dimanche 15 mai 2016

MEDICAL WISDOM FROM CUBA: AN EGALITARIAN APPROACH TO WHAT IS GOOD FOR SOCIETY

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