Cancer is clearly the deadliest disease known worldwide as it is the second leading cause of deaths globally with an estimated prevalence of one in three people developing cancer during their lifetime .
The term Cancer defines a large group of diseases that can affect any part of the body; the pathological mechanism of cancer is the transformation of normal healthy cells that become abnormal and proliferate excessively. These disordered cells eventually form a mass called malignant tumor. Cancer cells tend to invade nearby tissues and become detached from the tumor. They then migrate through the blood vessels and lymphatics to form another tumor (metastasis).
The most commonly diagnosed cancers in the world are lung, breast and colorectal cancer AND The most common deaths are caused by lung cancer, stomach and liver cancer.
The definitive cure for cancer still does not exist nowadays and we can also say that the cancer response will never come from a single miracle pill , but complete remission has been achieved in many cases in response to various treatments.
treatment of cancer requires having a diagnosis of certainty and knowing the type of cancer; evaluation of local and regional extension and the presence or absence of metastases with assessment of the general condition of the patient (age, cardiac and renal function, presence of other diseases).
The classic cancer therapies include surgery, radiation and chemotherapy that aim to remove cancer cells surgically and destroy them by toxic chemicals that are also toxic to normal cells as well, these classic therapies rarely succeed to eradicate every single cancer cell, so even if few cancerous cells survive the therapy, they can proliferate again and produce a relapse of the disease few months or years later
Cancer treatment definetly changed over the last decades with the emerging of new strategies based on better understanding of cancer cell biology , these new therapies include : antibodies ,viral therapy and antiangiogenic drugs that stop tumors from growing new blood vessels
one leading research in the treatment of lung cancer, which is one of the deadliest cancers, is the CimaVax-EGF: a vaccine used to treat patients with lung cancer and as a preventive measure for people at high risk of suffering from this disease. At present, this drug is available in the country’s hospital network, and it has been registered in several countries.
With Trials organized in the United States, the European Union, Japan, and Serbia that showed increased a chance of survival.
CIMAvax is based on a unique mechanism because it starves cancer cells : It does not target the cancer cells directly, but is expected to work against these cancers by denying the cancers the growth stimulus they require.
In addition, Cuban scientists have just completed their research on two other promising cancer drugs: Racotumomab and VSSP. The first acts on a molecule present in all cancer cells, which means that this drug may one day be effective against leukemia and tumors of the lung, breast, prostate and colon, while the VSSP, designed to Originally as a compound to activate the immune response to vaccines, it also seems to stimulate the immune response to cancer.
Nimotuzumab is also used to treat many types of head and neck cancers, including those that form on the mucous surfaces of the mouth, nose, brain and nasopharynx. This drug can bind epidermal growth factor receptors in cancer cells, preventing them from dividing and spreading.
Epidermal growth factor receptor (EGFR) is a key target in the development of cancer therapeutics, it is a signaling protein that normally controls cell division. In some cancers, this receptor is altered to cause uncontrolled cell division, a hallmark of cancer, nimotuzumab works by blocking that receptor and eventually it stops the uncontrolled cell division.
Cuban Approach to Cancer Treatment:
Cancer is one of the leading causes of death in Cuba. This is partly due to longer life expectancy but also to the adoption of unhealthy lifestyles. Too many people abuse alcohol, have an unbalanced diet and consume tobacco
To cope with this situation, Cuba has followed the recommendations of the World Health Organization and has put in place a comprehensive national plan that guarantees access to all levels of health services – prevention, diagnosis, treatment and palliative care. The plan builds on a strong primary care system that allows physicians to see their patients regularly and detect health problems early. Patients suspected of having cancer are referred to specialized centers for diagnosis and appropriate treatment.
To support this approach, the government has invested heavily in biotechnology. In recent years, Cuban scientists have made tremendous progress in finding new treatments for cancer and new tools to improve diagnosis and prevention.
Early detection of cancer remains the ultimate treatment option: Screening in both healthy and high-risk populations offers the opportunity to detect cancer early and with an increased opportunity for treatment and curative intent
Screening for the identification of cancer or precancerous lesions at an early stage of its development greatly increases the chances of successful treatment. It is based on screening, but also on the education of patients with early diagnosis, when it comes to early detection of cancer awareness is the most important factor, some early signs of cancer include lumps, sores that fail to heal, abnormal bleeding, persistent
indigestion, and chronic hoarseness. Certain types of cancer are accessible to simple tests that identify, in a healthy population, subjects who have cancer but do not yet have symptoms. This is particularly the case with breast, colorectal and cervical cancers.
