Very Personal Draft of 30 Lectures Recompilation from Nov. 6, 2000 to Sept. 27, 2003  (14 117 words - 33 pages A4 at one-line space).

 

[Awaiting for improvement in English style and edition, quotation of bibliography, incorporation of more achievements, updated statistics, and political corrections]

 

 

Progress on Health Care, Research, Education Policies and Systems in Cuba from 1492 to 2003.  Beginnings, Efforts, Results, Reflections, Challenges, and Next 10-20 Years Scenarios.

 

 

Rodolfo J. Stusser, M.D.

• This is an informal personal view of a senior researcher who lived in Cuba from 1945 to 2003. It is not necessarily the same one of the institution where he works or of his superior health and scientific government authorities.
• The study began in the Clinical Research Center, of the Scientific productive Pole of West Havana and finished in the Vedado Education Polyclinic, of the Ministry of Public Health at West Havana, Cuba too.

 

Introduction

 

Frequently in the world media and even in medical articles we have heard expressions like these: “Old-fashioned doctoring keeps Cubans healthy”; “the country may be one of the poorest nations in the world, but its inhabitants report health indicators that rival those of rich countries, such as the USA”; “the Cubans are the absolute best at doing something with nothing”.

 

The health care, research, education policies and systems in Cuba, advanced and powerful, have carried their scientific prestigious overseas in the 20 century, but really their scientific bases began more than 200 years ago. Cuba shows rich antecedents and landmarks, which is fair to address and must be divulged as ones of our most precious treasures.

 

The first 300 years of her 511 years of modern western civilization could be evaluated of dry grain, but allow the nesting of the germen again scholasticism. Ulterior stages were definitively of fertile seed and harvest of scientific fruits.

 

Cuban health research and science progress, efforts, and results, constitutes a singular example of development, which could be considered by more than 160 developing countries, and some of the 50 developed countries too. The health of its children, women, men, and elder, express their level of progress.

 

In the last decade and now in the year 2003, the Cuban health care, education, and research policy and system are facing an extremely complex situation, and very hard challenges. Nevertheless, it could be forecasted some promissory perspectives for the close decades of the 21-century.

 

Objective

 

The objective of this report is to introduce and overview the main moments of the progress  and results of the Cuban medical, nursing, technological and public health care, research, education policies and systems, through its process driver string, as an analytical base to reflect its main challenges and forecast main scenarios for the next 10-20 years, and to help reorient its policies and programs in the future.

 

Method

 

The methods of this study is of an international health country case study. The design was born in 1998, when the author accessed the Intranet and an email box of the Ministry of Public Health of Cuba, and afterwards, to the Internet in 1999, contacting the World Health Organization headquarters web site and whole world. It began to be done in the framework of the rich exchanges and discussions of southern country case studies with more than a thousand international researchers and stakeholders in the International Forums of the Global Forum for Health Research Foundation at Geneva and Bangkok from 1998 to 2003. Its realization was very encouraged by the talks and rich exchanges that the author had at Havana and through email with near a thousand academic physicians, nurses, natural, social and political scientists, educators, public administrators, and students, of the US People to People Professional Ambassadors Program and Other US Academic Programs with Cuba from 2000 to 2003. The information for this study came from hand searches of the health and science monographs and papers that the author have reviewed in near 40 years guided through the Index Medicus and Current Contents books, Medline CDs, Current Contents disks, and through Internet Medline searches in the US National Library of Medicine and through search engines of many other world web sites of published literature on the matter, collective and personal discussions and correspondence with experts in the subject, and the personal experiences of the author.

 

 

Development

 

The progress of health care, research, education policies and systems in Cuba could be analyzed in several moments of a process that could be divided in five-six main stages.

 

Cuba 1492-2003: Health Research and Science Progress Stages

 

0) 1492-1727: Discovery of the Island and Indians, and the Spanish Colonization.

 

1) 1728-1898: Health Research under Spanish and African Old Influence.  (Retarded Pro-Slavery, Behind Feudalism, and Capitalism, in a very Primitive Land)

 

Transit to an Untenable Capitalism (Socially)

 

2) 1899-1959: Health Research under American and Caribbean Old Influence. (Retarded, Hasty and Firstly Subsidized Capitalism in a Very Underdeveloped Country and Polarizing World)

 

Transit to an Untenable Socialism (Economically)

 

3) 1960-1990: Health Research under Chinese, Soviet-Russian and Comecon Old Influence. (Hasty and Subsidized Socialism in a Very Advanced but Blocked Developing Country and Polarized World)

 

Transit to a Viable Socialism (In Both Ways?)

 

4) 1991-2003: Health Research under Spanish, European Union, and Chinese New Influence. (Surviving very Poor Socialism and State Capitalism in a very Blocked, Disproportionate and In-harmonious Developing Country and Globalized World)

 

Transit to a Viable…?

 

5) 20?? Health Research under American New Influence?

 

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0) Cuba 1492-1727: Discovery of the Island and Indians, and the Spanish Colonization.

 

Primitive Cuba has more than a half-millennium of been discovered by Genoese navigator Christopher Columbus on October 27, 1492 in a Mission of the Spanish kings.

 

He found an island with the area of Pennsylvania, 45 000 square miles, inhabited by 60 000 native peaceful Indians, very retarded in the savagery and barbarism stages. They were enslaved, mixed and exterminated by 10 000 Spanish whites and Moors, and substituted since 1514 by Sub-Saharan Africans and Spaniards.

 

In 1500 the population was of about 100 000 aborigine Indians and 10 000 Spanish conquerors. Between 1500 and 1850 were brought to Cuba 1 000 000 of black Africans as slaves.

 

The Indians suffered dermatitis, eczema, niguas and other parasites, a pellagra type, frustrate yellow fever, typhoid fever, diarrhea, etc. The Spaniards and other whites introduced the smallpox or pock, tuberculosis, syphilis, typhus by fleas, etc. The Africans brought leprosy, skin affections, etc.

 

There were founded seven villages: Baracoa, Bayamo, Santiago of Cuba, Port Prince, Sancti-Spiritus, Trinidad and Saint Christopher of Havana.

 

It began a very slow educational, cultural, technique, and scientific transfer from the retarded Cadiz Port in Andalusia, Spain, Mexico and rest of Latin America, through the Spanish fleet.

 

In 1520 sprouted a pock epidemic in a Cuban region and in 1521 at Havana, finished by a fire in 1522, affecting the Indians more. In 1603 sprouted a pest epidemic at Havana and again in 1621. In 1637 sprouted measles and pock again.

 

In 1649 sprouted a yellow fever epidemic at Havana (probably brought from Tierra Firme or Veracruz Ports), with 121.7 deaths x 1000 inhabitants.  In 1652-54 it sprouted at Havana and spread to the island. In 1658 the yellow fever sprouted in Bayamo. In the next 40 years, the pock and yellow fever continued affecting Havana and Santiago of Cuba.

 

From 1492 to 1728, there was academic inactivity, and only personal teaching of few proto-physicians or empirical practitioners until 1717 that began to be examined by a Tribunal of Proto-Physicians of the Crown.

 

Three-century was delayed the introduction in Cuba of the printing of Gutenberg in 1723, beginning the first newspaper of Havana, with medical articles. 

 

1) 1728-1898: Health Research under Spanish and African Old Influence. 

 

In the 18-century, continued the yellow fever and pock more in blacks. It began the rabies in dogs, measles, pock, typhus, and other malignant fevers. 

 

In 1728, Friar José Fernandez of the Dominicans catholic order in the Saint Juan of Letran Convent founded the Royal and Papal Havana University, with its first Medical Faculty, second in the Caribbean and fourth in Latin America, with influence of the University of Salamanca.

 

Medicine was still submerged in the lethargy of the scholastic ignorance of the Middle Ages on the island. The teaching of medicine was in the 18-Century of the “Theories and Systems”, still based in Avicenna and Galenic’s teachings, behind the new modern medical advances of the Renaissance in Europe. The useful discoveries of Harvey, Malpighi and Sydenham in the 17 century were unknown and not applied yet.

 

The yellow fever was worsened at the arrivals of the Spanish Navy in 1738 and 1742, and when the Englishmen took Havana in 1762.

 

Later, these observations and others made by Carlos J. Finlay, M.D. created the Natural Immunization Theory of the natives by the Culex mosquito, while Louis Pasteur was looking for a vaccine.

 

Havana in 1762 was the third city in all the Americas, more opulent than Boston and New York, but less than Lima and Mexico City. The economic activity passed from mining in rivers, through tobacco bend and cattle breeding, to sugar factory, requiring science and technology. The British capture of Havana, opened commerce with the Thirteen North American Colonies. 

 

Western Europe and USA began to buy sugar and coffee in Cuba.

 

Foundation of the Seminary of Saint Carlos in 1773, where were graduated many Cuban physicians.

 

 There began flu, dysentery and dengue epidemics, the last one in 1782.

 

There were founded the Economic Society of the Country Friends, with the first Cuban Library in 1793.

 

There were built roads and bridges, schools and hospital in the sugar mills’ towns, other towns and cities, beginning the primary and secondary care.

 

Began first works in geography and geology of Cuba of Alexander Humboldt, Second Discoverer of Cuba.

 

In 1800 Cuba had a population of about 200 000 inhabitants in an area of 45 000 square miles, as the state of Pennsylvania. There were around 95% of illiterates as in Spain, France, and other European countries. The Gross Mortality Rate was 39 x 1000 inhabitants (without epidemics), and the Gross Natality Rate was 47 x 1000 inhabitants.

 

There were about 500-600 nurseries and hospitals in sugar mills, towns and cities. There was public and private medical practice.

 

The Immigration from 1492 to 1898 was of 1 million of black Africans as slaves, 1 million of Spaniards (including also French, British, German), 123 000 of Chinese, and thousands of Latin American Indians.

 

There were initiated the training of physicians and scientists, besides Spain and Mexico, in France and USA. There was an escalation of the cultural, scientific and technological transfer from France and USA, as training there of bachelors, physicians, engineers and scientists.

