The COVID-19 pandemic began at an unprecedented time when humans, organizations and institutes were not prepared. Like the global cases and deaths, Cuba had a recurring cases and deaths totaling 70,000 and 408 respectively as at March 2021 (Yaffe, 2021). The severity of cases and the resulting deaths influenced the production of COVID-19 vaccine in Cuba. Among countries that made great efforts at seeing to safety, and the containment of coronavirus, Cuba played an intensive role in not only competing with top-tier countries like the United States, the United Kingdom, Germany and India among others; but also demonstrating an exceptional feat by the production of “Abdala” and “Soberana” vaccines for COVID-19.

COVID-19

COVID-19 is viral disease that emanates from coronaviruses. The disease-causing virus was first discovered in Wuhan, China in 2019 but has since spread to other countries of the world including Cuba. Although, the virus is from the family of severe acute respiratory syndrome (SARS) and was in spread in 2002-2003, the latest variants have shown to cause severe respiratory disorders (Kandola, 2020). Thus, the virus is code-named, COVID-19.

The Abdala Vaccine

Cuban’s COVID-19 “Abdala” vaccine has been found with a 92.28 percent efficacy in combating coronavirus. The vaccine effectiveness declaration comes after the last-stage clinical trials made in the country (Frank, 2021). The vaccine’s potency is evident in the drastic reduction of coronavirus cases and deaths across the country. According to Cuban’s authorities, COVID-19 cases reduced by half after a country-wide vaccination in the country using “Abdala” (Frank, 2021). The vaccine production has been found sufficient as over 11.2 million Cubans are considered for vaccination—a huge stride considering the resources of the country.

Abdala, a coronavirus vaccine produced in Cuba was a rapid response to containing the virus. The rapidity in the vaccine’s development influenced the trial stages and the eventual manufacturing. The clinicals at the first stage showed that, “safety and reactogenicity profile of the immunogen was favorable for the two doses of the vaccine candidate”. In other words, the first stage of the trial was tested valid for immune efficacy (Santos, Martin and Medina, 2021).  760 volunteers participated in the second stage trial for the 11.25 million population of people in Cuba including people between 19 and 54 years and a special involvement of people around 80 years (Santos et al, 2021). The vaccine development process had a preferential consideration for people with comorbidities and those with chronic diseases; their inclusion was monitored and medically controlled (Santo et al, 2021). The effect of the trial stages is shown in the quality of the vaccine and its reliability at performing that which it was manufactured for. The third stage of the vaccine development was charged for immunogen results in the third phase trial participants. The third phase had a total of 48,290 volunteers from provinces including Granma, Guantanamo and Santiago de Cuba (Mola, 2021). The trials show that, the vaccine generates antibodies against COVID-19 and that, it yields a “viral neutralization assay” with “functional activity” (Santo et al, 2021).

Abdala’s Efficacy

Mola (2021) reports that Abdala was developed by the Center for Genetic Engineering and Biotechnology in Havana, Cuba. The center also manufactured Mambisa but mainly for nasal administration the reporter says. Abdala vaccine is protein subunit and contains a synthetic segment of the SARS-CoV-2 S protein, which is identified as an RBD (receptor binding domain) (Mola, 2021). The notable part of the vaccine product is its quality. Abdala is thus ranked fourth in the list of vaccine production mostly among first world countries—right after US’s Moderna third, US and Germany’s Pfizer second and US’s Novavax as the first ranked COVID-19 vaccine globally. The World Health Organization (WHO) has attested to the efficacy of Abdala with a test response that, the vaccine rates above the 50 percent benchmark set for coronavirus production as a global standard (Mola, 2021). Despite being short of funds, Cuba has risen beyond its financial incapability to competing medically with rich nations globally. Although, Cuba is placed on a financial blockade by the United States for over sixty years, Cuban authorities rose to the occasion to protect Cubans from the haphazard effects of coronavirus; placing the country high among comity of nations (Mola, 2021).

Notably, Cuba has been able to present five vaccine candidates to containing COVID-19; Abdala tops the candidates based on its near perfect efficacy. The center in charge of Abdala production claims the vaccine is capable of elevating immune responses through antibody generation. Abdala was tested active for efficacy, the production was inspected and certified for standard and safe practices. The vaccine production centers were equally validated—a step which places the vaccine in a public light that would later yield a global audience, purchase and revenue for Cuba. The country’s authorities have been able to maximize Abdala’s production to source revenue for the country. The benefit of Abdala’s production has been identified as reducing COVID-19 cases, reducing coronavirus related deaths, strengthening the country’s biotechnological infrastructure and professionalism, generating income through Abdala’s exportation and sales and competing on a global standard with well-resourced nations.

Cuba’s Abdala Against Other Vaccines: Testimonials

Cuban authorities pulled off the risk and opted for ‘homemade’ coronavirus vaccine. Although, medical professionals advised the authorities such a decision was risky but it paid after the success Abdala and Soberana. Cuban government supported the vaccine production from the outset; a testament to this is the tweet from the President, Miguel Diaz-Canel that despite a hard hit of COVID-19 in Cuba, the authorities were set to provided needed support for the vaccine production institutes including Finlay Institute and Center for Genetic Engineering and Biotechnology (Reuters, 2021). Testimonials from the authorities indicate that Abdala does not only cater for COVID-19 containment and public safety, it is also targeted at boosting the morale of medical professionals in the country while revamping the health sector for more rapid and responsive public health cases and emergencies. The government’s justification for the homegrown component vaccine is that, “it would create a centrally controlled and free health care system in Cuba toward a fast-pace vaccination and coronavirus suppression” (VOI, 2021). The implication of Abdala’s successful production in Cuba is that it reveals the tenacity of the authorities, the ingenuity of the biotechnologists and medical experts and the resilience of the public in safely receiving the vaccine. World Health Organization (WHO) commends the efficacy of Abdala noting that the vaccine creates optimism for the country and a great news for the people. The representative, Jose Moya is described to have knowledge of the formula for Abdala, a vaccine which has become globally competitive and required by different countries in combating the prevalence of COVID-19 (Vincent, 2021). Upon a successful production of vaccines for coronavirus, Cuban authorities targeted a 70 percent vaccination of the people. However, Reuters’ report indicates that only 6.4 million of the 11.2 million population have been vaccinated (Reuters, 2021).