Cuba is at the forefront of orthopedic surgery, continuously evolving, creating new surgical techniques, designing medical devices, and improving patient’s quality of life. Hospitals in Cuba adhere to a strict conduit of hygiene, while also providing patient-center medical care. Due to the high standards of professionalism and efficiency that hospitals and medical staff uphold. Cuba attracts over 25 000 medical tourists each year.
Cuba has brought numerous innovations in the field of Orthopedics and Traumatology over the years, from which the entire world has benefited. Cuba has contributed to numerous advancements in joint replacement surgical techniques, As well as the development of more durable and efficient joint replacement prosthesis.
Total Hip Replacement Surgery
The primary indication for total hip replacement surgery is to relieve pain caused by severe osteoarthritis, inflammatory arthritis and avascular necrosis of the femoral head. Secondary indications include correction of significant deformities and post-traumatic reconstruction. Joint replacement is considered when the pain is disabling and significant or in cases in which joint dysfunction is causing significant reduction in the patient’s quality of life.
The surgery implies removing the damaged joint and replacing it with an artificial prosthesis. The artificial hip joint replacement has traditionally been made with cemented polyethylene cup implants.
However, Cuba has advanced to using “cementless” prostheses. These particular prostheses have microscopic pores which allow bony ingrowth from the normal femur into the prosthesis stem. This “cementless” hip is felt to have a longer duration and is considered especially for younger patients. The prosthesis can also be customized acording to the patient’s needs and anatomy.
Cuba has pioneered the surgical technique for cementless hip replacement surgery that is currently being used world-wide. Although many varieties of these specialized prostheses now exist; the most used model in Cuba is a prosthesis made of metal and polyethylene covered with hydroxyapatite , which is the main mineral component of bone , obtained naturally from coral and also synthetically in the laboratory. It is produced at the National Scientific Research Center, part of the west Havana scientific complex.
Advances in hip replacement surgery have also allowed for a „minimal invasive” surgery technique to be developed. The classical hip replacement surgery technique implies making an 10 to 25 cm cut along the side of the hip. In the minimally-invasive approach, doctors make one to two cuts from 5 to 13 cm long. The same procedure is performed through these small incisions as with standard hip replacement surgery. The aim of the minimal invasive approach is to limit soft-tissue and bone dissection.
Specialized instruments and trained assistants are essential for the success of this technique. The instruments are designed to keep the assistant’s hands out of the operative field while generating less tension on the soft tissues. Robotic or computer guidance can be used to virtually visualize the minimally exposed anatomy.
The use of small incisions, coupled with minimal tissue damage has been shown to lessen blood loss, ease pain following surgery, shorten hospital stays, reduce scar appearance, and speed healing. Moreover, 97% of patients attained standard physical therapy goals (transferring in and out of bed from standing, rising from a chair to standing, moving from standing to sitting, walking 100 feet, and negotiating a full flight of stairs) within 1 day of surgery.
While the technique is certainly an advancement in hip replacement surgery; it is difficult and requires highly trained medical team. Smaller incisions mean poor visibility of the area. Surgeons need to have excellent understanding of the anatomy of the region and have access to specialized hands-on training by operating on cadavers and by visiting experienced surgeons.
Specialized instruments and trained assistants are also essential for the success of this technique. The instruments are designed to keep the assistant’s hands out of the operative field while generating less tension on the soft tissues.
Total Knee replacement surgery
The primary indication for total knee replacement surgery is relief of significant, disabling pain caused by severe arthritis. Generally, it is indicated in older patients with more modest activities. It is also clearly indicated in younger patients who have limited function because of systemic arthritis with multiple joint involvement.
Significant advances have occurred in the type and quality of the metals, polyethylene, and, more recently, ceramics used in the prosthesis manufacturing process, leading to improved longevity. As with most techniques in modern medicine, more and more patients are receiving the benefits of total knee arthroplasty. In Cuba, an average of 140 total and revision knee replacement surgeries per 100.000 population are performed annualy.