 

Tomas Romay, MD, was a self-taught man initiator of the scientific movement in Cuba. He had to add the scientific acquisitions and doctrines of more than 200 years to reform medicine in the island. He began an intense transfer of culture, scientific knowledge, technology, from the University of Valencia in Spain, as well as of the University of Edinburgh. On February 10, 1792, he published the first scientific article in the Havana Newspaper, after his first experiments with patients was made. Introducing the elements of Evidence Based Medicine, he demonstrated the superiority of the value of clinical research over the prestige of authority. It was putting clear the value of the prescription of cow dung and certain water taken in the spring, for a group of dissimilar diseases such as elephantiasis, epilepsy, dropsy, and others.

 

Dr. Romay initiated a reform in the educational program to drive from the faculties the barbarous Arab medicine, which superimposed reasoning on observation and experiment. He replaced this with true sciences: experimental physics, botany, chemistry, pathology, and a faculty to teach the practical elements of Cullen of the University of Edinburgh, to produce worthy works comparable with those obtained in Europe. He tried to restore the teachings of the Hippocratic medicine, as professor of pathology, but he had to leave the Havana University to do so     .

 

Dr. Romay introduced the study of botany, chemistry and mineralogy for medicine and industry in 17??. He made the first scientific dissertation of Yellow Fever in the Patriotic Society in 1797, and afterwards, it was published. He introduced in Cuba the vaccine against smallpox in 1804. In 1826, he was an initiator of a movement in pro of a National Academy of Science.

 

Introduction of 1 000 US operatives to help in the building and functioning of the first Latin American railway, before than in Spain.

 

A main activity of the Havana Bay that continued was as key station of provisioning, commerce and stay of the fleets at the door of the Gulf of Mexico.

 

There arrived to Havana many Africans slaves with pest. Afterwards the cholera entered for the first time in Cuba in 1833. Continued the yellow fever, pock, scarlet fever, croup, dengue, rabies, serious & gangrenous angina, typhoid, dysentery, cerebral fever, flu, measles, diphtheria, human muermo, TB, malaria, diarrhea, etc..

 

It was made the First Reform secularizing the Royal and Literary Havana University in 1842, putting it in worldly hands, and creating a Faculty of Pharmacy.

 

José Luis Casaseca founded a Cathedra of Applied Physics and Chemistry in the Havana University in 1845, and a Chemistry Research Institute in 1948, for applied research in the agriculture, industry, medicine, and hygiene.

 

First outstanding works in agronomy by Alvaro Reynoso, Juan T. Roig, Ramon Sagrá, and Julián Acuña, in meteorology by Andres Poey, and Benito Viñas, in biology by Felipe Poey, in philosophy by Jose de la Luz y Caballero, and in economy by Francisco de Arango y Parreño.

 

Priest Felix Varela started teaching experimental physics, the first ideas about “thinking in Cuban” and the “Cuban nationality”, and founded the Bimonthly Magazine with Saco and Luz.

 

In 1840 was the opening of the National Archive at Havana.

 

Since 1840, Nicolas J. Gutierrez, M.D., founded the Havanan Medical Repertory, the Scientific Bulletin in 1842, and 6 others.

 

There entered for the first time in Cuba the mumps and whooping cough in 1850.

 

Dr. Gutiérrez founded the Royal Academy of Medical, Physical and Natural Sciences in the old Saint Domingo Church in 1861. He introduced in Cuba the use of the chloroform as anesthetic for surgeries.

 

In 1864 the Academy Annals were published by Antonio Mestre, MD, achieving 5 639 articles until 1958.

 

There were created the first High School Institutes, and Faculties of Sciences, Philosophy and Writing, and it was published the Cuban Magazine by Enrique J. Varona.

 

There were outstanding works in economy of Francisco Arango, and of Jose de la Luz y Caballero and Enrique José Varona in philosophy.

 

In 1968, began the first of three big consecutive Revolutionary Wars for the Independence of Cuba from Spain, with starvation, homeless, and misery, raising many epidemics until 1898. It was enacted the 1st Guaimaro Constitution.

 

The Asiatic cholera had its third and last irruption in Cuba in 1868. The diphtheria mortality was of 26 x 100 000 inhabitants. In 1872 reached 90 in 1890, decreasing to 58 in 1994. In 1890 were reported deaths by human muermo.

 

The wars increased all epidemics of pock, yellow fever, dengue, dysentery, flu, measles, typhoid fever, scarlatina, croup, TB, malaria, diarrhea, etc.

 

From 1882 to 1894, USA invested 50 Millions dollars in Cuba.

 

Publication from 1875 by José Santos Fernández, M.D. of the Medical Surgical Chronicle of Havana (4 451 articles) until 1940. He was Dean of Latin American Medical Press.

 

It was founded the Society of Clinical Studies of Havana from 1881 publishing its Archives until 1958.

 

Cuban born Joaquin Albarrán, M.D. and Manuel Gonzalez, M.D., trained and living in France made valuable contributions to the urology and neurology.

 

In 1886 was abolished the slavery. There were built bridges, telegraph lines, a modern Havana Aqueduct by the Eng. Francisco Alvear, civil and military hospitals at Havana and big cities, Spanish health regional centers by her different colonies.

 

It was built the Hospital Alfonso XIII at Havana, converted later in the University Hospital General Calixto Garcia.

 

The catholic nuns were the first empirical nurses since the beginning of the colony.

 

There were outstanding Cuban works in clinics, surgery, geography, agronomy, biology, meteorology, economy and philosophy in the island and abroad. It was organized the Society of Hygiene of Havana from 1891-95, which restarted in 1901-05, with its Hygiene journal.

 

In this period, the Havana University prepared most of all lawyers, physicians, and pharmacists. The poor development of physics and mathematics, natural sciences, and literature, and low educational level of the people, was a reflex of the still semi-feudalist retarded metropolis. The more developed sciences owed their progress to technical requirements of the nascent but retarded capitalist economy of the 19-century.

 

Carlos J. Finlay, MD, made the First Great Cuban Scientific Discovery in 1881: “The Mosquito as Transmission Agent of the Yellow Fever”, and the Metaxenic Transmission of Infectious Diseases Mechanism (through Biologic Vectors) in 1882. Dr. Finlay studied High School in France, and Medicine in the Jefferson Medical School, University of Philadelphia, Pennsylvania, USA.

 

Cuba found in barbarism by Spain, in 400 years went as service colony through slavery to a semi-feudal, late and slow capitalism, with her best physicians, pharmacists and scientists, educated overseas, because of its still behind educational, health, and scientific systems, including the Havana University. The poor city-planning and retarded economy, old technology, low education and health levels of most of the people, slow progress in mathematics, physics, natural & social sciences, were faithful reflex of the cultural encounter of the most retarded European metropolis and primitive Indian natives and African tribes of those times.

 

It had also behind Spanish public hospitals, regional centers, private practice, clinics, public sanitary system as the regressive Spain of that times.

 

In the 19-century Cuba & Latin American economies had 1/4 of the economical growth of USA & Canada, without neocolonial dependence already: Technology & what more?

 

José Martí, our most brilliant Cuban thinker and fighter for the Independence of Cuba and Constitution of a Sovereign and Democratic Republic, after becoming lawyer in Spain, living and writing for 20 years in USA, said about the origins of the two Americas something like this: “The colonization of the Anglo-Saxon America was less bloody done by laborious farmers (from Ireland, Britain and France), whereas the Latin America colonization was very cruel done by soldiers with prey dogs (from Spain and Portugal)”.

 

Cuba 1899-1959: Health Research under American and Caribbean Old Influence.

 

In 1898, USA intervened in the Cuban-Hispanic War finishing it with the total defeat of Spain. Cuba was in ruins with 400 000 war deaths, and lost 2/3 of its wealth. In 1899, the island had 1 587 792 inhabitants and Havana 250 000. There were 57 % of illiterates, within them: 58% woman, 55% men; 72% black, 53% white. Public Primary Schools were 541 with a budget of $ 716 892.

 

Appeared cases of meningo-encephalitis at Havana (Marianao municipality) --probably imported from the US troops.

 

Within the first ten causes of death in 1899 were malaria, tuberculosis, yellow fever, typhoid fever, enteritis, dysentery, infantile tetanus, birth affections, diphtheria, flu.

 

In 1899, began an intensive sanitation and vaccination of the island and its inhabitants. Also, started an intensified transfer of modern medicines, equipment and educational system from USA, as well as of the latest scientific knowledge, with unlimited double sense flow for training of physicians and scientists in USA and exchanges of US professionals in Cuba.  A US nurse founded it in that same year the first Nursing School in Cuba.

 

In 1900, the mortality rate was 26 x 1000 inhabitants [In 1893 was 33.0 deaths, in 1897 during the war 127.8, the highest], the yellow fever had 25% of lethality, dying 322 cases, and dying from malaria 4 107 cases. The natality was 32 x 1000 inhabitants, infantile mortality was 224 x 1 000 live births, and the life expectancy at birth was 33 years.

 

In 1900, was made the Second Reform strengthening scientifically Havana University by philosopher Prof. Enrique José Varona, and was founded the Dentistry Faculty. The scientific center of the country passed again from the Academy to the Havana University. In 1901 was opened the National Library at Havana.

 

It was improved the primary, secondary and university educational system, increasing the enrollments in primary, secondary and university schools. There were created schools for sanitary, clinical and x-ray technicians, and more infirmary schools. There was an escalation of the transfer of the latest scientific knowledge and technologies from USA and Europe, and began an unlimited double sense flow of physicians and scientists for training and exchange with USA.

 

For 20 years the scientific community of Cuba, USA, and Europe, ignored Dr. Finlay’s discovery and proofs, letting dye thousands of persons. In 1901, Walter Reed, MD confirmed definitively the Finlay’s discovery, and began a campaign against the Culex mosquito, and the yellow fever was eradicated at the Panama Canal, at Havana in 1902, and in all Cuba in 1909. The discovery of the viral etiology of this disease had to wait for new techniques in 1921 in USA.

 

The Republic of Cuba was founded on May 20, 1902, with a US Platt Amendment to its Constitution to intervene in it, until 1936.

 

In 1902, the Gross Mortality Rate of cancer was 31 x 1000 inhabitants.

 

In 1903 was introduced the aseptic package for the umbilical cord cure to eradicate infantile tetanus.

 

It was founded the Experimental Agronomic Stations in Santiago de las Vegas in 1904. It was founded the Experimental Station for the Sugar Cane Culture in Jovellanos, and it was founded the Botanic Garden of the University of Harvard, near Soledad Sugar Factory in Cienfuegos.