Global Importance and Demand for Abdala

Abdala has proven to be an effective vaccine in generating antibodies against COVID-19. The vaccine has been robustly used in the island country and is now yielding respects from international level. Venezuela has received Abdala from Cuba and has embarked on populating it to the tune of four million doses for local use in the country. Venezuelan authorities have been reported to receive a shipment of the vaccine toward public use (Berti, 2021). The Cuban vaccine is named Abdala, the name of the country’s independence hero; this shows how significant the name is supported by the potency of the vaccine for local and resulting global use.

COVID-19 was unexpected globally. Although, there had been variants of the SARS virus earlier before 2020, the emergence of the pandemic caught the world unaware. The unaware nature of the virus influenced its effects in cases, prevalence and eventual deaths. However, countries with research and biotechnological infrastructure were able to produce vaccine for the containment of the virus. Among the top-leading countries of the world who made COVID-19 vaccine, Cuba impacted with a giant stride coming fourth in a league of countries including the United States, Germany and India. The vaccine has been found efficacious in arresting coronavirus; it has thus been in widely-accepted use in Cuba and beyond.

References

Berti, L. (2021) Venezuela receives first batch of Abdala vaccine from Cuba https://brazilian.report/liveblog/2021/06/30/venezuela-abdala-vaccine-cuba/

Kandola, A. (2020) Coronavirus cause: Origin and how it spreads https://www.medicalnewstoday.com/articles/coronavirus-causes

Mola, A. (2021) Cuba says its Abdala vaccine among the most effective in the world https://www.financialexpress.com/lifestyle/health/cuba-says-its-abdala-vaccine-among-the-most-effective-in-the-world/2277680/lite/

Frank, M. (2021) Cuba says Abdala vaccine 92.28% effective against coronavirus https://www.reuters.com/business/healthcare-pharmaceuticals/cuba-says-abdala-vaccine-9228-effective-against-coronavirus-2021-06-21/

Reuters (2021). Reuters COVID-19 tracker https://graphics.reuters.com/world-coronavirus-tracker-and-maps/countries-and-territories/cuba/

Reuters (2021) Cuba says Abdala vaccine 92.28% effective against coronavirus https://www.google.com/amp/s/m.timesofindia.com/world/rest-of-world/cuba-says-abdala-vaccine-92-28-effective-against-coronavirus/amp_articleshow/83769856.cms

Santos, I., Martin, L., and Medina, O. (2021) COVID-19: Russian vaccine efficacy is 91.6% show phase III trial results https://doi.org/10/1136/bmj.n309

Vincent, M. (2021) Cuba announces its Abdala vaccine is 92.28% effective against COVID-19 https://www.google.com/amp/s/english.elpais.com/usa/2021-07-01/cuba-announces-its-abdala-vaccine-is-9228-effective-against-covid-19.html%3foutputType=amp

VOI (2021) Abdala vaccine made in Cuba is rated effective against COVID-19 up to 92.3 percent https://www.google.com/amp/s/voi.id/en/amp/abdala-vaccine-in-cuba-is-rated-against-covid-19-up-to-923-percent

Yaffe, H. (2021) Cuba’s five COVID-19 vaccines: The full story on Soberana 01/02 Plus, Abdala, and Mambisa https://https://blogs.Ise.ac.ui/latamcaribbean/2021/03/31/cubas-five-19-vaccines-the-full-story-on-soberana-01-02-plus-abdala-and-mambisa/

COVID-19: The World’s Common Enemy

The novel coronavirus of 2019, known as COVID-19, fiercely swept across the entire world within just a matter of months, causing panic, fear, and uncertainty. For over a year now, COVID-19 has been the daily talk of the world as we have all been fighting this devastating pandemic together. Quarantines, shutdowns, social distancing, and mask mandates have been put in place all around the world in hopes of slowing down the spread of this deadly virus, and these precautions are still in effect in many places today as cases continue to rise and new variants of the virus emerge.

COVID-19 Vaccines Show Promise Against the Coronavirus

The United States’ recent development of their COVID-19 vaccines has shown promise in being effective against the coronavirus. Based on clinical trials, Pfizer’s BioNTech mRNA two-shot COVID-19 vaccine has shown to be 95% effective at preventing COVID-19 infection in those who received both doses of the vaccine and had no prior infection.¹ Based on clinical trials, Moderna’s mRNA two-shot COVID-19 vaccine has shown to be 94.1% effective at preventing COVID-19 infection in those who received both doses of the vaccine and had no prior infection.² In clinical trials, Johnson & Johnson’s Janssen viral vector COVID-19 vaccine has shown to be 66.3% effective at preventing COVID-19 infection in those who received the single-dose vaccine and had no prior infection.³

The United States aren’t the only ones trying to stop COVID-19 for good with their immunizations. Cuba has now joined the race to beat COVID-19 as new cases continue to rise and new variants of the virus emerge.

Can Cuba’s Homegrown Vaccines Help Solve the Worsening COVID-19 Pandemic?

Cuba is working to become the first Latin America country to develop and manufacture its own COVID-19 vaccines.⁴ Cuba’s development of two new COVID-19 vaccine candidates has been reported in the news a lot during the past few weeks. Cuba is betting that its own vaccines, made by local laboratories, can beat COVID-19 on its own.^{5 “}Vicente Vérez Bencomo, director-general of the state-owned Finlay Institute of Vaccines in Havana, where one of Cuba’s most advanced vaccine candidates was created, thinks the chances are good.”⁴

Guaranteeing Cuba’s Sovereignty with Its Own COVID-19 Vaccines

Cuba decided to develop and manufacture its own coronavirus vaccines rather than compete with richer countries for vaccines⁶ to immunize its tiny island of 11 million inhabitants.⁶ After the COVID-19 pandemic began, “Cuban leader Miguel Díaz-Canel said that guaranteeing the nation’s sovereignty was the main goal of producing a homegrown vaccine,”⁶ naming the first vaccine candidate Soberana which is Spanish for “sovereign.”⁶ Abdala, another of Cuba’s vaccine candidates, was named after a poem by independence hero José Martí.⁶ For Cubans, the names of these homegrown vaccines show that the tiny island of 11 million inhabitants “cannot be broken by a deadly virus.”⁷

