Vedado
Education Community Polyclinic
Vice-Direction
of Education & Research
Primary
Care (PC) & Family Medicine (FM) Research & Development (R&D) Unit
Brief
Proposal of Initiative to Strengthen Health R&D
[To
the Cuban Ministry of Public Health (MINSAP)]:
“Vedado
Education Community Polyclinic: Pilot R&D Area for the Integrated
Development
in the National Health System (NHS) of the FM & PC R&D Subsystem”
Antecedents of High
Scientific Rigor R&D in PC
Since the 1970s began R&D projects for morbidity and risks of
diseases in our PC with the integral polyclinic model and since 1975 with the
community model, by mutual interests with the National Institutes for Child,
Cardiology & Cardiovascular Surgery, Endocrinology & Metabolic
Diseases, Angiology, Neurology, Health Development (HDI), Hygiene, Epidemiology
& Microbiology, Hermanos Ameijeiras Hospital, Medical & Surgical
Research Center, and others. Investigators, among them, Drs. Porfirio Nordet,
Oscar Díaz, Eduardo Zacca, Armando Zeuc, and many others, coordinated this
R&D, even creating some scientific centers at a municipality level as Dr.
Alfredo Dueñas, cardiologist-epidemiologist researcher from the Cardiology
Institute in the “10 de Octubre” Municipality. At the same time there began to
be make operative R&D by the hospital & PC specialists with
collaboration of the three basic general specialists, and from 1984 by the PC
& FM specialists until the present.
When the Health Development Institute was closed, in the 1980s a
multidisciplinary team of non medical investigators, mathematicians and others,
went to work to an office in the Plaza Polyclinic, without integrating its
staff by the interest of Dr. Abelardo Ramirez to do PC R&D for the
Direction of the MINSAP, in the Plaza, Lawton and other health areas.
In the middle of the 1980s, Dr. Carlos Cervantes, researcher and professor
of the first courses prepared integrally by the Revolution in the Havana Institute
of Basic & Preclinical Sciences (HIBPS) in 1962 and in the National Center
for Scientific Research (CNIC) in 1968, due to the massive emigration of
physicians and professors, went out of our National Cancer Institute (NCI) to
elevate as clinical biochemist scientist, supported by the Vice-Minister Dr.
Abelardo Ramirez, the scientific level of the clinical laboratory of the “Reina”
Community Polyclinic supporting also
scientifically its first PC geriatric R&D themes, present for the
first time in the National Plan of R&D of the Cuban NHS.
Between 1990-94, Dr. Rodolfo J. Stusser, classmate of Dr. Cervantes in
the HIBPS and in CNIC, after training in Internal Medicine, Rural Medical
Social Service in Oriente, Institute for Health Development and our NCI, and after
return from Nicaragua as MINSA scientific adviser, stimulated by the Pan
American Health and World Health Organizations (PAHO/WHO) there, went out of our
NCI and with support of Professors Fidel Ilizástigui & Cosme Ordoñez, increased
as clinical biostatistician scientist the level of the clinical,
epidemiological & social research of the FM & PC, giving the first
courses in research methods, biostatistics & informatics, and developing a first
plan of 7 themes and 24 tasks of R&D, (at our NCI scientific level), with
protocols, presentations & publications in international meetings &
journals, working in the staff of the Plaza Community Polyclinic.
Difficulties of every type in those times due to other priorities aborted
both efforts. Dr. Cervantes returned to
a Clinical-Surgical hospital and Dr. Stusser to a center of the scientific pole,
although continued supporting the PC R&D in the Plaza and other health
areas.
In the middle of the 1990s, the Health Faculty created a graduate &
master in PC, and in the 2000s the National School of Public Health created one
in family & community health, strengthening PC R&D.
In the 2000s, Dr. José E. Fernández-Britto, pathologist professor &
researcher founder of the CIRAH, between the HIBPS & the Military Hospital
Carlos J. Finlay, relocated his center in the 19 de Abril Community Polyclinic,
opening a graduate, master & doctorate in Atherosclerosis & its Risk
Factors, strengthening the R&D in PC & other levels of care in Havana
City.
Since the 1990s the Vedado Polyclinic is an Experimental Area of the NHS
for health informatics & telemedicine in PC & FM. In 2002 Dr. Stusser
returned to the staff of this polyclinic, to promote the FM & PC R&D
from inside again, and designed with Dr. Marco J. Albert, Vice-Deputy for
Education & Research, and a team with family physicians, engineers &
mathematicians of CEDISAP & ICID the “Vedado e-Health Community Project”.
This proposal of initiative to strengthen the FM/PC R&D is product of this
interaction as well.
Scientific
It is the increment of the scientific level & quality of the FM
& PC Prevention, Diagnostics, Therapeutics, & Rehabilitation; Undergraduate
and Graduate Education in FM and PC general specialties; R&D in FM & PC
on Informatics & Telecommunications, and in Health Research Policy &
Systems in PC & FM, in the Vedado Polyclinic, Plaza Municipality, Havana City
& NHS.