 

In 1906 appeared the first cases of infantile acute poliomyelitis from the US harbors, and 3 years later sprouted an epidemic of 200 cases,  8% deaths. In 1909 the population grew to 2 182 842 Inhabitants.

 

It was founded by Dr. Finlay, the first Secretary of Health and Charity (or Ministry of Public Health) of America and the World in 1909. Cuba had then 2 182 842 inhabitants. The health per-capita was $ 1.57 x inhabitants. The percent of budget for health was 11.3% with $ 3 427 062.00 dollars, while the National Budget was $ 30 327 982.00 dollars.

 

The Gross Mortality by Cancer in Cuba was 44.2 x 1000 inhabitants in 1910, and appeared beriberi in a prison.

 

Cuba was one of the first Southern countries that began the peaceful use of the nuclear techniques, with the search of radioactive mineral waters in 1910.

 

Juan Guiteras, M.D., initiator of a movement in pro of the creation of a Scientific Institute of Preventive Medicine “Carlos J. Finlay” in 1911. Afterwards, it was considered as National Sanitary School and Center for Research, to protect the work of Dr. Carlos J. Finaly. After the annexation to the Institute of the Hospital “Las Animas”, it investigated the rabies, poliomyelitis, and the yellow fever with monkeys.

 

It was founded the National Museum in 1913. There were founded the eastern Santiago de Cuba and central Las Villas Universities.

 

There was an immigration from 1913-27 of 250 000 Antilleans (Haitians, Jamaicans) and 800 000 Spaniards. The population was doubled to 3 962 000 inhabitants in 1925. In the 30ies a part of them had to return due to employment protecting laws for Cuban workers in state and private companies.

 

In 1918-1919 died in Havana 5 000 patients of serious influenza. In the world died 40 millions, while were 10 millions of victims in the First World War.

 

From 1898-1925, USA invested 1500 Million dollars in Cuba. It began the building and modernization of the greatest 150 sugar factories, mines, railroads, and building of modern electrical and telephone, metal industries, as well as for food, textile, soap and detergents, and sugar and oil refineries, and banks.

 

There were also built most of the housing, buildings, stores, schools, parks, main service facilities of the present cities and towns, and cafeterias, restaurants, hotels, cabarets, and clubs.

 

It was modernized the urbanization of main cities and towns’ streets with pavement, aqueducts, sewer and drainage systems; modernized the ports and constructed railways for trams and trains, highways, and airports.

 

In 1920, the Public Primary Classrooms were 5 652 with a budget of $ 7 884 316. Cuba was after Argentine in Primary-Secondary School enrollment; 1 138 vs. 1 401 x 10 000 inhabitants.

 

The pock or smallpox was eradicated in 1921, increasing the pneumonias, parasites, equine encephalitis, brucellosis, rubella, hepatitis, histoplasmosis, too.

 

In 1925 was founded the charitable League against Cancer and the first Oncologic Unit by the League. Afterwards, was founded the Radium Institute, and published its Bulletin.

 

There were organized the main Scientific Medical Societies, the Medical College in Havana, and began the national and international meetings by specialties

 

It was organized the National Geographic Society and founded the National Meteorological Observatory in Havana Bay.

 

Progressive and socialist student Julio A Mella did the Third Reform nationalizing and opening more the studies at Havana University. In the 20ies, Mella was expulsed from the Politic Bureau of the Communist Party because he made a strike of hunger in jail.

 

In the first 3 decades continued the malaria, diphtheria, typhoid fever, TB, chicken pox, meningitis, poliomyelitis, gastro-enteritis, influenza, lethargic encephalitis, measles, dysentery, whooping cough, rabies, and tetanus, within many other diseases.

 

In the last 3 decades were additionally pneumonias, parasites, encephalitis, brucellosis, rubella, hepatitis, equine encephalitis, and histoplasmosis.

 

In the 1930s began a fourth revolutionary war that ended revoking the Platt Amendment to its Constitution in 1936, and enacting in 1940 a very advanced Constitution.

 

Foundation of the Cancer Institute in 1929, and publication of Archives of Cancerology, Archives of Oncology, and other oncologic journals.

 

In 1936, Pedro Kouri, M.D. founded the Tropical Medicine Institute, discovering the hepatic fasciola. There was a progress to the state of the art of all the clinical and surgical sciences by transference of advance knowledge from USA and France, and strengthening of Havana University Medical School as one of the best in Latin America and all southern countries.

 

It was created a wide network of public and private primary, pre-university, commerce, technological, civic schools covering cities but less the rural areas. It flourished all fine arts education in a wide network of halls, conservatories, auditoriums, theaters, lyceums, institutes, academy, and museums. There blossomed general culture, books, magazines, libraries, and literary competitions, Braille system lectures for blinds, cultural broadcasting, movie theaters, cultural and philanthropic societies. It was founded Eastern University of Santiago de Cuba, and the Central University of Las Villas.

 

In 1941, the percent of illiterates was 27 %; within them:  25% women, 30% men; 22.4% black, 22.1% whites.

 

In 1943 urban primary school houses were 3 099 day/night, classrooms 7 516, and professors 9 515 and students 360 912. Rural classrooms were 58 fixed, and 11 traveling; 40 rural missions: 1 education, 1 hygiene, 1 dental, teaching in home, farming, occupational,  technical in labor, radio, etc. Rural homes and Mission’s venues were 1 151 and 1 639 teachers. Private primary schools were 587 with 71 077 students.

 

High School institutes 21, Commerce schools 7, Education schools 6, Kindergarten Educators School 1. Technical-Industrial schools 2, Home schools 6, Natural fine arts schools, arts and occupational schools 3. Rural Education school with 1200 teacher-students. Rural-Civic institute [Technological Center, Spa, school center]

 

Fine Arts: National Fine Arts hall, Symphonic & Philharmonic orchestras, choruses, vocal music; National & County conservatories 75, Music teachers 5 802. National & County theaters, auditoriums, free study for painters & sculptors, amphitheater; National & County lyceums, institutes, academies. International & National expositions in halls, music clubs, cathedral square-museum, photo halls, National 1, Havanan 15 & County museums 6.

 

General Culture: Books, Cuban Magazine, Culture Notebooks, literary competitions. National & County libraries 469, Braille system lectures for blinds, National archaeological board & magazine, People’s Theater-Library.

 

High Studies Institute, Institute of Plastic Arts, cultural broadcasting, movie theaters, cultural & philanthropic societies.

 

In 1943, the Havana University was a public and autonomous center that grew to 13 main schools: Philosophy and Letters, Sciences, Engineering, Architecture, Education, Agronomic and Sugar Engineering, Right, Social Sciences and Public Right, Commercial Sciences, Medicine, Pharmacy, Dentistry, and Veterinary Medicine. It also had nine attached schools: Nurses & Male Nurses, Midwifes, Optometrists; Public Administration Institute, University Theater, Dramatic Arts Seminary, Summer, Scientific Research & Studies Enlarging Institute; Practical of Right

 

There were built 500 pharmaceutical laboratories: 50% of USA, 30% of Cuba, 20% of others; and a wide net of drugstores handling 40 000 pharmaceuticals.

 

The National Hygiene Institute produced vaccines against rabies, typhoid, smallpox and the BCG.

 

It was founded the National Corporate Council for Anti-TB Struggle with modern laboratories, and the League against Blindness, with Blind Rehabilitation Center and a modern Ophthalmologic Hospital at Marianao. This league received the aid of the charity campaigns of the Lions’ Club International of Cuba.

 

In 1944 were 3 000 cases of leprosy and 61 cancer deaths x 1000 inhabitants, and died 3 103 in 1945. Foundation of an Annex Preventive Center to the Radium Institute in 1946.

 

There were outstanding works in clinics, surgeries, obstetrics and gynecology, pediatrics, microbiology, veterinary medicine; in biology, anthropology, botanic, zoology, geography, physics, and mathematics.

 

There were outstanding works of: Angel Aballi, M.D., in Pediatrics; Eusebio Hernandez, M.D. in Obstetrics and Gynecology; Raimundo Menocal, M.D., Francisco Dominguez, M.D. and Jose Presno, M.D. in Surgeries; Juan Guiteras, M.D., Diego Tamayo, M.D., Federico Grande, M.D., Luis Ortega, M.D., and Pedro Castillo, M.D. in Clinics; and of Arturo Curbelo, M.D. in Microbiology.

 

There were also outstanding works of: Idelfonso Perez in Veterinary Medicine; Julio Fernandez in Biology;  Manuel Gran in Physics; Jose Villalon, Pablo Miquel, Rafael Fiterre and Mario Gonzalez in Mathematics; Julio Fernandez in Biology; Luis Montane and Fernando Ortiz in Anthropology; Manuel Gomez in Botanics; Carlos de la Torre in Zoology; and Salvador Massip in Geography.

 

There were built main public clinical and surgical civil and military hospitals, hospitals and sanatoriums for Leprosy, TB, Psychiatry, spa for arthritis. There were constructed private clinics and clinics of mutualism (insurance) in the main cities and towns. In 1949 began the use of the Chloromycetin.

 

It was introduced in the phone and electric companies the advanced ITT System and IBM cards, and in the Academy of Science the electronic computer. It was also introduced the first Radio stations, three TV channels Black and White, and one in Color, in Latin America, as other many last technologies, products and services. Cuba had in the 50ies the last US automobiles (240 000), more than Japan and some European countries, but less than Venezuela, and the last US buses, rail gas-cars and airplanes. It had a first helicopter airport in an Old Havana modern building. It had more TV sets and phone lines than any country in Latin America, and more than Italy.

 

Cuba had experimental research in the Cancer Institute founded by the League since the 40s, and founded an Institute for Technological Research in the 50ies. It was of the first southern country in transfer from USA last vaccines, diagnostics, biologicals, radio-pharmaceuticals, and devices for clinic, surgery, oncology, renal dialysis, cardiology, etc.; in transfer antibiotics, chemotherapeutics, equipments of X Rays for diagnosis and therapy, ²²⁶Raium needles and ⁶⁰Cobalt. In 1956 there was in design a project coordinated by Generals Fulgencio Batista and Dwight D Eisenhower to build a Nuclear Research Laboratory: US 1 MW reactor, 2.5 MeV accelerator and ⁶⁰Co source, for gamma irradiation.

 

From 1934 to 1948, Gross Mortality rate decreased from 11.6 death X 1000 inhabitants. In 1934, to 7.9 x 1000 in 1948, whereas in USA was of 9.9 x 1000 inhabitants in that year.

