By Anne O'Callaghan
Professor Manuel Amador is vice-director of the Cuban Institute of Nutrition and Food Hygiene. He was in Australia recently to attend the 15th International Conference of Nutrition, held in Adelaide from September 26 to October 1.
Held every four years, the conference is sponsored by the International Union of Nutritional Sciences, a non-governmental organisation. Professor Amador was elected for a second term to the 11 member International Council of the IUNS.
Another Cuban, Dr John Gay, was one of 15 scientists chosen from around the world to become a member of the Fellowship of the IUNS.
How is it that this developing Caribbean country of fewer than 11 million people should hold such prominent positions in the international arena of health alongside such highly developed countries as Germany, Japan and the United States? How is it that its vital health indicators, such as life expectancy and infant mortality rates, rival these countries of massive wealth and far exceed those of any other developing country?
Because, says Professor Amador, of the enormous political will which has turned the wheels of the Cuban revolution since 1959. Speaking to several hundred medical students and health workers in 1961, Che Guevara outlined the revolution's vision: "One day medicine will have to become a science that serves to prevent diseases, to orient the entire public toward their medical obligations and that only has to intervene in cases of extreme urgency to perform some surgical operation or to deal with something uncharacteristic of that new society we are creating".
This approach continues to inform Cuban medicine today. Says Amador, "Every individual, regardless of social contribution, social background or economic capacity, has the right to any kind of health care, ranging from basic health promotion through to very sophisticated treatments, free of charge. What is most important is that the individual has to be healthy, to become healthy and to remain healthy in such a way that he or she can have a long and productive life."
Fundamental to this is health education. "It is not very easy to change the bad habits and lifestyle which usually characterise the population. In Cuba we are not exempt from this question. We have some aspects of lifestyle that could be improved, and all these have to be changed through a proper education."
A very important advance in this process is the family doctor system, a development of the last 10 years. Fidel Castro, in an interview with the Italian journalist Gianni Mina in 1987, described its importance:
"We estimate that we'll have around 65,000 doctors by the year 2000. Of those, some 30,000 will work in the hospital network and 20,000 will work in the community as family doctors. Each family doctor cares for a given community as the main element of primary medicine. Around 5000 will be in factories and schools so that there is a doctor wherever there is a citizen: in each workplace, neighbourhood, school and hospital. This is a very new program that other countries haven't yet developed but which is yielding some truly extraordinary results."
The US blockade has forced Cuba to create its own, strong, pharmaceutical industry, developing many products from raw materials which are obtained through biotechnological methods. These include interferon, used in the treatment of cancer, and a vaccine for infections produced by meningitis. The vaccine is exported to Brazil and other countries.
Intensive studies are carried out in alternative medicines. Green medicine studies the possibilities of producing products from the natural flora of the country which could provide alternatives to the use of drugs. This alternative medicine has been developed on a local as well as a national level, encouraging the development of initiatives in provinces which have access to products unavailable elsewhere.
The economic situation has greatly limited the possibility of providing some of the basic foodstuffs. One of these is milk. Dr Amador explains, "Since the disruption of the socialist system in eastern Europe and in the former Soviet Union, we no longer have access to the raw products for preparing the feed for the dairy cattle. So we had to completely change their system of nutrition to one of intensive grass feeding, and this has greatly reduced milk production. Previously one cow could produce around 15 litres of milk a day. Now they are producing two or three. As they adapt to the new diet, they will produce more milk.
"However, the complement to our own milk production was the powdered milk we imported from the eastern European countries. We got the powdered milk as an exchange for torula yeast, a product from our sugar industry which is very good for feeding animals. Since this exchange has stopped, we now have to reduce the availability of milk for the population. Only children up to three years of age have milk assured for them."
Heart disease is the highest cause of death in the Cuban population, followed by cancer and stroke. "The most important developments in cancer are linked not so much with treatment but with prevention, especially breast and cervical cancers in women and lung cancer in men. Mammography is highly developed throughout the country, as is the diagnosis of cervical-uterine cancer. Again, regular check-ups through the family doctor are essential here."
Reduction of smoking is as very important. While the number of cigarettes consumed in Cuba has decreased, the proportion of people who are smoking has not declined as much as expected. "Instead of heavy advertising campaigns promoting smoking, all our advertisements are against smoking. Nevertheless, there is an increase in smoking in young people and in women. This is worrying, and we are trying to change this."
Alcohol consumption has increased gradually over the years. While not currently seen as a serious health problem, it is being closely followed. "Cirrhosis of the liver is among the 10 main causes of death. In addition to alcohol consumption, this is partly related to the relatively high incidence of hepatitis B. That's why we have started the vaccination program for this with a vaccine which is also produced in Cuba."
Cholesterol was a problem up until 1989 because of the high consumption of animal fats and eggs. But since then there has seen a reduction of both eggs and total fat intake, especially of animal fat, which came from the former Soviet Union. Now vegetable oil is imported, a change Dr Amador describes as "perhaps a positive outcome of this negative event".
While in Australia, Professor Amador met with the Aboriginal Medical Services in Adelaide, Brisbane and Sydney. "It was a very important and interesting experience for me.
"One of the aims of the AMS is to develop the primary health care of the Aboriginal population because it is a very important step for health promotion and for making real changes to the health indicators which are so very different from those of the non-Aboriginal population. We offered the experience of our primary health care specialists as well as providing the opportunity for Aboriginal students, and indeed any Australian student, to go to Cuba to study medicine, dentistry or nursing if they are interested in doing so. The Cuban revolution can learn a lot from our friends around the world, and we have much to offer as well."