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. 

Cuba has a highly developed health care system, which can be compared to those of more industrialized countries. The Cuban health care system has many new and unique features. It is funded by the Revolutionary State and is based on the needs of the population rather than on financial solvency ratios. Medical and dental care is a constitutional right and patients are not charged for it. 

It is impossible to think of human life and health without the care of a nursing professional.  Nursing is part of the health sciences and encompasses the care of people of all ages, families, groups and communities, being sick or not, and in all circumstances. They are always on the front line in any situation involving a struggle for life, whether it is the birth of a baby, the care of a sick or injured person, the terminal condition of a person, or even in preventive health care. 

In Cuba, nurses play an essential role in the National Health System, since they provide their services at all levels of medical care. Their presence, for example, in primary health care enables to improve the functioning of services in all community clinics and polyclinics. 

They usually form a great team with the family doctor, and are often a great support for recent graduates or medical students, who are nurtured by their experience and skills. Nurses are trained in the country’s universities of medical sciences, in several faculties and at the National Public Health School, thus seeking to ensure their presence at all three levels of care. 

On the other hand, a large number of nurses are part of the Cuban healthcare professional brigades engaged in international missions in other countries and respond to the calls of brotherly peoples in need of medical attention. 

The Cuban nursing staff is recognized for their scientific and technical preparation and their dedication to work in primary health care in each locality, in hospitals, in health promotion and prevention campaigns and in international work. 

The world is currently facing a deadly and silent enemy. It is the SARS-CoV-2 virus, whose outbreak began in China in December 2019 and has already spread to 183 other countries, leaving almost four million people infected and more than 270,000 dead worldwide. In this context, our nurses have shown their compassion, courage and professionalism to face difficult situations. 

The scientific and technical development of nursing professionals in Cuba has allowed them to reach higher levels in the understanding of values, based on the evaluation of each patient as a starting point for their treatment, considering them not as an object but as a subject. This concept implies that the person is deemed as the most necessary and active element to be taken into account. 

Cuban nursing staff has always been characterized by a high level of response to different situations. Nurses graduated on the island have demonstrated their competence in the face of major health crises, showing their ability to act while maintaining high standards of professionalism. 

When it comes to excellence in health, Cuban nursing staff is a paradigm, playing an essential role in building resilient health systems. Throughout the world, and without leaving aside other health services, they were on the front line of the battle against COVID-19 and have been the soul of vaccination to prevent this and other diseases. As a service profession, but also of many challenges, dedication and altruism, the work carried out by nurses is fundamental to promoting health, preventing disease and sustaining patient care. With their daily work, Cuban nursing staff faces every crisis situation both in Cuba and in the rest of the world. 

The Largest Island of the Antilles is one of the countries with the biggest number of nurses in the world. In addition, they are qualified personnel, since most of them are specialists in emergency, community and maternal and child nursing. 

They have centered their training on the basis of full integration to work. This premise aims to train professionals who respond to the present and future needs of the country’s development. The nursing specialty is based on the theoretical knowledge and practical skills of the profession, from a holistic and integrative conception of the social factors of health, which are applied in the work from the community, in order to promote, maintain and restore health. 

Cuban nurses show their knowledge, judgments and technical skills and a series of attributes and attitudes in each treatment, in each patient. They are able to apply nursing procedures and protocols and at the same time, establish assertive interpersonal and interprofessional communication. 

Cuban nursing has been a determining factor in the training of health brigades, vaccination campaigns, analysis of health situations, confronting population aging, combating epidemics and viral diseases, and international collaboration. 

The Cuban nurses’ work has a social impact that lies in the fact that the technological development advances are used by this group of healthcare workers without losing the humanistic sense of the profession in the relationship with the patient, the family and all the personnel involved in the process. 

The Cuban nursing has unavoidable duties, primarily related to providing professional care of quality and excellence, based on a system of knowledge and evidence guaranteeing the efficacy and efficiency of its practice. 

Today Cuban nursing staff is a vanguard army, a symbol of love, hope and full consecration, as well as of high professionalism and ethics, which is recognized and loved by the whole world. 

Lung carcinoma is the leading cause of cancer-related death worldwide. In lung cancer, the healthy cell that becomes the tumor cell is in the epithelium lining the entire respiratory tree from the trachea to the thinnest terminal bronchiole. Symptoms may include cough, chest discomfort or pain, weight loss and less frequently hemoptysis (coughing up blood). Depending on the stage of the disease, treatment consists of surgery, chemotherapy, radiotherapy or a combination of some of these modalities.

