COVID-19 severely collapsed operational systems and health structures in different countries of the world. The pandemic started at a time the world was not ready and this worsened its effects on humans and the environment. It was a different case for countries with limited financial resources like Cuba because the economic backbone of the island state was disrupted. The disruptions were birthed by the closure of tourist centers, airports and other physical engagements. However, despite the unexpected nature of the health emergency, Cuban authorities were able to coordinate public health safety and put in place preventive and protective measures to deal with the pandemic.
The first case of COVID-19 was in Wuhan in China. The virus through human spread moved beyond China to internal communities and such to Cuba. The first coronavirus case in Cuba was confirmed on the 11th of March, 2020 after four Italians tourists tested positive to the virus (NBC, 2020). The early cases were predominant as they came at a time little or no guidelines had been put in place to contain coronavirus. The first four cases would later spread to 207,322 cases and 1,372 COVID-19 deaths in the island state (Worldometers, 2021). Cuba is a tourist-centric country and this informs the high rate of visitors coming in and out. The effect of the tourism-dependent nature of the country is evident in the early fast spread of the virus. Despite the early severity and widespread of coronavirus in Cuba, the containment level and national protocol were notable. They were notable because COVID-19 was professionally contained and public health safety was ensured by the authorities according to recognized international standards.
COVID-19: National Protocol in Cuba
Cuba has a long-standing record and huge revenue base from tourism. In 2019, the country raked in 2.97 billion (US dollars) for its gross domestic product in tourism (Statista, 2021). This striking economic growth base came after Cuba recorded a decade history of highest contribution from tourism to the tune of 3 billion (US dollars). At the onset of the pandemic, Cuban authorities had the tough task of making decisions critical to the revenue base, human lives and the sustainability of the nation. It was a contest with an inevitable option of sacrificing one for the other; locking down the country to protect lives or continuing to receive visitors for increased revenue. Cuban authorities chose the latter—notably, in the interest of Cubans.
Travel Protocol during the Pandemic in Cuba
The first cases of COVID-19 in Cuba were discovered on tourists. Thus, the national protocol specially regulates traveling for containment and protection of lives in the country. The travel protocol includes:
“Travelers were mandated to present a negative result from a polymerase chain reaction (PCR) COVID-19 test taken within 72 hours before entering the country”;
“Health status of travelers must be declared and they were required to undergo a COVID-19 test on arrival to Cuba”;
“A 5-day compulsory isolation was mandated on all travelers entering the country in which the 5th day would be for PCR—the isolation was made free for Cuban nationals and residents while foreigners were expected to cover their expenses”;
“COVID-19 testing and sanitation must be paid for by all travelers entering the country in form of a health/sanitary tax”;
Importantly, nose masks were mandated for people in public spaces including airports and adherence to physical distancing was openly emphasized for travelers” (Gardaworld, 2021).
Cuban authorities essentially provided travel protocols in protecting residents and foreigners during the COVID-19 pandemic. The authorities restricted flight frequency for Cuba and placed a ban on non-essential transport and commercial activities. Group activities, recreational centers and physical businesses were included in the lockdown that was observed countrywide in Cuba (Gardaworld, 2021).
National Protocol during the Pandemic from Cuban Authorities
The United States sanction on Cuba for international finances and funding worsened the pandemic situation for the country. The sanction is evidently one of the back-drawing areas for Cuba as external trade and international services were limited in some form. The unsavory situation imposed on Cuba because of its financial not-well-to-do posed a great risk when the pandemic began. However, Cuba’s government handled the situation accountably and has set precedence for effective leadership. The national protocol for the pandemic includes an early training of medical workers, the preparation of medical students for contact tracing and reliably informing the public about the symptoms, precautions and steps to take when certain symptoms were observed (Morris and Kelman, 2020). Cuban authorities launched a full-scale contact tracing immediately the first three cases of COVID-19 were discovered in the country. Trained medical experts and students were mobilized for tracing contact persons and host cases; after which a structured, open-to-public COVID-19 testing commenced in Cuba.
Also, Cuba’s government announced a travel ban in March 20, 2021 after 21 confirmed coronavirus cases were recorded (Morris and Kelman, 2021). The government introduced a large-scale online buying and selling when physical distancing and the use of nose masks did not work well for the country. Public transport was also suspended and private vehicles were hired to commute essential workers (Morris and Kelman).
Vaccine Protocol and Vaccination in Cuba
Cuba’s government opted for a homegrown COVID-19 vaccine instead of importing from other countries. This decision came amidst tight criticisms from medical experts. However, authorities supported Cuban based production of COVID-19 vaccine. The question that arose at the heart of the pandemic was, can Cuba beat COVID-19 with its homegrown vaccines? After a three-phase clinical trial for Cuban coronavirus vaccines, Abdala and Soberana were produced, deployed for national use and validated by the World Health Organization (WHO). Abdala had a 92.8 percent efficacy while Soberana, a nasal administered vaccine recorded 62 percent efficacy. The country’s COVID-19 vaccine production leader, Verez Bencomo described the produced vaccines as, “results of independent streak reflecting the ingenious initiative of Cubans—a needed effort to contain the virus across the country” (Nature, 2021). To ensure that Cuban nationals were well catered for with the vaccines, five candidates were presented by the authorities through the biotechnologists and medical experts. The vaccines include Abdala, Soberana, and Mambisa.
The successful production of COVID-19 vaccine has helped in containing the virus in the communist-run island nation while also opening up novel revenue sources for the country through the exportation of vaccines. The vaccines, Abdala and Soberana have been announced efficacious and above the 50 percent World Health Organization (WHO) validation mark for vaccines. The efficacy validates the safe use of the vaccine. The increasing demand for the vaccine from other countries including Venezuela has proven the authorities right on homegrown production of coronavirus and has placed the island nation on a valuable pedestal in the comity of nations. Cuba is ranked fourth in the list of countries with the most effective COVID-19 vaccine—an extraordinary achievement considering the financial stand of the country before and at the onset of the pandemic.
