On May 23, Tuesday, Cuba marked the 60th anniversary of its global health assistance initiative, a program that has extended its solidarity to countries worldwide. This initiative officially commenced on the same date in 1963, when Cuba dispatched its inaugural medical brigade to Algeria, freshly freed from French rule, as France had withdrawn its medical staff following Algeria’s victorious independence struggle.

However, prior to this, a small contingent of Cuban doctors had been dispatched to Chile in 1960 in response to an earthquake that had occurred there.

From that point forward, the scope of Cuba’s health solidarity has experienced significant growth. Cuban healthcare professionals have offered their services to over three million people, performing over 16,000 surgical procedures in 165 countries. These professionals have bravely ventured into perilous areas where even local doctors and healthcare workers have been apprehensive to approach, including regions affected by cholera outbreaks and the fearsome Ebola epidemic in Africa. It’s approximated that through this global healthcare initiative, Cuba has helped save over eight million lives globally.

Various countries, primarily in Latin America, Africa, Asia, and the Caribbean, owe a great debt of gratitude to Cuba for this priceless assistance. Currently, 22,632 Cuban health professionals are serving in about 57 countries. Alongside the Cuban health workers stationed in St Vincent and the Grenadines, seven specialists have recently arrived from Cuba to assist with the setup and operation of new MRI equipment at the Modern Medical Complex in Georgetown.

Despite these humanitarian efforts, the United States has criticized this assistance, labeling it as “human trafficking”. It’s a unique case of alleged “trafficking” that has, paradoxically, saved countless lives and provided medical care to those who otherwise would not have access to it.

I had read about the pediatrician who was part of the brigade of 32 healthcare professionals who traveled to Turkey on February 11^th to provide medical assistance to those affected by the violent earthquake that struck that country and Syria earlier that month. It was not difficult to identify her among her companions, not only because of the affectionate and heartfelt greeting that the Cuban Minister of Health, Dr. José Ángel Portal Miranda, greeted her with, as is his custom, but also because of her youth and her excited face during the official reception of the brigade. A few minutes later, I was able to speak with her:

“An experience like this tests you in every way, the professional part, as a doctor; the human part; the physical part, it is very strong. It is a beautiful experience, but strong and grateful to have been able to participate in the mission, grateful to have been able to go to help the Turkish people who were in very bad conditions, there in the city where we arrived.”

“And it touches each one of us because it is one thing to go to work as a doctor and it is another thing to see the conditions in which these people live, the conditions in which you treat these people, often for days without medical care, since the earthquake itself, people who have lost a lot, lost family members, lost material goods. Above all, they are people with an enormous human quality, in spite of the situation in which they lived, they always showed gestures of affection, of gratitude, of humility. They gave us what little they had, often without having anything, and this was evident from the highest officials to the people with the lowest cultural level, it was shocking but really beautiful,” she added.

“Children who lived in tents, who had lost their families, children who had only one neighbor, one relative, it is hard, it is very hard. Many times I had to take care of them in tents, in their homes, people who had pitched their tents on the edge of the collapse of their homes, who had lost practically everything, it is hard, hard, hard. And the children’s part even more so when you come across these cases”.

“I had no experience outside of Cuba, my professional experience had always been in the country, and this was a school in every way, you could say, a wonderful experience, but also a school”.

“The most striking thing was the Turkish people’s knowledge of Cuba, their gratitude to the Cuban people. For them to mention Cuba, to tell them that you are a doctor, to tell them that you are a Cuban doctor, is something enormous for them. The children, the elderly, the doctors, the nurses, the health workers, everybody was very grateful to us at all times, and without their help we would not have been able to do the work, because of the language, because of the terrain. We were really able to work hand in hand with them, and I think it was partly because of this affection, this appreciation, this knowledge that they have of Cuba. They love Cuba, they love the Cuban people.

These were the words of Dr. Alemy Paret Rodríguez, a first-degree pediatrician and teacher. Unbeknownst to this journalist, she works at the Roberto Rodríguez Teaching Hospital in Morón, the city where she lives. The surprise when I arrived from Turkey was that that morning I would be interviewing a beautiful doctor of whom I already had references, but without knowing that we were compatriots. Morón in Turkey.

When asked what she planned to do, she replied with the same honesty as in the previous questions: “Rest, I need to rest, go see my family, I haven’t seen them for a month, and most of all rest, I need to rest.

Ministry of Public Health of Cuba
Medical Collaboration
Medical Collaboration
The Modern Poetry (La Moderna Poesía) – Morón, Cuba
People from Morón – Cuba.

Surgical myocardial revascularization is the most frequent cardiac intervention and one of the greatest achievements in surgery. It consists of bypassing the blood flow through native coronary arteries with high-grade stenosis or occlusion that cannot be solved by angioplasty with the introduction of an endovascular prosthesis. 

Cardiovascular diseases can manifest itself in many forms: high blood pressure, coronary artery disease, valvular disease, stroke and arrhythmias. 

Major risk factors for cardiovascular disease include: 

• High blood pressure; 

• High cholesterol; 
• Diabetes; 
• Obesity and overweight; 
• Smoking; 
• Sedentary lifestyle; 

• Genetic diseases; 
• Age; 
• Alcoholism. 

