November 2009

Higher Institute of Medical Sciences
Hospital Dr. Salvador Allende
Saturday, November 28, 2009

Influenza A (H1N1) has arrived in Cuba and it has created a delicate epidemiologic situation that worsens with the existence of other infectious diseases such as dengue.  In order to prevent a fatal outcome, one must lower the risk factors and act quickly and efficiently in the presence of a confirmed or suspected case.  Here is where preventative medicine comes in handy.
 
Transmissible diseases such as Influenza A (H1N1) constitute one of the main causes of death in developing countries and in medically-underserved communities in developed countries like the United States.  Cuba is a developing country with very limited resources.  This is no surprise since this country has quietly suffered the consequences of the US embargo for many years.  Despite all of the financial difficulties, this small Caribbean island is able to provide free healthcare access to its entire population.

In the past few months we faced an outbreak of dengue but fortunately dengue is now under control.  Today, Influenza A (H1N1) poses a bigger threat with the arrival of winter and for this reason Cuba has been preparing to confront the unwelcomed arrival of the virus.

To better fight Influenza A (H1N1) Cuba trained more than 500,000 employees and reserved more than 2,000 medical centers throughout the country.  The hospital “Dr. Salvador Allende” is one of those medical centers in Havana designated to admit patients with Influenza A (H1N1). 

All patients that come to the emergency room with symptoms of Influenza A (H1N1) are admitted to the hospital as a preventative measure.  Once at the hospital they start an individualized treatment plan and undergo a series of lab exams on a daily basis in an effort to monitor them closely.  An average hospital stay for these patients is two weeks.  Monitoring the patients inside the hospital is crucial because the patients receive the treatment that they need and we also minimize their contact with healthy individuals.
 
I have noticed that most of our patients undergoing testing for Influenza A (H1N1) are chronic smokers.  It only takes a short walk on any Havana street for you to realize that smoking is fairly common in this culture.  This is unfortunate because smoking predisposes the patient to a number of respiratory problems.  The elderly enjoy the famous Cuban cigars while the younger generations prefer the Criollos, a non-filtered cigarette brand.

Aside from the respiratory infection a number of our patients are also afflicted by other pathologies.  To better serve our patients, we examine them from head to toes.  All patients are meticulously interviewed and everyone is guaranteed a complete physical exam when they first arrive at the hospital.  The physical exam and the patient interview are great diagnostic tools and they play an important role in preventative medicine.  Performing them is an art that requires skills which can only come with practice.  In fact, the focus of the first semester of third year of medical school here in Cuba is to acquire these skills.
 
Today while I was performing a physical exam on my patient with a respiratory infection I palpated an abnormally large liver (hepatomegaly) for the first time.  I was thrilled as the palms of my hands slowly invaded the border and smooth surface of the liver.  I closed my eyes for a few seconds as my hands gently continued palpating the liver in an effort to make a sketch of this liver in my brain for future reference.  Upon finishing the physical exam my professor verified my finding and this patient had to undergo further testing to determine the underlying cause of his pathology.  At the end of the day I thanked God for giving me the opportunity to help this patient.
 
People live a longer and healthier life in a system that does not make healthcare a profitable business.  For me it’s hard to believe that equal access to healthcare is possible especially in such a poor country like Cuba.  If you find it hard to believe, come to Cuba and see it for yourself.  Healthcare is a priority in this island as it should be everywhere else.  It doesn’t matter if it’s fighting Influenza A (H1N1) or dengue, Cuban physicians will always be there with their patients; it’s a promise that we make when we decide to study medicine in this beautiful Caribbean island. 
Sincerely,

Alejandro Bernal
Website:  www.pnhpwesternwashington.org
Email: alex238209@yahoo.com