 

In the 50ies were 300 deaths of malaria, 3200 of TB, 100 of dysentery, 4000 of pneumonia, 300 of TF, 80 of diphtheria, 80 of whopping cough, 40 measles, yearly.

 

Havana had one sixth of Cuba population after London and Vienna, and was known as “The Paris of America”. Cuba was the “The Pearl of the Antilles”. Cuba was the most heavily capitalized country with the third per-capita income in Latin America after Argentine and Venezuela, with the same exportations as Mexico, and a network of railways, highways and ports, covering the country. It had in Latin America a high standard of life of the masses in the cities, with 70 newspapers and journals, although had electricity only 7% of rural houses, and one third of the sugar labor force was partially unemployed, because the three-month harvest.

 

Cuba had in Latin America a highest standard of life in the cities, 70 newspapers and journals, though had electricity in 7% rural houses, and 1/3 of the sugar labor force was partially unemployed due to 3-month harvest.

 

In 1959, there were 735 280 illiterates for 11-15% of the population, the lowest after Argentine, Chile and Costa Rica. The population of Cuba grew to 6 900 088 inhabitants and of Havana to 1 007 000, 5.5% older than 64 years and more than 57% urban. Heart Diseases, Cancers, Gastro-Enteritis, Strokes, Baby Affections, Pneumonia, Accident, TB, Hypertension, Congenital Anomalies, were in that order the 10 first causes of death. The percent of population greater than 64 years was 5.5%. There was very advanced the Demographical and Epidemiological Transition since the 1940s. There was a gross mortality rate of 6.5 x 1000 inhabitants and natality of 27 x 1000.

 

Since 1953 to 1957, in the Western hemisphere, Cuba achieved 1 physician per 1 000 inhabitants, and was fifth in the rank of countries regarding physician density, i.e. ratio of physicians to population; this was only exceeded by the Argentina, USA (1 x 800), Uruguay and Canada (1 x 960) ratios, although it exceeded the ratios of Finland, England and Sweden.[11] Then, there was little emigration of physicians and other professionals from Cuba.

 

In this hemisphere, also in 1957, Cuba with estimates from 32.3 to 36.3 per 1 000 live births,[12-16] ranked third in the lowest infant mortality rate, after USA (26.4) and Canada (30.9), and was between 13^th and 17^th in the world relative to the lowest infant mortality rates. It had lower rates than that for the very industrialized nations of Federal and Eastern Germany, Israel, Japan, Singapore, Greece, Austria, Italy, Spain, Portugal, Bulgaria, Hungary, Poland, Romania, Yugoslavia, and Soviet Union.[12] Of course, it had the best rates in Latin America and the entire Third World. Cardiac diseases and cancer were Cuba’s first and second highest causes of death, as is in other industrialized nations as well.[16] Cuba was one of the world most advanced developing countries by an overall evaluation of all the socioeconomic statistical indexes in the United Nations Yearbooks, with similar biases as USA then: excellent records in the cities, but incomplete in the countryside.

 

The direct maternal mortality was 125 x 100 000 live births, and the life expectancy at birth was 58.8-61 years, when South America had an average of 56 years.[   ]

 

The health per-capita was $ 4 Cuban pesos (or US dollars) x inhabitant, with a 7.2% of the budget for health, representing $ 25 690 200 Cuban pesos. The overall per-capita income was about $ 450-550 Cuban pesos x inhabitant, when there was only an exchange rate in banks: one Cuban peso was then equivalent internationally to one US dollar. The per-capita consumption of meat was about 65-70 lbs; of sugar 50 kilos, exceeded only by England, Australia, Denmark, and higher than the USA. Finally, there was 1 Soldier x 138 inhabitants (50 000 Military troops).

 

Cuba as service neo-colony of USA for 60 years was cleaned up and hasty rebuilt in 10 years. In the first quarter of the 20-century, Cuba hasty developed with US investments the first steps of an economical, social and cultural base of a modern capitalism. It was still unfair and inequitable with the more poor and abandoned (40% of the people), but with average much higher standards of living and work than in the Spanish colony. Cuba had this development by an elitist adaptation strategy of the latest scientific knowledge and technologies from USA.

 

In 1958, Cuba very close to North America, Argentine and Uruguay with the third best health levels and resources in Latin America, the Caribbean, and all southern countries (including Asia and Africa), as well as economical, cultural, scientific and technological base, to start in the rest of the century a scientific selective strategy in tropical medicine, oncology, cardiology, medicine, surgery, dentistry, obstetrics, pediatrics and epidemiology.

 

It developed a modern network of public county, industrial, city and university hospitals, mutual clinics, private practice and clinics, SOS houses and sanitary service mix of the Spanish and US systems.

 

What Happened Then? The Cuban tobacco workers exiled at Tampa when the Independence Wars returned in 1900 transferring the strong US trade union experience. Cuba was the most potential socialist country in America, after the Russian Revolution and the Crack of 1929, by its third Constitution of 1940 and very advanced Union laws enacted in the 1950s.

 

In 1959, Cuba had 1/3 people of middle class, but 23% of skilled working class; very rich foreign and national land, house and company-owners; 175 000 jobless and 270 000 at all other levels of underemployment by the 1953 Census, 700 000 illiterates, and administrative corruption. Its economy was stagnated due to a lack of entrepreneurial incentives. USA employing 1% of Cuban people in firms earned 77 Billions USD?

 

Cuba 1959-1989: Health Research under Russian and Chinese Old Influence

 

Triumphed on January 1, 1959, our fourth-fifth revolutionary war, made with the Oriental poorest peasants, against an unconstitutional dictatorial and unpopular government, starting a socialist des-privatization of the big and medium enterprises of the market economy, and centralization of media and labor unions in 1960. This process reached the smaller, family and one-person businesses until 1967. 

 

It was enthroned only one leader, party, owner, opinion, labor union, media with daily political propaganda; agrarian and urban reforms, nationalizations and seizure of companies and banks, social clubs, private beaches; lost of overtime, insurance, and retirements boxes by the workers that owned them; ban to buy land, housing, cars, to free transit and tourism overseas, holding of US dollars

 

It was setup a central economy planning board, boom of unnecessary employments, decrease of productivity, consumption felt, devaluation of currency and salaries freezing, rationing card for minimal food and stuff for subsistence.

EXTERNAL DEBT?

In 1960-1961 was enacted the Law of Rural-Medical Service for graduates of medicine, dentistry, nursing, and health technicians. The Ministry of Public Health MINSAP was socialized, unifying public hospitals with private and mutualism (type of insurance) clinics ending in a unique NHS in 1967. Most of the first polyclinics, and rural hospitals began in health installations, SOS houses, and family houses. The latter were also used for the communist party and government bureaucratic offices.

 

The Psychiatric Hospital of Havana was transformed in a more humane and scientific health care center, and began a more in depth research in the field.

 

In 1960-1961, Cuba began to supported armed insurrections in many Southern countries, and started the first medical missions. It was carried out a Literacy Popular Campaign in rural areas reducing illiterates from 15% (707 000) to 4% of capable, and nationalized all the private schools and the Villanueva Catholic University, and a Faculty of Commercial Sciences of the La Salle Catholic School.  Belen School could not build its Catholic university. The Pigs Bay Invasion was defeated.

 

In 1960-61 began the US economic sanctions and commercial embargo, cutting sugar and other exportations to USA,  importations of oil, raw materials, technologies from USA, for agriculture, industry, army, transportation, including spare parts; cutting purchase of food, vaccines, medicines, reagents, medical equipment and supplies, remaining the sale of Journals and books.

 

This facilitated the trade with URSS, East Europe and China, and the economic dependence, suffering a technological setback of agriculture, transport, industry, including health care, with obsolete or old technology. It was adapted the Czechoslovakian public health and Russian science-technology,  and superior education models, and  revived the old academy as National Academy of Sciences in 1961, creating a Brain Institute, and a dozen of other centers for fundamental research.

 

It began Cuban emigration to USA, remaining in 1961 only 3-4 000 of the 6-7 000 physicians in Cuba, and the same happened with dentists, nurses, technicians. There remained only 12 senior professors of the School of Medicine, as well as in the other schools.

 

It was founded the Basic and Pre-Clinical Sciences Institute in October 1962, to speed up the formation of physicians, dentists, integrating subjects by systems, and later of graduate nurses in the 1980s. During the Caribbean Missiles Crisis, it was converted in an antiaircraft military training unit. Its students and professors were the first line of defense of one of the nine Soviet Bases with Nuclear Heads at Quiebra Hacha, Mariel. We had then in Cuba 270 000 Cuban troops with assistance of 50 000 Soviet troops.

 

Surpassed the crisis in 1964 a Radio-Electronic Military Base was built in Lourdes by the USSR, and several modern military bases more, which let very behind the symbolic US Naval Base of Caimanera, Guantanamo.

 

There were extremely limited the very natural and usual scientific medical mail, telephone calls, trainings, fellowships, and professional exchanges and meetings of Cubans  in USA, and extremely limited relations, although when some meeting was authorized in USA, was without the couple that was retained as hostage, although always remained the scientific information by textbooks and Journals.

 

There was an increased formation of general, obstetrical and pediatric nurses in the old infirmary schools, and in new schools for the 14 provinces since the 70ies, as well as technicians to work in hospitals, polyclinics, hygiene-epidemiology centers. Later in the 80ies were graduated university nurses and technologists too. There was increased formation of biologists, chemists, physicists, biochemists, psychologists, within other professions, many of them in East Europe. In the 80s were graduated technologists.

 

A fourth reform of the Havana University occurred, giving free access, copied-books without paying authorship, and scholarships in buildings that before were of apartments confiscated, to most of the needy people, excepting the non-revolutionaries. The non-revolutionary professors were excluded too. It began the foundation of new Faculties of Medicine in Santiago de Cuba in the East, Las Villas in the Center, and the creation of the University of Camagüey between the latter.

 

It was founded the National Center for Scientific Research in 1965, copy of a similar center in France, to train professors-researchers in medical basic sciences, and other sciences for agriculture and industry. It began scientific exchange with Russian and East Germany in basic sciences and with Mexico and Colombia in public health sciences. It was intensified scientific and technological exchange for basic and clinical sciences with France, and began with Canada, UK, FGR, Italy, Sweden, and others.