Cuban authorities have been credited for early approval of diagnostics even before the first cases were recorded. Taylor (2021) reports that Cuba’s primary health care system was instrumental to containing the virus. The government ensured a public education on the virus, the causes and effects. The public education has also been found useful in converting people to taking the homegrown vaccines. Although, Cuba lacked certain medical materials to adequately contain the virus, the country made up by deploying well trained medical workers to take care of Cuba’s nationals and residents.
COVID-19 demanded immediate response as a global health emergency. Countries that found it tough to give a fast response to the pandemic recorded huge fatalities and have indelible marks from the unprecedented occurrence. In Cuba, a quick national response was given to protect the nationals and residents and contain the spread of coronavirus. For its national health protocol during the pandemic, Cuba authorities locked down the nation, banned travels in phases, adopted open health education on public safety and health care, and produced two globally recognized vaccines. The set protocol from Cuba’s government is exemplar and indicates a functional leadership in the country. Cuba has demonstrated a robust health protocol that is in tandem with the conditions of the citizens and thus, the wide acceptance of the vaccines was significant. The health protocol in Cuba during the pandemic included the suspension of tourism, closure of airport, closure of recreational centers, closure of businesses centers and the shift to online commercial activities. Cuba had a scheduled COVID-19 vaccination free for nationals and residents.
The COVID-19 pandemic began at an unprecedented time when humans, organizations and institutes were not prepared. Like the global cases and deaths, Cuba had a recurring cases and deaths totaling 70,000 and 408 respectively as at March 2021 (Yaffe, 2021). The severity of cases and the resulting deaths influenced the production of COVID-19 vaccine in Cuba. Among countries that made great efforts at seeing to safety, and the containment of coronavirus, Cuba played an intensive role in not only competing with top-tier countries like the United States, the United Kingdom, Germany and India among others; but also demonstrating an exceptional feat by the production of “Abdala” and “Soberana” vaccines for COVID-19.
COVID-19 is viral disease that emanates from coronaviruses. The disease-causing virus was first discovered in Wuhan, China in 2019 but has since spread to other countries of the world including Cuba. Although, the virus is from the family of severe acute respiratory syndrome (SARS) and was in spread in 2002-2003, the latest variants have shown to cause severe respiratory disorders (Kandola, 2020). Thus, the virus is code-named, COVID-19.
The Abdala Vaccine
Cuban’s COVID-19 “Abdala” vaccine has been found with a 92.28 percent efficacy in combating coronavirus. The vaccine effectiveness declaration comes after the last-stage clinical trials made in the country (Frank, 2021). The vaccine’s potency is evident in the drastic reduction of coronavirus cases and deaths across the country. According to Cuban’s authorities, COVID-19 cases reduced by half after a country-wide vaccination in the country using “Abdala” (Frank, 2021). The vaccine production has been found sufficient as over 11.2 million Cubans are considered for vaccination—a huge stride considering the resources of the country.
Abdala, a coronavirus vaccine produced in Cuba was a rapid response to containing the virus. The rapidity in the vaccine’s development influenced the trial stages and the eventual manufacturing. The clinicals at the first stage showed that, “safety and reactogenicity profile of the immunogen was favorable for the two doses of the vaccine candidate”. In other words, the first stage of the trial was tested valid for immune efficacy (Santos, Martin and Medina, 2021). 760 volunteers participated in the second stage trial for the 11.25 million population of people in Cuba including people between 19 and 54 years and a special involvement of people around 80 years (Santos et al, 2021). The vaccine development process had a preferential consideration for people with comorbidities and those with chronic diseases; their inclusion was monitored and medically controlled (Santo et al, 2021). The effect of the trial stages is shown in the quality of the vaccine and its reliability at performing that which it was manufactured for. The third stage of the vaccine development was charged for immunogen results in the third phase trial participants. The third phase had a total of 48,290 volunteers from provinces including Granma, Guantanamo and Santiago de Cuba (Mola, 2021). The trials show that, the vaccine generates antibodies against COVID-19 and that, it yields a “viral neutralization assay” with “functional activity” (Santo et al, 2021).
Mola (2021) reports that Abdala was developed by the Center for Genetic Engineering and Biotechnology in Havana, Cuba. The center also manufactured Mambisa but mainly for nasal administration the reporter says. Abdala vaccine is protein subunit and contains a synthetic segment of the SARS-CoV-2 S protein, which is identified as an RBD (receptor binding domain) (Mola, 2021). The notable part of the vaccine product is its quality. Abdala is thus ranked fourth in the list of vaccine production mostly among first world countries—right after US’s Moderna third, US and Germany’s Pfizer second and US’s Novavax as the first ranked COVID-19 vaccine globally. The World Health Organization (WHO) has attested to the efficacy of Abdala with a test response that, the vaccine rates above the 50 percent benchmark set for coronavirus production as a global standard (Mola, 2021). Despite being short of funds, Cuba has risen beyond its financial incapability to competing medically with rich nations globally. Although, Cuba is placed on a financial blockade by the United States for over sixty years, Cuban authorities rose to the occasion to protect Cubans from the haphazard effects of coronavirus; placing the country high among comity of nations (Mola, 2021).
Notably, Cuba has been able to present five vaccine candidates to containing COVID-19; Abdala tops the candidates based on its near perfect efficacy. The center in charge of Abdala production claims the vaccine is capable of elevating immune responses through antibody generation. Abdala was tested active for efficacy, the production was inspected and certified for standard and safe practices. The vaccine production centers were equally validated—a step which places the vaccine in a public light that would later yield a global audience, purchase and revenue for Cuba. The country’s authorities have been able to maximize Abdala’s production to source revenue for the country. The benefit of Abdala’s production has been identified as reducing COVID-19 cases, reducing coronavirus related deaths, strengthening the country’s biotechnological infrastructure and professionalism, generating income through Abdala’s exportation and sales and competing on a global standard with well-resourced nations.
