Postcard from Havana

Global health lessons: Observing health care in newly opened Cuba

Just-graduated DO is among the first U.S. medical students to train inside Cuba’s hospitals.

When I traveled to Cuba this spring to be among the first U.S. medical students to train in Cuba’s hospitals, it was my sixth global health trip with the Michigan State University College of Osteopathic Medicine (MSU-COM) in East Lansing. As we arrived at our lodging—a convent—I looked around in awe at the city of Havana. The sun was blazing hot with the smell of old cars and cigars creeping in from the distance. Owners of restaurants and stores enthusiastically called out to us, trying to convince us to enter their businesses.

Seeing the world with associate dean at MSU-COM Gary Willyerd, DO—my mentor and the attending physician/leader on all these trips—has helped me realize some important lessons about global health care. Below are my takeaways from Cuba.

Basic necessities can be limited

What we would consider basic necessities in the U.S., including basic lab tests such as complete blood count, can be limited in Cuba. Cuban physicians tend to rely heavily on physical exams to treat patients.

Observing medical care in an environment where resources are limited helped me see just how much physicians can accomplish by conducting a physical exam, and I realized how important it is for physicians to conduct them thoroughly.

Primary care focus

In Cuba, being a family physician means that the doctor is considered a part of the family being cared for. A family doctor often conducts daily house visits for her patients, especially for elderly patients and patients with multiple comorbidities.

Cuban physicians pride themselves on their primary care focus. After two weeks of getting to know their health care system, I can see how this focus and devotion to the patient-physician relationship benefits patients.

Medical judgment varies by culture

During internal medicine rounds, we met a patient who was diagnosed with metastatic colon cancer. According to the attending physician, the patient had a limited amount of time to live. However, the attending physician repeatedly told the patient that she was going to be just fine.

When we later asked the attending physician about the conversation with her patient, she explained that in Cuba it is culturally acceptable for doctors to hide the true prognosis of a deadly disease from the patients upon request from the family, as was the case in this scenario.

The approach to end-of-life care differs in the U.S., where we generally tell patients the whole truth even if their prognosis is dim (unless patients ask us to retain such information). But Cuba isn’t the only country where physicians don’t always reveal the entire diagnosis to the patient, and sometimes respect the family’s wishes for discretion. Learning about the different cultural values that come into play when physicians provide care was an eye-opening experience.

Lessons to remember

As I prepare to begin my residency, I hope to carry with me these lessons I’ve learned from my trip to Cuba. I want to see things from my patients’ perspective and assist them in making judgment-free decisions.

8 comments

  1. Dr. Pang, did you visit any of the prison facilities in Cuba and evaluate there medical care. And would have been very interesting to hear about the “end of life care” for those detained and moved to the execution areas.

  2. I especially appreciate your emphasis on the importance of physical examination in the diagnostic process. The ability to obtain a detailed history and conduct a careful physical examination pays dividends.

  3. This article is a breath of fresh air from some authors on certain news sites that claim they went to cuban hospitals and they intend on demonizing cuba healthcare without understanding how it works or not understanding the diligent in home care patients receive by physicians, etc! Thank you for writing about your own experiences!

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