India squanders much of its scarce health funds on over-treatment, exposure to contagion through over-hospitalization, creation of illnesses through un-necessary investigations, disease-focused instead of prevention-focused interventions, and making the poor sicker by denying them access to treatment and leaving them at the mercy of quacks. Unfortunately we follow a model of western countries, which focus on treating disease, rather than attending a person or community. This is an enormously profitable system for manufacturers of pharmaceuticals or owners of diagnostic and radiologic centres, as well as for advertisers and insurance companies. The doctors have lost personal touch with the community in general and patients in particular. Many of them even do not listen to their complaints or offer physical examination and push them for investigations in the first instance. Many results from these investigations are inconclusive or misleading, besides being irrelevant. This prompts for more investigations and avoidable referrals or surgeries. Nobody seems to be interested in the patient cure or community health. We have adopted a fragmented medical system with a growing disconnect between family physicians and hospitals, and multiple subspecialists who often communicate poorly with each other or the patients. Instead of a gentle co-operation between the private and public services, the latter are found to criticize and denigrate the former with impunity, further making the whole system less credible and hardly efficient. This state of affairs reflects a lack of political will on the part of leaders to protect their most vulnerable populations. We talk of VIKAS (development) day in and day out but the country’s leadership has not made health an essential pillar of development. Health gets a back seat in almost all for and is often neglected; since it is neither a vote catcher nor it creates vote banks. India cannot afford the luxury of expensive and wasteful curative model of the west. Why not look at a model practiced successfully by a third world country like Cuba? While praising Cuba, the World Health Organization observed, ‘it is possible for Third-world countries with limited resources to implement an efficient health care system and provide all segments of the population with social protection worthy of the name.’
The Cuban health system is recognized worldwide for its excellence and its efficiency. The Cuban government operates a national health system and assumes fiscal and administrative responsibility for the health care of all its citizens.This is in contrast to India where the poor as well rich both are left alone to fend for themselves. Health and sexual education are promoted; contraceptives are free in Cuba. Universal health care is free, and everyone has a family physician and nurse. There is no private doctor or private practice. The focus is not on money. Health and medical services are totally disconnected from exchange of money or any greed associated with it. The most revolutionary idea is that doctor-nurse team lives in the neighborhoods, which they serve. A doctor-nurse team is a part of the community and knows their patients well. Cubans call their system ‘comprehensive general medicine’. Its programs focus on preventing people from getting diseases and treating them as rapidly as possible. It has brought the Cuban infant mortality rate to 4, which is below that of the US and less than half that of US Blacks. Cuba has a record unmatched in dealing with chronic and infectious diseases with amazingly limited resources. Cuba, which has the same 78-year life expectancy as the US while spending 4% per person annually of what the US does.
The integration of neighborhood doctors’ offices with area clinics and a national hospital system also means the country responds well to emergencies. It has the ability to evacuate entire cities during a hurricane largely because doctor’s staff knows everyone in their neighborhood and know who to call for help getting disabled residents out of harm’s way. Perhaps the most amazing aspect of Cuban medicine is that, despite its being a poor country itself, Cuba has sent over 124,000 health care professionals to provide care to 154 countries. and has over 20,000 students from other countries studying to be doctors at its Latin American School of Medicine in Havana.
What are the essentials of this revolutionary concept?
1) It is not necessary to focus on expensive technology as the initial approach to medical care. This is in direct contrast to Western medicine, which uses costly diagnostic and treatment techniques as the first approach and is contemptuous of natural and alternative approaches.
2) Doctors must be part of the communities where they are working.
3) This model is not static but is evolving and unique. It avoids the futility of seeking to impose a Western mindset of medicalisation, where every natural event is medicalised and gets the support of a doctor
4) There is a need for medical staff to put healing above personal wealth. In Cuba, being a doctor, nurse, or support staff and going on a mission to another country is one of the most fulfilling activities a person can do. The program continues to find an increasing number of volunteers despite the low salaries that Cuban health professionals earn. Average earning of a doctor is 20-30$ per month.
5) While Indian society has become highly medicalized and specialist minded, the need is for family medicine. In Cuba more than 97% of medical graduates become family physicians, who spend one internship year and two residency years in training after they receive their medical degrees. Later, they can apply for a residency in a second specialty. As a result, the numbers in these second specialties are not large.
India can learn a great deal from the simple and inexpensive healthcare system of Cuba.