Primary lung cancer is a cancer that originates from lung cells. It may start in the respiratory tracks that branch off from the trachea (windpipe) to ventilate the lungs (bronchi) or in the small air sacs of the lung (alveoli). Metastatic lung cancer is cancer that has spread from other parts of the body, most often from the breast, colon, prostate, kidneys, thyroid glands, stomach, cervix, rectum, testicles, bones or skin. Most patients do not see a doctor until they have the first symptoms and these vary depending on the stage of the disease. Diagnosis usually occurs because the tumor begins to interfere with nearby organs.

CAUSES:

The most important cause of lung cancer in about 85% of cases is smoking. The risk of lung cancer increases with combined exposure to toxins and smoking. Other risk factors include air pollution, marijuana use, exposure to carcinogens (asbestos, arsenic, nickel, chromates, among others). The risk of lung cancer associated with electronic nicotine delivery systems such as electronic cigarettes has not yet been determined, although it is believed that tobacco combustion products are the main carcinogens. Other causes also include genetic factors.

Respiratory epithelial cells require prolonged exposure to cancer-promoting agents and the accumulation of multiple genetic mutations before becoming neoplastic.

SYMPTOMS:

About 25% of lung cancer patients are asymptomatic and are detected mainly incidentally by chest x-ray. When symptoms begin to appear they are a consequence of the progression of the disease whether local, regional dissemination or metastasis. The manifestations of lung cancer generally depend on the stage of the disease. The initial stages are usually asymptomatic or with symptoms that can be confused with other diseases.

The most frequent symptoms are:

• Tiredness;
• Loss of appetite;
• Dry cough;
• Coughing up blood;
• Shortness of breath;
• Pain in bone structures;
• Other symptoms may arise from metastasis or invasion of tumor cells into the lymph nodes, bones, brain, liver and adrenal glands.

Lung cancer is classified according to what type of cells make up the tumor:

• Non-small cell lung cancer;
• Small cell or microcytic lung cancer. This is a very aggressive cancer that grows and spreads very quickly.

When the tumor is local it may cause cough and less frequently dyspnea due to respiratory track obstruction, post-obstructive atelectasis or pneumonia and parenchymal loss due to lymphangitic spread. In the case of pneumonia, it may present with fever. Some patients report vague or localized chest pain. Hemoptysis is less common, and blood loss is minimal, unless the tumor erodes into a major artery and causes massive hemorrhage, but as mentioned above hemoptysis only occurs in about 10% of patients.

When tumor spread is regional it can cause pleuritic chest pain or dyspnea due to the development of pleural effusion; hoarseness, resulting from tumor invasion of the laryngeal nerve; and dyspnea and hypoxia due to diaphragmatic paralysis, due to involvement of the phrenic nerve.

Over time metastases cause other symptoms that vary by location, metastases can spread to:

• Liver: causes pain, nausea, early satiety and even liver failure;
• Brain: causes behavioral changes, confusion, aphasia, seizures, paralysis, nausea and vomiting;
• Bones: can cause severe pain and pathological fractures;
• Adrenal glands: rarely with adrenal insufficiency.

Diagnosis is made through:

• Chest x-ray;
• Positron emission tomography;
• Cytopathologic examination of pleural fluid or sputum;
• Bronchoscopy-guided biopsy and core needle biopsy;
• Lung biopsy.

To determine the treatment for lung cancer, the size and location of the tumor must be taken into account. Depending on this, there are different types of treatment, including surgery, chemotherapy and radiotherapy.

In the case of lung cancer surgery, it involves the total or partial removal of the tumor from the lymph nodes near the thorax, depending on the type of intervention. There are three types of surgery: segmentectomy, lobectomy and pneumonectomy. The recovery period is several weeks or months.

Radiotherapy consists of eliminating cancer cells by means of high-energy ionizing radiation, which can stop their growth and division. This type of therapy can produce, to a greater or lesser extent, a series of side effects such as tiredness, difficulty in swallowing, coughing and slight respiratory difficulty.

Chemotherapy uses intravenous or oral drugs to destroy tumor cells. It is administered in cycles, alternating periods of treatment and rest. Depending on when it is administered, there are different types of chemotherapy. Chemotherapy drugs, like radiation therapy, can also damage healthy cells in the body.

