400 more Cuban-trained Peruvian doctors graduate

A Policlínico and Consultorio in Pisco, Peru

On August 15, 2007, my daughter, Rebecca Fitz and her partner, Ivan Angulo Torres, were vacationing in Arequipa, Peru. At 6:40 PM a level eight earthquake hit the town of Pisco in Ica province of Peru. Rebecca went back to Lima, but Ivan had just completed his fourth year at the Latin American School of Medicine in Havana (ELAM, Escuela Latinoamericana de Medicina) and went to Pisco to help.4

Soon, reports would show that over 500 Peruvians died, another 1,042 were injured, and over 100,000 were left homeless.5 The first international relief to arrive was the Henry Reeve Brigade from Cuba. (Cuba’s first response teams for international disasters are named after Reeve, a New Yorker who joined the Cuban fight for independence and was killed in battle in 1876.6) The Brigade comes complete with medicines, medical equipment (including autoclaves for sterilization), and tents for examinations and surgery.

Finding the Cuban doctors well-organized to deal with the disaster, Ivan and other ELAM medical students devoted themselves to documenting the Brigade’s work. The resulting twelve-and-a-half-minute movie, Nuestra Misión (Our Mission), shows remnants of the poorly constructed homes which crumbled from the quake and the makeshift thatched homes that replaced them. Many initial injuries were followed within a week by pneumonia deaths from the cold weather. The emergency tent hospital of the Cuban doctors housed 1,980 operations, ran 30,734 diagnostic tests, and performed 151,454 therapeutic treatments. Help only arrived from the Peruvian government when press cameras were rolling.7

As the response to the earthquake subsided, the Cuban doctors transformed the emergency tent hospital into the Pisco policlínico, which has medical exam rooms, a birthing room, recovery room, and outpatient operating rooms. By far, the rooms most in demand at thepoliclínico are for adult and child physical therapy. Three years later people were still suffering effects of the earthquake. When I visited the Pisco policlínico in 2010, its director, Leopoldo García Mejias, explained that then-President Alan García did not want any more Cuban doctors and that they had to keep quiet in order to stay in Peru. As is typical for Cuban medical directors, Leopoldo has multiple international experiences, his first being in Honduras after Hurricane Mitch in 1998.8

Unlike in Cuba, health care at the policlínico is not free. It collects about 80,000 soles per year from patients, which it turns over to the Peruvian government for improvements.9 But the improvements were not always forthcoming, which forced discussions with the Alan García administration. By 2010 everyone knew that 200 or so Cuban doctors were in Peru, making it possible for the policlínico to garner public support. Clearly, sustaining a health center is as much a political as a medical happening.

Backing is also likely to come from Peruvians who visit a neighborhood consultorio. Peruvian doctors trained in Cuba have set up three consultorios in Pisco, each with assistance from a nurse completing the last year of nursing school. Dr. Johnny Carrillo Prada and Dr. María Concepción Paredes Huacoto helped set up the Consultorio No. 2 in Pisco. They are Peruvians who received medical degrees at Cuba’s ELAM, which offers a rigorous six-year course of study for free to students who must pledge to provide care for impoverished communities.10

Johnny and María explained that the Peruvian health care system is not socialized medicine. For those who work, Peruvian social security takes money out of their paycheck for national health care, which has limitations such as covering only two visits per month and only covering the “primary” illness for those with multiple health problems. A different system offers insurance to the poor and provides even less coverage.

The consultorio must work within the framework of limited potential for reimbursement while attempting to see everyone who comes through the door. Consultorio No. 2 serves about 180 families which each pay one sol per month.

The backbone of the Cuban system of medicina general integral (MGI, which translates as “comprehensive general medicine”) is preventive community health care, with the consultorioas its building block. The doctor-nurse team live at (or near) the consultorio where they work, so they are part of the community. Cuban policlínicos assist thirty to forty consultorios by providing services during off-hours and offering a wide variety of specialists. They coordinate community health programs and are a conduit between nationally designed health initiatives and their local implementation. In contrast, the Pisco policlínico provides a much smaller array of services than would one in Cuba, not only because it has a smaller staff and is linking fewer consultorios, but also because it is not part of a policy of free health care.

There are other challenges to applying an MGI model in Peru. Cuban-trained doctors make home visits to everyone in the consultorio area. But in low-income areas of Peru the only official-looking persons to come to the front door are cops. So medical staff have had to explain the central role of home visits.

Since the country is also rife with scam artists, Peruvians were skeptical of a consultorioproviding almost-free anything, especially something as vital as medical care. In order to establish rapport with the neighborhood, the doctors had to work through businesses and schools where they could distribute health materials and provide physical exams.

Perhaps the largest challenge has been education. The Cuban Revolution saw equality in employment, income, education, and medical care as proceeding together. The foundations of Cuban medical accomplishments are a primary care system that prioritizes prevention and scientific research scrutinizing population health needs. Thus, wiping out illiteracy has been vitally important to Cuban medical accomplishments. This makes it difficult to bring the model to a country where many cannot read and write.

One problem that Cuban-trained doctors have not had in Peru is a highly mobile population. In the United States, poverty often accompanies moving from home to home, which would make it very difficult to apply a model which assumes the doctor personally knows everyone in the community. In Pisco, however, even the poor tend to stay in the same home.Consultorio doctors are able to know their patients.

When Cuban doctors prepare to join a health brigade to another country, they learn to respect its culture rather than impose their social values. Without this approach, Cuban medical efforts in Peru never would have succeeded. The Cuban doctor has to simultaneously practice medicine and adapt to a different society.

The Alan García government, in power from before the earthquake through the first half of 2011, merely tolerated Cuban medical efforts. A few days before being sworn in as the new President of Peru, Ollanta Humala visited Cuban leaders in Havana. During his July 28, 2011, inauguration, Humala pledged to eliminate “exclusion and poverty,” which suggests closer collaboration between Cuban and Peruvian medical systems.11

HAVANA TIMES — The presence of a group of Cuban doctors in Peru, where they allegedly practice without the necessary permits, has generated an outcry from local physicians, reported EFE.

The dean of the Medical College of Peru, Cesar Palomino, came out against this presence, while the doctors of the Social Security system stated that the issue would be among the demands in a strike called for May 13.

The head of the Institute of Health Services Management in the Ministry of Health, Oscar Ugarte, confirmed that in the country there are 42 Cuban health specialists, and each will receive about $1,785 dollars in total for lodging, food, transportation, life insurance and health care.

The Fujimori parliamentary group submitted a request to question the ministers of Health, Midori de Habich and Labor, Ana Jara on the subject.

For his part, the chairman of the Health Committee of Congress, Joaquín Ramírez, said “We see no logical justification for these doctors to have a salary and a long list of benefits that any doctor Peru would have.”