 

In 1966, began to be founded 11 National Institutes of Health of the MINSAP in 1966, copy of the NIH in URSS, which were copy of the NHI in USA. They were for the research and postgraduate education in the fields as follows: Oncology and Radiobiology, Cardiology and Cardiovascular Surgery, Angiology and Vascular Surgery, Hygiene, Epidemiology and Microbiology, Hematology and Immunology, Neurology and Neurosurgery, Gastro-Enterology, Endocrinology, Nephrology, Sport Medicine, and Institute for Dentistry Improvement. Afterwards, there were founded the Institute for Aeronautic Medicine, for Military Medicine, and the Center for Medical Sciences Information.  

 

There were founded the Institutes for Sugar Cane Research,  for Animal Science and for Digital Investigation, Center for Animal Health, Industrial Automation, Communism Theory, within others between 1965 and 1969.

 

Cuba rejected the US Naval Base in Caimaneras, Guantanamo, as an attack to her sovereignty, but accepted the secret building of a USSR Naval Base to provisioning Atomic Submarines in Cienfuegos Bay, several USSR special military bases and motorized units since the 1960s. This included the huge USSR Radio-Electronic Operations Center in Lourdes, in the Havana suburbs, in 1964-67, the biggest base of USSR-Russia overseas with 2 000 Russian military personnel, dismantled unilaterally by Russia after 9/11. All this was public in 2002.

 

 

The failure of the Ten Tons Harvest of the year 1970, forced Cuba to enter in the Council of Mutual Economical Assistance (Comecon) of Eastern European Socialist Countries and Yugoslavia in 1973. Until that moment Cuba was reproducing the first years of voluntarism and subjectivism of the Leninist and Maoist Revolutions looking for a new own socialist model that did not find. There were created the Studies Committee for Health Multilateral Collaboration with Comecon, beginning within many spheres, the cooperation on biomedicine and public health in three complex scientific problems:

Malignant Tumors, coordinated by the Institute for Oncology and Radiobiology, Biomedical Equipment, coordinated by a Group of Equipment in the Pharmaceutical Industry, Hygiene of Environmental Protection, coordinated by the Institute for Hygiene, Epidemiology and Microbiology.

 

 

 

It was created the first National Council for Health Research in 1974, and first Health Research Plan with 7 main lines and 35 main problems for 1975-80: Morbidity and Mortality (10 problems); Human Reproduction (4 problems); Environment and Health (4 problems); Clinical Trial (6 problems); Health Management (4 problems); Population and Health (2 problems); Technological Development (5 problems).

 

It was created the Science and Technique National Council in 1974, the Science and Technique State Committee, within others in 1976, with Institutes for History and Organization of Science, Central Planning, Statistics, Economy, World Economy, within others. It was revitalized, enlarged, and modernized the Institute for Tropical Medicine IPK since 1976, and created the Institutes for Health Development, for Nutrition and Food Hygiene, for Labor Hygiene, and Pharmacological Surveillance. There were created the Medical Sciences Superior Institutes of Havana, Santiago de Cuba, Villa Clara, Camagüey, in 1977, and also there were converted the Central Pharmaceutical Laboratories in Pharmaceutical Research Laboratories. Until this years most of the schools, polyclinics, centers, institutes, were organized in old installations, buildings and houses.

 

Creation of Science & Technique State Committee, from 1974-76, besides de NAS, with its institutes.

 

The principles of the National Scientific Policy in 1975 were: Planning development of science and technique in function of social progress; adequate combination of fundamental and applied investigations with emphasis in the latter; transfer and assimilation of technological advances achieved by other countries; quick introduction in practice with economical criteria; strengthening of the material and human resources.

 

Enacted the Cuban Communist Party Program, in 1975, and the fourth Constitution of Cuba, & made the 1st Elections (since 1956) with a unique candidacy in 1976.

 

From 1977-1987, there was an increased participation of Cuba in the Comecon collaboration from 3 to 13 Complex Problems: Methods for Population Health Studies  IHD, Cardiovascular Diseases ICCVS,  Malignant Tumors IOR, Viral Diseases (Influenza)  IHEM, Hygiene of Environmental Protection  IHEM, Labor Hygiene and Professional Diseases  ILM, Infectious Diseases and Vaccination IPK, Organ and Tissue Transplant and Immunology HHA, Devices and Equipment for Clinical Research PI, Organization-Management Improvement of PH, Drug Research, Evaluation and Standardization, Development of New Clinical-Laboratory Methods, Infantile-Maternal Protection.

 

Second Cuban population exodus of 125 000 Cubans in 1980 by the Peru Embassy and Mariel Port, and Migratory Agreement with the US Reagan’s government.

 

It began teaching of Basic, Clinical and Epidemiological Research Methodology and Logic, by US articles and books in 1978, without the funds of the Rockefeller Foundation, as had China then. It was created the first Long-Term Forecast Public Health and Social Assistance in Cuba 1980-2000, with gross predictions in the MINSAP, and was created the Scientific and Technical Advisory Council of the MOPH in 1980.

Miyar Barrueco and Machado Ventura

Two medical personalities have assisted all this development in medical and health research. One was Prof. Zoilo Marinello, oncology surgeon (onco-man) trained in the 1950s at the Roswell Memorial Sloan-Kettering Hospital, New York. In the 1960s was Director of the IOR. In 1971, he presided the NAS. Afterwards the SCST and all time the MOPH Scientific Council until his death in 1990. The other was Prof. Ernesto de la Torre, pediatrician-hematologist trained in the 1950s at the Chicago Cook County Hospital, Illinois. In the 1960s was Director of the Institute for Hematology and Immunology. In 1972-82 was Vice-Minister for the MOPH education and research, continuing the advice to the government as Chair of the Health Commission of the Cuban Parliament in the 90ies.

 

There were founded the Hermanos Ameijeiras Hospital with high-technology research and postgraduate education in 1982, as Center of Reference for the national network of hospitals, and the Center for Medical and Surgical Investigation with high-technology for the government and military officials in 1983.

 

It began the teaching in National Scientific Policy. Concepts and Applications, in 1984 in the National Academy of Science. It was presented a Doctoral-degree (Dr.Sc.=Ph.D) thesis 1981-87, 1st Hispanic American Unified Scientific Forecast & Policy made in a NEC-PC "Unified Forecast & Policy for the Anticancer Struggle. Cuba 1985-2000".  It gave main methodological bases for 3 Cuban Programs: Cancer Prevention & Oncology Specialty 1987-2000, and Objectives, Aims & Directives for the Health System 1992-2000. This thesis was frozen due to extra scientific affairs and is still waiting to be academically defended having all the Postgrade Requirements, State Examinations in English (1979) & Philosophy (1988) for a Ph.D degree in HU from 1988 up-to-date.

 

The Cuban mulatto pilot Col. Arnaldo Tamayo, was the first cosmonaut of the South flying in a USSR Satellite, doing the first telemedicine experimental research designed by Soviet and Cuban medical scientists in 1980.  It began the USSR Projects for the Electro-Nuclear Plant in Juragua ($2 500 000 000 USD), which will supply the Naval Base of USSR Atomic Submarines in Cienfuegos Harbor, Nickel Plant in Camariocas, the Havana City Underground, etc. These USSR investments stopped in Apr. 1989, when Gorbachev visited the Cuban Parliament at Havana.

 

In the 60ies were eradicated the poliomyelitis, in the 70ies, malaria, diphtheria, TB-meningitis, rabies,  and eradicated measles, rubella, tetanus, mumps.  The intestinal parasitism by ameba, lamblya, ascaris and other worms, have been more controlled, but very far of been eradicated yet. There were increased deaths in lung cancer in the 70s and of CAD in the 90s in women, and reduction in the cases of TB to 546, TF 59, leprosy 310, whooping cough 23 --in 1990.

 

It occurred 2 dengue epidemics (1 hemorrhagic) in 1979-81 with 350 000 cases, 158 (101 of them children) deaths, Intensive Care Units network, hemorrhagic conjunctivitis, besides sugar cane roya and tobacco blue mold, as African swinish fever in 1972 and other plagues, supposedly coming from US laboratories. It occurred an increment in the cases of meningitis by meningococcal to 461, viral hepatitis to 13 214, syphilis 9 200, hemorrhagic leptospirosis 517, chicken pox 11 000, gonorrhea 36 000, –in 1990. The AIDS epidemic sprouted in 1986, increasing its cases yearly to 28 –in 1990. ???

 

It was founded as the first effort of the Biological Front, the Center for Genetic Engineering and Biotechnology from 1980 to 1986. It began in 1980-1981 to produce interferons, first from leukocytes and later recombinant too. Developed developing recombinant EGF, recombinant vaccines for hepatitis B, hemophilus influenzae B, recombinant streptokinase for MI; it is researching in AIDS, dengue and hepatitis C vaccines, in VEGF for severe CAD, in diagnostics, biologicals; it is doing projects with the most advanced technology for human, animal and vegetal health, agriculture, industry, and other spheres. Afterwards, it was founded the Center for Immuno-Assay that works in the field of diagnostics, and gave the ultra-micro-analytical system (UMAS), Center for Bio-Products, and Center for Laboratory Animals.

 

It was enlarged and modernization the Finlay Institute for Research, Develop and Manufacture Vaccines and Biologicals. It achieved in 1986 the first and unique effective Vaccine against the Meningitis B (and C), Second Great Medical Scientific Discovery of all the times. It was developed by a multidisciplinary team of researchers and tested in Cuba under the direction of its main investigator Dr. Concepción Campa, graduated in Pharmacy at Havana University. It is developing anti-leptospirosis and multiple vaccines, and is researching in Salmonella thypi, Anti meningococcal ABC, DPT combinations and anti cholera vaccines too.

 

It was made the First Cuban mission of a senior researcher as scientific adviser of a Vice-Minister for Health Research in a poor country, in Nicaragua from 1988 to 1990.

 

In these 30 years were taken the old schools and clinics, housing buildings and houses to use as schools, polyclinics, hospitals, and mainly party, government bureaucratic and mass organization offices.

 

First, the high and middle class were faded, poverty of the poorest was softened but expanded to old medium class and even high-class people, and most people become poor. However, shortly, new 50-100 000 high and medium class families emerged from the political leaders to handle the state bureaucracy without any option.