Cuba has carried out numerous studies on the subject and has a treatment for lung cancer with monoclonal antibodies, CIMAVAX EFG and VAXIRA. Both vaccines offer the possibility of converting advanced cancer into a controllable chronic disease for those patients who are eligible for treatment. The vaccine has shown encouraging results in terms of survival and improvement in the patient’s quality of life, in addition to having no adverse side effects.

Cuba’s local but efficacious approach to COVID-19 vaccine development is laudable. Cuba has adopted intense production and deployments of country-made vaccines while other Latin American countries look up to foreign aids in containing the pandemic. Vaccine production in Cuba has helped the island nation cater for mass vaccination of Cubans without breaking the national budget while also assisting other countries with the vaccines.

Cuba is the first Latin American country to successfully produce COVID-19 vaccines with 92 percent efficacy recorded in the Abdala vaccine.¹ The success of Abdala’s production has gingered further vaccine production including Soberana 1, Soberana 2 with a 91 percent efficacy rate, Soberana Plus, and Mambisa.¹ These vaccines have placed Cuba alongside the United Kingdom, the United States, Germany, and India in successful vaccine production. The vaccines are completely manufactured in Cuba making it possible for a country-wide vaccination.

Cuba’s vaccines effectiveness is shown in the fewer death rates in the country. In 2020, at the peak of the pandemic, Cuba recorded 146 deaths in 11, 863 infections while the UK had 1084 deaths per million.¹

Benefits and Effectiveness of Cuban Vaccines

Abdala

The Abdala vaccine is Cuban-made. The vaccine is patterned in a similar approach to the Novavax COVID-19 vaccine and the hepatitis B vaccine. Abdala is different from other vaccines because it’s engineered in cells of yeast and not from coronavirus protein extracts.² The vaccine is applied in three doses to train the immune system to identify and fight coronavirus whenever it contacts it. Abdala has been tested and found effective in destroying coronavirus when it contacts it. The vaccine has a 92 percent efficacy against coronavirus and protects against diseases and deaths.²

Abdala has been effective in containing COVID-19 in Cuba. Cuban health authorities have combined Abdala and Soberana 2 in driving mass vaccination in the country. The vaccine integration technique also resulted in the successful vaccination of 90 percent of the 11 million Cuban population.² COVID infection rates in Cuba are declining while local vaccine production is increasing; this has made it possible to sell vaccine doses abroad.

More countries are indicating interest in Abdala. The vaccine is efficacious and has been taken for trials in Iran. While the vaccine is undergoing trial in Iran, it’s been adopted for vaccination in Vietnam, Venezuela, and Nicaragua.² Argentina and Mexico have also shown interest in using the effective Abdala vaccine.

Soberana

The Soberana vaccine involves a chemical binding of tetanus toxoid to the virus antigen for COVID-19.³ The vaccine has been tested effective by several medical institutes and centers after the approval for trial testing from the Cuban Center for Quality Control of Medicines, Equipment and Medical Devices in 2020. A non-peer review study has confirmed that Soberana is excellent for neutralizing COVID-19 and gives a complete safety profile.³ The clinical trials for the review showed that the vaccine gives all participants excellent safety profiles one month after the vaccination; increases antibody 20 fold one week after the vaccination and is four times effective for neutralizing the virus.³ Majority of the Cuban population has benefitted from the vaccine. Soberana gives 91.2 percent when boosted with Soberana Plus and is effectively safe to use in three-dose.³

Soberana is gaining traction in international communities. In Iran, the Pasteur Institute has confirmed Soberana and Soberana Plus effective for containing the Delta strain of COVID-19.³ After using the Soberan 2, boosting it with the Soberana plus returns an increase from 71.0 to 92.4 percent.³ According to Reuters on healthcare and pharmaceuticals, a peer-review of the Soberana vaccines will position Cuba among countries like Russia, Germany, and the United States that have successfully produced vaccines with more than 90 percent efficacy.⁴ This means Soberana is ranked alongside Sputnik V., Moderna, Pfizer, and Novavax with over 90 percent efficacy after peer reviews.

Soberana and the other four Cuban vaccines are locally manufactured. They’re produced on low-tech forms but with a high natural-focused biotechnology process.⁴ The vaccines are less expensive and fit perfectly for countries that can’t afford the more expensive COVID-19 vaccines. Practical applications of Cuban vaccines to its population have confirmed safety, efficacy, and costs effectiveness which are prime determinants in vaccine selection and purchase.

