Policlinico Guanabo

The following is based on interviews on January 6, 2009 with some of the staff at the Policlinico Guanabo, a state-funded physiotherapy clinic in Guanabo, a town 15km east of Havana.  Treatment at the clinic, as in all Cuban health care facilities, is free of charge to Cubans.

After visiting the acupuncture ward at a Cuban hospital a few days earlier, I was curious how health care was provided in other environments. At the community level, the Policlinico Guanabo provides for all the health care needs of the town of Guanabo and its environs. There is a full range of medical personnel including a physiotherapy ward.

The physiotherapist was named Reinier. He was 27 years old and licensed in physiotherapy after completion of a 5 year program.   He was also licensed in acupuncture after taking a specialization course.  He headed the department and worked primarily with electronic therapeutic devices such as laser, magnetic gamma, ultra sound, Hivamat, as well as acupuncture. The machines were all very new, in good condition and surprisingly sleek and modern, in contrast to the clinic’s rustic appearance.

Reinier

Servilio was licensed in “cultura fisica” which literally translates to “physical culture”. I imagine that it means something similar to kinesiology. He is the graduate of a 3 year program with a specialization in rehabilitation. While Reinier works primarily with electronic therapeutic devices, Servilio does almost all of his work manually. He was 54 years old with 25 years of experience. He particularly enjoys working with children and was extremely proud to say that in his career, he has helped more than 15 handicapped children learn to walk. This was inspirational, but even more surprising was that the process only took a year on average. He has also helped 30 handicapped adults learn to walk. I loved how content he was in telling me this. How wonderful it must be to say that the thing they love most of their work or the thing that they are most proud of is that they helped 50 handicapped people learn to walk.

Servilio

Servilio has a standard education in cultura fisica, but he has taken courses, lectures and workshops in a wide variety of modalities. He has branched out his approach into quite a few alternative healing modalities which he regularly incorporates into his treatments. His treatments can contain any combination of massage, tai chi, reflexology, qi gong, acupressure, shiatsu, reiki, chakra healing, ear acupuncture, yoga, william technique, pilates and su jo.

In Canada these therapies are not uncommon, but you would almost never find them in a state run physiotherapy clinic. You would also never find these courses, workshops or treatments offered free of charge. These alternative therapies are strictly operated on a for profit basis outside of Canada’s government run medical system. We have access to natural healing but only if we can afford $20 a group session or $100 for a treatment. Unfortunately, this usually means that much of the market for alternative therapy in Canada choose it only after the western medical system fails them. There is a strong growing movement of people that are adopting alternative health care as a personal preference, but wouldn’t it be grand if we didn’t have to make a choice? What if the Cuban system could be adopted to other western countries and we received prescriptions for yoga, acupuncture, massage or Aspirin from our family doctor?

Here is an article that I have been working on since my trip to Cuba in January. I am embarrassed it took me so long to write. This article is based on information I gathered from an interview with an acupuncturist on January 4, 2010.

After receiving numerous massages (the things I do for work, sheesh;-)) at the hotel, the massage therapist gave me some names and addresses of people I could interview about how acupuncture is incorporated into the Cuban health care system. My articles would finally start taking shape. As luck would have it, unclear directions, missed bus stops and a dozy bus driver turned the half hour trip into a 2 hour ordeal. 2 hours of getting lost in Cuba is not exactly a horrible experience though.

My host was a nurse at the hospital that performed acupuncture. He was generous with his time.

He explained to me that he was a nurse that was licensed to practise acupuncture after completing a 2 month acupuncture course. It was an intensive course that taught 4 hours of theory and 4 hours of practical work daily for 5 days per week. The course was actually more thorough than the courses available to health care practitioners in Ontario. While our practitioners need a 100 or 200 hour course (depending on whether they are a chiropractor, RMT, or physiotherapist) to be qualified to practise acupuncture, his course was over 300 hours. There were only 20 students in his class. I was envious of this as my course had over a hundred students in it. He was trained in the theory of Tao, the 5 elements, and yin and yang. The course covered the location, indications, cautions and contra-indications for the 80 most common acupuncture points.

In Cuba, health care is free for all of its citizens. In addition to the standard western medical care, the system provides physiotherapy, massage and acupuncture for free. In fact, acupuncture is available at every hospital in Cuba and widely available of all 3 (national, provincial and municipal) levels of health care. Acupuncture is so common because it costs considerably less than pharmaceuticals or surgery. Medicine that we consider cheap costs a small fortune in Cuba due to the exchange rate and trade restrictions. Acupuncture also has considerably less side effects. With conservative, responsible needling techniques, acupuncture is completely safe. Simple acupuncture treatments are very cost effective and quick to administer helping the hospital avoid medicine shortages, surgery waiting lists and expensive procedures.

When a Cuban is experiencing musculoskeletal pain, he may visit an orthopedic doctor who will triage the case and send him on to receive x-rays, medication, physiotherapy or acupuncture and traditional Chinese medicine. In this system, not only is the patient referred to acupuncture by an MD, but often in many cases, the acupuncturist and MD will work in tandem providing a combination of western and eastern care in one comprehensive treatment plan.

The hospital did not use disposable single-use needles as is the practice in western countries. Instead, they would re-use the needles after sterilizing them. After use, the nurse washes the needles in soap and water then sends them to the sterilization facilities where they are sterilized along with surgical instruments in high pressure, high temperature chambers.

Acupuncture was administered in the hospital in his office. There were beds for 4 patients as he would see 4 patients an hour for a total of 25 to 30 patients per day. All of these receiving free treatment under the direction of an MD.

When we think of Cuba, certain incongruous images come to mind: sandy beaches, salsa music, and poverty.  But while the typical visitor to this little island nation is busy soaking up rays and drinking one too many Cuba Libres, poor little Cuba has been quietly accomplishing something that few western countries have been able to do: Develop a health care model that provides free universal health care blending and balancing western medicine with eastern, natural medicine.