Stress is considered a contributing factor to cardiovascular risk, as stressful situations increase heart rate and blood pressure, increasing the heart’s need for oxygen. At times of stress, the nervous system releases more hormones causing blood pressure to rise, which can damage the inner lining of the arteries. Stress also increases the concentration of clotting factors in the blood, which can lead to the formation of a blood clot. 

Procedure: 

The traditional surgical myocardial revascularization consists of a thoracotomy through a midline sternotomy. A pump must be used to maintain extracorporeal circulation between the heart and lung, which allows the heart to be stopped and emptied of blood in order to achieve maximum surgical exposure and facilitate the completion of vascular anastomoses. Stopping the heart also significantly reduces myocardial oxygen demand. 

Before starting cardiopulmonary bypass, the patient must receive a very high dose of heparin to prevent clotting in the circuit through which the blood will circulate out of the body. The aorta is then clamped and the heart is stopped with an injection of cardioplegic solution which also contains substances that help myocardial cells tolerate ischemia and reperfusion. The patient’s temperature is also reduced by a pump-dependent mechanism to achieve the same ends. 

Once the vascular anastomoses are completed, the aorta is unclamped, allowing perfusion of the coronary arteries with oxygenated blood, which restores cardiac activity. Heparin anticoagulation is reversed with protamine. Despite cardioprotective measures, stopping the heart is not without risk; these events are treated with conventional measures, such as pacemaker placement, defibrillation, and administration of inotropics. 

Complications: 

The main complications and disadvantages of traditional myocardial revascularization are: 

• Sternotomy; 
• Extracorporeal circulation. 

The median sternotomy is fairly well tolerated, however it takes 4 to 6 weeks to heal. Infections of the incision can cause mediastinitis or sternal osteomyelitis, which can be very difficult to treat. 

Extracorporeal circulation causes several complications, such as: 

• Hemorrhage; 

• Organ dysfunction; 
• Neuropsychiatric effects; 
• Stroke. 

Post-pump bleeding is a problem caused by a variety of factors, including hemodilution, heparin use, platelet dysfunction generated by pump exposure, disseminated intravascular coagulation, and induced hypothermia. 

Organ dysfunction may be due to a systemic inflammatory response caused by the heart-lung machine. This response may cause organ dysfunction in some system or apparatus such as the lungs, kidneys, brain, among others.  

Other frequent complications related to surgical myocardial revascularization include: 

• Focal myocardial ischemia; 
• Global myocardial ischemia; 
• Arrhythmias. 

The mortality rate depends mainly on the patient’s previous state of health, but the experience of the medical staff and the conditions of the institution are very important.  Newer techniques attempt to limit the complications of traditional surgical myocardial revascularization by: 

• Avoiding the need for cardiopulmonary bypass, i.e. surgical myocardial revascularization without a heart-lung bypass pump. This pump can be avoided in selected patients by means of techniques that allow the surgeon to revascularize the heart without stopping its beating. 
• Avoiding median sternotomy (minimally invasive myocardial revascularization surgery). This technique is somewhat difficult and may not be possible when several anastomoses must be performed, particularly when they involve vessels behind the heart.  

Coronary revascularization is a therapeutic intervention that, although not without risk, is fully established and therefore included in all treatment strategies for patients with coronary artery disease. 

You may need this procedure if you have a blockage in one or more coronary arteries. The coronary arteries are the blood vessels suppling the heart with oxygen and nutrients carried in the blood. 

When one or more of the coronary arteries become partially or completely blocked, the heart does not receive enough blood. This is called ischemic heart disease or coronary artery disease and can cause chest pain (angina). 

Coronary artery bypass surgery may be used to improve circulation to the heart, although  specialists usually first try to treat it with medication, dietary changes or angioplasty and stenting. 

Coronary artery disease is different for everyone. The way it is diagnosed and treated also varies. 

Recovery from surgery takes time and in some cases the full benefits may not be felt until 3 months after surgery. In most cases, patients who undergo coronary artery bypass surgery, the grafts remain open and work well for many years. It is recommended to take measures to reduce the risk of a relapse for example: 

• Not smoking; 
• Eating a healthy cardio diet; 

• Control arterial hypertension; 
• Control glycemia and cholesterol. 

Among the risks that a person may have for needing long-term cardiovascular surgery are high blood pressure, smoking, diabetes mellitus and dyslipidemia (elevated lipid levels).  

Risk factors: 

• High blood pressure; 

• High cholesterol; 
• Diabetes; 
• Obesity and overweight; 
• Smoking, alcoholism, drug addiction; 
• Sedentary lifestyle; 

• Inherited genetic diseases; 
• Age 

It is never too late to start improving your cardiovascular health. Some risk factors can be controlled but others cannot, but if you eliminate bad habits and start living a healthy lifestyle, you are likely to reduce your risk of heart disease.  

If you suffer from high blood pressure, obesity or any of the risk factors mentioned above, we recommend you to visit a specialist immediately so that you can prevent cardiovascular disease. CHMT offers you the possibility of accessing innovative medical methods through which you will be able to obtain a safe, effective and personalized treatment.