Mambisa

The Mambisa vaccine is the fifth Cuba-made vaccine with high efficacy. The vaccine is produced by Genetic Engineering and Biotechnology in Cuba.⁵ Mambisa is made from a combination of produced antigens and gives fewer side effects to users.⁵ The vaccine is highly beneficial because of its multiple application possibilities without constituting harm to users. Multiple application of Mambisa increases immunity against coronavirus making the vaccine highly demanded.⁵ Mambisa centered the protein nucleus in generating higher immunity against COVID-19.⁵ This vaccine is different from others because it’s capable of increasing immunity with a single dose unlike other vaccines that require double or three doses for immune responses. Multiple applications of Mambisa may not be advised because the vaccine is efficacious at a single dose.⁵

Cuba Medical Milestones

Cuba, an island nation with over 11 million populations has a long history of medical efficacy. While the US sanction on the Cuban economy has affected import-export relations in some ways, Cuba has remained significantly top of other Latin American countries in medical effectiveness. The mass production of the COVID-19 vaccines using local resources and ingenious biotechnologists has gained the country recognition among top nations like the UK, US, and Germany in medical innovation and manufacturing. One important effect of Cuban vaccine production is that the country can protect its million population while also helping other countries by selling the effective Cuba-made COVID-19 vaccines.

The COVID-19 pandemic has come with rising global inflation and economies are reacting negatively. What this portends is that countries might find it difficult to purchase expensive vaccines like Sputnik V., Pfizer, and Moderna or wait for foreign aids. While waiting, the pandemic may badly hit the most vulnerable and further threaten global health and prosperity. Cuban vaccines are safe and less expensive alternatives with testimonials from Cuban populations, Vietnam, Venezuela, and Iran among others.

Cuba’s medical effectiveness dates back to when Fidel Castro invested heavily in Cuban public health. The investment has yielded results in combating cancer and meningitis in Cuba.⁶ Cuban health research and vaccine production have reduced Cuba’s infant mortality rate to 4.2 percent of 1,000; a lower percentage than obtainable in the US.⁶

Medical investment in Cuba is people-oriented. Cuban authorities have thus mandated BioCubaFarma, the country’s leading biotechnology center to manufacture vaccines and equipment to contain the COVID-19 pandemic and assist struggling economies with treatments and equipment at this time.⁷

Cuba High Ranking in COVID-19 vaccination

Medical innovations and productivity is driving Cuba’s mass vaccination. Cuba has reached an all-time milestone of vaccinating 90 percent of its population putting it behind only the United Arab Emirates in vaccination.⁸ Cuba’s rapid and effective vaccination puts the country ahead of richer countries and stronger economies in Latin America and the Caribbean.⁸ The secret to this milestone is described as focus and value on local production of vaccines while many countries struggle for more expensive and foreign-made COVID-19 vaccines.⁸

Cuba has successfully vaccinated 90 percent of its population with children between 2-18 being fully vaccinated.⁸ Effective vaccination has returned normalcy in Cuba; schools have reopened and tourists are now welcome to the island nation. Although the COVID-19 variants are being reported in the UK and South Africa, Cuba’s vaccines are efficaciously lined up for use as they’ve been tested for effectiveness within and outside the country. It’s safe to say that Cuba-made vaccines are stronger and better alternatives even to COVID variants.

Cuba has achieved a milestone that many rich nations aspire to attain in medical innovation. Medical innovation has translated to excellent manufacturing of world-class COVID-19 vaccines in Cuba including Abdala, Soberana 1, Soberana 2, Soberana Plus, and Mambisa. These vaccines have helped Cuba to near-all population vaccination and have sustained the island’s economy in the face of the pandemic. The vaccines are high in efficacy with Abdala and Soberana reaching more than 90 percent efficacy rates. More countries are beginning to demand Cuba-made vaccines because of the high efficacy, safe profiles, naturalness, and cost-effectiveness making them competitive globally.

Purchasing Cuban vaccines will help countries contain the virus without breaking their treasury on containment. The vaccines are less expensive and available for distribution to any country in the world.