Cuba’s Abdala Against Other Vaccines: Testimonials
Cuban authorities pulled off the risk and opted for ‘homemade’ coronavirus vaccine. Although, medical professionals advised the authorities such a decision was risky but it paid after the success Abdala and Soberana. Cuban government supported the vaccine production from the outset; a testament to this is the tweet from the President, Miguel Diaz-Canel that despite a hard hit of COVID-19 in Cuba, the authorities were set to provided needed support for the vaccine production institutes including Finlay Institute and Center for Genetic Engineering and Biotechnology (Reuters, 2021). Testimonials from the authorities indicate that Abdala does not only cater for COVID-19 containment and public safety, it is also targeted at boosting the morale of medical professionals in the country while revamping the health sector for more rapid and responsive public health cases and emergencies. The government’s justification for the homegrown component vaccine is that, “it would create a centrally controlled and free health care system in Cuba toward a fast-pace vaccination and coronavirus suppression” (VOI, 2021). The implication of Abdala’s successful production in Cuba is that it reveals the tenacity of the authorities, the ingenuity of the biotechnologists and medical experts and the resilience of the public in safely receiving the vaccine. World Health Organization (WHO) commends the efficacy of Abdala noting that the vaccine creates optimism for the country and a great news for the people. The representative, Jose Moya is described to have knowledge of the formula for Abdala, a vaccine which has become globally competitive and required by different countries in combating the prevalence of COVID-19 (Vincent, 2021). Upon a successful production of vaccines for coronavirus, Cuban authorities targeted a 70 percent vaccination of the people. However, Reuters’ report indicates that only 6.4 million of the 11.2 million population have been vaccinated (Reuters, 2021).
Global Importance and Demand for Abdala
Abdala has proven to be an effective vaccine in generating antibodies against COVID-19. The vaccine has been robustly used in the island country and is now yielding respects from international level. Venezuela has received Abdala from Cuba and has embarked on populating it to the tune of four million doses for local use in the country. Venezuelan authorities have been reported to receive a shipment of the vaccine toward public use (Berti, 2021). The Cuban vaccine is named Abdala, the name of the country’s independence hero; this shows how significant the name is supported by the potency of the vaccine for local and resulting global use.
COVID-19 was unexpected globally. Although, there had been variants of the SARS virus earlier before 2020, the emergence of the pandemic caught the world unaware. The unaware nature of the virus influenced its effects in cases, prevalence and eventual deaths. However, countries with research and biotechnological infrastructure were able to produce vaccine for the containment of the virus. Among the top-leading countries of the world who made COVID-19 vaccine, Cuba impacted with a giant stride coming fourth in a league of countries including the United States, Germany and India. The vaccine has been found efficacious in arresting coronavirus; it has thus been in widely-accepted use in Cuba and beyond.
The novel coronavirus of 2019, known as COVID-19, fiercely swept across the entire world within just a matter of months, causing panic, fear, and uncertainty. For over a year now, COVID-19 has been the daily talk of the world as we have all been fighting this devastating pandemic together. Quarantines, shutdowns, social distancing, and mask mandates have been put in place all around the world in hopes of slowing down the spread of this deadly virus, and these precautions are still in effect in many places today as cases continue to rise and new variants of the virus emerge.
COVID-19 Vaccines Show Promise Against the Coronavirus
The United States’ recent development of their COVID-19 vaccines has shown promise in being effective against the coronavirus. Based on clinical trials, Pfizer’s BioNTech mRNA two-shot COVID-19 vaccine has shown to be 95% effective at preventing COVID-19 infection in those who received both doses of the vaccine and had no prior infection.1 Based on clinical trials, Moderna’s mRNA two-shot COVID-19 vaccine has shown to be 94.1% effective at preventing COVID-19 infection in those who received both doses of the vaccine and had no prior infection.2 In clinical trials, Johnson & Johnson’s Janssen viral vector COVID-19 vaccine has shown to be 66.3% effective at preventing COVID-19 infection in those who received the single-dose vaccine and had no prior infection.3
The United States aren’t the only ones trying to stop COVID-19 for good with their immunizations. Cuba has now joined the race to beat COVID-19 as new cases continue to rise and new variants of the virus emerge.
Can Cuba’s Homegrown Vaccines Help Solve the Worsening COVID-19 Pandemic?
Cuba is working to become the first Latin America country to develop and manufacture its own COVID-19 vaccines.4 Cuba’s development of two new COVID-19 vaccine candidates has been reported in the news a lot during the past few weeks. Cuba is betting that its own vaccines, made by local laboratories, can beat COVID-19 on its own.5 “Vicente Vérez Bencomo, director-general of the state-owned Finlay Institute of Vaccines in Havana, where one of Cuba’s most advanced vaccine candidates was created, thinks the chances are good.”4
Guaranteeing Cuba’s Sovereignty with Its Own COVID-19 Vaccines
Cuba decided to develop and manufacture its own coronavirus vaccines rather than compete with richer countries for vaccines6 to immunize its tiny island of 11 million inhabitants.6 After the COVID-19 pandemic began, “Cuban leader Miguel Díaz-Canel said that guaranteeing the nation’s sovereignty was the main goal of producing a homegrown vaccine,”6 naming the first vaccine candidate Soberana which is Spanish for “sovereign.”6 Abdala, another of Cuba’s vaccine candidates, was named after a poem by independence hero José Martí.6 For Cubans, the names of these homegrown vaccines show that the tiny island of 11 million inhabitants “cannot be broken by a deadly virus.”7
Cuba is Hopeful That Its Homegrown Vaccine Candidates Will Be Effective Against COVID-19
As of today, Cuba has five coronavirus vaccine candidates at various stages of [clinical] trials.6 Just last week, Cuba said that two out of five vaccine candidates have shown to be highly effective against COVID-19.6 The Cuban government-owned pharmaceutical company, BioCubaFarma, said that its three-dose Abdala vaccine has shown to be 92.28% effective in Phase III trials.6 However, The Pan American Health Organization says Cuba has yet to “publish trial data on its Abdala vaccine in peer-reviewed scientific journals so that the global scientific community can evaluate efficacy rates of the COVID-19 [vaccine].”6
Cuba has already been administering its vaccines “even before receiving certification from local authorities”6 after a surge in coronavirus cases led to an emergency response in May.6 According to Díaz-Canel, more than one million Cubans have already been vaccinated with at least one dose of the Abdala or Soberana 02 vaccines.6
Cuba’s Surge in COVID-19 Cases: A Race Against Time
Cases of the coronavirus have been steadily rising since November 2020 after Cuba reopened its borders to tourists.6 The island is now dealing with its worst outbreak for the first time since the pandemic started,8 registering more than 3,000 daily cases. According to the Ministry of Public Health, since the start of the pandemic, Cuba’s total cases have reached 188,000 with 1,270 deaths.6 The government is aiming to have 70% of Cuba’s population fully vaccinated by August 2021.7
Is Cuba’s Abdala COVID-19 Vaccine One of the World’s Most Effective Coronavirus Vaccines?
