors have carried out 3m free eye operations in 33 countries, mostly in Latin America and the Caribbean, and largely funded by revolutionary Venezuela. That’s how Mario Teran, the Bolivian sergeant who killed Che Guevara on CIA orders in 1967, had his sight restored40 years later by Cuban doctors in an operation paid for by Venezuela in the radical Bolivia of Evo Morales. While emergency support has often been funded by Cuba itself, the country’s global medical services are usually paid for by recipient governments and have now become by far Cuba’s largest export, linking revolutionary ideals with economic development. That has depended in turn on the central role of public health and education in Cuba, as Havana has built a low-cost biotech industry along with medical infrastructure and literacy programmes in the developing countries it serves – rather than sucking out doctors and nurses on the western model.

Internationalism was built into Cuba’s DNA. As Guevara’s daughter, Aleida, herself a doctor who served in Africa, says: “We are Afro-Latin Americans and we’ll take our solidarity to the children of that continent.” But what began as an attempt to spread the Cuban revolution in the 60s and became the decisive military intervention in support of Angola against apartheid in the 80s, has now morphed into the world’s most ambitious medical solidarity project.

Its success has depended on the progressive tide that has swept Latin America over the past decade, inspired by socialist Cuba’s example during the years of rightwing military dictatorships. Leftwing and centre-left governments continue to be elected and re-elected across the region, allowing Cuba to reinvent itself as a beacon of international humanitarianism.

But the island is still suffocated by the US trade embargo that has kept it in an economic and political vice for more than half a century. If Barack Obama wants to do something worthwhile in his final years as president he could use Cuba’s role in the Ebola crisis as an opening to start to lift that blockade and wind down the US destabilisation war.

There are certainly straws in the wind. In what looked like an outriding operation for the administration, the New York Times published six editorials over five weeks in October and November praising Cuba’s global medical record, demanding an end to the embargo, attacking US efforts to induce Cuban doctors to defect, and calling for a negotiated exchange of prisoners.

The paper’s campaign ran as the UN general assembly voted for the 23rd time, by 188 votes to 2 (US and Israel), to demand the lifting of the US blockade, originally imposed in retaliation for the nationalisation of American businesses and now justified on human rights grounds – by a state allied to some of the most repressive regimes in the world.

The embargo can only be scrapped by congress, still stymied by the heirs of the corrupt US-backed dictatorship which Fidel Castro and Guevara overthrew. But the US president has executive scope to loosen it substantially and restore diplomatic ties. He could start by releasing the remaining three “Miami Five” Cuban intelligence agents jailed 13 years ago for spying on anti-Cuba activist groups linked to terrorism.

The obvious moment for Obama to call time on the 50-year US campaign against Cuban independence would be at next April’s Summit of the Americas – which Latin American governments had threatened to boycott unless Cuba was invited. The greatest contribution those genuinely concerned about democratic freedoms in Cuba can make is to get the US off the country’s back.

If the blockade really were to be dismantled, it would not only be a vindication of Cuba’s remarkable record of social justice at home and solidarity abroad, backed by the growing confidence of an independent Latin America. It would also be a boon for millions around the world who would benefit from a Cuba unshackled – and a demonstration of what can be achieved when people are put before corporate profit.

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