References

1. Why Cuba developed its own covid vaccine—and what happened next https://www.bmj.com/content/374/bmj.n1912Cuba’s COVID vaccines: the limited data available suggests they’re highly effective https://theconversation.com/cubas-covid-vaccines-the-limited-data-available-suggests-theyre-highly-effective-172725
2. Cuba Soberana COVID-19 Vaccine https://www.precisionvaccinations.com/vaccines/cuba-soberana-covid-19-vaccine
3. Cuba says second COVID-19 vaccine Soberana 2 boasts 91.2% efficacy https://www.reuters.com/business/healthcare-pharmaceuticals/cuba-says-second-covid-vaccine-soberana-2-boasts-912-efficacy-2021-07-09/
4. Covid-19: Single vaccine dose is 33% effective against variant from India, data show https://www.bmj.com/content/373/bmj.n1346/rr-1
5. Fidel Castro: A champion of public health https://www.downtoearth.org.in/news/health/popular-prolific-populist-56607
6. Cuba’s National Regulatory Authority & COVID-19: Olga Lidia Jacobo-Casanueva MS Director, Center for State Control of Medicines and Medical Devices (CECMED) https://pubmed.ncbi.nlm.nih.gov/34516531/
7. Cuba has vaccinated most against Covid-19, more than most large, rich countries https://www.nbcnews.com/news/latino/cuba-vaccinated-covid-19-large-rich-countries-rcna9498

8. Cuba has vaccinated most against Covid-19, more than most large, rich countries https://www.nbcnews.com/news/latino/cuba-vaccinated-covid-19-large-rich-countries-rcna9498

Drug and substance abuse has taken a higher toll in recent times. The United Nations Office on Drugs and Crime has accounted that over 275 million between 15-64 years of age abuse drugs and substances at least once a day. The higher rates of drug and substance abuse have not been unconnected to ravaging consequences including 20 million substance-induced disability and 8.6 million deaths with 160,235 and 145, 565 deaths caused by drug and alcohol respectively. As more people engage in drug and substance abuse, the rate of addiction has also gone up; birthing the need for proactive drug rehabilitation activities. In drug rehabilitation excellence, Cuba has earned a good mark.

Diego Maradona the great told his lawyers and families to return him to Cuba to continue his rehab activities. The story of the sports legend’s drug addiction topped the news in the 1900s and 2000s. After the suspension from the Italian League in 1991 and the 1994 World Cup, Maradona resumed rehab in Cuba in 2000. The sports star said he was convinced of getting rehab in the Island nation by the belief of the revolutionary, Fidel Castro and Ernesto Guevara known for fighting for revolution in Cuba and leading as a communist leader. Another reason Maradona chose Cuba was because of privacy. He indicated in his interviews in Cuba that in the Island nation, he had more privacy and could work about without having reporters flock around him trying to monitor his rehab process. He considered the heavy presence of reporters in his Argentine rehab place as unnecessary and disturbing. The remarkable thing about the first-class rehab provided to Maradona is that Cuban rehab facilities are top medical industry standard and can take in global leaders, world-class celebs and individuals seeking quality rehab programs.

The rehab program in Cuba includes a three-month rehabilitation with a focus on cognitive behavior and community regime therapies. The rehab includes a behavioral approach that allows patients to develop mechanisms of social control which are needed to repel the attraction to, ‘hard drug, alcohol, and substances. Also, community regime therapy is used. The therapy indicates that patients will live with co-visitors, share ideas with them, express frustrations and aspirations with them. The therapy’s target is ensuring full recovery through inter-persons engagement and communication. The Cuba rehab program runs for three months and at the end of the program, verification and evaluation will be done. The program includes feeding, medical examinations, electrocardiogram, blood tests, clinical and physical treatment, accommodation, psychotherapy, physiotherapy and recreational engagement. The Cuban rehab is one of its kind and widely known globally for effectiveness. The effectiveness depends on the top-rated medical facilities in Cuba; including the oxygen hookup, electronic bed, equipment for those with disabilities, nursing care, well-equipped individual bathroom, fast internet access, laundry and telephonic services. Language translation (Spanish/English) is also provided for guardians of the patients to aid effective communication all through the program.

The Cuban Rehab Approach

The history of drug rehab in Cuba dates back to the 1970s when the famous Ricardo A. Gonzales established the first medical center for treating substance abuse in Cuba. The medical centers became 15 in a short time and attracted the top crop of people from leading sectors in the world to Cuba. Rehab program for treating drug and substance addiction in Cuba has since been based on ‘Cuban approach’ which has not only proven to be efficacious and result-based but also pronounced in the successful treatment of Diego Maradona in Cuba. The approach has been highly used for successful rehab programs in Cuba; being one of the highlights of Cuban medical tourism popular on the global scene. The Cuban approach to rehab is carrying out detoxification and rehabilitation using therapies in serene and natural environments. High profile medical experts are engaged in implementing top-industry medicine and rehabilitative skills. The experts also conduct formative and summative evaluations for the rehab participants to monitor recovery progress. Also, the approach includes allowing patients to talk with others to improve their psychosocial balance and free their minds. The patient undergoes rehabilitation for behavioral changes to overcome addiction. Skills and strategies for coping with cravings, adapting to healthy behaviors, developing intelligence for acceptance and rejection, and controlling withdrawal symptoms.