With its reported 92.28% efficacy against COVID-19 in Phase III clinical trials,6 Cuba’s three-shot Abdala COVID-19 vaccine may become one of the most effective coronavirus vaccines in the world, rivaling Pfizer-BioNTech’s 95% efficacy,1 Moderna’s 94.1% efficacy,2 and Russia’s Sputnik V’s 91.6 efficacy.9
Countries including Argentina, Bolivia, Jamaica, Mexico, and Venezuela are interested in obtaining Cuba’s coronavirus vaccines.7 The reported high rate of efficacy of Cuba’s Abdala vaccine, as well as the hope for efficacy with other Cuban vaccine candidates in various stages of clinical trials, could enable vaccine exports to other countries to help lift Cuba out of its economic crisis.9 In fact, Venezuela received their first batch of Abdala just this week.10 And Caracas signed a deal to buy 12 million doses of Abdala.10 Cuba has plans to manufacture 100 million doses in 2021 for export to more than 30 countries10 around the globe.
Cuba’s COVID-19 National Protocol
Although vaccines are being developed and administered to people all over the world, Cuba still has protocols in place to protect the country and its tourists from COVID-19 infection. In fact, Cuba is facing its worst outbreak since the beginning of the pandemic.8 As a result, Cuba is under a level 4 travel alert (DO NOT TRAVEL).11
According to the U.S. Embassy in Cuba, all travelers must present a negative COVID-19 polymerase chain reaction (PCR) test administered no more than 72 hours prior to entry into Cuba.11 “All travelers are required to fill out a health declaration card,”11 take a COVID-19 PCR test at the port of entry, and self-isolate until results of the COVID PCR test are received.11 If the results are negative, another PCR test will be administered on the fifth day of isolation; if the second PCR results are negative, the isolation period is over.11 Travelers who test negative upon arrival can self-isolate in a government-run facility or at a hotel participating in the government’s COVID-19 isolation protocol.11 Travelers who test positive will be moved to the National Institute of Tropical Diseases Pedro Kouri.11
All individuals are required to wear a facemask in all enclosed public spaces and comply with sanitization and social distancing requirements.12
Commercial flights are operating but are limited and can be cancelled unexpectedly.11 According to the U.S. Embassy in Cuba, “if U.S. citizens choose to travel to Cuba despite the level 4 alert for Cuba, they should stay in close contact with their travel agents and/or airlines and be prepared to cover their living expenses in Cuba should their return flight(s) be cancelled. The U.S. Embassy is closed for routine services and cannot assist with travel arrangements.”11
Public transportation is operating but is limited11,12 to essential workers.12
Fines for Non-Compliance
If individuals do not comply with Cuban government measures and hygiene protocols, a fine and/or criminal penalty may be issued.11
Cuba’s Hope to End the World’s Common Enemy
As the world continues to fight the common enemy known as COVID-19, Cuba remains hopeful that its homegrown vaccines will officially beat the virus.
Pfizer-BioNTech COVID-19 Vaccine Overview and Safety. Centers for Disease Control and Prevention. Updated June 24, 2021. Accessed July 2, 2021. https://www.cdc.gov/corona
Johnson & Johnson’s Janssen COVID-19 Vaccine Overview and Safety. Centers for Disease Control and Prevention. Updated June 23, 2021. Accessed July 2, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/janssen.html.
Mega E. Can Cuba beat COVID with its homegrown vaccines? Published April 29, 2021. Accessed July 2, 2021. https://www.nature.com/articles/d41586-021-01126-4.
Wyss J. Cuba Bets Big on Its Own Vaccines as Covid Surges. Bloomberg Businessweek. Published May 25, 2021. Accessed July 3, 2021. https://www.bloomberg.com/news/arti
Brasileiro A. WHO tells CUBA to publish its COVID-19 vaccine data and to seek approval for COVAX. Miami Herald. Published July 1, 2021. Updated July 1, 2021. Accessed July 3, 2021. https://www.miamiherald.com/news/nation-world/world/americas/cuba/article2
Pieper O. Cuba’s COVID vaccine rivals BioNTech-Pfizer, Moderna. Published June 27, 2021. Accessed July 3, 2021. https://www.dw.com/en/cubas-covid-vaccine-rivals-biontech-pfizer-moderna/a-58052365.
Cuba says Abdala vaccine 92.28% effective against coronavirus. Reuters®. Published June 22, 2021. Accessed July 3, 2021. https://www.reuters.com/business/healthcare-pharmaceuticals/cuba-says-abdala-vaccine-9228-effective-against-coronavirus-2021-06-21/.
Cuba reports a high success rate for its homegrown Abdala vaccine. The New York Times. Accessed July 3, 2021. https://www.nytimes.com/2021/06/22/world/americas/
Berti L. Venezuela receives first batch of Abdala vaccine from Cuba. Published June 30, 2021. Accessed July 3, 2021. The Brazilian Report. https://brazilian.report/liveblog/2021
COVID-19 Information. S. Embassy in Cuba. Updated June 16, 2021. Accessed July 3, 2021. https://cu.usembassy.gov/covid-19-information/.
Cuba: COVID-19-related travel protocols and domestic restrictions in force as of May 4 remain largely unchanged /update 21. Published May 4, 2021. https://www.garda.com/crisis24/news-alerts/474861/cuba-covid-19-related-travel-protocols-and-domestic-restrictions-in-force-as-of-may-4-remain-largely-unchanged-update-21.