For total knee replacement surgery Cuba now uses the KALISTE prosthesis model, manufactured by the French company FHorthopedic. Kalisté Total Knee System is a tricompartmental resurfacing prosthesis that allows the surgeons to begin the knee replacement surgery with either the tibial stage or the femoral stage. This prosthesis can be customized to the patient’s anatomy and has been designed to admit posterior cruciate ligaments PCLretaining or posterior stabilized PS Knee prosthesis.
The use of this knee replacement prosthesis coupled with the excellent surgical techniques that Cuban surgeons employ have led to excellent success rates. Statistics show that 91% of patients that have undergone the technique attained standard physical therapy goals within 2 day of surgery.
In addition to providing excellent medical care, Cuba has extremely affordable prices for various orthopedic surgeries, including total hip and knee replacement. A standard that should be upheld all over the world as medical care is a right, and not a privilege.
The Cuban biotechnology industry is known worldwide. The human and veterinary vaccines, bio-products, drugs, diagnostic means and monoclonal antibodies created by brilliant scientists, in top-level facilities, place Cuba as one of the developing nations, together with India and Brazil, with more advances in this sector.
The Bio Cuba Pharma Business Group, one of the most economically powerful in the country, is responsible for leading the biotechnology and pharmaceutical industries. This organization has registered products and exports to more than 50 countries, has 1,800 patents abroad and its annual income exceeds 2,000 million dollars. Among the institutions attached to the huge Group, which employs more than 22,000 workers, are the Center for Genetic Engineering and Biotechnology (CIGB), the Center for the Production of Laboratory Animals (CENPALAB), the National Center for Biopreparations (BIOCEN), the Center of Immunoassay and the Center for Molecular Immunology (CIM).
What are the medications, made in Cuba, with the most international prestige? Pan American World proposes to approach five creations, unique in the world, born of the brilliance and long years of research by Cuban scientists.
HEBERPROT-P, THE BEST TREATMENT FOR DIABETIC FOOT ULCERS
According to the World Health Organization, some 300 million people suffer from diabetes, and of these, between 15% and 35% may suffer amputation of one of their extremities. The Cuban drug Heberprot-P, the only one of its kind in the world, has been able to reduce amputations by diabetic foot ulcer in Cuban patients more than four times. Born from the creative genius of a team of scientists, led by Dr. Jorge Berlanga, at the CIGB, the drug is used in more than 20 countries.The treatment includes injection into the affected area of the person and accelerates the healing process of the skin, so that the wound would be closed in a period of approximately three months.
The chances of survival for people diagnosed with lung cancer at an advanced stage are very low; However, with CimaVax-EGF a new hope has appeared. This vaccine was created by researchers from the CIM who took 25 years to develop the product. The treatment slows down the growth of cancer cells and, therefore, prevents the disease from spreading throughout the body and thereby prolongs people’s lives. The scientists clarify that it is not a preventive vaccine, but therapeutic, although it has also been used in those with higher risks of suffering from the disease.
The CIM also developed the VAXIRA vaccine (known as Racotumomab) that works on a molecule found in all cancer cells. Scientists hope that, in the future, the drug may be effective against leukemia and other tumors that accompany lung, colon, prostate and breast cancers.
CimaVax-EGF caught the attention of scientists from the Roswell Park Cancer Institute in New York who continue to evaluate the possibility of taking this medication to the United States, which would be a milestone, because the Washington Blockade has prevented access to Cuban inventions.
POLICOSANOL (PPG), A NATURAL PRODUCT TO LOWER CHOLESTEROL
This drug, made from the wax of sugar cane, is used mainly to lower cholesterol, although the product also has other applications, since its antiplatelet, anti-ischemic and antithrombotic effects have been demonstrated; In addition, some take the medication because they consider that it invigorates the male genital tract. The PPG, being natural, has few contraindications, unlike what happens with other drugs on the international market for cholesterol.
Venezuela is one of the biggest consumers of PPG and Cuba also markets it in Serbia, Slovakia and Spain, among other nations.
VA-MENGOC-BC, VERY EFFECTIVE VACCINE AGAINST MENINGOCOCCI B AND C
During the 80s of the last century, Cuba suffered an outbreak of meningococcal disease. The scientists worked intensely to find a solution and the Finlay Institute of Havana created VA-MENGOC-BC, a bivalent vaccine composed of meningococcal B outer membrane vesicles and meningococcal C capsular polysaccharide. It is currently the only commercially available drug in the world that attacks meningococci B and C.