Cuba is Hopeful That Its Homegrown Vaccine Candidates Will Be Effective Against COVID-19

As of today, Cuba has five coronavirus vaccine candidates at various stages of [clinical] trials.⁶ Just last week, Cuba said that two out of five vaccine candidates have shown to be highly effective against COVID-19.⁶ The Cuban government-owned pharmaceutical company, BioCubaFarma, said that its three-dose Abdala vaccine has shown to be 92.28% effective in Phase III trials.⁶ However, The Pan American Health Organization says Cuba has yet to “publish trial data on its Abdala vaccine in peer-reviewed scientific journals so that the global scientific community can evaluate efficacy rates of the COVID-19 [vaccine].”⁶

Cuba has already been administering its vaccines “even before receiving certification from local authorities”⁶ after a surge in coronavirus cases led to an emergency response in May.⁶ According to Díaz-Canel, more than one million Cubans have already been vaccinated with at least one dose of the Abdala or Soberana 02 vaccines.⁶

Cuba’s Surge in COVID-19 Cases: A Race Against Time

Cases of the coronavirus have been steadily rising since November 2020 after Cuba reopened its borders to tourists.⁶ The island is now dealing with its worst outbreak for the first time since the pandemic started,⁸ registering more than 3,000 daily cases. According to the Ministry of Public Health, since the start of the pandemic, Cuba’s total cases have reached 188,000 with 1,270 deaths.⁶ The government is aiming to have 70% of Cuba’s population fully vaccinated by August 2021.⁷

Is Cuba’s Abdala COVID-19 Vaccine One of the World’s Most Effective Coronavirus Vaccines?

With its reported 92.28% efficacy against COVID-19 in Phase III clinical trials,⁶ Cuba’s three-shot Abdala COVID-19 vaccine may become one of the most effective coronavirus vaccines in the world, rivaling Pfizer-BioNTech’s 95% efficacy,¹ Moderna’s 94.1% efficacy,² and Russia’s Sputnik V’s 91.6 efficacy.⁹

Countries including Argentina, Bolivia, Jamaica, Mexico, and Venezuela are interested in obtaining Cuba’s coronavirus vaccines.⁷ The reported high rate of efficacy of Cuba’s Abdala vaccine, as well as the hope for efficacy with other Cuban vaccine candidates in various stages of clinical trials, could enable vaccine exports to other countries to help lift Cuba out of its economic crisis.⁹ In fact, Venezuela received their first batch of Abdala just this week.¹⁰ And Caracas signed a deal to buy 12 million doses of Abdala.¹⁰ Cuba has plans to manufacture 100 million doses in 2021 for export to more than 30 countries¹⁰ around the globe.

Cuba’s COVID-19 National Protocol

Although vaccines are being developed and administered to people all over the world, Cuba still has protocols in place to protect the country and its tourists from COVID-19 infection. In fact, Cuba is facing its worst outbreak since the beginning of the pandemic.⁸ As a result, Cuba is under a level 4 travel alert (DO NOT TRAVEL).¹¹

Travelers

According to the U.S. Embassy in Cuba, all travelers must present a negative COVID-19 polymerase chain reaction (PCR) test administered no more than 72 hours prior to entry into Cuba.¹¹ “All travelers are required to fill out a health declaration card,”¹¹ take a COVID-19 PCR test at the port of entry, and self-isolate until results of the COVID PCR test are received.¹¹ If the results are negative, another PCR test will be administered on the fifth day of isolation; if the second PCR results are negative, the isolation period is over.¹¹ Travelers who test negative upon arrival can self-isolate in a government-run facility or at a hotel participating in the government’s COVID-19 isolation protocol.¹¹ Travelers who test positive will be moved to the National Institute of Tropical Diseases Pedro Kouri.¹¹

Local Restrictions

All individuals are required to wear a facemask in all enclosed public spaces and comply with sanitization and social distancing requirements.¹²

Transportation

Commercial flights are operating but are limited and can be cancelled unexpectedly.¹¹ According to the U.S. Embassy in Cuba, “if U.S. citizens choose to travel to Cuba despite the level 4 alert for Cuba, they should stay in close contact with their travel agents and/or airlines and be prepared to cover their living expenses in Cuba should their return flight(s) be cancelled. The U.S. Embassy is closed for routine services and cannot assist with travel arrangements.”¹¹

Public transportation is operating but is limited^11,12 to essential workers.¹²

Fines for Non-Compliance

If individuals do not comply with Cuban government measures and hygiene protocols, a fine and/or criminal penalty may be issued.¹¹

Cuba’s Hope to End the World’s Common Enemy

As the world continues to fight the common enemy known as COVID-19, Cuba remains hopeful that its homegrown vaccines will officially beat the virus.

References:

1. Pfizer-BioNTech COVID-19 Vaccine Overview and Safety. Centers for Disease Control and Prevention. Updated June 24, 2021. Accessed July 2, 2021. https://www.cdc.gov/corona

virus/2019-ncov/vaccines/different-vaccines/Pfizer-BioNTech.html.

2. Moderna COVID-19 Vaccine Overview and Safety. Centers for Disease Control and Prevention. Updated June 11, 2021. Accessed July 2, 2021. https://www.cdc.gov/corona

virus/2019-ncov/vaccines/different-vaccines/Moderna.html.

3. Johnson & Johnson’s Janssen COVID-19 Vaccine Overview and Safety. Centers for Disease Control and Prevention. Updated June 23, 2021. Accessed July 2, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/janssen.html.

4. Mega E. Can Cuba beat COVID with its homegrown vaccines? Published April 29, 2021. Accessed July 2, 2021. https://www.nature.com/articles/d41586-021-01126-4.

5. Wyss J. Cuba Bets Big on Its Own Vaccines as Covid Surges. Bloomberg Businessweek. Published May 25, 2021. Accessed July 3, 2021. https://www.bloomberg.com/news/arti

cles/2021-05-25/cuba-s-big-bet-to-solve-its-covid-19-crisis-homegrown-vaccines.

6. Brasileiro A. WHO tells CUBA to publish its COVID-19 vaccine data and to seek approval for COVAX. Miami Herald. Published July 1, 2021. Updated July 1, 2021. Accessed July 3, 2021. https://www.miamiherald.com/news/nation-world/world/americas/cuba/article2

52480218.html.

