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A US Journalist Reports on Health from Havana

Gail Reed interview
Gail in center with Haitian resident and medical students (left in foto) and Cuban physicians (right) at MEDICC's December 2018 conference in Santiago de Cuba: "A Healthy Cuba, Healthy World: Linking Culture, Community & Cooperation." Photo courtesy: Gail Reed

Interview with MEDICC’s Gail Reed

In this interview with Cuba Business Report, MEDICC’s journalist, Gail Reed speaks to us about her work as a foreign journalist in Havana, MEDICC’s work in Cuba, US-Cuba health cooperation, and the Cuban healthcare system.

Cuba Business Report: Tell me a bit about yourself, for example, when did you first arrive in Cuba? Were you working at the time for MEDICC? And why did you come to Cuba? Did you come first as a tourist?

Gail Reed:

I first went to Cuba as a student. Those were the years of Civil Rights and the Vietnam war, and I think it was natural that many of us were curious to see the different society Cubans were attempting to create. I then went on to do graduate studies in journalism at Columbia in New York, where I had the privilege of meeting professor Phyllis Garland, who became my friend and mentor and encouraged me to open my eyes further to society’s challenges. I remember that my graduate thesis was an original and very long article on violence against a Black family in Rosedale, Queens. I also began writing about Cuba’s role in southern Africa.

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But it wasn’t until several years later that I made Havana a “second home” with a Cuban partner. We had a child together, and even after we separated, I decided to stay on with my son as a temporary resident and journalist.

Then, in 1993-1995, I returned to my first love: public health. Because when I was young, I had always wanted to be a doctor, but in those days, scholarships for women to study medicine just weren’t available. Returning to public health first meant working with UNICEF to jump start U.S. NGO collaboration with Cuba’s health sector during the very difficult time of the 1990s. That was after the collapse of the socialist bloc, when the U.S. also reinforced the embargo (or as Cubans call it, the blockade) with the Torricelli legislation. Then came a foundation request to lead a study to determine if the embargo violated the human rights of Cuba’s 11 million people. The research was the result of a Washington DC law firm’s allegation to this effect presented to the OAS Human Rights Commission—to which the Commission basically replied “prove it.”

With local support in Havana, our small team took 18 months to dig into the files of medical importers and an array of healthcare institutions; interview patients, care providers and international agencies; and finally produce a 300-page report published by the American Association for World Health: Denial of Food & Medicine: The Impact of the U.S. Embargo on Health & Nutrition in Cuba. The Executive Summary by Kai Bird and Julia Sweig was translated into several languages, and was used in Congress to make the case for allowing food exports to Cuba, still with significant restrictions.

The report also turned out to be the foundation stone for our nonprofit MEDICC (Medical Education Cooperation with Cuba). The idea and the first board members came from the blue-ribbon, bipartisan commission that visited Cuba to validate the study’s methodology.

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As I did my research, I kept running into U.S. doctors and other health professionals who had visited Cuba at one time or another, but had no way of continuing to collaborate—much less communicate—with their Cuban colleagues. By then, the Cuban health system, its universal nature and outcomes, had drawn the attention of the U.S. medical and public health communities. So MEDICC was founded to provide a bilateral institutional bridge between these medical and health professionals—always looking for best practices that improve the health of individuals and populations as a whole.

Cuba Business Report: Was life in Cuba easy or difficult for you to adapt?

When I first became a temporary resident, I was housed in the Alamar district, a bedroom community of some 100,000 residents in eastern Havana. Each building had 30 apartments, most destined for those who had participated in the construction. As an antidote to the obvious housing shortage, “microbrigades” had been set up in a number of workplaces, where employees would volunteer to pitch in to raise the new structures under the guidance of experienced builders, while others took their place at the office, factory or wherever they worked. The building where I lived was built by cigar workers. And that turned out to be fascinating. As you may know, these folks are enormously talented, rolling cigars by hand. But they also have a decades-old tradition: the reader, who reads fragments of news, novels, all sorts of things, throughout the day. So, no matter their formal education, these craftsmen and craftswomen are full of knowledge. They were also full of curiosity and solidarity when it came to the “norteamericana” who suddenly appeared in the fifth-floor walkup.

So I never felt alone, even at first. And Cuba is such a child-friendly place, that I was lucky in that respect, too. “It takes a village” became real to me whenever I would hear a neighbor calling down to my son to “be careful!” or to “stop throwing the ball there! You’re going to hit somebody!”

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The most difficult thing for me was language. I barely spoke Spanish, and I had to make my way to the grocery store, learn to use my ration card, to get in line, to just get along with daily life. But there is nothing like total immersion to put you to the test!