Cuba’s health care system has always been a priority for Castro’s government.  Article 50 of the country’s constitution states: “Everyone has the right to health protection and care. The state guarantees this right by providing free medical and hospital care by means of the installations of the rural medical service network, polyclinics, hospitals, preventative and specialized treatment centers; by providing free dental care; by promoting the health publicity campaigns, health education, regular medical examinations, general vaccinations and other measures to prevent the outbreak of disease.”

Here are some stats:  The average life expectancy in Cuba has risen from 63 years in 1955 to 78 years in 2007.  The infant mortality rate has dropped from 1960’s 54 deaths per 1000 children to 6.5 per 1000 in 2007.  In 1957 Cuba had 128 physicians and dentists per 1000 people.  In 2005, those numbers had swelled to 627 doctors and 94 dentists per 1000.  To put that into perspective, the USA in 2005 had 225 doctors per 1000.  In fact, Cuba performed better on all 3 criteria when compared to the USA.

But as a massage therapist and acupuncturist, I am more interested in how alternative or natural medicine was integrated into their health care model and offered free to all.  The idealist in me would like to believe that Fidel or Che hatched up the idea while savouring a perfect cigar and planning their utopia on earth, but their medical miracle was born out of disaster and necessity.  In 1992, the USA increased its trade embargo against Cuba by passing the Democracy Act which made it illegal for foreign subsidiaries of US companies to sell goods to Cuba (it was already illegal for American companies to sell goods to Cuba).  It also forbade ships that had docked in Cuban ports from docking in any US port for 6 months.  This, combined with the collapse of the Soviet Union and Soviet support and trade as well as Cuba defaulting on its foreign debt in 1986 made it very difficult for Cuba to purchase medical equipment, supplies and medicine.

Dr. Fe Bosch (right)

The Chinese character for disaster is comprised of two other characters: one is the character meaning danger, the other means opportunity.  With aspirin and other western goods being either unavailable or unaffordable, Cuba adopted a natural approach.  Dr Fé Bosch had been sent to Sri Lanka and Vietnam in 1984 to study eastern medicine and the possibility of incorporating elements into the national health system.  In 1992, the Ministry of Public Health approached Dr Bosch with a new proposition: develop a training program in acupuncture and natural medicine for the country’s doctors.  In less than 2 years 20,000 health care professionals had been trained and Cuba was on the road to integrated health care.

I just got back from Cuba a week ago and let me tell you, it was just what the doctor ordered. The warm tropical air, amazing music and friendly people were just what I needed to get through another Canadian winter.

I didn’t go to Cuba just for fun though. I turned the vacation into a business trip for research, promotion and training. Cuba offers something very unique that I hope my readers will appreciate. Cuba’s health care system is free for all Cubans. You might remember that scene from Michael Moore’s movie “Sicko” where he takes a boat load of Americans without health insurance to a Cuban hospital where they receive the care and medication that they couldn’t afford at home. Cuba’s health care system is also a great example of a fully integrated health care system that blends eastern and western medicine offering citizens free access to massage, acupuncture and herbal medicine.

Turning the vacation into a business trip might sound like a bit of a downer, but it actually added to the experience. I didn’t go to Cuba for the beach and sun. I was far more interested in seeing the culture and getting some insight into their way of life. Arranging the interviews was a wonderful way of seeing a side of Cuba that I would have never seen otherwise. It added to the sense of adventure.

The added tasks of gathering info for the articles did take some extra work. It took me a couple of days of asking around to arrange doctors, massage therapists and acupuncturists who were willing to meet with me. And it took a bit of hunting to find these people as well. For one interview, I ended up literally going in circles for two hours before I was able to find the hospital I was looking for. The work took up much of my time during the day, but it was such interesting enjoyable work that I really didn’t mind. Plus, I still had my nights free.

One of the bonuses of turning vacations into business trips is the tax deductions. As the trip was for business purposes, the full cost of the flight, transportation, accommodations, and business related expenses as well as half the cost of meals were tax deductible. And let’s not forget my brand new digital SLR camera for some shiny new pictures for the website. Many people think that a $1000 expense will mean a $1000 tax savings, but in reality you only save the taxes on the expense and not the entire expense. This means that a $1000 expense will translate into a tax savings of $300 – $400 (30% – 40%) depending on your tax bracket. While the trip isn’t free, it still ends up being a good deal.  The camera is treated differently. I won’t be able to write off the full cost right away. Instead, I’ll have to write off a portion of the cost every year for a few years.

Be careful though, to qualify as a tax deductible expense, the trip does have to be for legitimate business purposes. And, of course, you will need receipts for all the costs you want to deduct.  For more information on claiming travel expenses, visit the Revenue Canada Website.

How does my trip qualify as a business trip? First of all, I researched enough material to write a series of 3 or 4 articles for my website, which is my primary means of promotion and advertising. Hopefully the unique content of the articles will help raise the rankings of the website as well as attract a new audience. Second, from interviews and from receiving treatments, I was able to learn a few new approaches and techniques that I can incorporate into my practice.

If you like the idea of the working holiday but aren’t interested in journalism, why not take a course? There are quite a few massage courses that are being offered in Mexico and other tropical destinations. Perfect for getting away and minding your books.

PS:  I was just about to hit the publish button when I received an email from Jenings.com advertising their workshops on myofascial release of the the shoulder and lumbar regions.  The seminar will be in sunny Arizona (not exactly sea, sun and salsa, but at least it won’t be 20 below).  Here is the link http://cts.vresp.com/c/?jenings.com/a65343c641/38b4e1cddf/c397c05a8f