7. Pieper O. Cuba’s COVID vaccine rivals BioNTech-Pfizer, Moderna. Published June 27, 2021. Accessed July 3, 2021. https://www.dw.com/en/cubas-covid-vaccine-rivals-biontech-pfizer-moderna/a-58052365.

8. Cuba says Abdala vaccine 92.28% effective against coronavirus. Reuters®. Published June 22, 2021. Accessed July 3, 2021. https://www.reuters.com/business/healthcare-pharmaceuticals/cuba-says-abdala-vaccine-9228-effective-against-coronavirus-2021-06-21/.

9. Cuba reports a high success rate for its homegrown Abdala vaccine. The New York Times. Accessed July 3, 2021. https://www.nytimes.com/2021/06/22/world/americas/

cuba-vaccine-abdala.html.

10. Berti L. Venezuela receives first batch of Abdala vaccine from Cuba. Published June 30, 2021. Accessed July 3, 2021. The Brazilian Report. https://brazilian.report/liveblog/2021

/06/30/venezuela-abdala-vaccine-cuba/.

11. COVID-19 Information. S. Embassy in Cuba. Updated June 16, 2021. Accessed July 3, 2021. https://cu.usembassy.gov/covid-19-information/.

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

An overview

There are many people who are curious about the Cuban healthcare system. Many people feel that the Cuban healthcare system is one of Fidel Castro’s greatest achievements. Because of the socialist ideology of Cuba healthcare is considered to be a fundamental right which should be available at all times to all citizens. Cuban healthcare focuses on a preventative approach as far as healthcare is concerned. Absolutely all kinds of healthcare are free of charge. This includes all medicines, dental care and even doctors doing home visits are covered by the Cuban healthcare system. Cuban healthcare authorities have all of the required statistics to show how effective this system is. As far as infant mortality rates are concerned there are 4.2 deaths per 1000 births while in the UK there are 3.5 deaths per 1000 births. In Cuba the life expectancies among males is 77 years and among women it is 81 while life expectancies in the UK is 79 and 83 respectively.

Best doctor-patient ratio

In Cuba there is one doctor for every 150 patients. This is significantly better than in any other developed country. In the UK there are 2.8 doctors for every 1000 patients. This is why it does not come as a surprise that the Secretary-General of the UN points to the Cuban healthcare system as a model which should be followed by other countries. Foreigners who have spent time in the Cuban healthcare environment have seen for themselves the many positives and negatives relating to the Cuban healthcare service. Many of them are therefore able to confirm the available statistics. Even among US citizens they are respect for how much Cuba has been able to accomplish when they themselves seem to have so little compared to other developed countries. US citizens are especially impressed by the humility and the professionalism which can be seen among Cuban healthcare workers. Even though Cuban doctors do not earn much and they are often overwhelmed because so many of their colleagues had been sent to African countries in order to assist in healthcare missions they still persist with their endeavors.

Accomplishing the impossible

It is frequently see how Cuban healthcare workers maintain a high standard of service even when they do not have access to sophisticated diagnostic technology. It often happens that you have to wait long periods of time for basic equipment to arrive before they can proceed with procedures. Sometimes there is no running water and no electricity but still healthcare workers find a way to overcome those obstacles and they still manage to deliver a high standard of healthcare. Many Cuban doctors maintain that healthcare is about the need to help others and not so much about personal welfare. Even though this is a concept which is taught in most medical schools it is not something which is seen in actual practice. However, Cuban doctors are the exception. According to statistics the healthcare for a single Cuban is between 300 and $400 per year.

Orthopedic surgery

It is widely accepted that orthopedic surgeons in Cuba are today offering some of the very best Orthopedic Surgical Programs in the world. Because of their extensive training Orthopedic surgeons are able to use both nonsurgical and surgical means to treat a whole range of injuries and other healthcare problems. A long list of orthopedic services is now provided by orthopedic surgeons in Cuba. This include Orthopedic trauma, sports injuries, ankle surgery, foot surgery, pediatric surgery, reconstruction of joints, elbow and hand surgery, spinal surgery, shoulder replacement as well as knee and hip replacement.

Overcoming challenges

Many health professionals continue to be amazed about the fact that Cuba has been experiencing extreme problems for the last six decades because of US economic sanctions. Nevertheless, it still has one of the best health systems in the entire world. In fact, it continues to deliver a higher standard of healthcare than many other developed countries including the US. This is because of the commitment of Cuba to prevent health problems. There is also community oriented primary health care available everywhere. It is an ongoing struggle for healthcare providers to maintain their high standard because of shortages in medicine. It still continues to improve its national healthcare. Another interesting statistic is the fact that Cuba spent 23% of the national budget on healthcare. A further 50% is spent on education which is almost double as much which is allocated for education and healthcare in the US.

Pharmaceutical companies in Cuba

Cuba has its own state owned pharmaceutical industry. One of the priorities of this industry has been the production of treatments which can be used for Covid 19. It also produces another 21 products which are being used to combat the virus. Many healthcare providers all across the planet are in agreement that the success of the Cuban health system is an example to the rest of the world. As far as education is concerned Cuba has the world’s largest medical schools. A perfect example is the Havana Latin American School of Medicine. This institution has provided free education to over 35,000 students from 138 countries in only 20 years. Students coming to these medical schools will receive full tuition and this will include accommodation, textbooks, meals and even a small income. All of the students are encouraged to provide their services to poor communities. This has the result that Cuba currently have over 50,000 doctors which is active in more than 60 countries which is substantially more than the current efforts by other developed countries. The inescapable reality is that this tiny island nation which have encountered so many obstacles over many decades have still managed to improve the lives of so many people.

Re-Evaluating healthcare

It seems in many countries the original concept of what it means to be a doctor has been lost. This is not the case as far as Cuba is concerned. In this country there is a persistent attempt to reverse the trend seen in other developed nations where patients are increasingly viewed as customers and clients while healthcare provider is becoming service providers. There are so many problems as far as healthcare is concerned all across the planet. There is the current corona virus pandemic and in many places there are difficulty when it comes to access to healthcare. In many places healthcare systems are collapsing especially at a time when such services are critically needed. The sad reality is that despite many sophisticated technologies constantly emerging and also the success of medical science we currently see a situation where it seems we have so many problems when it comes to caring for our own.

