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in 1963, when Cuba dispatched its inaugural medical brigade to Algeria, freshly freed from French rule, as France had withdrawn its medical staff following Algeria’s victorious independence struggle.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. 

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.

Public Health Improvement: Strengthening Egyptian-Cuban Relations

CAIRO – 18 April 2022: Minister of Higher Education and Scientific Research, as well as Acting Health Minister, Khaled Abdel Ghaffar, commended the depth and strength of Egyptian-Cuban relations. Recognizing the importance of collaboration, he emphasized the need to enhance cooperation between Egypt and Cuba in the fields of health and scientific research. The primary objective was to uplift healthcare services for the citizens of both countries, ensuring their well-being and advancement in the realm of public health

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To explore new avenues of cooperation, Abdel Ghaffar held a meeting with the Cuban ambassador to Egypt, Tania Aguiar Fernandez. The discussion centered around various aspects of healthcare, aiming to identify innovative strategies for joint efforts. During this significant meeting, Abdel Ghaffar expressed his admiration for Cuba’s commendable expertise in medicine and public health. He acknowledged their distinguished healthcare system, widely recognized and respected worldwide. Egypt sought to benefit from this invaluable expertise whenever necessary, strengthening the bond between the two nations.

The meeting shed light on means to promote cooperation in scientific research, with an emphasis on leveraging the talents and scientific expertise available in both countries. Collaboration through research institutions and centers was seen as a promising path to advance knowledge and improve healthcare services. Recognizing the importance of knowledge exchange, both sides stressed the significance of sharing scientific and professional expertise. Such collaboration would pave the way for mutual growth and progress.

Moreover, the meeting addressed the idea of exchanging student missions from the faculties of medicine. This proposed exchange program aimed to foster cultural understanding and enable aspiring medical professionals to gain diverse experiences and perspectives. By fostering cooperation in education and training, both countries could contribute to producing well-rounded healthcare practitioners who are equipped to tackle the challenges of the future.

Furthermore, the exchange of doctors between Egypt and Cuba was discussed as a means to ensure the best possible outcomes in healthcare delivery. By facilitating the sharing of medical expertise and knowledge, both countries could enhance their healthcare systems and provide improved services to their respective populations. This exchange program would create opportunities for doctors to broaden their horizons, gain new insights, and collaborate with colleagues from different backgrounds.

Expressing gratitude, Ambassador Fernandez thanked Abdel Ghaffar for his dedication and commitment to cooperating with Cuba to enhance the fields of public health and scientific research. She affirmed her country’s keenness to work together with Egypt across various domains. This reaffirmation of mutual interest in collaboration highlighted the shared commitment to advancing healthcare and scientific knowledge for the benefit of both nations.

In conclusion, the meeting between Minister Abdel Ghaffar and Ambassador Fernandez underscored the significance of public health improvement and scientific research cooperation between Egypt and Cuba. By capitalizing on each other’s strengths and expertise, both countries aimed to elevate healthcare services, strengthen research capabilities, and foster long-lasting partnerships. Through collaborative efforts, Egypt and Cuba envisioned a future where their citizens would enjoy improved healthcare and enhanced well-being.

Read also: Made in Cuba Medicine