In the 21st century, we are facing the fact that the global population is ageing quite rapidly. The reason for this increasing trend lies in several factors. Firstly, the number of babies brought to this world declines and more and more couples face fertility issues. Second, more important factor includes better availability and quality of healthcare worldwide, which in return prolongs life expectancy. Western countries, and those with high quality of primary healthcare, are impacted the most with ageing phenomenon. According to some estimations provided by the World Health Organization (WHO), the total world’s population over 60 years of age will nearly double by the 2050. Shown in numbers, we can anticipate an increase from 900 million today, up to nearly 2 billion people of elderly people in thirty years. These, what appears to be dramatic data have multiple consequences, including social, economical, as well as healthcare issues.
Mental problems are well recognized health issue in the elderly. It is estimated that approximately one fifth of the global elderly population suffers from some form of psychological disorder which prevents them from independently performing everyday activities. As a society, we sometimes perceive intellectual and mental decline almost as a natural consequence of ageing. On the other hand, stigma that surrounds these conditions often prevents elderly people and their families from seeking professional help and assistance. Support and care are crucial when we discuss about how to overcome the challenges related to psychological problems in the old age.
What are the risk factors?
The spectrum of risk factors responsible for developing psychological problems in old age is quite extensive. Multiple chronic illnesses, especially those of cardiovascular and cerebrovascular origin (hypertension, stroke, coronary heart disease) may have direct consequences to the brain, thereby producing cognitive disturbances and mental issues. Chronic pain is a perfect trigger of psychological distress in the old age. Hospital admission and any change of the environment (moving to a care setting) can also have a negative impact for the overall psychological well-being in the elderly. Social isolation, reduced income during retirement and loss of close family members are significant stressors to cope with – these may produce severe psychological disturbances leading to anxiety or depression. In fact, any severe and long-term illness, such as cancer, tends to affect the behavioral and psychological status of an older person.
Sadly, people of older age are also recognized as a population group prone to abuse. There is evidence that one in six older people will experience some type of abuse. Loss of dignity and respect is, not surprisingly, tightly linked with severe psychological issues.
Are there any symptoms?
Close family members and caregivers should be aware of signs and symptoms related to mental disorders in the elderly in order to seek professional help in a timely manner. When we see our loved ones age, occasional forgetfulness is usually not something to especially worry about. However, persistent loss of memory is a clear indication of a severe health condition needing medical attention.
Significant changes in appearance including changes in clothing may implicate a psychological and behavioral problem. Confusion, disorientation, inability to concentrate or make decisions represent early signs of cognitive decline and dementia. If you experience that your loved ones persistently ask the same questions, forget important dates, frequently misplace their belongings, this is a clear sign to refer them to a medical professional.
It is advisable to especially keep an eye on the feelings of guilt, worthlessness, helplessness – such symptoms are linked with depression. Mood swings, ranging from e.g. being carefree to anxious are indicative of psychological issues. Inability to cope with everyday routine, problems in maintaining hygiene, home or garden should not be disregarded – they are often a sign of mental illness in older people.
Noticing any type of social withdrawal should be taken seriously. If your loved ones lose interest in social activities that they used to be excited about, or just avoid regular social engagements, you should consider seeking professional support for them.
Common psychological issues in old age
It is probably not that surprising that cognitive decline and dementia represent the most common mental health disorder in people older than 65 years. This severe and progressive disease affects approximately five million senior Americans or fifty million seniors worldwide. Concerning is the fact that this number will almost triple in the next twenty years. The disease by itself is estimated to take more lives than breast and prostate cancer combined. Any type of dementia can produce significant physical, emotional and economic pressure to patients and their caregivers. This is why an early diagnosis and appropriate care are essential for patients and their caregivers.
Depression and mood disorders are also quite frequent among seniors, however, the problem with this health condition is that it often goes undiagnosed and, therefore, untreated. Center for Disease Control (CDC) estimates that 5% of elderly individuals suffer from depressive disorder. It is worth mentioning that some medications such as those for the treatment of increased blood pressure may cause depression. Sadness is not the only symptom. Lack of motivation and energy are the usual complaints linked to depression. Prolonged suffering and impairment in performing daily activities are well recognized consequences of untreated depression. Timely diagnosis, accompanied with adequate treatment, care and support is crucial for increasing the quality of life of elderly individuals.
Anxiety is also quite prevalent and may encompass a wide range of mental issues including obsessive-compulsive disorder, post-traumatic stress disorder, panic disorder or phobias. Women are more prone to anxiety than men. Anxiety related disorders tend to occur after a stressful situation such as loss of a spouse or side by side to other chronic and prolonged disease. As in depression, anxiety disorders are usually overseen in elderly individuals, which may have severe implications to the overall well-being of seniors.
Sleep disorders including are common among seniors. Prolonged time needed to fall asleep (usually more than 45 minutes), trouble in maintaining sleep with frequent periods of being awake during night, as well as short overall duration of sleep represent clear signs of insomnia. Proper sleep is very important as it will reduce the probability of a severe psychological disorder. Maintaining a “sleep hygiene” reduces the need for sleep medications, which are sometimes responsible for memory impairment or poor daytime performance.
Is there a solution ( psychotherapy )?
It is important to mention that all of the above-mentioned disorders may coexist, and it is usually the case that seniors suffer from more then just one mental disorder. This is why they need all our support. WHO clearly recommends as a standard of care both psychological and medicinal treatment of seniors affected with mental disorders. This approach is essential for improving both physical and mental health and keeping an optimal quality of life of elderly individuals.
The demand for care and support of seniors with mental issues will increase as the elderly population grows. Providing a timely, high-quality professional help to older people directly reduces the number of complications that may arise as a consequence of mental disorders and prolongs the physical and emotional well-being of the elderly.