An army in disarray

There are long list of problems all across the planet which continues to prevent countries from providing optimum healthcare for all of their citizens. It seems there are simply not enough health workers and those which are available are not properly trained or they have not been properly distributed. The result is that there are many health systems that simply do not have sufficient personnel. This is especially true in developing countries. It is frequently seen that health systems do not have enough personnel; there are simply not proper leadership and effective organization. Although it is certainly true that Third World countries experience the most problems it is also true that there are many affluent nations where there are also many problems.

The Cuban effort

No other country has done more than Cuba to bring about a change in the healthcare problems of this planet. They have done so much with their medical education system which has the result that there are more than 24,000 Cuban health professionals active in over 60 countries. This has encouraged more than 10,000 international students to enroll in a full scholarship at one of the Cuban medical school. The healthcare situation in Cuba was not always so efficient. After the revolution of 1959, 3,000 of Cuba remaining 6000 physicians immigrated. However Cuba immediately started to educate students coming from developing countries training them with their own students. From the start there was a commitment on the part of Cuba to make a difference as far as international healthcare systems was concerned. Over the years thousands of international students have graduated from Cuban medical school. In fact there are many of those graduates who are today secretaries of health and some are even involved in the health ministries of other countries.

Sharing their knowledge

Many other countries benefited from the educational system of Cuba. This includes Yemen, Guyana, Ethiopia, Uganda, Ghana, Gambia, Equatorial Guinea, Haiti and Guinea Bissau. Cuba was also involved in other countries such as Venezuela, South Africa, Peru, Paraguay, El Salvador, Ecuador, Dominican Republic, Colombia, Brazil, Bolivia and Angola. Many of these countries have benefited from Cuban professors who provided them with assistance as far as their medical education was concerned. The reality is that the world today and in particular underdeveloped countries would have been in a desperate situation if it had not been for the Cuban influence in global healthcare systems. It is remarkable how much of a difference this tiny country has made.

Growing old is a phase in life impossible to hinder. The elderly are sensitive individuals who require proper care and special attention to maintain steady health and guarantee their good living. Elderly care or senior care is, therefore, necessary and essential to keep the older living citizens amongst us healthy and happy. Elderly care encompasses a deliberate system developed to guarantee vibrancy and access to needed resources required to maintain health and stamina for the prolonged living of older citizens. This system should include a relaxed environment with the proper centres and health workforce to preserve and keep physical strength, an economic system that supports older citizens in financial benefits, locations filled with senior citizens friendly neighbourhood and a dependable healthcare sector with available professionals and geriatric specialists to handle common diseases peculiar to older patients.

Taking all these factors into consideration, the effective transition from working class to senior citizenship is not a comfortable process for both older individuals and relatives. Choosing the area for retirement must be explicitly deliberate as retirement from jobs can be mentally tasking to come to terms with. Newly retired older citizens could develop depression without activities to build the mind and an adequate environment to promote engagement to manage mental alertness. Without a proper location also, the elderly are at the risk of being neglected and abused. The deteriorating health and troubles that accompany old age require special attention and an environment with specialist doctors is very essential. Elderly care is quite sensitive and crucial. It is therefore essential that both the environment, people surrounding the elderly patients and economic conditions must be suitable to enlongate life and promote good health in the old.

Elderly Care in Cuba

The Republic of Cuba located in the Northern Caribbean, south of the state of Florida and the Bahamas, is a beautiful country with a rich Spanish culture and spectacular scenery. With the average life expectancy in Cuba being 70years, the senior citizens make up about 14% of the general population has recorded in urban areas. Due to the high percentage, elderly care in the Republic of Cuba has significantly improved in the past decade. Presently, there are governmental and private-led social, medical and financial care available for older citizens.

The medical care for the elderly in Cuba include free access at all levels for both specialized and general health issues. There is a current surge in geriatric doctors with training initiatives provided to boost the knowledge of family doctors towards understanding geriatric medical needs and expanding their practice. This medical care system has been developed to boost the care and life expectancy of the elderly creating a better health system for the older citizens. The financial assistance towards elderly care in Cuba doesn’t fall short of perfect too. Pensions are usually paid expressly irrespective of the economic situation. Social assistance for older people is rooted deep into Cuban society, creating an environment that facilitates proper care, attention and support for the elderly. The communities are sensitive towards older persons in society and stand in solidarity with neighbourhood assistance and friendly people considerate and open to the elderly.

Elderly care in Cuba is above the standard with both communal and economic ingenuities developed to sustain and improve the lives of elderly persons in the country. As a result of Cuba’s deliberate attempt to improve elderly care, life expectancy remains high and growing. With senior citizens clubs, senior care facility, psychological and sociological research centres, Cuba is fortified with every necessary tool present for senior citizens and elderly persons to thrive.

Benefits of Retirement in Cuba

Retirement is an opportunity to begin a new life and start afresh. In the beautiful city termed a retirement haven, Cuba is the perfect place to take in and relax after a long hectic life of struggles. The benefits of retiring in Cuba thus includes;

1. Low Cost of Living

The cost of living in Cuba for retirees is quite low. Food and rent are cheap and easy to access with the government offering Snow Bird visas for short term visits. The value of top-notch living in a tropical environment with good-natured individuals, interesting culture and language in comparison to surrounding countries is cheap and affordable. Staying in Cuba does not come at a cost and planning for permanence is highly advisable.

• Assisted Living Homes

The assisted living homes in Cuba for the elderly are developed on the foundation of respect, medical adeptness and true support. Cuban culture thrives on quality care and attention for the older generation. The treatment and care costs for an environment that offers good medical services and non-abusive educated workers are relatively cost-effective. Retired individuals with disabilities are given the opportunity to enjoy life irrespective of the condition with excellent assistance at a good rate.

• Beautiful Scenery and Safe Environment

An accommodating environment that is safe with an abundance of places to see, explore and visit is Cuba in a nutshell. Explore the architecture and cultural diversity of Camaguey, enjoy the mild beautiful sunset on the beaches in Varadero and be taken captive by Havana and Trinidad’s charm. Old age can be a fun experience in a safe country like Cuba.

• Suitable Healthcare

The healthcare sector in Cuba is built on a foundation of elderly care available for senior citizens. General practitioners and specialists in the geriatric field are in abundance. Senior citizens care centres are equipped with standard equipment and medical professionals to keep older people in good health. The cost of care for older persons is considerable inexpensive for high-quality care received. Cuba’s life expectancy at 70 years mirrors the United States, proposing evidence for high-quality medical care for the older generation.