My second challenge had nothing to do with Cuba: I always thought I would have a daughter. I only knew girls, after all, since all my cousins were girls and I was an only child. So when I had a boy, I knew that both my son and I were in for a mutual learning experience. He is still the joy of my life.

Cuba Business Report: You’ve been running a series of conferences in Cuba focused on health and your next one is coming up soon. Have these been successful? How has the response and participation been? Are conference attendees solely Americans?

We have actually had only two conferences… one in 2017 and one in 2018. The rest have been opportunities for mainly (but not solely) U.S. health professionals to make the trip to Cuba, see the island and the health system for themselves, and in many cases establish long-term relations of cooperation. Our mission at MEDICC is to foster cooperation among the U.S., Cuban and global health communities that leads to improved health and health equity.

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MEDICC was founded in 1997, at first organizing electives and rotations in Cuba for medical, nursing and public health students. By the time former president George W. Bush limited student exchanges in 2004, over 1,000 had taken advantage of MEDICC electives to earn credit from 118 U.S. universities.

Then, we changed direction to involve health professionals, policymakers and others who could still legally travel to Cuba. We must be nearing 2,000 by now. The response has been extraordinary, as a result I think of Cuba’s continuing impressive population health outcomes on a shoestring budget and its outsized role in strengthening health systems worldwide.

In 2018, there was a downturn after the current administration’s announcements of new travel restrictions and the whole “sonic” affair, but the trend is once again upwards in 2019.

I also think enormous credit is due to the US medical, health and scientific communities, which have never stepped back, but maintained their interest in cooperation, against even the fiercest headwinds. We saw that very clearly in the spring of 2018, when our journal MEDICC Review published a special issue, The Path to U.S.-Cuba Health & Science Cooperation. Not only did we have prestigious American and Cuban guest editors, but virtually all the articles had U.S. and Cuban co-authors and the issue was launched both in Havana and at the American Association for the Advancement of Science (AAAS) in Washington DC.

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One of our key messages was that U.S.-Cuba cooperation is good for the health of Americans, as well as Cubans, providing examples such as Cuban biotech’s lung cancer vaccine now in clinical trials at Roswell Park Comprehensive Cancer Center in Buffalo, New York.

Cuba Business Report: What is it like for you as a foreign journalist working in Cuba?

Gail Reed:

I’ve worked as a teacher of journalists on the Cuban end, and also for US media such as Cuba Update, NBC News and Business Week. An assignment in Havana is a complicated one for any U.S. journalist. First, because the two social and economic systems are so different… it makes it almost impossible to understand the dynamics in Cuba for those who “parachute in.”

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For those who are accredited on a more long-term basis, I think the biggest challenge is to dump your baggage… and get your editors to do the same… to keep from repeating the tired old notions of “communist Cuba.” That doesn’t mean there isn’t a Communist Party that plays a formidable role. It does. But Cuba is far from communist. Its system is socialist, and it’s very much “Cuban socialism.” What that means, how it has evolved, the changes going on right now (for some, too fast and for others too slow), all these are very hard to grasp for any outsider.

And of course, now it’s not just Cuba’s official press: as in many other countries, a journalist in Cuba has to keep informed through blogs and other social media, as well as on-the-street experiences, interviews and old fashioned research. How to ascertain what is balanced, who has an axe to grind, what are the “legitimate concerns”, and in what context? All these are more difficult in Cuba I think, because reading people in such a different society as the U.S. is a major challenge. There is also the challenge of the Cuban bureaucracy, its snail’s pace, and multiple levels of authority. These can be frustrating, to say the least.

Cuba Business Report: What’s your take on healthcare in Cuba?

They have done an impressive job on health and health care, with seriously limited resources. That’s not just my opinion. It is the opinion of the United Nations (U.N.), PAHO/WHO, UNICEF and even the former head of the World Bank. Their infant mortality at 4 per 1000 live births is well under that in the USA, and other indicators match or better those in many of the richer countries. Importantly, their indicators also reflect fewer disparities. Cuba’s is a very robust primary health care system, a condition deemed internationally to be the cornerstone of any health system worth its salt. And care is truly universal and free to patients.

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Yet, they are also terribly challenged by the lack of resources, complicated by the U.S. embargo. Equipment is expensive, training is expensive, research is expensive. And most expensive is to maintain this universal access to quality care for 11 million people. During the frightening recession of the 1990s, keeping people healthy was like balancing on a fraying tightrope. I witnessed health professionals in tears when they had to bend a protocol, to extend the amount of time between mammograms or other important preventive tests. The health indicators made it through, but not without enormous sacrifices.