Solutions at CubaHeal
CubaHeal offers specialized programs for diagnosis and treatment of psychological problems in the elderly. An array of psychological therapies is available at CubaHeal facilities. Our team of health professionals can provide top-notch, evidence-based medical expertise. This includes diagnosis and treatment for our users, no matter the psychological condition and its stage.
Eczema is the most common form of chronic dermatitis, a non-infectious skin condition characterized by an itchy rash. Commonly, across the literature, it is referred to as atopic dermatitis (AD) as well. Typically, it affects children and the situation gets better as time goes by, but adults can suffer from it as well. However, when it comes to the causes, there is no straightforward answer to explain these. By what we know about it so far, the most accurate answer would be – it is caused by a combination of genetic and environmental factors (basically, this means it is caused by something that’s written in the patient’s genetic code and something in his or her environment). However, giving that this answer can hardly satisfy the curiosity of people interested in the condition, we will discuss it in more detail and provide a broader perspective on the perplexity of eczema origin.
The roots are deep within the DNA 13
Although the pathophysiological mechanisms that cause eczema are pretty well described, their exact background remains to be a subject for academic debate. There are two widely accepted hypotheses – the first one concerns the imbalance in the immune system, and the second one concerns a defect in the skin barrier. The definitive answer to why eczema happens is still not found, but the two hypotheses offer a reasonable explanation. Also, they shouldn’t be taken as mutually exclusive but rather as points of view that complement each other.
The imbalance in the immune system hypothesis
The theory argues that the eczema results from an imbalance in the T cells production – in particular, in people with eczema, there are more T-helper 1 and T-regulatory cells (subtypes of T cells) than there should be. As a result, the amount of interleukins (substances that promote inflammatory response) is increased, so is the intensity of inflammation in the affected areas of the body.
The skin barrier hypotheses
The theory is a newer one and argues that individuals with mutations in the filaggrin gene more often develop eczema than those without the mutation. The filaggrin (filament aggregating protein) binds cells in the upper layer of the skin (referred to as epidermis) together and seals the tiny cracks between them. Filaggrin minimizes the water loss through the skin and penetration of the allergens from the environment (the size of the allergens varies – from small inorganic to large organic molecules or even microorganisms). In some people with the mutation, the production of filaggrin drops critically low, so the skin barrier doesn’t function as it should. The skin becomes more permeable for water (increased water loss), allergens and microorganisms.
The toll on health goes beyond the skin surface
Let’s take a pause from eczema causes here and briefly discuss the phenomenon known as “The Atopic March.” Our immune system works as a whole – defects in the execution of its functions reflect themselves on the whole body more often than not. Eczema is a skin condition, but the same genetic factors that lie in its background also affect other regions of the body. “The Atopic March” describes a temporal sequence of conditions that develop on the terrain of inadequate immune response seen in patients with eczema. The flaw mentioned above in the T-helper
lymphocyte function also can cause food allergies, asthma or allergic rhinitis. The eczema kicks in first and, in the early years of life, is often followed by the rest of the atopic cascade. The importance of this phenomenon lies in the fact that a timely treatment of eczema can reduce the severity of or prevent in temporary conditions that follow it.
As mentioned earlier, the leading cause of eczema is a combination of genetic and environmental factors. Not all people with the “right genetic code” develop the condition. Eczema happens only if all or the majority of contributing factors align, creating a perfect storm. In this section, we’ll take a look at contributing environmental factors. The prevalence (the number of cases of a disease present in a particular population in a given time) of eczema has increased in the past few decades at a pace that changes in gene pool cannot explain. So, the increase in prevalence is explained by changes in environmental factors. At this moment, we can’t tell for sure what those factors are. Still, the growing body of scientific evidence suggests that exposure to dust mites, various allergens, infections, irritants and antibiotics increases the prevalence of eczema 1.
The theory was introduced to the public back in 1989, and it suggests that the main cause of increased eczema prevalence may be the development and “sanitization” of society. The theory argues that the lack of adequate stimulation of the immune system in early life (children that are “too clean”) and failure of maintaining balanced gut flora in adulthood (antibiotics in food) are triggering factors in the pathogenesis of eczema. Furthermore, the hygiene hypothesis explains the rapid rise in prevalence among smaller, wealthier and more educated families in comparison with larger families and those attending a nursery.
The bottom line is that exposure to some pathogens in early life, as well as the timing of exposure, play an essential role in the pathogenesis of eczema. However, some pathogens may trigger the condition; for example, measles infection increases the risk of the disease.
References : 2,3,4,5
Soap acts as an irritant. It causes skin dryness, increases its pH, and transepidermal water loss. Several studies have shown that exposure to soap is in relation to increased eczema prevalence and that removal or avoidance of such chemicals reduces its prevalence. Some studies have shown that eczema prevalence is increased in areas with harder water, but in recent years this hypothesis has been rejected. Namely, the increased hardness of water requires increased use of soap, so the scientific community accepted the use of irritants as the cause of eczema rather than the water harness. The avoidance of irritants early in life is vital as a preventive measure – once the condition establishes, exclusion of those chemicals do not affect further development of the disease (eczema, followed by atopic march).
So, what is the main cause of eczema?
After this discussion, it is essential to underline that eczema is a multifactorial disease. Its causes are not yet fully understood, and some claims about it are still wrapped in a veil of controversy. However, here are some important takeaway notes: – The condition is a multifactorial disease caused by a combination of genetic and environmental factors. – The genetic mutations in people with eczema affect not only the skin but potentially other organ systems, primarily respiratory organs. Eczema is often only the first in a cascade of health issues that arise from altered genes. – Restriction from exposure to the microbes in the environment is in association with the increased prevalence of eczema, but some infective agents may increase the chance of disease establishment. – Once the condition establishes, it is impossible to reverse the process, but it tends to milden or completely disappear during puberty. – Exposure to skin irritants, soap in the first place, plays an important role in the pathogenesis of the disease.
