Lessons from Cuban Medicine for the World: The Case of Venezuela

Visita casa por casa de médicos y enfermeros del CDI María del Mar ÁlvarezThere are more than 20,000 Cuban doctors and nurses in Venezuela. They run thousands of medical clinics, hundreds of health centers, and tour popular neighborhoods daily. This is a massive deployment, reinforced by new brigades, which have proven to be crucial against the COVID-19.

It is common to see doctors in the popular neighborhoods of Caracas. They are dressed in white and blue, knocking on the doors of houses, climbing stairs and buildings, carrying out medical examinations, asking questions, giving advice, taking notes, and referring. It is a daily work, a health policy, which has in its center the cooperation offered by Cuba.

This collaboration between the two countries is not new. Dr. Reinol García Moreiro, head of the Cuban Medical Mission in Venezuela, situates the beginning of the Mission in 2003, with antecedents that go back to 1999, when a landslide took place in the state of Vargas that left thousands of victims: “that was the first gesture of solidarity”. Hugo Chávez had been in government for a year.

The deployment of the Mission includes more than 15,000 popular consultancies, 572 integral diagnosis centers (CDI), 586 integral rehabilitation rooms (SRI), 35 high technology centers and more than 20,000 Cuban collaborators, including doctors, nurses and technicians in the different ranges of medicine.

This structure was reinforced and put into service to address the COVID-19 pandemic. “We have put the 572 CDIs into operation for this situation, 398 are attending the COVID-19, and the rest are attending to other pathologies of the population, but they have respiratory consultations attached to the rehabilitation rooms,” says Garcia Moreiro.

According to the mission chief, the services of the IRS were adapted as inpatient centers, “and many IDCs have become intensive care clinics to serve these patients. In total, more than 4,000 beds were made available for the care of patients with COVID-19, of which 2,000 are “equipped with all the technologies of intensive care, doctors, nurses, trained technicians”.

The conversion for the fight against the pandemic was accompanied by the deployment of thousands of doctors. They were seen from the beginning, when the essential components of the disease caused by the SARS-CoV-2 coronavirus were still unknown, touring popular neighborhoods across the country, providing education about the pandemic and detecting cases. There are, says Garcia Moreiro, between 12,000 and 15,000 Venezuelans and Cubans, ready for this task.

An integral diagnostic center of reference

Doctors leaving the red zone receive an examination by the CDI team Maria del Mar Alvarez, located in the popular Maternity Zone: they have spent 14 days in a row with COVID-19 patients, and now another group is being admitted in their place. While they receive applause, another team is getting ready to go out and tour one of the nearby neighborhoods, going house to house to make the daily visits.

CDI has recently been remodeled. Its director, Dr. Lilian González Rosales Verdesia, a Cuban, explains that it is a “sentinel ICD”, that is, those who are especially prepared to fight the pandemic: “We have care for patients with severe and moderate COVID-19, we have a hospitalization and therapy service with an availability of 12 beds”.

Patients who arrive with symptoms of COVID-19 may come on their own because they have, for example, respiratory problems, lack of a sense of smell and think they may be positive, or because they have been referred by Cuban doctors after a visit on a tour of the neighborhood.

“The house to house is a Cuban experience that we apply a lot in primary health care, which is a preventive system, of health promotion, and the main objective is to arrive on time before any epidemiological situation and that the indicators of morbidity, mortality, lethality, decrease”, the head of the Mission remarks.

This method was implemented since the beginning of Cuban-Venezuelan cooperation. It acquired particular importance when facing the pandemic because it allowed anticipating in many cases the virus’ expansion, carrying out pedagogy of care, quick tests to detect the presence of outbreaks.

“There have been 87 million of screenings, examinations of the population, some have received three and four visits of the medical teams looking for the appearance of symptoms, respiratory pathologies, possible complications, patients who have diseases with high morbidity in association with the disease, looking for children, pregnant women, elderly people,” explains Garcia Moreira.