• Friendly Climate

Dry and wet seasons in Cuba are characteristic of the tropical nature of the country. The bright sunshine and cool weather is suitable for the old. The weather is not harsh or dangerous and is perfect for retiring old persons. The tropical area provides a warm comforting environment to garden, enjoy the beach and learn new sporting activities even in old age.

The level of quality elderly care in Cuba is the reason it is a top-tier destination for retiring individuals. Alongside the first grade medical care, the inexpensive cost of living and assisted care is perfect for the elderly from all the world. A country where the environment, government and people are designed to promote health of the old is a destination for the best elderly care.

—> Long-Term Elderly Care

Almost everybody in this world has faced face a little pain in their ankle while walking it because they are either twisted or turned in an awkward way which our whole leg was unable to handle. This whole twist and turn of the tissue in the ankle can sometimes lead to a rupture in the ligament which was responsible for holding ankle bones together.

The tissue helps to keep the bones together due to which our joint works and move properly. A little bit of tear in a ligament can lead to disturbance in the motion of the entire portion. The sprained ankle mostly happens when the tissue and bones go beyond that particular motion. The sprained ankle can be both internally that is a ligament tear or externally that a twist in a bone structure.

Few symptoms relate to a sprained ankle.

The symptoms of sprained ankle differ from person to person depending upon how severe the pain is. Sometimes the twist in the ankle heals with hours and sometimes it takes days  so the basic symptoms might be the same but the severity level can be different.

• Pain, especially when you bear weight on the affected foot
• Tenderness when you touch the ankle
• Swelling
• Bruising
• Restricted range of motion
• Instability in the ankle
• Popping sensation or sound at the time of injury

If the severity of the symptoms increases then the pain might be equal to that of breaking the bone. In adult’s the sprain in the ankle is common but in children’s also the sprained ankle is caused due to some minute reasons such as

• uneven walking
• jumping
• pain in  ankle
• Changes in every level of walking.
• Sometimes due to tenderness in the bones, there might be a fracture in the bones of the baby.

Causes of Sprained ankle are:

As discussed earlier sprained ankle is a condition which is commonly occurred when the whole ankle gets twisted or there’s a tear in a ligament. Some basic causes can also be reason of sprained ankle such as

1. Falling 

Falling can be the major reason why people usually get sprained ankle and by the way the height while falling is not yet determined so if the person falls from a very tall place the severity of the ankle twist will be a lot more than that of pain which will be after falling from a shorter height. Falling while running or during exercise also falls under the falling category.

2. Overuse 

The overuse of the ankle can be another major reason why people tend to get the sprained ankle. In overuse, there belongs a lot of leg work and less resting due to which at the end of the day all the pressure gets on the ankle and it starts getting sore and causes pain.

3. Previous ankle sprain

An ankle sprain is of many types some of them are acute while some of them are having a huge impact on the entire leg. The acute ankle sprain is a minute ankle sprain that can easily be recovered within 2 3 hours but what if that ankle sprain is not properly healed and people are still putting the same amount of pressure on the ankle which indeed causes a severe ankle sprain.

Treatments and medication regarding ankle sprain:

Treating an ankle sprain is sometimes easy and quite difficult at the same time because sometimes a little ice pack can heal the swelling and pain of the ankle but sometimes that same ankle sprain can last for 3 4 days which will be very dangerous to handle.

1. RICE protocol

Rest, ice, compression, and elevations. In the RICE protocol, one should rest his or her ankle for a while applying some ice over it because ice helps in reducing the swelling then followed by compression and elevations over the respective ankle.

2. Exercise

The exercise will stretch the respective muscles such as ankle circles, toe raises, or heel raises. After the surgery or the ankle sprain, the doctors usually suggest performing some minute exercise to keep the blood flowing and prevent it from swelling.

3. Medication

Nonsteroidal anti-inflammatory drugs such as ibuprofen can ease pain and reduce swelling.

Few respective Medicines for ankle sprain are:

• ibuprofen (Advil, Motrin IB, others)
• naproxen sodium (Aleve, others)
• acetaminophen (Tylenol)

Recovery regarding ankle sprain:

The ankle sprain can be of different types the phases of the ankle sprain are categorized into grade 1, grade 2, and grade 3.

• The grade 1 ankle sprain might take few weeks to heal say 1 to 3 weeks.
• The grade 2 ankle sprain might take 3 to 5 weeks to heal.
• The grade 3 ankle sprain might take few months to heal.

Conclusion:

So in conclusion, an ankle sprain can happen to anybody who has a bad walking structure. The ankle sprain can be ignored because that same ignored sprain can cause permanent damage to the ankle so it’s highly suggested that one should always consult a doctor even if there a minute ankle sprain.

In the 21^st century, we are facing the fact that the global population is ageing quite rapidly. The reason for this increasing trend lies in several factors. Firstly, the number of babies brought to this world declines and more and more couples face fertility issues. Second, more important factor includes better availability and quality of healthcare worldwide, which in return prolongs life expectancy. Western countries, and those with high quality of primary healthcare, are impacted the most with ageing phenomenon. According to some estimations provided by the World Health Organization (WHO), the total world’s population over 60 years of age will nearly double by the 2050. Shown in numbers, we can anticipate an increase from 900 million today, up to nearly 2 billion people of elderly people in thirty years. These, what appears to be dramatic data have multiple consequences, including social, economical, as well as healthcare issues.

Mental problems are well recognized health issue in the elderly. It is estimated that approximately one fifth of the global elderly population suffers from some form of psychological disorder which prevents them from independently performing everyday activities. As a society, we sometimes perceive intellectual and mental decline almost as a natural consequence of ageing. On the other hand, stigma that surrounds these conditions often prevents elderly people and their families from seeking professional help and assistance. Support and care are crucial when we discuss about how to overcome the challenges related to psychological problems in the old age.

What are the risk factors?