Today, the situation is complicated by some younger health professionals’ decision to work permanently abroad because of the admittedly quite low salaries they earn in Cuba…or who are turning to other jobs in Cuba itself. This is a problem that, in my view, begs urgent attention, but also solutions that can also be applied to other public-sector workers. And how do you enact major salary raises across the board when the economy is growing so slowly.

There are several ways they’re now working at sustainability for this universal public health system: increasing “health tourism” from Latin America, Canada and Europe (taking advantage of the prestige of Cuba’s health professionals); exporting biotech and other pharmaceutical products developed in Cuba to address important health issues (such as Heberprot-P for diabetic foot ulcers, studies showing it decreases amputation risk by over 70%); and of course the “export” of health professionals.

The latter has received some criticism from abroad, since where a foreign government pays significant salaries to Cubans serving in their country, the Cuban government heavily taxes these salaries to fund the health system at home. The taxes can run as high as three fourths of the salaries paid.

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However, those working abroad (and thousands continue to volunteer) make about ten times what they do in Cuba itself, and return with all manner of goods for their families.

In other cases, where Cuban assistance is to a very poor country, the Cuban government doesn’t expect the host nation to pay salaries. So Cuban health professionals staff the public health system (mainly in underserved areas, as determined by the host country), receiving housing and a small stipend (paid by either Cuba or the host government). In all cases, Cuban volunteers abroad receive their regular salaries in full, as if they were working in Cuba itself.

Of course, Cuba has invested not only in the education of its own health professionals… with over 90,000 physicians, for example… but also in talented students from low-income families in over 100 countries. The Latin American School of Medicine, which celebrates its 20th anniversary this year, has graduated nearly 30,000 physicians from and for the world’s poorest communities. This is an unprecedented contribution to extending health care globally.

Cuba Business Report: What does the American healthcare system have anything to learn from the Cuban healthcare system?

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I remember years ago sitting in the waiting room in my doctor’s office in the States, reading the “Patient’s Bill of Rights.” By then, I had spent a lot of time in Cuba. I got to the end of the poster and realized that one right was missing: the right to health care. So, that would be the first thing to learn, not only from Cuba but from many other countries: in the richest country in the world, health care should be a fundamental right for everyone.

The second thing of course is a conceptual difference that I’m not sure can be learned. That is, viewing medicine as a public service rather than a business, making health services free to patients. In the U.S., patients’ health expenses are bloated by insurance companies, big pharma and often tethered to being employed. So it’s difficult to imagine it any other way. But some are actually beginning to, and that’s where the Medicare for All movement is coming from, which also enshrines the idea that quality health care is first and foremost the responsibility of government.

I think we also must learn to collaborate more effectively with a country like Cuba, with which we may have many differences, but where cooperation can make a great contribution to global health. The Ebola epidemic in West Africa is just one example: there was last-minute joint activity. But how much more could have been done, how many more lives could have been saved, if the U.S. (with its technology and logistics) and Cuba (with its trained emergency doctors) could have counted on such collaboration from the outset?

The U.S. embargo, as I mentioned, also tends to hurt American patients who suffer from diseases where Cuban biotech may offer novel, proven solutions, such as diabetic foot ulcers (DFU). Some 70,000 DFU amputations are carried out on American patients every year. Most such disabilities, hardships and expenses could be avoided, if U.S. law provided our companies with more assurances that positive trial results and FDA approval of Cuba’s Heberprot-P would result in permits to import and use this medication to treat the tens of thousands of Americans suffering from DFU.

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It is axiomatic now to point out that comprehensive primary care is the basis for good health outcomes, since 70 to 80 percent of prevention and treatment happen at this level. That is something we could learn from in the USA, where our system is overburdened with a reverence for high-tech at the expense of simpler tests and overstocked with subspecialists at the expense of internists, pediatricians, OB/GYNs and family physicians.

And we have a medical education system that is sorely in need of reform, in which grads are forced into these subspecialties just to pay off their student loans, a personal debt running at about $200,000 by graduation time. It’s interesting to see schools like that of Kaiser Permanente and NYU offering free or lower-cost medical education. Let’s see what happens with that, in terms of heading off the 15,000 to 50,000 shortage of primary care physicians by 2030, predicted by the AAMC, and a more serious shortage of physicians who are people of color. (Just 6 percent of physicians are African Americans, Hispanics or Native Americans, while they are some 32 percent of the U.S. population).

In the end, you have to ask yourself: how is it possible that Bloomberg’s 2019 Healthiest Country Index rates Cuba higher than the United States, when it spends one tenth of what we do per capita on health care? That alone would indicate we have something to learn.

Cuba Business Report: Gail, thank you so much for the chance to speak with you and learn of your experiences and work as a foreign journalist in Havana, the country’s healthcare system, and your very valuable work with MEDICC.

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