1. McPherson T. (2016). Current Understanding in Pathogenesis of Atopic Dermatitis. Indian journal of dermatology, 61(6), 649–655 2. Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989;299:1259–60. 3. Williams HC. Atopic eczema – Why we should look to the environment. Br Med J. 1995;311:1241–2. 4. Flohr C, Yeo L. Atopic dermatitis and the hygiene hypothesis revisited. CurrProblDermatol. 2011;41:1–34. 5. Hesselmar B, Sjöberg F, Saalman R, Aberg N, Adlerberth I, Wold AE. Pacifier cleaning practices and risk of allergy development. Pediatrics. 2013;131:e1829–37. 6. MJ Cork. The importance of skin barrier function. Taylor & Francis J Dermatological Treatment. 1997. 7. McNally NJ, Williams HC, Phillips DR, Smallman-Raynor M, Lewis S, Venn A, et al. Atopic eczema and domestic water hardness. Lancet. 1998;352:527–31. 8. McNally NJ, Williams HC, Phillips DR. Atopic eczema and the home environment. Br J Dermatol. 2001;145:730–6. 9. Font-Ribera L, Gracia-Lavedan E, Esplugues A, Ballester F, Jiménez Zabala A, Santa Marina L, et al. Water hardness and eczema at 1 and 4 y of age in the INMA birth cohort. Environ Res. 2015;142:579–85. 10. Thomas KS, Dean T, O’Leary C, Sach TH, Koller K, Frost A, et al. A randomised controlled trial of ion- exchange water softeners for the treatment of eczema in children. PLoS Med. 2011;8:e1000395.
11. Simpson EL, Chalmers JR, Hanifin JM, Thomas KS, Cork MJ, McLean WH, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy ClinImmunol. 2014;134:818–23. 12. Harris JM, Williams HC, White C, Moffat S, Mills P, Newman Taylor AJ, et al. Early allergen exposure and atopic eczema. Br J Dermatol. 2007;156:698–704. 13. Thomsen S. F. (2014). Atopic dermatitis: natural history, diagnosis, and treatment. ISRN allergy, 2014, 354250.
90 % of head and neck cancers are mostly squamous cell carcinomas. These carcinomas include nasopharyngeal cancer, nasal cavity, paranasal sinus cancer, oral and oro pharyngeal cancer, laryngeal cancer, hypo pharyngeal cancer and salivary gland cancer. As carcinomas their name indicates they are malignant tumors.
Oral and oro pharyngeal, laryngeal, hypo pharyngeal and salivary gland cancers are included in oral cavity cancers which are all squamous cell carcinomas and salivary gland carcinomas are adenocarcinomas. 95% of oral cavity cancers are squamous cell carcinomas. This aggressive epithelial malignancy is the sixth most common neoplasm in the world today .The overall long term survival rate has been less than 50% for the most past years. Multiple primary tumours will be present in initial diagnosis .These multiple primary tumours develop independently as a result of years of chronic mucosal epithelium exposure to carcinogens such as alcohol or tobaccos .Oropharynx cancer is due to mutations in TP53 gene and genes that regulate the differentiation of squamous cells such as p63 and notch1. Squampous cell carcinoma can arise anywhere in the oral cavity .The most common locations are the ventral surfaces of the tongue floor of the mouth lower lip soft palate and gingiva. These tumors appear as raised firm pearly plaques. Republic of CUBA has succeeded in combating these cancers.
Salivary gland adenocarcinomas include pleomorphic adenoma and muco epidermis carcinoma. Pleomorphic adenomas are painless slowly growing mobile discrete masses. They represent about 60% in parotid and are less common in submandibular glands. While muco epidermoid carcinoma are composed of variable mixture of squamous cells, mucus secreting cells and intermediate cells.
Nasal cavity and paranasal sinus cancers. Squamous epithelial cells of the normal nasal cavity or sinuses can become squamous cell carcinomas. This is the most common type of cancer in the nasal cavity and Paranasal sinuses. Apillomas are warts that can grow inside the nasal cavity or paranasal sinuses and destroy healthy tissue. They usually have a bumpy surface. Papillomas are not cancer, but sometimes a squamous cell carcinoma will start in a papilloma .Republic of CUBA is trying to cure these carcinomas. Different drugs are given in CUBA and 24 hour observation of a patient is done.
Treatment by Cuba health centre.
The Republic of Cuba is in the forefront in battling these cancers. Cuba is taking measures to stop these carcinomas. Available Treatments are surgery radiations and chemotherapy in combination with immunotherapy. The treatment is based on the stage of cancer and on the health of the patient.
The program is carried by guiding the patient properly and thoroughly. If the cancer has not metastasized and its size is small, we can do surgery and also can treat him through radiations. Some drugs will also be given .Chemotherapeutic agents will be given according to their effects and by keeping in mind the condition of individual because chemotherapeutic agents also destroy the normal cells. Treatment procedure is mostly same in all the cancerous patients. But it depends upon the severity and stage of cancer In CUBA by the following method we treat cancer
First of all a proper medical check-up is done .or we can say pre-application medical check-up is applied.
Anti-cancerous drugs are given.
These drugs include cyclophosphamide 200mg. This is a nitrogen mustard agent.it inhibits DNA function and its synthesis. It is given for breast cancer, ovarian cancer and chronic lymphocytic lymphoma. In republic of CUBA this drug is given with proper dosage and according to the condition, otherwise every drug has some adverse effects. This drug is given for 15 days and when further treatment starts.
Another drug which is given in republic of CUBA is NIMOTUZUMAB it is also called CIMAher EGF. It is given for head and neck cancers in combination with radiotherapy and chemotherapy. 24 Vials are given for 6 weeks treatment. It should be given with precautions otherwise nausea tremors and chills can develop.It is given in IV form.
The induction phase last six weeks corresponding to the 24 vials of the drug. The first dose will be given in republic of Cuba , and next dose he can take himself in CUBA or any other country.
There are many drugs available for the chemotherapy. These drugs are bortizomib imatinib, antimetabolites, vincristine, and etoposide. Each drug first dose is given in CUBA. Patient is monitored. If this drug found successful then second dose of the drug he can take himself.
Surgeries are also performed. That involves dissecting of the whole infected part. If less part is infected then a small part is dissected but mostly if small part is infected we took out large part even the whole part is not infected as a precaution.