In Cuba, more than 60 million doses of the vaccine have already been applied. The drug has proven to be very effective and with a high safety profile, as recognized by the World Health Organization.
NEUROEPO, A MEDICATION TO SLOW THE PROGRESSION OF ALZHEIMER’S
Population aging is one of the biggest problems facing Cuba. Currently, Alzheimer’s is the sixth cause of death in the country, among people over 60 years of age and, by 2040, this disease could affect 2.7% of Cubans. Today, more than 35 million people in the world have Alzheimer’s and there is no medication that is able to cure or stop its progression. In this context, the CIM scientists created a drug, called NeuroEpo, that delays the expansion of this disease.
“It would be the first time it is used on people and we have to wait for the results. This compound does not prevent Alzheimer’s disease, nor does it eliminate it, but the preclinical results are encouraging in that it could help to change the course of the disease, that is, slow down the deterioration that the patient inevitably suffers. Alzheimer’s is a neurodegenerative disease without regression, she will move forward. What we want is to help delay this degenerative process and improve the quality of life of that person, and of the family, “acknowledged CIM researcher Leslie Pérez Ruiz.
Cuban scientists are working on a clinical trial with Heberferon, which acts on renal carcinoma and in patients with malignant brain tumors.
Since you’re reading this article, the chances are, you are thinking about assisted living or nursing home care facility for the beloved elderly in the family. The decision is not easy- standards of care and prices across different facilities vary a lot. Also, no matter how cheap they claim to be, they’ll still put tremendous strain on your budget. Nevertheless, you would compromise on the price for the sake of higher quality of care. And finally, the decision comes with a sense of guilt. It’s normal, and it’s ok.
This article aims to give you a new idea, a different perspective, and solution that will put you at ease, so keep reading! The future is brighter than it might seem at the moment.
Today, about 2.5 million people in the US use services of assisted living and nursing homes. According to the statistic, the number of users by 2050 is going to triple. Longer life expectancy, growing population, improvements in healthcare quality, and availability did its thing- the population of elderly grows at a staggering rate. They need a kind of care that overgrows the capabilities of the family home surrounding. Some are dealing with physical disabilities that require expensive home modifications to maintain normal daily functioning. Others suffer conditions that require the use of specialized medical equipment and procedures. This is where assisted living and nursing homes come into play.
Assisted Living VS. Nursing Home Care- the Cuban way
Just like its name says- residents in assisted living need a helping hand in everyday activities. Someone to take care of their diet, personal hygiene, or maybe help them get into and out of a vehicle.
On the other hand, Nursing Home Care is for people whose health is severely impaired so they cannot take care of themselves or function normally without specialized healthcare.
The World Health Organization defines health as not only the absence of disease but a state of physical, social, and mental well-being. That is precisely what we do on Cuba- help our users to achieve an as healthy lifestyle as possible, giving the limitations of their health impairment.
The Cuban program offers these two major categories of care. However, there are many shades in between. Since no two humans are alike, flexible, and individually tailored integrative approach is what we offer. After the Initial Needs Assessment that includes consultations with doctors of various medical specialties and comprehensive medical examination, we make the program that fits the user’s needs the best way.
You can find more info about the whole procedure of admission at the end of this article.
Additional healthcare costs
Our assisted living and nursing home care facility provides medical services to a certain extent. If needed, our staff coordinates the appointment of the users to a closest hospital or outpatient clinic. The expenses of the hospital stay and medical treatments carried out there are not included in the price of our program. However, with the medical support we provide at the facility, such situations are rare and prices of medical treatments on Cuba is at least half the price compared to the US.
How much assisted living and nursing homes cost across the US – Why Cuba?
According to the American Seniors Housing Association, the median price for a one-bedroom apartment in the assisted living in 2017 was $48,000 annually, with a projection of 3% price increase over a five-year period. Depending on the part of the US, annual expenses of assisted living can go up to $72,000 (NY).
Nursing homes are even more expensive throughout the US – median monthly price for a private room is $8,121 with a projection of 13% price increase over a five-year period. Depending on the part of the US, monthly expenses of nursing home care can go up to $12,927 (NY).