 

Also were semi-urbanized many rural areas, and built rudimentary schools, polyclinics, hospitals, and housing, but were deurbanized and impaired Havana and the rest of the big cities and towns in all provinces, after emigration of one-million citizens and arrival of 2.5 millions of poor peasants and marginal people to the heart of Havana and the rest of the cities.

 

Havana City multiplied its population by 2.5 with great overcrowding of inhabitants in practically the same old infrastructure of built area, but completely deteriorated due to lack of civility and maintenance of the housing, streets, transportation, social services, water and waste systems, and electrical, phone, gas services, etc., as well as periodic blackouts and phones out of order, collapsed transportation, etc, etc, etc.

 

In three decades the Health Care Policy and System of Cuba passed from:

 

A Two-tied Health Systems (private, mutualism clinics & public hospitals) to a unique “free” public health system   (people-bureaucracy), on an implicit invisible tax basis to working population, specially physicians and researchers very low wages, individual economic liberties restrictions and Russian subsidies with the size of “Three Marshall Plans” to West Europe after the Second World War. [State funded, comprehensive, universal, and equal]

 

A 100% theoretic covering of population by all the health services, worse in far countryside, to a more equal 100% public service cover, better in far countryside but worse in quality than before in the cities, long waiting lists, behind technology, subsidized drugs to outpatients, with highest expenditures due to much waste of them. [Very medicalized system with poor nurse retention]

 

Health care programs for harms, specially by transmissible diseases in general population, to also for integral care of infantile less than one & five years and  maternal high risk groups, with  more preventive orientation since1968 to also for non infectious diseases with more health promotion orientation since 1980.

[Central normalization/“Executive decentralization”]

 

Primary health care with clinics and hospitals emergency rooms  to integral Russian polyclinics and H ER since 1962, to community medicine polyclinics and H ER since 1974, to education polyclinics and family physician offices since 1984, with community participation,  same hospitals in cities, but many more in the far countryside. [The Cuban Health Act 1980s]

 

In 1990, cardiac diseases (CAD), cancer, stroke, accident, pneumonia, suicide, diabetes, emphysema, birth affections and congenital anomaly, filled the 10 firsts causes of deaths. It finished the Epidemiological and Demographical Transition in the early 80ies. There were achieved since 1983, the WHO main goals of “Health for All in the Year 2000”: 100% health care cover, Infant mortality < 20, 100% child-pregnant immunization. There were not achieved 100% of drinkable water due to lack of aqueducts and contamination (well; grave, latrine); and 100% of liquid & waste collection, due to lack of sewer systems and suitable infrastructure and sanitation.

 

There was an infantile mortality of 10.7 x 1000 live births and 7.6% of low weight birth, a peri-natal mortality of 14.6 x 1000 (LB + LFD), a 0-5 years mortality of 13.2 x 1000 LB, and an overall survival rate at 5 years of 98.7%. The direct maternal mortality rate was 31.6 x 100 000 LB, and the life expectancy at birth was of 74-75 years.  There were reached 1 500 health units & 66 000 beds networks with one billion and 99 pesos of Health Budget and per capita; and 19.6 billions & 1 870 pesos GIP and income per capita. Rates of exchange of currency only in Cuban Banks by state ministries and enterprises: 1 US dollar =1 Cuban peso; Illegal in the Street 1 USD = 3-4 Cuban pesos. Cuba had the lowest salary or wage ratio 1:4 of all the Soviet Block. Finished the 1st Cuban mission of a senior scientist as infantile mortality and scientific research adviser of the MOPH in Managua, Nicaragua from 1988-90. Cuba had one Soldier x 42 inhabitants (250 000 Military troops), second Military Forces in the America.

 

Cuba developed a social superstructure more equitable with the poorest, instructed (although not educated and cultured), and healthy, over a poorer 30-year retarded economy than before, behind in technology, and at the high cost of very decreased overall welfare, standard of life & civility of the whole population. This was made using huge economical subsidies, due to a command unproductive economy, owing 7-11 billions USD to the IMF, and 15-21 and 85 billions in economic and military assistance to Soviet Union –equivalent to three Marshall Plans for the restoration of West Europe after the World Second War.

 

In 1990, Cuba showed again one of the best human education and health indexes of all the southern countries, with one of the best health scientific and technological progress, but with a low-income per-capita. This was obtained with a very costly network of public county, city, university hospitals and polyclinics, family physicians offices, research institutes and a more powerful sanitary service. Then, Cuba began a selective strategy in tropical medicine, in oncology, in cardiology, in biotechnology, pharmaceuticals and medical devices, the last three as a new industrial ways to develop the economy.

 

The economical disaster and speedy transition of East Europe and the USSR, after their disintegration, to a free market economy from 1989 to 1991, decreased to 0 the subsidies, and to one third our trade with them and the western world, because we were living of credits without cash. This bankruptcy situation forced the beginning of a slow transition to a mix market-socialist economy of subsistence with the help of the Spanish investors and Chinese and Vietnamese ideologists.

 

Since 1986, Cuba did not pay unilaterally the external to the IMF and the WB having a 3-year economic growth mirage up to1989. This produced the worst contrast possible with the situation in the 1990s.

 

 In 1990, the government to survive started urgent forced adjustments in our weak and dependent economy of the Soviet Block. These were as follows: 1. Demobilizing the excessive military troops, 2. Salary and subsidized sales were frozen; 3. Rationalizing the bureaucracy in the central apparatus, 4. investing relative huge sums in installations for foreign tourism, bio-pharmaceutical and ICTs centers and industries, at expense of stationary hungry and misery as in China in the 1980s; 5. stimulating self-financing and external financing in science from Canada, West Europe, and international agencies; and 6. Alternative and herbal medicine.

 

Cuba 1991-2003: Health Research under Spanish and Chinese New Influence

 

In 1990-1, Cuba was as sovereign again as a half-millennium before, when the Indians were found by the Spaniards, but drawing a desperate strategy to recover the fallen economy and to find new sources of hard currency.

 

It was developed an Alimentary Program up to 1993, and granted an obsolete non-profitable sugar industry.

 

There were developed much more as alternative more profitable industries: international tourism in Varadero Beach, Large Key, Coconut Key, Old Havana, Old Villages and Big Cities, as well as the pharmaceutical & supplies, biotechnological and medical equipment industries up to now. (Billions of US Dollars).

 

Creation in the Plaza Community Polyclinic, national center of reference of the first Health Research & development Plan 1990-1995, 2000, with seven scientific problems of Primary Health Care: Low Weight Birth Risks and Local Program, Reproductive Risks and Family Planning Programs, Population Satisfaction with Health Primary Care and Family Medicine, Prevention of Common Risk Factors of Chronic Disease and Accidents, Role of the Nurse in the Family Medicine Program, Positive Health Diagnosis and Action Plan, Impact Evaluation of the Family Medicine Program.

 

The CNIC discovered policosanol a lipid-lowering and anti-atherosclerotic natural product, hidroxi-apatite for aesthetic eye transplant, improved the Diramic equipment for quick bacteria diagnosis, and produced Ozomed for pigmented retinosis, feet ulcerations, etc. The Neurosciences Center developed the Medicid, Neuronic, Audix, Electric-magnetic tomography equipment for brain, and a Estereoflex for minimum access surgery, together with CIREN, a center for neurological restoration of patients.

 

In 1992 was approved the Torricelli Act to increase US Embargo and destabilize the Cuban government, with its first and second track.

 

It was founded in 1992 the Molecular Immunology Center, to research and produce monoclonal antibodies for cancer, radio-immuno diagnosis, prognosis, radio-therapy, vaccines; renal and heart transplant sub-acute rejection; diagnostics and biologicals.

 

It was founded the Scientific Productive Pole of West Havana, integrating all the scientific productive centers, and others new related.

 

Creation in 1992 of the Annual Forums of Science and Technique from the municipalities and provinces up to the nation giving stimulus and recognitions. They integrate all health and non-health results of institutes, university, and labor union and young technical brigades in hospitals, factories, etc, to substitute importations and increment exportations, saving the institutional walls erected by the soviet pattern since 1961. Enlarged and modernized the National Orthopedic Hospital, and Orthoptop Convention Complex.

 

Creation in 1992 of the Annual Forums of Science and Technique from the municipalities and provinces up to the nation giving stimulus and recognitions. They integrate all health and non-health results of institutes, university, and the innovations and rationalizations movement of the labor union, juvenile technical brigades of the communist youth union, in every working center, factories, etc, to substitute importations and increment exportations, saving the institutional walls erected by the soviet pattern since 1961. Enlarged and modernized the National Orthopedic Hospital, and created the Orthoptop Convention Complex.

 

It was designed a clinical trial of the recombinant streptokinase for the thrombolysis in the early phase of the myocardial infarction in the PHC with the family doctor in the Plaza Community Polyclinic. There were analyzed 1 carotid and 2 CAD’s clinical trials and designed a population trial as WOSCOPS and AFCAPS/TexCAPS, with policosanol natural product; and designed and analyzed clinical trials of pharmaceutical and Monoclonal Antibodies radiolabeled for different cancer sites and other diagnosis, in the Clinical Research Center.

 

In 1992, it was created INFOMED in the MINSAP to impulse Intranet facilities [national and international E-mail and selected web sites restricted and censored] in health education search of foreign literature, but not with participation of patients in health care yet. It was created to impulse also telemedicine and teleducation.

 

There were also founded CECMED, regulatory agency (similar to US FDA), and CEECEM for equipment; CENCEC a contractual clinical trials organization, CIC Center for nuclear clinical trials, CCE Center for endoscopic surgery, CITED for geriatrics and gerontology, within others.

 

Ending 1992, while the economic crisis was going in depth, appeared in Pinar del Rio province an optic and peripheral neuritis epidemics, extended to all the country in 1993, seemingly due to lack of nutritious factors plus  toxic or infectious factors, controlled from 1993-94 with B complex vitamins. In the studies and campaign against the epidemic, the Cuban government and MOPH received a strong scientific collaboration especially from the NIH of Bethesda, Ml, and from the CDC of Atlanta, Ga.

 

Then there were realized some adjustments to the state health policy & system:   

 

There stayed opened although impaired all health units; supplies and drugs huge shortages; deepened technologic abyss; stopped investments; frozen physician, nurse and technicians wages; fallen health care in quantity and quality in all kind of units, specially for mature adults and elderly.