A multidisciplinary approach is also engaged in Cuba to address the complexity of drug and substance addiction. Multidisciplinary experts are assembled to give rehab patients world-class services in Cuba. The experts include neurologists, psychologists, nurses, medical specialists, and psychiatrists working as a team to give patient-centric rehab services. The multidisciplinary approach is more effective because medical experts in collaborating branches of medicine pool their expertise and intelligence together in ensuring that patients are freed from addiction. Addiction treatment is more psychological and thus the approach isn’t one-way, unlike other medical services. The team identifies what level of damage the addiction has caused and begins to teach adaptive behaviors to break away while also using treatment to correct observable anomalies. The diagnosis from each expert will create a smooth rehab direction that will yield quality behavior-changing treatment for the patient. The recommendation from the experts creates a window for each member of the team to participate in integrative therapies for the patients rather than disjointed and isolated rehab care. Using the Cuban approach of naturality and community therapy coupled with the multidisciplinary approach has positioned rehab care in Cuba on a golden pedestal in global ranking; making Cuba a priority place for treating drug and drink addiction.

North American Rehab Program vs Cuban Rehab Program

The North American rehab programs depend on an individualistic approach. The approach is applicable when rehab patients are given personalized services and not a kind of community regime therapy as it is done in Cuba. The approach is integrated into medical detox and patients can opt for in-facility or home services. The North American rehab approach is flexible and is easily customized to accommodate patients’ differences to bring about effective behavioral changes. Natural coping skills and strategies are also used at the North American rehab programs and this has proven effective because patients can get freedom from drug or alcohol addiction without resorting to drugs. The programs combine human nutrition, yoga services, gardens for meditation, massage, bio-sound therapies, and acupuncture to arrive at a lasting addiction-free treatment. Leading medical experts are engaged in rehab services in North America and they provide effective services from time to time. However, getting rehab treatment in North America costs as high as paying $18,000 for a single-track treatment. In rehabilitative treatment, experts have suggested that patients are likely to recover more on a single-track rehab than a mixed one thus when a patient doesn’t recover at the end of a rehab track, such an individual will have to start all over again—a fresh rehab program. Starting a new rehab program will help the experts working on the case make new diagnoses and adapt strategies for improvement where needed. The point is, rehab service in North America is expensive and not designed for the middle class and average individuals.

The rising death rates and psychological disorders are taking tolls on the lives of people especially the youths and young adults. Thus, affordable and quality rehab is needed to improve lives and correct the increasing anomalies resulting from drug, alcohol, and substance abuse. Unlike North America, Cuba offers specialized rehab programs for addiction and is considerably cheaper and more effective than the services provided in North America. With $26,000, you’ll get a world-class rehab service in Cuba including therapies led by medical industry leaders of ground-breaking research orientation. Cuba’s cost of rehab services isn’t up to 15 percent of what’s obtainable in North America and far outweighs the individual approach rehab programs provided there. Cuba’s record of successful treatment of Diego Maradona has placed the country higher than other countries in a track record of excellence in rehab programs. The cost-effectiveness makes Cuban rehab programs outstanding and easily accessible to individuals and communities.

Also, Cuba offers clean rehab programs free of unethical practices as they apply in North America. Some addiction treating centers in North America operate without a license and run body brokering. Brokering means they take in drug addicts in the guise of giving assisted medical treatments to them and instead, use them for profit-making. Some centers go as high as selling the pee of patients in thousands of dollars and implanting harmful drugs in them. These unethical practices are dangerous and may ruin the integrity of medical practice. In Cuba, only licensed medical centers are allowed to operate by the authorities. Cuba makes a safe addiction treating environment for patients because they do not have to fear getting worse or losing their lives while on the program.

Getting treated for drug and drink addiction requires trust. In Cuba, rehab participants are put at the center of the treatment and tended with utmost trust. Participants are not used for drug racketeering and they consent before the program starts; luring or coercing does not obtain.