The good news is – treatment costs and our program prices are just a fraction of the price throughout North America
Cuba has been internationally renowned for its high-quality medical care at affordable prices. According to the Association of Caribbean States, the number of people from North America seeking for medical help in Cuba skyrockets every year- from 3,500 foreign patients in 2001 to 20,000 in 2005. The trend of medical tourism in Cuba kept growing up to this day. The list of available interventions is quite long- from minor fixes such as dentistry to major surgical procedures such as hip replacement.
Generally speaking, the bigger the intervention, the higher the price discrepancy between Cuba and the US is. The prices are at least 50-80% lower than those in the US; for some procedures, patients pay 3-5 times less than in the US.
Can you rely on the Cuban healthcare system?
Numbers show that Cuba matches first-world health statistics. The primary healthcare in Cuba operates through more than 450 outpatient clinics, which makes it one of the most proactive healthcare systems in the world.
Back in 1985, Cuba pioneered the vaccine against meningitis B. Since then, the country’s scientists developed medical treatments of unmatched efficacy in the world of medicine. Hepatitis B, diabetic foot, psoriasis, vitiligo, and lung cancer are just some of the conditions whose prognosis and treatment outcomes improved thanks to Cuba.
In 2015 WHO recognized that Cuba is the first country in the world to eliminate HIV and syphilis transmission from mother to child.
Airplane tickets to Cuba – it’s easier to get here than you might think
Arriving in Cuba is not expensive- depending on where you’re located in North America the ticket price ranges from $200 to $450, and the flight time ranges from 1h30min (from Miami) to about 4h (from Toronto).
Our assisted living and nursing care home can organize pick off and drop out to the airport. We take care of our users and their families from the moment they touch the soil of Cuba until they leave (transportation, correspondence with authorities, and all other necessary logistic support).
We look forward to hearing from you soon!
If you have any questions or you need additional info about the program, feel free to reach out to us (link to contact form and links to the programs)
Medical Tourism In Cuba Is Becoming Increasingly Popular
Why are so many US and other nations becoming so interested in Cuba’s medical tourism? Well Cuba has well trained doctors and nurses and excellent health facilities and that these facilities are funded by their government. This type of funding is vital to the medical facilities to ensure excellent care to their patients.
Cuba’s medical facilities are well equipped for all kinds of medical treatments and their doctors and medical staff charge a fraction of the cost than a regular medical facility. This is another huge factor why medical tourism is becoming more popular in this island.
Another reason why Cuba’s Medical tourism is rising. Cuba’s doctors are well versed in all types of medical conditions that can arise which makes it even more desirable to come to Cuba for medical care. The only issue for US citizens is that the US has more rules that its citizens have to follow. For instance they can go and visit Cuba but they have to follow rules that the government provides. US citizens also may be audited as to their visit in Cuba so they have to keep a strict record of why they were there.
Other countries like Canada for instance don’t have this restriction like US citizens do, so they can go and receive medical treatment. Tourism in Cuba is becoming more popular among other countries because of their affordable medical care and if needed surgical care.
There are medical professionals in the US that are hoping that these regulations will be waived so that their patients can receive excellent care and treatment. So far the negotiations towards that are looking to become more favorable which will help Cuba be able to fund more of their doctors salaries to further help cuba’s health tourism.
There is a website that can help with the pricing of cuba’s medical tourism. Cuba offer all kinds of packages so that choosing the right one that fits within your budget is attainable and desirable. health tourism in Cuba helps with them being able to give their doctors and staff a more stable income and that in turns helps Cuba out immensely.
Cuba’s medical tourism is a great asset to those that are needing specific healthcare. Cuba’s doctors have a more hands on approach to help their patients achieve their long term goals, which is great let’s say for an addict to overcome their addictions. The medical tourism in the republic of Cuba is gaining more notoriety and popularity among other countries.
Is medical tourism a good thing for Cuba? The answer is yes. The more popular it is becoming the more of an asset medical tourism is to Cuba. The more money that Cuba gains for their doctors, nurses and medical centers the more funding they can get for their patients as well. Medical tourism is really good for Cuba. It will help achieve more revenue and prove that their medical care is exceptionally great for everyone.
