CNN YOUR HEALTH
Cuba's Health Care Manages Despite Embargo; Cuba's Pioneering Parkinson's Procedure; Cuba's Minister of Health Discusses Health Care in Cuba
Aired August 18, 2001 - 15:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
ANNOUNCER: Today, on a special edition of YOUR HEALTH: Lessons in healing from Cuba.
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DR. HERMINIA PALENZUELA: We have very many difficulties to get things. Sometimes they don't allow this company who used to sell things to us, they don't allow them to.
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ANNOUNCER: A nation struggling to care for its sick in the mist of a decades-long economic embargo. How Cuba has managed some medical successes.
Plus, a look at the pioneering Parkinson's procedure that has people from all over the world flocking to Cuba. And the doctor next door: How the old-fashioned house call is keeping Cubans healthy and happy.
CHRISTY FEIG, CNN MEDICAL CORRESPONDENT: Welcome to a special edition of YOUR HEALTH, from Havana, Cuba, I am Christy Feig.
The U.S. embargo has kept American medicines from Cubans. We will start with look at how that embargo is affecting them and just what this country is doing to work around it.
(voice-over): Now healthy, Enrigue Cento went to Spain a year and a half ago for a kidney transplant. For Santo, who spent months on dialysis in Cuba waiting for a new kidney, that trip gave him a perspective few Cubans have.
ENRIGUE CENTO, DIALYSIS PATIENT: Here we use everything. And there, they throw away every (UNINTELLIGIBLE) and the (UNINTELLIGIBLE).
FEIG: Beyond throwing out used equipment, doctors here say they can't get parts to fix critical machines. They say it is the patient's who pay the price. And doctors are forced to make difficult choices. SR. RAUL HERRERA VALDES, DIRECTOR, INSTITUTE OF NEUROLOGY (through translator): Sometimes we have machines working 24 hours daily and sometimes you can't give all of the time that a patient needs. Other times we prefer to give more time and more space to young people, people with an active social life, than to older people.
FEIG: Young people also make sacrifices. Some of the children in this pediatric hospital have to have open heart surgery. Even though newer technologies in use outside of Cuba could fix the same problem without surgery.
PALENZUELA: We have many difficulties to get things even in other countries because if the company belongs to the states or has a share of the company with the state, some times they don't allow this company who used to sell things to us, they don't allow them to continue selling.
FEIG: Cuban medicine is forced cope with the embargo throughout its health care system. But by far, the most pervasive affect is reflected in the use of alternative drugs and therapy.
Take drugs, for starters. Cuba makes 80 percent of their own, but because of the embargo, pays 3 times more than other countries for the raw materials, often paying expensive shipping cost. The high costs limit the amount the government can buy, creating a shortage. To cope, doctors here have embraced an approach that most western doctors have rejected.
(on camera): Each neighborhood has what's called a "green pharmacy." It is here they make and sell alternative medicine to compensate for the drugs they don't have.
(voice-over): Doctors write prescriptions for things like Oregano extract, believed to reduce the frequency of epileptic seizures. When Juan Carlos was on conventional medicine for his seizures, his mother says he had about 20 a month. Since doctors added the, oregano extract three years ago, she says he is down to about five a month.
GEROGINA VELAZCO, JUAN CARLOS' MOTHER (through translator): His doctor thinks it is the result of both treatments working together.
FEIG: And it is not just drugs, it is therapy too. At this pain clinic, patients arrive before the doctors and wait for hours to be seen. All they use here are procedures like acupuncture and the moxibustion, the burning of herbs. Experts here say the integration of alternative and conventional medicines is such good approach, it will last beyond any economic improvement.
DR. LEONCIO PADRON, NATIONAL DIRECTOR OF NATURAL & TRADITIONAL MEDICINE (through translator): If a see of petroleum were to appear and we wake up one day to this good news, we would still continue with traditional and natural medicine as part of the same arsenal.
FEIG: In fact, the two are woven so tightly, in Cuban medical schools alternative approaches are taught at the same time as conventional methods.
When we come back we will take a look at how Cuba is fighting two diseases that puzzle U.S. doctors.
ANNOUNCER: The top three causes of death among the elderly in Cuba are: Heart disease, cancer and stroke.
ANNOUNCER: Meningitis means inflammation of the meninges or the brain lining. It is caused by several different germs, mainly bacteria and viruses.
FEIG: The U.S. has an average of 1,000 meningitis cases every year and more than 100 people die, but researchers in Cuba have developed a vaccine against the disease. Already sold in some countries, it may soon be available in the U.S.
(voice-over): When Evan Bozof died from meningitis his junior year in college, he joined a growing number of young people who catch the disease. It is often brought on by a dorm lifestyle.
His mother is now pushing for all freshman college students to be vaccinated for the disease.
LYNN BOZOF: After Evan died, we found out that there has been a vaccine that's been around for 30 years, that if we had known about it, would have saved his life.
FEIG: But even if she gets her way, the current vaccine available in the U.S. only covers four strains -- not the one accounting for one-third of cases -- strain B.
In fact, it has proven difficult for U.S. drug companies to develop a vaccine for that strain.