The spectrum of risk factors responsible for developing psychological problems in old age is quite extensive. Multiple chronic illnesses, especially those of cardiovascular and cerebrovascular origin (hypertension, stroke, coronary heart disease) may have direct consequences to the brain, thereby producing cognitive disturbances and mental issues. Chronic pain is a perfect trigger of psychological distress in the old age. Hospital admission and any change of the environment (moving to a care setting) can also have a negative impact for the overall psychological well-being in the elderly. Social isolation, reduced income during retirement and loss of close family members are significant stressors to cope with – these may produce severe psychological disturbances leading to anxiety or depression. In fact, any severe and long-term illness, such as cancer, tends to affect the behavioral and psychological status of an older person.

Sadly, people of older age are also recognized as a population group prone to abuse. There is evidence that one in six older people will experience some type of abuse. Loss of dignity and respect is, not surprisingly, tightly linked with severe psychological issues.

Are there any symptoms?

Close family members and caregivers should be aware of signs and symptoms related to mental disorders in the elderly in order to seek professional help in a timely manner. When we see our loved ones age, occasional forgetfulness is usually not something to especially worry about. However, persistent loss of memory is a clear indication of a severe health condition needing medical attention.

Significant changes in appearance including changes in clothing may implicate a psychological and behavioral problem. Confusion, disorientation, inability to concentrate or make decisions represent early signs of cognitive decline and dementia. If you experience that your loved ones persistently ask the same questions, forget important dates, frequently misplace their belongings, this is a clear sign to refer them to a medical professional.

It is advisable to especially keep an eye on the feelings of guilt, worthlessness, helplessness – such symptoms are linked with depression. Mood swings, ranging from e.g. being carefree to anxious are indicative of psychological issues. Inability to cope with everyday routine, problems in maintaining hygiene, home or garden should not be disregarded – they are often a sign of mental illness in older people.

Noticing any type of social withdrawal should be taken seriously. If your loved ones lose interest in social activities that they used to be excited about, or just avoid regular social engagements, you should consider seeking professional support for them.

Common psychological issues in old age

It is probably not that surprising that cognitive decline and dementia represent the most common mental health disorder in people older than 65 years. This severe and progressive disease affects approximately five million senior Americans or fifty million seniors worldwide. Concerning is the fact that this number will almost triple in the next twenty years. The disease by itself is estimated to take more lives than breast and prostate cancer combined. Any type of dementia can produce significant physical, emotional and economic pressure to patients and their caregivers. This is why an early diagnosis and appropriate care are essential for patients and their caregivers.

Depression and mood disorders are also quite frequent among seniors, however, the problem with this health condition is that it often goes undiagnosed and, therefore, untreated. Center for Disease Control (CDC) estimates that 5% of elderly individuals suffer from depressive disorder. It is worth mentioning that some medications such as those for the treatment of increased blood pressure may cause depression. Sadness is not the only symptom. Lack of motivation and energy are the usual complaints linked to depression. Prolonged suffering and impairment in performing daily activities are well recognized consequences of untreated depression. Timely diagnosis, accompanied with adequate treatment, care and support is crucial for increasing the quality of life of elderly individuals.

Anxiety is also quite prevalent and may encompass a wide range of mental issues including obsessive-compulsive disorder, post-traumatic stress disorder, panic disorder or phobias. Women are more prone to anxiety than men. Anxiety related disorders tend to occur after a stressful situation such as loss of a spouse or side by side to other chronic and prolonged disease. As in depression, anxiety disorders are usually overseen in elderly individuals, which may have severe implications to the overall well-being of seniors.

Sleep disorders including are common among seniors. Prolonged time needed to fall asleep (usually more than 45 minutes), trouble in maintaining sleep with frequent periods of being awake during night, as well as short overall duration of sleep represent clear signs of insomnia. Proper sleep is very important as it will reduce the probability of a severe psychological disorder. Maintaining a “sleep hygiene” reduces the need for sleep medications, which are sometimes responsible for memory impairment or poor daytime performance.

Is there a solution ( psychotherapy )?

It is important to mention that all of the above-mentioned disorders may coexist, and it is usually the case that seniors suffer from more then just one mental disorder. This is why they need all our support. WHO clearly recommends as a standard of care both psychological and medicinal treatment of seniors affected with mental disorders. This approach is essential for improving both physical and mental health and keeping an optimal quality of life of elderly individuals.

The demand for care and support of seniors with mental issues will increase as the elderly population grows. Providing a timely, high-quality professional help to older people directly reduces the number of complications that may arise as a consequence of mental disorders and prolongs the physical and emotional well-being of the elderly.

Solutions at CubaHeal

CubaHeal offers specialized programs for diagnosis and treatment of psychological problems in the elderly. An array of psychological therapies is available at CubaHeal facilities. Our team of health professionals can provide top-notch, evidence-based medical expertise. This includes diagnosis and treatment for our users, no matter the psychological condition and its stage.

You can find more info about our programs here. Long Term Elderly Care

If you need any additional info about our programs, feel free to Contact us.

Eczema is the most common form of chronic dermatitis, a non-infectious skin condition characterized by an itchy rash. Commonly, across the literature, it is referred to as atopic dermatitis (AD) as well. Typically, it affects children and the situation gets better as time goes by, but adults can suffer from it as well. However, when it comes to the causes, there is no straightforward answer to explain these. By what we know about it so far, the most accurate answer would be – it is caused by a combination of genetic and environmental factors (basically, this means it is caused by something that’s written in the patient’s genetic code and something in his or her environment). However, giving that this answer can hardly satisfy the curiosity of people interested in the condition, we will discuss it in more detail and provide a broader perspective on the perplexity of eczema origin.

The roots are deep within the DNA 13

Although the pathophysiological mechanisms that cause eczema are pretty well described, their exact background remains to be a subject for academic debate. There are two widely accepted hypotheses – the first one concerns the imbalance in the immune system, and the second one concerns a defect in the skin barrier. The definitive answer to why eczema happens is still not found, but the two hypotheses offer a reasonable explanation. Also, they shouldn’t be taken as mutually exclusive but rather as points of view that complement each other.

The imbalance in the immune system hypothesis

The theory argues that the eczema results from an imbalance in the T cells production – in particular, in people with eczema, there are more T-helper 1 and T-regulatory cells (subtypes of T cells) than there should be. As a result, the amount of interleukins (substances that promote inflammatory response) is increased, so is the intensity of inflammation in the affected areas of the body.