 

There were prioritized primary care in the NHS more than ever, and the infantile mortality program & alternative-herbal medicine; exported more than 5 000 physicians and nurses to Latin America, Africa, and strengthen the medicine manufacturer industry.

 

In Aug 1993, began a short des-radicalization process: There were re-legalized US Dollars (USD) holding, small private family services; reopened in USD only normal shops, clubs, pharmacies, gas-stations, clubs, bars, services; encouraged US familiar USD remittance, overseas mixed investments and private-public partnerships to transit to a viable socialism.

 

Then, arrived to Cuba tax-free 100 millions USD by overseas familiar shipments, which increased, achieving in 2000 about 1 billion USD, while foreign tourism with near 1.7 millions tourists, gross and net revenues were 2 billions and 700 millions.

 

After the 30 000 ferrymen crisis in 8/1994, electricity rose to maintain the lightening of the residential sector. There were reopened the free farmer and craft markets.

 

In 1994 was reorganized a Ministry for Research, Technology and Environment to direct the scientific centers of the island with more real economical tools.

It was built from 1995-1997 by the Russians and funded by the Cubans a huge Radio-Electronic Military Base (estimated in $600 000 000 USD) in Bejucal, Havana county, which functions with other sub-bases in Havana and Oriente of hundred receiving antennas each one by the Titan Project, and equipped with Chinese ultra-fast computers connected to Russian satellites. When was closed the Lourdes Base by the Russians in 2002, the Bejucal Base began to use Chinese satellites and military personnel too.

 

In 1996 was approved the Helms-Burton Law to reinforce the US Embargo with overseas power, and in 1997 was approved a Detailed Plan of US Aid for the Transition of Cuba to a capitalist economy. In 1997 it was another dengue epidemic not attributed to USA. It was reestablished holiday for Christmas Day, and in 1998 Pope John Paul II gave four masses in Cuba, but Catholic schools continued forbidden. Protestants had an evangelical celebration in 1999.

 

There were founded in 1999 of the Latin American Medical School for 5 000 poor students from Center America and the Caribbean (and even eight from USA), with privileged living and studying conditions over the Cuban students. It was also created a special Integral Health Program for Latin America, the Caribbean and Africa, with 5 000 physicians in several countries.

 

Clinton’s broadened USD remittances, expanded People to People contacts, increased direct flights, authorized food sales to NGO, and reestablished Western Union. Cuban emigration was of about 500 000 inhabitants to USA, Latin America, Canada, Europe, Asia, Africa, including good physicians, scientists, engineers.

 

Cuban emigration was of about 500 000 inhabitants to USA, Latin America, Canada, Europe, Asia, Africa, including good physicians, scientists, engineers.

 

The Strategic Projection of the MOPH in Science and Technological Innovation 2000-2005, with five main prioritized strategies, and five prioritized programs are as follows:

5 Prioritized Scientific Strategies: Improvement of Primary Care, Revitalization of Hospitals, Development of Drugs, Traditional and Natural Medicine, Advanced Technology Development.

5 Prioritized Scientific Programs: Maternal-Infantile Care, Transmissible Diseases Control, Non-Transmissible Diseases Control, Elderly Care.

 

In 1999, with the Anti-Meningitis B (and C) Vaccine, the Anglo-American Smith Kline and Beecham Co., began to make the population trials in UK, before sells it to USA and Europe, going through the US embargo. It was achieved a first historical agreement in 40 years between a Cuban and a US institution over the US economic sanctions. The story was repeated ending the 21-century. Some Southern countries trusted in the vaccine, and Cuba tried to market it without middle-man for 10 years, whereas it was ignored in USA and Europe, Dr. Campa’s discovery and trials, dying thousands of thousands of children and adults in the Southern and Northern countries.

 

In 1999, the population was 11 200 000 Inhabitants (70% urban, 30 rural; 51% mulattos, 37% whites, 11% blacks, 1% yellow). Cuba had the highest mean years of schooling in Developing Countries (up to 9^th grade), although with inflated promotion levels from primary to university and doctorate. It had a natality rate of 13.5 x 1000 Inhabitants, with 150 785 live births. It had a crude mortality rate of 7.1 x 1000 inhabitants, with a 13% of population greater than 59 years.

 

In 1999-2000, Cardiac diseases, cancer, stroke, pneumonia, accidents, vascular diseases, suicide, mellitus diabetes, liver cirrhosis, homicide, pulmonary emphysema, filled the eleven first causes of deaths. Suicide has been important for four decades. It has been the fourth cause of deaths from 15-49 years and third from 10-19 year, with rates of 26 and 15 x 1000 inhabitants in male and female.

 

Then, Cuba had one physician per 172 & 150 Inhabitants (67 000 physicians), one dentist per 1 123 & 1 120 Inhabitants (10 000 dentists), and one 1 Nurse per 128 & 135 Inhabitants (88 000 nurses). Cuba had also the teachers and gold medal Olympic sportsmen highest per capita in the world. 

  

There are 40 000 physicians, nurses and technicians which have made civil and military cooperation missions in some dozens of poor countries overseas in 42 years.

 

Beside this we had in 1999-2000 the lowest infantile mortality rate of 6.4 & 7.2 x 1000 live births, although there were born 47 842 live births less than in 1959, with a  double population due to a half natality.  From 0-4 years a rate of 8.3 & 11.1, and survival rate at 5 years of 99.2 & 98.9%. The maternal mortality rates direct and total were 30.5 & 34.1, and 51.1 & 55.7 x 100 000 LB, and the life expectancy at birth was of 75-76 years.

 

In America, Cuba achieved 7 x 1 000 live births in 2001, and was second after Canada (5 x 1 000) in lowest infant mortality rate. In the world, Cuba shares the place 29-35^th in lowest infant mortality rate with USA and Croatia.[21] Cuba has continued improving, more main indexes as high life expectancy at birth, low incidence rates of low birth weight, AIDS, tuberculosis, hepatitis B, and B meningococcal meningitis, within others, even after the loss of the three decades huge economic subsidies from the Soviet Union.[19,22]

 

Cuba has developed an important network of biomedical research centers. In the Americas, Cuba ranks sixth in the number of researchers per capita of population active economically, and tenth in publications registered in the Scientific Search (general science database) per hundred researchers.  Furthermore, Cuba ranks fifth in publications registered in Biosis, sixth in PubMed (after Brazil, Mexico, Argentina, Chile, and Venezuela), and the seventh in invention coefficient (requested resident patents per hundred thousand inhabitants).[23] Cuba has been acknowledged by USA for her biomedical progress --highly subsidized by the Cuban government-- in pharmaceutical, biotechnological, and medical equipment research and development (R&D).[24-25]  A primary remarkable example is one of Cuba’s greatest healthcare research achievements of the 20^th century, in 1986, the first and uniquely effective vaccine against the microorganism B meningococcal, responsible for meningitis B. This was the contribution of the Cuban researcher Dr. Concepcion Campa –-a graduate in Pharmacy at Havana University.[24-25]

 

Cuba has achieved one of the highest health equity in health services among all the nations of the world. In 1999, Cuba was second in the number of physicians per capita (172) after Italy. USA (358) has almost half of the Cuban index.[18-19] Since the 1980s, US experts advised Cuba about her excess of medical consultations, hospital admissions, physicians, nurses, and inpatient beds relative to Cuba’s results in healthcare.[20] In relation with this plethora of resources, from 1962 there was the prediction that never the Cuban physicians and facilities would be more than enough, because they and their services would be exported in the future for the peoples of more than a hundred poorest countries.

 

However, paradoxically today, Cuba, one of the closest US neighbors, is the premier country in the world that, due to her very good health indexes and high performance standards of physicians, dentists, nurses, technicians, scientists, engineers, desperately needs to increase health research exchanges, training, technology assimilation and support from USA. But at the same time, Cuba remains at the highest risk of her professionals’ emigration to USA, still higher than ever before. A new “brain drain” from Cuba could strongly influence her deep health and economic crisis again much worse than before. Now Cuba emigration is slow and mainly produced by very difficult living and working conditions even of her top professionals. This particularly affects Cuba’s professionals in her less subsidized institutes, hospitals, and polyclinics of the MINSAP.[25]  These health facilities include ninety percent of Cuba’s almost 1 000  biomedical units. The worst situation is at the primary care and family medicine program. In addition, contributing to stimulate this brain drain problem from Cuba is that USA has today almost half the ratio of physicians to population that has Cuba,[18] and that USA is more than never before the first biomedical power of the world, with top possibilities of development for biomedical professionals.

 

In 1999 we attended to the Global Forum for Health Research 3 in Geneva, and in 2000 to the Conference on Health Research for Development and Forum 4 in Bangkok, and in 2001 to Forum 5 at Geneva, trying to learn and find global sources of funds for our most important research projects, from WHO, GFHR, COHRED, International, European GO, NGO, and even from the Rockefeller Foundation, Bill & Melinda Gates Foundation, the Inter American Development Bank and the World Bank.

 

Cuba is trying to facilitate public-private partnerships of our centers with different initiatives and alliances handled by the world donors for health research.

 

In 1997, the per capita of Kcal was 2 480, mainly of sugar, Protein 52 g, mainly of peas, and of Lipids was 49 g, mainly of fat. These figures were below Cuba in the 1950s and now the last in Latin America.

 

There have been done 2 000 Renal Transplants and 100 Heart and other organs Transplants.

 

About AIDS, from 200 HIV sero-positives in 1985-1986, there are in the year 2000 more than 1 000 AIDS cases, 832 deaths, having now more than 3 171 HIV sero-positives.

 

In 2000, the GIP was of $ 18.6 Billion Cuban pesos (US Dollars?) with a real annual growth rate of 6.2%. The Health Budget was of 1 860 millions CP/USD. The internal exchange rate was one US Dollar = 22-26 Cuban Pesos at the street; and 1 US Dollar = one Cuban Peso, between state institutions. The GIP Per-Capita was 1 700 CP (USD?) x Inhabitant, with a Health Per-Capita of 166 CP (USD?) x Inhabitants for a 10% of the GIP. The Education Per-Capita was 119 CP (USD?) x Inhabitant for a 7% of the GIP. The percent of the GIP for Science and Technique was 1.7%, for Scientific Research was 0.9%.

 

In Havana CITESA 2000, Cuba first put for sale our research projects to the world market. Cuba interacted with COHRED since 1995, and in CITESA 2000 defined a more formal interaction.