Often, people generalize concepts in the ophthalmology branch of medicine; Ophthalmologists, optometrists and opticians are regularly used as one. However, the concepts differ. Ophthalmology is the branch of medicine that involves caring for the eye. A medical doctor in the ophthalmology practice is identified as an ophthalmologist. The doctor must have completed six-eight years of studies in medicine and have been licensed to practice. The doctor is qualified after training and license to treat various eye diseases and may also engage in research on visual ailments and cures. An optometrist on the other hand isn’t a medical doctor but a healthcare professional who deals in visual testing, treatment and correction. An optician is a technical professional who deals in designing, verifying and fitting lenses for eye patients. An optician doesn’t test the patient but supplies eye wears based on the recommendations from the ophthalmologist.

Becoming an ophthalmologist requires six-eight years of study. The study usually involves spending some years in college, earning a medical degree, spending some months for residency and getting the license to practice as a medical doctor. Ophthalmologists by profession can choose to study more and specialize in certain subareas in ophthalmology. The subareas include learning to care for the cornea, uveitis, refractive surgery, neuro-ophthalmology, pediatrics, ocular oncology and reconstructive surgery. Studying ophthalmology is however different in Cuba with medical students spending five to six years on the program. The difference is also noted in the program costs and availability of facilities for medical teachers and students in the country. Cuba has become positioned on a top class in the league of countries with sophisticated systems and capacity in the world and now ranks alongside the United Kingdom, the United States and India in global medical excellence. Cuba has become a household name for global medical tourism and ophthalmology is an essential part of medicine practiced in the island nation. 

Cuba’s progress in the field of ophthalmology

The Cuban government has invested in the development of medicine in the country. Medical schools are provided resources and intervention funds. The regular tracking of the progress of medical students has helped strengthened medical performance and achievement in Cuba. Cuban ophthalmology program involves the diagnosis, treatment, surgery and care for the eye using modern technologies in world-class facilities. The level of industry-standard medical facilities and facilitators in Cuba has earned the country global respect and increased patronage in medical tourism. Successful surgeries have been conducted and the success has become a testament that attracts patients from foreign countries to seek medical care in the country. Eye surgery and eye care are majorly handled in Cuba by medical doctors with years of experience. Ophthalmology practice in Cuba is regulated by the Ministry of Health of Cuba and only licensed professionals are permitted to practice medicine in the country.

The Leading Ophthalmology Center in Cuba

Ramon Pando Ferrer Cuban Institute of Ophthalmology: RPFCI is an ophthalmology center established in 1956 in Cuba and has gone to become of the leading medical centers in the world. The institute is focused on the treatment of visual diseases with special care for low vision and blindness. Ramon Pando Ferrer Institute with its over 50 years of existence has achieved huge milestones in eye care, surgery and corrective visual procedures in Cuba. The institute has become globally renowned in retina treatment and cares for ‘macular and vitreoretinal diseases.’ The Institute is well known for its excellent records in Nero-ophthalmology and the testing and treatment of optical nerve conditions including surgical procedures. The Institute specializes in treating inflammation conditions of the eye, uveitis, treating of severe eye inflammation, and the application of surgical procedures for eye care and treatment. The Institute prides itself on refractive surgeries, cornea diagnosis and management, treatment of keratoconus, and cornea transplant where it has gained unmatched recognition for complications-free corrections and treatments globally. The Institute also treats visual disorders from birth including eyelid, lacrimal ducts, tumors and stenosis from birth. The Institute has projected the Cuban government’s efforts in caring for blindness using the integration of local medical knowledge and modern technological facilities. The milestones achieved by the Institute in eye care and treatment are positioning Cuba for greater medical tourism and medical education.

Why eye care, surgery and treatment in Cuba

Quality and affordable medical care: 3,500 foreigners land in Cuba annually to seek medical attention because it’s affordable than medical treatment in the United States of America. Medical experts in Cuba testify to the progressive inflow of international patients seeking ophthalmology care and treatment. Cuba has a record of cheap medical care dated as back as 1999 when rhinoplasty was $1,300 in the US and $1,700 Cira Garcia in Cuba and abdominoplasty cost $4198 in the US and $2340 in Cuba. The quality-oriented medical services in Cuba have testaments of excellence and the cost variation between the island country and the US has not in any way affected the quality. The quality of ophthalmology services in Cuba draws patients to medical centers in the country from the Caribbean and Latin America and Finland and Japan even though they are far away.

