MEDICAL WISDOM FROM CUBA: AN EGALITARIAN APPROACH
TO WHAT IS GOOD FOR SOCIETY
The other day I was having lunch with the Senior
Professor of Endocrinology and a Consultant Psychologist to the National
Institute of Endocrinology in Cuba at Café Presidente, along the beautiful
avenue of the Presidents in the heart of Vedado in La Habana, Cuba.
This is my neighbourhood and I have great pleasure
of observing what happens there and the visual changes in the society to the
recent rapid changes in Cuba.
As always happens, we talk for hours and our
conversations has a central theme, not what is good for us or what we should do
to improve our lot in life, which happens as a corollary to our efforts but
what is good for Cuba and Cubans in general. A good socio-anthropological
conversation.
In societies where individualism is less stressed
than the welfare of the society as a whole: I happen to know or study three
such societies, Japan, Native America and Cuba, the solutions to the problems
facing the society or its members usually is not individualistic but rather one
that is good for the entire society.
The conversations tend to be very good, A good
combination of a Psychologist, an Anthropologist and a socially conscious
medical specialist who has served as an ambassador for Cuban health system in
various countries such as Angola or Peru.
Our conversations always conclude with ways to
better the lives of Cubans in our own little way. I distinctly remember the
words of Jose Altshuler whom I met that many years ago: If you are interested
in your own welfare, I advise you to concentrate on a country like the USA, but
if you are interested in the welfare of others, you have come to Paradise here.
The words of illustrious scientist son of one of the founders of the Cuban Communist
party (his father was a Jew from Poland) had an impact upon me, reflecting my
own Jewish and ancestral socialist lineage.
Among the American Indians, with whom I have the privilege
to live and work on a regular basis, as their Anthropologist, Historian and
Medical Consultant, taught me about the frailties of the western concept of
Networking. When they talk about Networking, an elder advised me, denoting the non-Indian
population of these United States, they mean what can YOU do for ME? Whereas
among the Natives of this continent, Networking means what can I do for YOU?
So it has been a good combination for me, American
Indians and Cuba, learning and exchanging, an international highway of
knowledge, from one culture to another and vice versa.
While the western societies may be
individualistic, the western and western oriented scientists are tardy to pay attention
to the individual in the context of healing. They do experiments and talk as if
the same prescription fits one and all. We discussed the variability of blood
glucose excursions with various foods in Cuba among the patients. Cuba has a
fairly homogenous population in that whether you are white or black you can
expect to have a sizable native genes, around 5-10% and between 5-20% African genes
in case you identify yourself as White (around 65 per cent of the population)
or vice versa. (9 per cent identify themselves as black whereas 26 percent
identify as mulatto or mixed black race. There are no native or Asian population
left in the island)
Even with this uniformity, the blood glucose
excursions with various foods differ from patient to patient and this has been
known to the Cuban physicians who never truly subscribed to the Glycemic Index
which had been one of the cornerstones of western nutritional model. I told of
them exciting work, one of the best papers in Nutrition published last year,
from Israel from Elian Eliav and his group in which they could predict the
response to a variety of foods in the individual taking into consideration his
or her microbiome, life history and weight patterns. All the participants in
the study lost weight and also had better control of their diabetes, as we know
think that the type 2 diabetes may be an inflammatory response of the body in
which microbiomes do play an important part. We have always known it, even
though we did not have scientific proof, said the Professor of Endocrinology,
we would hear patients detailing the same food having various effects on their
attempts to control the blood sugar.
Then she said something, which resonated well with
me, with the philosophy of caring in Cuba and among American Indians: What the
patients with Diabetes need are not more doctors, at primary or secondary
level, but they need EDUCATION and EDUCATORS.
I was profoundly pleased!
It has been my experience while working with the
Indians that it is only rarely a primary care provider (Nurse Practitioner or
Physician Assistant) comes anywhere close to a Diabetes Educator in the
management of Diabetes among our patients. There are rare Family Practitioners
who are capable but the majority of them do not have the time nor the knowledge
about life style counselling.
I am
preparing to visit my good friend Maurits van Pelt who runs the efficient NGO
Mopotsyo.org where he employs peer educators with no medical background for
education and management of diabetes among poor patients in Cambodia. I had
read that in Cameroon, peer educators have better results than the Family
Practitioners in 96 % of the cases.
Diabetes as well as Obesity are social illnesses
and throwing newer medications which are of dubious value at the patients when
the blood sugar won’t budge is not good practice of medicine.
I am with the American Indians at the moment and I
see the wonderful work being done by the educators. They joke, you are just the
dusting on the cake, because you have the MD degree and write prescriptions!
Then what is my role then?
You are our window into the world, as they know
that I keep up with the Medical Literature, not only about science of medical
practice but also the anthropological aspects of medicine. When I came back from
attending the annual meeting of the Endocrine society in Boston just recently,
I gave them a summary of the best 15 things I learned there. Their work is not
valued much by their medical colleagues in the USA but knowing that their work
is valued elsewhere gives them courage to carry on, also a self-confidence.
These are part of the job as a Physician Anthropologist Consultant can do for a
tribe or culturally specific group of people.
When the young couple came over to discuss their
trip, I wanted to prime them up for their upcoming visit. In Asia, because
Indians mean a person of India, Native Americans are referred to as Red
Indians, I told them not to get annoyed by that. Also I told them that they
might be mistaken for Asians, especially from the Mongolian or Siberian region because
of their appearance. I am taking the couple with me who are nurses by
profession to show how the Peer Education works (mopotsyo.org) and how we can
introduce that model into the already socially oriented medical care among the
Omaha Indians.
I feel so good, it is yet another thing a medical
doctor can do when looking after people who are indigenous or belonging to
distinct cultural groups, to introduce them to the wider world. I will be going
with them on their 16 day journey through Malaysia and Cambodia.
I wish some of my Cuban colleagues could be on
this trip with me. Cubans have travelled with me, as far away as Australia but
currently the Cuban medical professionals have ample opportunities to go abroad
and learn and offer services to the indigenous populations as witnessed by a
sizable portion of 14500 Family Practitioners now representing Cuba at small
municipalities throughout Cuba.
Grateful for Cuba and my life there
Grateful to the Indians (Native Americans) and my
life among them..
CASA AZUL ENTRE LOS INDIOS UMONHON