<div class="at-above-post-cat-page addthis_tool" data-url="https://www.cubaheal.com/2018/01/27/2018-1-27-interviews-from-havana/"></div><p style="white-space: pre-wrap;">Cuba is well known for its world class health-care, but also for its scientific research in the field, in places such as the Molecular Immunology Center, which develops new products to diagnose and treat cancer. Such institutes are also now profitible ventures for the island nation.</p><!-- AddThis Advanced Settings above via filter on get_the_excerpt --><!-- AddThis Advanced Settings below via filter on get_the_excerpt --><!-- AddThis Advanced Settings generic via filter on get_the_excerpt --><!-- AddThis Share Buttons above via filter on get_the_excerpt --><!-- AddThis Share Buttons below via filter on get_the_excerpt --><div class="at-below-post-cat-page addthis_tool" data-url="https://www.cubaheal.com/2018/01/27/2018-1-27-interviews-from-havana/"></div><!-- AddThis Share Buttons generic via filter on get_the_excerpt -->
<div class="at-above-post-cat-page addthis_tool" data-url="https://www.cubaheal.com/2017/09/28/2017-9-28-nimotuzumab-cimaher-summary-of-product-characteristics/"></div><p style="white-space: pre-wrap;">The recommended dose of CIMAher® is 200 mg given once a week for 6 weeks concomitant with radiotherapy and / or radio-chemotherapy. Subsequently, dose of 200 mg every 15 days (maintenance dose) until the general condition of the patient allows it.</p><!-- AddThis Advanced Settings above via filter on get_the_excerpt --><!-- AddThis Advanced Settings below via filter on get_the_excerpt --><!-- AddThis Advanced Settings generic via filter on get_the_excerpt --><!-- AddThis Share Buttons above via filter on get_the_excerpt --><!-- AddThis Share Buttons below via filter on get_the_excerpt --><div class="at-below-post-cat-page addthis_tool" data-url="https://www.cubaheal.com/2017/09/28/2017-9-28-nimotuzumab-cimaher-summary-of-product-characteristics/"></div><!-- AddThis Share Buttons generic via filter on get_the_excerpt -->
<div class="at-above-post-cat-page addthis_tool" data-url="https://www.cubaheal.com/2017/09/12/2017-9-12-hurricane-irma-updaterepublic-of-cuba/"></div><p style="white-space: pre-wrap;">We would like to post the following update regarding the status of our field team and the restoration of essential services in the city of Havana, as well as other areas throughout the Republic of Cuba.</p><!-- AddThis Advanced Settings above via filter on get_the_excerpt --><!-- AddThis Advanced Settings below via filter on get_the_excerpt --><!-- AddThis Advanced Settings generic via filter on get_the_excerpt --><!-- AddThis Share Buttons above via filter on get_the_excerpt --><!-- AddThis Share Buttons below via filter on get_the_excerpt --><div class="at-below-post-cat-page addthis_tool" data-url="https://www.cubaheal.com/2017/09/12/2017-9-12-hurricane-irma-updaterepublic-of-cuba/"></div><!-- AddThis Share Buttons generic via filter on get_the_excerpt -->
<div class="at-above-post-cat-page addthis_tool" data-url="https://www.cubaheal.com/2017/08/14/2017-8-14-why-cuba-stands-tall-in-the-field-of-orthopedics/"></div><p style="white-space: pre-wrap;">Cuba has a countless number of Orthopedists who are keen on treating patients. So, this can be your next possible destination to cure your musculoskeletal disease. Most of Americans and Canadians go to Cuba to treat their problems as Cuba has become very popular in the field of Orthopedics.</p><!-- AddThis Advanced Settings above via filter on get_the_excerpt --><!-- AddThis Advanced Settings below via filter on get_the_excerpt --><!-- AddThis Advanced Settings generic via filter on get_the_excerpt --><!-- AddThis Share Buttons above via filter on get_the_excerpt --><!-- AddThis Share Buttons below via filter on get_the_excerpt --><div class="at-below-post-cat-page addthis_tool" data-url="https://www.cubaheal.com/2017/08/14/2017-8-14-why-cuba-stands-tall-in-the-field-of-orthopedics/"></div><!-- AddThis Share Buttons generic via filter on get_the_excerpt -->
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.