Immediate Objectives of the
R&D Unit of the Vedado Polyclinic
To support the Direction of PC, FM & NHS:
a) To suggest the creation of the health R&D
policy & subsystem in FM & PC for the 444 polyclinics and 30 000 general
practices of the NHS, with emphasis in the health problems and factors favoring
health, beginning it in the Vedado Polyclinic, and continuing gradually in the other
14 province polyclinics of reference
b) To assist the generation of the
policy for the integration of the FM & PC R&D, with the health
secondary & tertiary care R&D, and with the pharmacological,
biotechnological & medical equipment industrial R&D, as well as with
the results of the human genome & brain, among other R&D global
projects
c) To contribute to the development of the health
informatics & telecommunications policy, R&D subsystem & network in
the NHS through the Internet and other information & communication
technologies (ICTs), with emphasis in the physician care to the individual and his
family, in contact with the polyclinics and 280 hospitals, institutes &
centers of the NHS
d) To advice the elaboration of the policy &
network of e-health R&D to improve the R&D collaboration at a distance among
the different reference centers &
other units of the three-four health care level centers (physician office,
polyclinic, hospital, institute) and of the scientific industrial centers
e) To counsel to the PAHO/WHO and other UN
agencies, the edification of the international policy & subsystem of public
health R&D and e-health R&D starting from the PC & FM to increment
the results and to make more cost-effective the global health R&D cooperation
South-North-South, and South-South
Main Tasks and Activities
With the scientific-methodological support of other researchers of the
institutes, centers for development, hospitals of the MINSAP & university, and
scientific productive centers, as well as with an effective informatics &
telecommunications infrastructure with logistic assurance, and with the indispensable
international collaboration and external financing, between 2004 and 2008, it
could be started the carry out in the Vedado Polyclinic, and gradually in other
14 polyclinics of provincial reference, the creation of a solid MF and PC
R&D subsystem integrated to the R&D system of the NHS. The main tasks
and activities would be the following ones:
1) The creation of Areas of
Clinical & Population Trials in the PC & FM, to test the new
technologies & procedures transferable & assimilable from the
institutes & hospitals of the NHS in prevention, diagnosis, prognosis, therapeutics
& rehabilitation of diseases & risk factors, and in natural products
and alternative & complementary techniques, and of the centers of the
scientific industrial pole, in vaccines, pharmacological, biological &
biotechnological products, and medical equipment as well.
2) The creation of Areas of R&D to search for balanced strategies
& tactics, as much for the quantitative-qualitative measurement &
assessment of the status of health, health & risk factors, disease &
disability of the individual, family and community from the FM & PC with
the tools of the bioinformatics & mathematics, as for the health promotion,
maintenance & recover with a basic quality of life of a population of low
infant mortality and morbidity that can be preventive by vaccines and long life
span.
3) The creation of Areas of
R&D of solutions to the own scientific & technological problems of the
PC & FM, in prevention, classification, diagnosis, prognosis, therapeutics
& rehabilitation of the health problems and of the factors that favor,
maintain & recover the physical, mental & social health of the
individual, family & community, generated in the polyclinics and in general
practices, as well as in the e-health PC, management, education and R&D of
the population.
4) The creation of Areas of R&D to develop new own research spaces
of the family and general integral
medicine, and of the other community specialties own of the PC, as general
internal medicine, general pediatrics, general obstetrics, general epidemiology,
general management, and of other research spaces shared with other scientific disciplines
in and out of the PC.
5) The creation of Areas of R&D in PC & FM that could be
converted in reference centers of the PAHO/WHO for the Southern countries, in
global health research projects, doing R&D of the global public health
problems and of the e-health starting from the PC & FM, integrated with the
R&D of the hospitals & institutes, to increment the final health
results and social impact, and to make more cost-effective the global health
R&D cooperation South-North-South & South-South.
In the Vedado Polyclinic and the other 14-15 polyclinics of provincial
reference, it will continue the promotion of the assistance of academicians of FM,
PC, and others of foreign universities, scientific societies, non governmental
and government organizations of the world to our workshops & congresses of
FM & PC as well as visits, exchanges, conferences, internships,
fellowships, sabbaticals in our facilities, looking for external collaboration
and financing and donations to our concrete health R&D projects, to improve
progressively the PC of our patients in our NHS.
The carry out of this initiative of scientific development of the FM
& PC in close scientific association with the institutes, hospitals, universities
and industrial centers of the scientific pole, over a modern infrastructure of
informatics & telecommunications, is the only way to achieve, first, the
scientific strengthening of our FM & PC, and second, the scientific
integration of these FM & PC with the hospitals & institutes (& industrial
centers) that since more than 30 years we have being searching for, to improve
the quantitative & qualitative levels of health & life of our
population.
A full proposal of project of Initiative for an Integrated Development
in the NHS of the PC & FM Health R&D Subsystem, in the Vedado
Polyclinic and other centers, could be prepared, if this brief letter of
intention is totally or partially accepted by the pertinent instances of the
MINSAP and government.
Dr. Rodolfo Stusser,
Researcher, Professor & Adviser
MF & PC Research Unit
Vedado Community Polyclinic,
[Scientific Adviser to Institute for Cardiology,
Center for Informatics Development,
Cuban Family Medicine Society,
Primary Care Direction of MINSAP]
Tel/Fax: 832-3461 [email protected]