The skin barrier hypotheses

The theory is a newer one and argues that individuals with mutations in the filaggrin gene more often develop eczema than those without the mutation. The filaggrin (filament aggregating protein) binds cells in the upper layer of the skin (referred to as epidermis) together and seals the tiny cracks between them. Filaggrin minimizes the water loss through the skin and penetration of the allergens from the environment (the size of the allergens varies – from small inorganic to large organic molecules or even microorganisms). In some people with the mutation, the production of filaggrin drops critically low, so the skin barrier doesn’t function as it should. The skin becomes more permeable for water (increased water loss), allergens and microorganisms.

The toll on health goes beyond the skin surface

Let’s take a pause from eczema causes here and briefly discuss the phenomenon known as “The Atopic March.” Our immune system works as a whole – defects in the execution of its functions reflect themselves on the whole body more often than not. Eczema is a skin condition, but the same genetic factors that lie in its background also affect other regions of the body. “The Atopic March” describes a temporal sequence of conditions that develop on the terrain of inadequate immune response seen in patients with eczema. The flaw mentioned above in the T-helper

lymphocyte function also can cause food allergies, asthma or allergic rhinitis. The eczema kicks in first and, in the early years of life, is often followed by the rest of the atopic cascade. The importance of this phenomenon lies in the fact that a timely treatment of eczema can reduce the severity of or prevent in temporary conditions that follow it.

Environmental factors

As mentioned earlier, the leading cause of eczema is a combination of genetic and environmental factors. Not all people with the “right genetic code” develop the condition. Eczema happens only if all or the majority of contributing factors align, creating a perfect storm. In this section, we’ll take a look at contributing environmental factors. The prevalence (the number of cases of a disease present in a particular population in a given time) of eczema has increased in the past few decades at a pace that changes in gene pool cannot explain. So, the increase in prevalence is explained by changes in environmental factors. At this moment, we can’t tell for sure what those factors are. Still, the growing body of scientific evidence suggests that exposure to dust mites, various allergens, infections, irritants and antibiotics increases the prevalence of eczema 1.

Hygiene Hypothesis 

The theory was introduced to the public back in 1989, and it suggests that the main cause of increased eczema prevalence may be the development and “sanitization” of society. The theory argues that the lack of adequate stimulation of the immune system in early life (children that are “too clean”) and failure of maintaining balanced gut flora in adulthood (antibiotics in food) are triggering factors in the pathogenesis of eczema. Furthermore, the hygiene hypothesis explains the rapid rise in prevalence among smaller, wealthier and more educated families in comparison with larger families and those attending a nursery.

The bottom line is that exposure to some pathogens in early life, as well as the timing of exposure, play an essential role in the pathogenesis of eczema. However, some pathogens may trigger the condition; for example, measles infection increases the risk of the disease.

References : 2,3,4,5

Irritants 6,7,8,9,10,11,12

Soap acts as an irritant. It causes skin dryness, increases its pH, and transepidermal water loss. Several studies have shown that exposure to soap is in relation to increased eczema prevalence and that removal or avoidance of such chemicals reduces its prevalence.
Some studies have shown that eczema prevalence is increased in areas with harder water, but in recent years this hypothesis has been rejected. Namely, the increased hardness of water requires increased use of soap, so the scientific community accepted the use of irritants as the cause of eczema rather than the water harness.
The avoidance of irritants early in life is vital as a preventive measure – once the condition establishes, exclusion of those chemicals do not affect further development of the disease (eczema, followed by atopic march).

So, what is the main cause of eczema?

After this discussion, it is essential to underline that eczema is a multifactorial disease. Its causes are not yet fully understood, and some claims about it are still wrapped in a veil of controversy. However, here are some important takeaway notes:
– The condition is a multifactorial disease caused by a combination of genetic and environmental factors.
– The genetic mutations in people with eczema affect not only the skin but potentially other organ systems, primarily respiratory organs. Eczema is often only the first in a cascade of health issues that arise from altered genes.
– Restriction from exposure to the microbes in the environment is in association with the increased prevalence of eczema, but some infective agents may increase the chance of disease establishment.
– Once the condition establishes, it is impossible to reverse the process, but it tends to milden or completely disappear during puberty.
– Exposure to skin irritants, soap in the first place, plays an important role in the pathogenesis of the disease.

Reference list

1. McPherson T. (2016). Current Understanding in Pathogenesis of Atopic Dermatitis. Indian journal of dermatology, 61(6), 649–655
2. Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989;299:1259–60.
3. Williams HC. Atopic eczema – Why we should look to the environment. Br Med J. 1995;311:1241–2.
4. Flohr C, Yeo L. Atopic dermatitis and the hygiene hypothesis revisited. CurrProblDermatol. 2011;41:1–34.
5. Hesselmar B, Sjöberg F, Saalman R, Aberg N, Adlerberth I, Wold AE. Pacifier cleaning practices and risk of allergy development. Pediatrics. 2013;131:e1829–37.
6. MJ Cork. The importance of skin barrier function. Taylor & Francis J Dermatological Treatment. 1997.
7. McNally NJ, Williams HC, Phillips DR, Smallman-Raynor M, Lewis S, Venn A, et al. Atopic eczema and domestic water hardness. Lancet. 1998;352:527–31.
8. McNally NJ, Williams HC, Phillips DR. Atopic eczema and the home environment. Br J Dermatol. 2001;145:730–6.
9. Font-Ribera L, Gracia-Lavedan E, Esplugues A, Ballester F, Jiménez Zabala A, Santa Marina L, et al. Water hardness and eczema at 1 and 4 y of age in the INMA birth cohort. Environ Res. 2015;142:579–85.
10. Thomas KS, Dean T, O’Leary C, Sach TH, Koller K, Frost A, et al. A randomised controlled trial of ion- exchange water softeners for the treatment of eczema in children. PLoS Med. 2011;8:e1000395.

11. Simpson EL, Chalmers JR, Hanifin JM, Thomas KS, Cork MJ, McLean WH, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy ClinImmunol. 2014;134:818–23.
12. Harris JM, Williams HC, White C, Moffat S, Mills P, Newman Taylor AJ, et al. Early allergen exposure and atopic eczema. Br J Dermatol. 2007;156:698–704.
13. Thomsen S. F. (2014). Atopic dermatitis: natural history, diagnosis, and treatment. ISRN allergy, 2014, 354250.

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