DR.JAMES TURNER, UNIVERSITY OF VIRGINIA: There are certain components of strains B that are recognized by the human body as common. They are not recognized as being foreign.
FEIG: But Cuba has just such a vaccine. Developed by researchers at the Finley (ph) Institute in Havana after an outbreak killed more than 200 Cubans in late 1970s and early 80s. They claim the vaccine is 85 percent effective. Today Cuban children receive the vaccine as young as three months, part of the country's regular immunization program.
That's good enough for the U.S. government to have made an exception to the embargo, giving Glaxo Smith-Kline a first of its kind license to study the vaccine in the U.S.
TURNER: Having an effective vaccine would prevent 20 to 25 percent of the cases in the United States. But internationally I would say it is also extremely important because strain B does account for a fair amount of disease worldwide as well.
FEIG: The vaccine has been registered in ten countries but Glaxo Smith-Kline says the necessary testing and regulations mean it will be several more years before they apply for FDA approval.
Now CNN's Lucia Newman takes a look how Cuban doctors are treating Parkinson's disease.
LUCIA NEWMAN, CNN CORRESPONDENT (voice-over): For Betty Yoraima this is bliss. Just two weeks ago, the 34 year old Venezuelan who has had Parkinson's disease for 14 years could not comb her hair, bathe, dress, or even eat by herself. Walking, she says, was torture.
I was absolutely useless, she says. I was totally dependent others. Now I depended on myself. I am independent.
What made the difference is an operation pioneered by Cuba's Neurological Investigation and Restoration Center, known as CIREN.
The treatment involves burning small lesions on each side of the sub thalamus, a small part of the brain involved with the coordination of many basic bodily functions. This patient remains awake throughout the delicate operation that slowly destroys hyperactive neuro transmitters which provoke the uncontrollable tremor and stiffness characteristic of this debilitating disease.
The result, says the CIREN chief neurologist are seen right in the operating theater. This man's hand tremor has stopped.
LAZARO ALVAREZ, NEUROLOGIST CIREN (through translator): The bilateral lesions to the sub thalamus which is this new technique we have developed, produces an improvement of more than 60 percent in patients with a reduction in 70 percent of the amount of medication they were taking.
With the operation they regain more than 70 percent of their functional capacity.
NEWMAN: Recovery time from this operation is about two weeks. The procedure is still considered experimental.
(on camera): The 54 patients operated here so far will be kept under observation for five years. Unlike another technique which uses a tiny implant to sent electronic impulses to the sub thalamus to numb the hyperactive areas. The results of this operation are permanent.
(voice-over): At this clinic however, surgery is seen as only a last resort. The majority of patients who come to the CIREN from all over Latin America as well as Spain, Canada, and even the United States respond to a treatment combining medication and highly specialized physiotherapy.
DR. OSCAR TORRES, PHYSIOTHERAPIST (through translator): When a person's motor skills deteriorate, their way of walking or talking, which is characteristic of this disease, we to have train them relearn how to walk, speak, and write.
NEWMAN: An integrated treatment which lasts about a month combining care by neurologists, therapists, and even psychiatrists. In most countries such labor intensive therapy would cost a fortune. But in Cuba the treatment is relatively affordable because the country has a surplus of highly educated medical specialists who earn next to nothing in comparison to their counterparts abroad.
Lucia Newman, CNN, Havana.
FEIG: When we come back, we will talk with Cuba's minister of health. ANNOUNCER: Parkinson's disease patients have an impaired sense of smell which, among other things, leads to little interest in food and poor nutrition. Experts believe that a key part of the problem is the patient's actual failure to sniff.
RHONDA ROWLAND, CNN MEDICAL CORRESPONDENT (voice-over): Welcome back to YOUR HEALTH. I am medical correspondent Rhonda Rowland with this week's health headlines. An Alzheimer's drug already on the market can help patients maintain their ability to carry out daily activities for at least a year. The drug, called Aricept or Donepezil will not improve a patient's ability to dress, shower, eat, take phone messages, or manage a checkbook, but maintain their level of functioning 72 percent longer than those that receive placebo. Not all patient benefited. Those that the earlier stages of the decease appeared to do better as a group.
Plus, heart pace-makers and implantable difibrillators are designed to even out irregular heart beats and prevent sudden death. Now for the first time, researchers have quantified the number recalls and safety alerts that occurred in the last decade for these devices. They found there were 52 advisories affecting half million devices. This resulted in 36,000 device replacements. Researchers say patients shouldn't unduly alarmed but the recalls and safety alerts are too high. They say possible solutions include longer testing periods and device tracking systems involving non industry groups.
And government researchers are recommending a higher daily allowance of vitamin C for young healthy women. Last year the official RDA for vitamin C in men was set at 90 milligrams. That was based upon a scientific formula. The RDA for women was set at 75 milligrams. The amount for women was extrapolated from men since data for women was not available at the time. Now the scientific data for women is available so researchers are now recommending that women get 90 milligrams a day as well, which equates to about an additional 3 ounces of Orange juice to meet the requirement. Researchers say it is best to have five servings of fruits and vegetables day. That will give you about 200 milligrams of vitamin C, and studies show that intake can help prevent cancer and increase longevity.