These surgeries involve Total glossectomy semi glossectomy semi glossectomy partial glossectomy, trans maxillary glossectomy with neck dissection.
Total glassectomy : It is performed for the tongue .if whole tongue is affected whole tongue we be cut down so that the tumour does not metastasize. This is done in republic of CUBA with proper care.
Semi-glossectomy :It is the removal of half the tongue. This can also be done in republic of CUBA with proper care. If half tongue is not infected and other half is infected so we can perform partial dissection with proper care. We will cut half tongue if there is no chance of spreading this tumour to the other half.
Trans maxillary glassectomy with neck dissection. When cancer in the oral cavity is spread to the lymph nodes in the neck so removal of these lymph nodes is necessary because there are many lymph nodes are present in different sites of body. So cancer can spread to the different organs through lymph nodes which will be worst condition. Neck surgery is also performed in republic of CUBA. These include partial and modified neck dissections. Radical neck dissections are also performed.in which few or all lymph nodes are removed. There are also some maxillary and larynx medical programs in republic of CUBA in which partial or full dissection of the affected region is performed.
So CUBA is making a great progress in the treatment of cancer.
Cuba had the honor to host the first international conference regarding autism and inclusion in 2013. Island’s extraordinary efforts to understand, recognize and manage the condition in it’s early stages highlight the prestige and excellence of Cuba’s autism management. Cuban physicians represent global subject-matter-experts in the field of autism spectrum disorder (ASD). Cuba strives to find the best possible solutions for individuals suffering from ASD through the development of specialized ASD centers that focus on ASD treatment and inclusion of families within the society – of course, absolutely cost-free.
ASD represents a complex condition requiring multidisciplinary approach – a burden for profit- based healthcare systems. The fact that the management of ASD has been assessed as costly best illustrates the difficulties of western systems to properly address the issue of growing incidence of ASD. Waiting lists, inefficiency, high prices are the characteristics of profit-based healthcare systems that often result in inadequate management of those requiring prompt and intensive treatment. Cuba has developed a sustainable program for the management of individuals suffering from ASD focused on meeting the needs of each child.
Cuba offers a carefully tailored program for individuals suffering from autism spectrum disorder (ASD). The main goal of this program is to improve the child’s learning capabilities and reduce the symptoms of ASD. Overall, the program aims to boost the development capacity of each child with ASD. As a result, a visible improvement is seen in the child’s physical and mental abilities, due to the specific nature of the program design that is specifically tailored to meet the needs of each child individually. The program offers a peaceful and comfortable treatment environment and expert medical attention, which is very relevant for achieving the favorable treatment outcome. The facility is equipped with services and amenities such as cable TV, internet, pool, sauna, gym, pharmacy, and laundry services.
The program duration is 38 days. During this period, a set of activities is performed that may be divided into two main stages – evaluation and treatment. A detailed description of each phase is given below.
Stage 1 – Evaluation
During the evaluation phase, the information regarding the ASD nature of each child is obtained through consultation with specialists, laboratory and clinical investigations, as well as specific assessments necessary for evaluation and staging of the disease.
The initial steps in the evaluation phase include consultations with the team of experienced specialists in order to plan and tailor the comprehensive treatment and rehabilitation program for each child. This includes assessments performed by pediatricians, neuro-pediatricians, child psychologists, genetics specialists, logophobia specialists as well as otorhinolaryngologists. Furthermore, detailed laboratory investigations are required for disease evaluation and assessments. Biochemistry panel includes measurements of urea, creatinine, serology investigations, urine metabolic testing, complete blood count, sedimentation rate, blood glucose level, including but not limited to liver function tests.
Following initial testing, complex assessments are performed in order to get the clear picture regarding disease nature and severity. The assessments are performed by highly experienced subject-matter-experts and include logopedic evaluation, neuropsychologic assessment, Brunet-Lezine scale evaluation, as well as psychotherapy assessment and evaluation. Additionally, during the assessment period imaging studies may be performed such as brain MRI, evoked potential studies, EEG etc.
Once all the information has been gathered and a treatment plan has been tailored, the findings and possible management options are discussed with the family. The duration of this phase is dependable on the nature of the underlying disease as well as the child’s abilities to adapt to the new environment. Approximately, it takes no longer than 10 days in order to complete the evaluation and tailor the specific treatment.
Stage 2 – ASD Management
ASD represents a complex disorder requiring multidisciplinary and individual treatment approach for each child. This program offers multiple treatment modalities including equine therapy, sensorial stimulation techniques, occupational therapy, language therapy, ozone treatment as well as trans-cranial electric stimulation, which has been proven useful in hyperkinetic patients. Treatment is conducted by highly experienced experts with the constant involvement of parents. The focus is on speech therapy that lasts for 20 days and involves both therapists and parents. This treatment modality lasts approximately 20 days and is conducted each day excluding Sundays and public holidays. Depending on the child’s ability to accept the treatment approach, initial sessions may last from 20 minutes to one hour. Protocol for conducting the therapy is tailored based on the individual characteristics of each child. It is strongly advised for the child to continue this treatment approach at home, once the language therapy is finished since this will ensure the long-lasting results in the future.
Occupational therapy will last approximately 30 days where the intensive treatment will aim to reduce neurological, mental and physical barriers of each child with ASD. This program allows a child to develop and maintain self-care activities, increases the overall productivity and enables a child to participate in leisure activities. The intensive treatment protocol is comprised of two treatment sessions during the day (in the morning and in the afternoon) approximately lasting for an hour or longer. The responsiveness of a child is stimulated by various methods including images projection, object identification, interactive and didactic games, palpation exercises as well as equine therapy.
At the end of each treatment, a detailed report is issued to parents with all of the activities performed at the site including detailed expert recommendations for further treatment and rehabilitation.
CubaHeal Medical is a global organization specialized in facilitating medical treatments, medical education, in addition to patient and student care in the Republic of Cuba. CubaHeal is a loyal supporter of the Republic of Cuba, the Cuban people, the Cuban revolution, and the Cuban revolutionary leadership.