"I HAVE found what we have lost," Dr. Mae Concepcion Dolendo told VoxPop Davao in an interview about the health system in Cuba.
Dolendo was the only hospital-based health personnel who joined the team led by Health Secretary Paulyn Jean Rosell-Ubial last August 2016. She and another delegate arrived a day late instead of the August 23-26 schedule that the Health Secretary followed due to some travel documents snafu.
Dolendo said this came as a blessing because they were made to stay another day after the official delegation left, allowing them a more candid interaction with the Cuban health officials that was limited because of the formality of the occasions during the official schedules.
In a post on her Facebook page last August 27 in Havana, Cuba, Dr. Dolendo wrote, “When President Duterte first said ‘I want you to go to Cuba’ I was perplexed. But now I understood.”
As early as June 2016, in his first meeting with his Cabinet members, he ordered them to look into the health system of Cuba for possible replication.
“They had perfected a welfare system for all na baka makopya natin (that we could copy),” the President was quoted as saying in the news last June 30, 2016.
“Kasi ang tao kapag walang maibili ng medisina patay. Masakit pakinggan yan pero that is the reality from the ground,” Duterte said. He then ordered Sec. Ubial to organize a Cuba visit soon after.
“We arrived a day late in Havana because of travel glitches but I was glad I came. The health system is at it is reputed to be with people having access to healthcare teams even in the mountains. But what impressed me the most are the people; who despite having so little for themselves give so much to others. I can't express fully what I have learned here because there is just so much. But I am most willing to share this experience so all can be part of the change coming in our healthcare system,” she added.
“One other thought that struck me is that there is so much patriotism and pride among Cubans. Not the ‘feeling magaling’ kind of pride, but pride born out of honest, diligent work and love for country,” she continued in her status update.
Dolendo is a pediatric oncologist of the Southern Philippines Medical Center (SPMC) and founder of the Davao Children’s Cancer Fund Inc. more commonly referred to as House of Hope, where children with cancer from poor families all over Mindanao are provided assistance for the families to be able to complete the treatments required by their patients.
While pointing out that Cuba is a socialist country that has to make do with the little its people has and can produce because of economic embargoes imposed on them by developed countries, Dolendo said, Cuba and its people share similarities with the Philippines and the Filipinos, the love for music among them.
While time seemed to have stopped in Cuba, all because of these economic sanctions, thus there are very limited infrastructure development and even the cars are all pre-Cuban Revolution vintage, there is no feeling of “general unhappiness” that can be perceived among its people.
That has led the doctor to ponder on how the Filipinos have, as one people, taken a lot of their freedom for granted.
But most impressive is that despite the backwardness of the country in terms of luxuries and structures, they have among the most advanced health system that focuses more on prevention than the cure. Plus, they have set up a medical education system that produces hundreds of doctors who are dispatched worldwide to serve calamity and downtrodden areas.
“Cuban doctors are the patrimony of the revolution,” she said, and it’s a patrimony that has been grabbing the attention of the World Health Organization (WHO).
Cuba is a small country with just 11,271,000 and a very low fertility rate of 1.77 percent, thus having a very old population that is seen as its biggest health problem.
Of note is that their health sector represents 7 percent of the total work force. This fact is taken from the WHO briefer on Cuba’s health system.
The country’s total health system is made of 152 hospitals with a total of 38,642 beds, 452 polyclinics that already includes 821 basic health groups composed of an internal medicine specialist, a pediatrician, a gyneco obstetrician, a dentist, a psychologist, and a statistician-informatics. The basic health groups are dispersed in communities, with each community getting the whole team.
These basic health groups comprise of 11,468 family doctors and nurse team health care units handling a total of 1,095 residents each.
“There are also 1215 dental care centers, 142 maternal homes, 126 elderly homes and 228 grandparent homes. The system has 76,506 doctors of which 36,478 are family doctors, 12,144 are dentists, and 103,014 are nurses,” the WHO briefer states. The total number of health workers is 535,305,” the WHO briefer continues. Of the total health work force, 69.5% are women.
The basic health team makes sure that every resident gets an annual health check-up and twice a week, they visit the families.
Dolendo said that it is only when you get sick that you go to a polyclinic for checkup. For all other concerns, you go to the basic health unit, the family doctor assisted by the nurse and hygienist. The patient who is monitored to have some affliction is referred to the polyclinic as an outpatient. This already covers emergency cases.
Thus, hospitals do not have emergency rooms and outpatient departments. All emergencies are attended to at the polyclinics.
The district hospital is where a patient diagnosed with some disease that needs hospital confinement is referred to. The doctors who diagnose and refer make sure that the patient is received and accommodated at the district hospital.
Then, there are the big hospitals, as Dolendo describes, the medical centers that attend to the debilitating diseases like cancer.
“You don’t see queues,” she said. “’Di ba sa atin nasanay na tayo makakita ng mahabang pila sa mga hospital. Doon wala. You only see these queues at the polyclinics.”
Even the queues at the polyclinics are not as long as we regard queues to be.
“Maganda ang system nila, they have different tiers of health services, thus there are no ER’s, it’s all referrals,” she said.
With the basic health unit tasked to conduct regular visitations and every resident getting an annual checkup, health problems are detected early and interventions are provided at the earliest time possible.
Most of all, Dolendo said, Cuba’s health system is data driven. They track the health risks and conditions of the population according to age and conditions.
“Kung well ka, vaccinations ka lang. Then those at risk, kunwari you are in your 40s, then you need to be screened for the diseases prevalent in your age group. That means, doon pa lang sa at risk parang may red flag na sila,” she said.
Then those who have diseases, whether congenital or acquired, and the handicapped are classified and monitored differently as well.
Even the elderly have a whole separate program. There are also day care centers for the elderly to allow the productive members of the communities to go about their work without worrying about their elderly family members that may already need assistance and special attention.
The elderly day cares, however, are for a very minimal fee, the equivalent of around P25 per month. They have mental facilities in the community.
“Ultimo braces are provided for free,” she said.
Of note, they have no drugs problem.
“They are very stiff on drugs. Since no drugs, then no crimes,” she said.
Admittedly, Cubans have to make do with a lot less. Their buildings are vintage Cuban revolution and the traces of the devastation remains.
“There are still buildings na rubbles pa siguro nung revolution, sira-sira ang mga bahay nila, pero healthy sila and they are well-educated,” she said.
Key to all these is the pride in service that is imbibed by all Cuban doctors.
“They don’t have anything for themselves, and yet, they go out to help other people. They have so much pride in what they do. That is what we lost and hopefully find again,” Dr. Dolendo said.
