By Senator Bill Frist, MD
It’s been an eventful year for Cuba since we last visited. The United States policy changes announced on Dec 17, 2014—the result of 18 months of negotiations—signified a new era for Cuba. On July 20 this year, the United States reopened its embassy in Havana which has been closed since 1961.
But on my most recent visit, last week with the Nashville Health Care Council, I was less concerned with diplomatic landmarks and more determined to do one thing: meet and talk with Cuban family doctors who deliver all primary care.
I was able to do that in the Nuevo Vedado neighborhood in Havana, where we walked into a clinic in a multifamily housing unit. Dr. Mercedes Pina runs her family medical practice with one nurse for assistance. Together they are responsible for the wellbeing of 393 families.
Dr. Pina is a small woman about 50 years old with full black hair, she wears a white, short sleeved coat and an easy smile. She is happy to talk with us, candidly answering questions and telling us so much that our translator has a hard time keeping up.
In the neighborhood where she and all of her patients live, Dr. Pina is a familiar and trusted figure. She’s not, however, a well-equipped one. Medical supplies are horribly scarce. Bandages, aspirin, medications, and even the most basic medical supplies are in short supply.
With such extremely limited resources, Dr. Pina’s main goal in her community is to observe, educate, and carefully monitor her patients. She’s particularly focused on maternal and child health.
The Cuban government reports an astonishingly low infant mortality rate: 4.2 deaths for 1,000 live births. Based on my conversations to determine the accuracy of those numbers, my hunch is that the rate is a bit higher, but I believe it’s clearly better than what we see in the U.S. Why? The extensive prenatal care which lets essentially no one fall through the cracks.
When I asked her about maternal and child health, Dr. Pina immediately parroted the government figures, but went on to describe the care she offers her patients in detail. She said she sees a healthy pregnant woman 13 to 14 times during the pregnancy; if the pregnancy is high risk she will visit the mother at home every week to 15 days.
Dr. Pina registers every pregnancy in her community before the 12th week. Within 15 days of registering, the patient has an appointment with the polyclinic obstetrician, and is referred to genetic specialists for genetic testing if necessary. The pregnant patient sees the obstetrician again at 26 and 34 weeks in addition to Dr. Pina’s care.
Once babies are born, Dr. Pina assiduously ensures that every child in her community is vaccinated, and the clinic nurse will travel to homes to do vaccinations if necessary. I conclude this is why the vaccination rate is so much better than here in the United States. Clearly this is something we can learn from.
We know that healthcare can be a powerful tool for diplomacy. The differences between our country and hers are vast and complicated, but sitting down together—physician with physician—Dr. Pina and I find much common ground. We can learn from one another. We love our communities and we want to build healthy habits and enable healthy choices for the people in them.
Read more about my visit and what I observed in Forbes.