When the people who were visited at home arrive at the office, referred by the doctors, they are given a quick test of COVID-19, then the so-called PCR or swab if necessary, and if they are positive, they are admitted or sent to another place if there is no bed available. Everything is free for patients.

The infection curve in Cuba and Venezuela

In Venezuela, as of Monday, September 28, 606 deaths from COVID-19 have occurred, a total of 72,691 cases, and in Cuba 122 deaths and 5,457 infections. “The fundamental thing is that there is political will, of government, and participation of the people. When these issues are brought together and there is a health system that is put in function of the essential and primordial situation that exists at a given time in a country, that yields results,” the head of the Cuban Medical Mission summarizes.

The numbers from Cuba and Venezuela contrast strongly with those from neighboring countries, such as Brazil, where as of September 28, there are more than 142,000 deaths and 4.73 million cases, and Colombia with almost 26,000 deaths and 813,000 infections.

“Cuba has control of the epidemic, and despite having very few cases, it operates as if it had thousands more. This has been achieved despite the US blockade, despite being a country with scarce resources. And furthermore, Cuba is among the first 30 countries authorized to research its vaccine, called Sovereign,” explains the head of the Cuban Mission.

In the case of Venezuela, García Moreiro highlights the situation of the blockade that the country is experiencing as a result of the US sanctions that affect, among other things, the income of the State. Even in this context, the leader affirms, “Venezuela is achieving a plateau in its epidemiological status and we are convinced that by the end of the year we will have a very favorable situation”.

Part of the reasons for the numbers has to do with the deployment of the Cuban Medical Mission, the development of a health system that, reinforces García Moreiro, is “for the poor, the middle class and the rich who also go to the CDIs”.

Other reasons that explain that curve can be found in the early decision to implement the quarantine, the consolidation of alliances with countries such as China and Russia that, in the face of the pandemic, helped to consolidate the capacities of the Venezuelan health system, hit by the years of economic decline.

How do Cuban medical brigades work?

At the beginning of September, six Henry Reeve brigades arrived in Venezuela from Cuba, made up of 93 health professionals. They were distributed throughout six regions of the country to reinforce the Medical Mission and the whole health policy against the pandemic.

This was the second deployment of health brigades to the country since the beginning of the pandemic: the first group came for five months, integrated by “scientists and people of advanced knowledge in the management of diseases and research”, explains García Moreiro.

The Henry Reeve brigades were born in 2005: created from the idea of providing aid to the victims of Hurricane Katrina that hit the United States, aid that was denied by the then government of George W. Bush.

The Henry Reeve Brigades, specialized in disaster situations and serious epidemics, are not the only Cuban brigades in different parts of the world. Cuba’s policy of cooperation in health matters spans decades: its first medical missions were in Algeria in the early 1960s, after the African country achieved, after years of war, its independence from France.

The policy of medical brigades had a central place in response to the world crisis of the coronavirus: the Henry Reeve brigades are today, says García Moreiro, distributed in more than 40 countries of the world: “They are doctors who save lives as they saved them in Turin [Italy], in Andorra, in Azerbaijan, in Africa, in the different regions of America”.

The United States has pressured different countries not to open their doors to the arrival of the Cuban brigades. An action that has also been deployed by different media to try to discredit the Cuban cooperation policy. “They accuse us of being politicians, of being soldiers, of being intelligence services, these are terrible lies,” García Moreiro explains.

The campaigns failed to stop the Cuban medical deployment, and the Henry Reef Brigades have recently been registered for the Nobel Peace Prize. “The prize would be an honor,” says García Moreiro, “a recognition from the world, especially from those who have received the selfless attention of our doctors who have offered their lives in all latitudes in order to help eradicate the epidemiological crisis in the world”.

In the case of Venezuela, Cuban cooperation has been in place for many years. The central acknowledgement comes from the people in the popular neighborhoods, when they see the groups of white coats arriving with community leaders, the acknowledgement of a daily effort close to those who need it, a deployment that is now central in the face of the pandemic.