Those are this week's YOUR HEALTH headlines.
FEIG: Welcome back to YOUR HEALTH. I am Christie Feig. And with me now is Cuba's minister of health Dr. Carlos Dotres. Dr. Dotres thanks for join us. Cuba has health statistics that rival some of the wealthiest countries in the world. Tell us a little bit about the Cuban health system. What is it that makes Cubans so healthy?
DR. CARLOS DOTRES, CUBA'S MINISTER OF HEALTH (through translator): In Cuba, after the triumph of the revolution has developed a public health system, free for all Cubans, equitable and accessible. One that has prioritized the prevention and the promotion of health without discarding the development of the most advanced technology in regards to medicine.
FEIG: What role does smoking play in the leading causes of death here in Cuba?
DOTRES: It is a habit that predisposes to sickness and death from a group of chronic diseases, such as hypertension and certain cardiovascular disease, stroke and some cancers. We have been developing tobacco control programs for the country and we have seen results. Let me give you some numbers.
Last year about 50 million pesos less were sold in tobacco than the previous year. This year's first trimester saw a decrease of 50 million pesos and a purchase of tobacco in comparison with last year's first trimester. The price of cigarettes has not changed, so these improvements are related to the measures we have put in place.
FEIG: The number of HIV cases in Cuba are low, but other sexually transmitted disease are spreading. Add to that the shortages and an increase in tourism, what is the likelihood that HIV numbers will rise in Cuba in future?
DOTRES: This disease has had a slow growth in Cuba thanks to the actions we have been taking. In Cuba people with Aids have the right through law to treatment, and everything is covered. They have free guaranteed medicines and every health procedure they might need is at their disposal. Risk might increase once tourism grows, even though we have now considered this to be a grave problem, we don't discard the possibility.
FEIG: Dr. Carlos Dotres, thank you very much.
When we come back: More medical news from Havana, Cuba. But now, our Doctor Q & A from our CNN health Web site.
FEIG: Now our weekly edition of "Feeling Fit"
UNIDENTIFIED MALE: I tried it and I fell in love with it two years ago and I haven't stopped dancing since.
FEIG (voice-over): Salsa, the dance of Cuba.
UNIDENTIFIED FEMALE: There is something about that Carribian music that -- even if you are sitting still you just want to get up and go.
FEIG: It is also a great form of aerobic exercise
TOMY SMITH, "MR. MAMBO": We're are going to angle here and just go one step and back, like so.
Well, if you do it properly all of the muscles in your torso should be moving. It's a lot of rowing, moving upward, shaking, you know, dancing and dips, and it is just, I would think it is probably the closest thing you can get to swimming.
FEIG: Tomy Smith has been teaching salsa 15 years. You can make it what you want, he says. It doesn't have to be high impact aerobics.
SMITH: Somebody next to you might be going all out at it, you can kind of take your time and do it at a nice moderate pace.
FEIG: And for some of his students, it's their key to losing weight. UNIDENTIFIED MALE: I've lost 10 pounds, lost a couple of inches in the waist, and I feel great.
FEIG: He calls salsa the fountain of youth. For "Feeling Fit," I'm Christy Feig.
ANNOUNCER: In spite of trade embargoes, Cubans have maintained a high level of health care. Cuba also has one of the most promising pharmaceutical and biotechnological industries of the third world.
FEIG (on camera): There are more than 66,000 doctors in Cuba for the 11 million people who live here. Now, a look at how the Cuban health system is keeping Cubans almost as healthy as Americans.
(voice-over): Dr. Jorge Sancristobal and his nurse are making house calls. DR. JORGE SANCRISTOBAL, FAMILY PHYSICIAN: It's very important because I can see the family environment and know if something is driving the disease.
FEIG: Dr. Aniet Reyes (ph) lives a short distance away and is also making rounds.
Have you been eating salty crackers? Because you know that's important, a diet low in salt and fat, you have to avoid stress.
They're both family doctors in Cuba and this is what they do every afternoon, five days a week. The doctors are responsible for the health of everyone in their neighborhood.
(on camera): This is the basis of the Cuban health system. Family doctors live above their office and can be found in every neighborhood throughout Cuba, each caring for about 120 families. In the mornings they see patients in their home offices. Their salary: about $25 U.S. dollars a month. Many experts say it's that constant watch over their patients that keeps Cubans so healthy.
How healthy? A good way to gauge a country's health is through infant mortality compared to similar countries. The Dominican Republic, for example, loses an average of 45 babies of every 1,000 born alive. Jamaica, 24.5 babies. Cuba: a fraction of its neighbors: 7.2., more in line with the rate of the richer, more modern U.S., at 7.
But the doctors do say there's a downside to the job. Since they live in the community, their patients call on them anytime, day or night.
(on camera): You can find more information on all of the stories in this week's show at CNN.com/health, produced in conjunction with Web-MD.
For this special edition of YOUR HEALTH from Havana, Cuba, I'm Christy Fieg. Thanks for watching.
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