 

It was enacted in October 2000 Nethercutt’s Amendment to the Embargo lifting sanctions for US sales of food and medicines to Cuba, North Korea, Libya, Iran and Sudan,  but maintaining the ban for US financing, purchase and tourism only for Cuba.

 

In 2000, there are of Scientists and Engineers 1.8 x 1 000 Inhabitants working in 222 centers for science and technique. There are 31 000 researchers, professors, engineers, technicians and other workers, of them 28 000 belongs to the Scientific Poles, which has spent an estimate of $4 500 000 000 USD in 10 years for its 32 Biotechnology-pharmaceutical Centers.

 

In 5 years for Cybernetics Development Cuba has spent an estimate of $2 500 000 000 USD. There were 1 600 technological innovation projects. There are 140 000 participants in the Juvenile Technique Brigades, and near half a million workers in the Innovators and Rationalizers National Association.

 

There is 1 Soldier x 232 inhabitants (50 000 Military troops), the same as in 1959, but with more than a million police, secret police, and collaborators for inside and overseas intelligence, all with an overall current expenditures estimated around $ 1 000 000 000 USD.

 

The Standard of Life of a Physician, Nurse, Scientist, Engineer, Technician

 

She/he satisfy minimally by rationing gadgets and subsidies the same main needs of food, soap, toothpaste, housing, cycle, education, health-care, social security that a lazy, illiterate, or criminal individual.

 

Her/his monthly salary is around 300 Cuban pesos (sweeper is 150), (Social Welfare for elder is 80). Ratios of 2:1 with the sweeper (with equal plus of 100 USD lows to 1.4:1), and of 3:1 with the social welfare.

 

By the moment, she/he has a ban to buy/rent a good apartment/house; have two apartments/houses; built an apartment building or a house in a beach or frozen area; buy/rent a car, motorcycle, airplane, boat; foreign media; overseas calls and faxes by their phones; cellular phone; video, microwave & toast ovens, freezers, electric heaters & kitchens, cloth drying; Sabbath year, fellowship, student internship, some specialty meeting & exchanges abroad; buy a PC configuration; Internet & even Intranet daily access; overseas and state tourism; self-employed, tourism and any extra work.

 

In ten years, Cuba has maintained instruction, but the people poorer, less healthy and spirited, with an equity with the poorest at the bottom, very unfair with the most productive people (physicians, nurses, technicians, engineers and scientists), on a behind and poor state capitalist or socialist-capitalist economy. Now the USSR subsidies were changed for our first industry since the 1990s: Dollars family shipments and donations from the USA, and our second industry: International Tourism. (Ironic sin and adventure)

 

Cuba after 9/11 received the impact of the restrictions of the air travel in the entire world, affecting the international tourism. The distancing with the European Union in the last years has also restricted the financing aid to our economic and social development.

 

From 2000 to 2003, Cuban biomedical professionals have met and had professional exchanges in Havana, Santa Clara, Cienfuegos, and Matanzas health facilities, with approximately 2 000 US colleagues under the sponsorship of the People to People Professional Ambassadors Program (PPAP), created in 1956. The People to People delegations are designed to improve understanding and collaboration between the peoples of USA and other nations. Since 1974, it began to visit the Soviet Union and China. In addition to these delegations and exchanges, thousands of more educational exchanges have been facilitated through the New York Academy of International Studies, Global Educational Facilitation, Global Exchange, Cross-Cultural Solutions, and other numerous US NGOs. However, these educational programs will stop in 2003, due to the highest political tension between the Cuban and US governments.

 

Cuba started the 21-century and 3rd-millennium with a unique experience of having lived a cross-cultural influence of philosophies, ideologies, and psychosocial behaviors toward life, society, economy, wealth, health, science and technology from the: Old Natives, Spaniards-Moors, Africans, Caribbean, Americans, from the 1940s to 1959; Old Soviets and Chinese from 1959 to 1989; and New Russians, Chinese, Spaniards, and Americans from 1989 to the 2000s.

 

In my very personal view, beside the advances in laboratory, epidemiological, and clinical research in differentiated vertical fields as tropical medicine, oncology, cardiology, surgery, biotechnology, pharmacy, radio-pharmacy, and medical equipment, Cuba also have the possibility to extend her progress in more integral horizontal fields as general and family medicine, nursing, technology, public health through an “Integration Science Program” designed since 1993-2003, with information as unique Material, PCs, PDA, Internet and ICTs as Methods. The program has 13 scientific research, research training, and research collaboration and is posted in the website:  www.fortunecity.com/skyscraper/systems/1000/website1.html

 

 

Framework of Social & Economic Challenges

Social Justice vs. Economic Efficiency vs. Popular Democracy

 

Inquiry of a more perfect capitalist system or of an unknown post-capitalist system to transit gently:

-Enterprise improvement

-Opening small and medium companies

-Remodeling of economic sectors (assembly plants)

-Letting invest to reproduce family shipments

-Opening of more democratic spaces

- Amnesty for political prisoners

-Civil society vs. bureaucracy with two or more parties

-Rescue of a fair distributive equity

-Reunification of Cubans & Cuban-Americans

-Advantage of the professional capacity

 

 

Forecast of Cuba Main Scenarios and Challenges for the 2010-2020

 

Social and Economical Scenarios for the 2010-2020

{E: embargo, MP: manpower, P: poverty, GDP: Gross Direct Product, CFN commercially favored nation}

 

Terrible) Socialism + State-Capitalism, US E, minor GDP, cheaper MP than Haiti, 5% of unemployment (75% sub employment), 95% population in equal and high P.

Minimum) Soc+Sta-Cap, lifted US E, better GDP, cheaper MP value than China, 7.5% of unemployment (60% sub employment), 90% population in equal but still high P.

Medium) Soc+Sta-Cap, US commercially favored nation, even better GDP, equivalent MP value to China, unemployment 7.5% (50% sub employment), 85% in equal and moderate P.

Superior Ideal) Soc+Sta-Cap, most efficient and democratic, US CFN, higher GDP, cheaper MP than in Chile, unemployment 5% (33% sub employment), 85% in equal and moderate P.

60% in equal and moderate P?

Superior Real) Transit to a Capitalism as in Florida, more costly MP than in Chile, 5-10% unemployed, 15-20% in high P.

Optimum) Transit to a Social-Democracy as in Sweden, cheaper MP than Chile, less 5% in high P.  

From Welfare to Work

 

 

Health and Life Standards Impact in 2010-2020 by Scenario

{H: health, QOL: quality of life, UB: urbanization}

 

Terrible) H and QOL decrease more in adults and elders, de-UB, largest equity at the bottom.

Minimum) H and QOL slowly recovery for adults and elders as in 1989, slower de-UB, still large equity at the bottom.

Medium) H and QOL slowly integral increase up to 2003 + arrested de-UB, less equity at a small higher level.

Superior Ideal) H and QOL quicker integral increase up to 2010 + arrested de-UB, more equity at a medium level.

Superior Real) H and QOL quickest and highest increase, quickest re-UB and sanitation, integral equity, 33% H uncover 

Optimum) H and QOL very quick and high increase, quick re-UB and sanitation, most integral equity, 100% H cover.

 

Health Research and Development Impact 2020 by Scenario

{HR&D: health research and development, BD: brain drain}

 

Terrible)  Stationary H R&D in general and in SPC, highest pressure for BD, due to lack of funds and lowest QOL.

Minimum)  H R&D recovery in general up to 1989, in SPC up to 2010, still high pressure of BD.

Medium)  H R&D increase in general up to 2001, in SPC up to 2015, still moderate pressure of BD.

Superior Ideal) H R&D increase in general up to 2010, in SPC up to 2020, low pressure of BD.

Superior Real) H R&D most harmonious increase with highest QOL, lowest pressure of BD. 

Optimum)  H R&D more harmonious increase with high QOL, very low pressure of BD. World Network of Scientific Brains!

 

How US Professionals could aid Cuban Colleagues?

-More exchange between scientific societies in Cuba and in USA, in health care, research and education, including more cross membership.

-More US publication of Cuban articles and books, and between Americans and Cubans.

-More personal invitations to lecture, academic exchange, meeting, training, internship, fellowship, professorship and Sabbath in USA and in Cuba.

-More personal partnership and sponsorship of Cuban & US collaboration research projects and needs by E-mail and shipments.

-More consultantships of Cubans with honorariums or fees by USA, western GO, an international NGO.

-More than 100 sisterhood of cities between USA and Cuba.

-Help to obtain Canadian, European, Asian, Latin American, Caribbean, and African Funds for Scientific Projects

 

 

Please, I want you to review the personal program of research projects, without partners and funds yet, I posted in my website: Integration Science Program for General Medicine, Nursing, Technology and Public Health

 

Many thanks for your very kindest attention and interest!

It has been a great honor to meet you and talk with you!

I would be very glad to answer all your questions, and to keep in touch with you by E-mail.

 

 

Conclusions

 

Cuba health advances are not the results of any social miracle neither of the last decades nor even of a century. They are the integration of the best achievements of the Spanish, American, Czechoslovakian and USSR health policies and systems of the last two centuries. The greatest challenge for the next nearby decades is to balance the main health indexes accomplished in its entire population with the quality of health and life standards of the western world where Cuba entered a half millennium ago. 

 

 

 

Background of the Author
Carciovascular Physiology Lab (1968-1970) Internal and General Medicine Practice (1971-74), Epidemiology, Biostatistics & Public Health (1975-2003)
Cancer & Coronary Artery Disease Research(1977-1987,1993-2003)
1.  Unified Approach to Scientific Research Methodology, Logic, Statistics & Computing
2.  Unified Approach to Scientific Forecast & Policy of Cancer Control, Research & Education
General Practice Research (1988-2003)
3. Integration Science Program for Global/General Medicine, Nursing, Technology & Health

 

 

 

Rodolfo J. Stusser, M.D.
Senior Researcher, Professor and Adviser
Primary Care Research Unit

Vedado Education Polyclinic
18 # 163 esq. 15, Plaza 10400 Havana Cuba
Tel. & Fax: (537) 832.3461
Alternative E-mail: rodolfo_stusser@hotmail.com
http://familydoctor.org/myhavananpolyclinic/
www.fortunecity.com/skyscraper/systems/1000/ 

[Associated to the National Institute of Cardiology]

{First Cuban International Member of the US-AAFP}