People-based medical care: Cuban health system is centered on providing basic health care to Cubans as part of the fundamental responsibilities of the government. The revolutionary advances in medical care in Cuba are testaments of Fidel Castro’s legacies in the country. The legacies have attracted the establishment of many medical centers which all contribute to the vision of improving access to medical care in Cuba. Beyond Cuba, Castro’s vision helps to extend standard medical care to other countries as a means of promoting peace and development. The years and the progressive nature of medical tourism in the country have been aligned to the overall vision and Cubans and foreign nationals benefit from Cuba’s promotion of medical care access to individuals.

Contained COVID-19: One of the key factors to consider before choosing a country for medical care is the level of coronavirus containment in the country. The global pandemic has disrupted the physical flow of activities including the medical line and new normal is just returning to many countries. It’s thus considered essential to know the COVID-19 containment level of a country before deciding to seek medical attention in the country. In Cuba, COVID-19 has been contained effectively with a record of over 60 percent population vaccination. Cuba has devised medical innovation and ingenuity to manufacture five COVID-19 vaccines and the production has improved mass vaccination in the country. The availability of the vaccines has helped restore physical activities in different sectors of Cuban economy as well as its medical sector. The Cuban government ensures adequate quarantine for foreigners seeking medical care and this helps to identify those who might have contacted the virus before getting into the country. Also, beyond quarantine, there’s consistent monitoring of the inflow and outflow of medical care seekers in Cuba by designated government officials and this contributes to maximal containment of coronavirus in the country. Seeking medical attention in Cuba is safe because medical practitioners are fully vaccinated, and regularly adhere to COVID-19 rules and protocols in receiving and attending to patients. The effective containment of COVID-19 in Cuba places the island nation in the league of countries that have recorded such tremendous feats including the United States, the United Kingdom and Germany.

High availability of medical experts: Cuba leads in ophthalmology care because there’s a growing potential and advancement in the medical space in the country. Medical doctors are massively available and getting medical attention doesn’t require having to queue. Cuban government’s investment in medicine is playing out well as medical universities in the country allow medical students to learn by practice and provide medical services while competently turning out well-trained doctors annually. The inclusion of medical scholarship in the Cuban medical curriculum has helped to attract the best minds to the discipline and this has translated into massive graduation of medical students into the medical profession and practice in the country. Specialists in subareas of ophthalmology are available in Cuba and getting eye care treatment and surgery of all kinds has become seamless and more effective because of the high numbers of medical doctors available to provide medical services. Medical experts in Cuba are effectively implementing the outcomes of medical research. The implementation has reduced dependence on traditional techniques but now on Cuban manufactured technologies, and drugs.

Accessing ophthalmology care is sensitive just as the visual system of the body. The eye isn’t available for trial and error and as such requires medical experts with proven track records to treat and operate as the case may be. In providing eye care, treatment and surgery, Cuba has reached a huge milestone with over 50 years of effective medical services on global standards.  The Ramon Pando Ferrer Cuban Institute of Ophthalmology is the leading ophthalmology center in Cuba with excellent surgery and eye care records and testaments from Cuban and foreign nationals. The Institute has world-class eye –treating facilities and top-rated ophthalmologists who are actively attending to patients and also researching in diverse subareas of ophthalmology to improve medical excellence and care.

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.

References

Gardaworld (2021). Cuba: COVID-19-related travel protocols and domestic restrictions in force as of May 4 remain largely unchanged/update 21 https://www.garda.com/crisis24/news-alerts/474861/cuba-covid-19-related-protocols-and-domestic-restrcitions-in-force-as-of-may-4-remian-largely-unchanged-update-21

Morris, E. and Kelman, I. (2020). Coronavirus response: Why Cuba is such an interesting case https://theconversation.com/coronavirus-response-why-cuba-is-such-an-interesting-case-135749

Nature (2021). Can Cuba beat COVID with its homegrown vaccines https://www.nature.com/articles/d441586-021-01126-4

NBENEWS (2020). Cuba confirms first coronavirus cases, tells people to make their own masks https://www.nbcnews.com/news/latino/cuba-confirms-first-coronavirus-cases-tells-people-make-their-own-n1156711

Statista (2021). Cuba: Direct tourism contribution to GDP 2010-2019 https://www.statista.com/statistics/528443/direct-contribution-travel-tourism-gdp-cuba/

Taylor (2021). How Cuba and Uruguay are quashing coronavirus as neighbors struggle https://www.newscientist.com/article/2247740-how-cuba-and-uruguay-are-quashing-coronavirus-as-neighbors-struggle/

Worldometers (2021). Cuba coronavirus cases https://www.worldometers.info/coronavirus/country/cuba/