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Lissie Arndt - Cuban Healthcare System and Culture

Published: Monday, 05 Feb 2018
Author: Cheryl Ann Benner
Department: Office for Education Abroad

Name: Lissie Arndt

Status: 3rd year DO-PhD Student (in 2nd year of medical school)

Major: Medical Anthropology and Osteopathic Medicine

Hometown: Boyds, Maryland

Program: Cuban Healthcare System and Culture, Cuba, 2017

 

Cuban Healthcare System and Culture: My Story

"I don't like to wear a white coat because I think that it is a barrier between myself and my patients. They recognize me in the community by my face, not by the color of my coat," a Cuban doctor explained to us with the assistance of our translator, Anna. It was only our third day of MSUCOM's elective study abroad trip to Cuba, and as an American medical student who cannot even claim a loose grasp on the Gordian knot that is the US healthcare system, the significance of his words did not truly sink in until I was sitting on the plane ride home almost a week later. In that span of time, I had the opportunity to visit over 10 different points of Cuban healthcare with my peers and not only learn about the policies that structure the Cuban healthcare system but also witness the resilient spirit of camaraderie between its members holding the entire structure together.

For example, when we visited the headquarters of the Sistema Nacional de Salud Cubano—Cuba's National Healthcare system, I learned how it has evolved over that past few decades, initially increasing the quantity of Cuban healthcare services to make healthcare accessible to all of its citizens and then adjusting the type, or quality, of healthcare services based on people's specific healthcare needs. This dynamism of the system allows it to adapt to changing public health issues; for example, to address the pandemic of diabetes within its own population, Cuba has created Centro de Atención Integral al Paciente Diabético, integrated outpatient diabetic healthcare centers patients with newly diagnosed diabetes are sent to for an entire week to learn how to sustainably manage their own nutrition and exercise as well as receive all diabetes-related health services—ophthalmology, podiatry, laser eye surgery under one roof. I couldn't help but appreciate the stark contrast of this arrangement in comparison to the care diabetic Americans receive in the U.S., where they only have to the 15 minute appointments with providers that often result in an increased dose of insulin and instructions to "eat better" before the next visit or, worse, an extended stay in the hospital after a gangrenous, ulcerated foot must be amputated.

But perhaps the aspect of Cuba's extensive healthcare system that has left the greatest impression upon me is its Policlinico—clinic of the people, surrounding Familia Consultorios del Medicos y Enfermera—offices of family doctors and nurses, and the home visits to patients Cuban family doctors make on a daily basis. Unlike in the U.S., where patients are expected to overcome all of the barriers to health on their own to make it to the healthcare providers' office, in Cuba healthcare providers go to them, allowing them to literally and figuratively meet the patient where they are at. During these visits, I learned important clinical skills, such as how to measure a patients' chest excursion with my hands, what lung crackles sound like in a patient with emphysema, and how to discern a collapsed lung based upon touch alone. And as valuable as these lessons were, the lesson I valued most was the one of seeing how much it means to patients when their physician bestows them the same respect and kindness that they do to their neighbor, their friend.