Introduction

In July 2004, a group of health professionals from the United States (US) traveled to Cuba to attend the V International Congress of Traditional, Natural Medicine and Bioenergetics, to exchange information & experiences with colleagues in the field, and to learn about the integration of Traditional and Natural Medicine (known in Cuba as Medicina Tradicional y Natural or MTN) in Cuba's Health System. The group arrived and departed Cuba through Habana's Jose Martí International Airport and spent one day and two nights in the capital at each end of the trip, as well as six days in Holguín where they participated in the Congress and visited local health care institutions. This report derives from participant notes and includes a description of conference sessions attended and visits made, a discussion of Cuba's health care system, an exploration of MTN in Cuba, a brief description of Yoga on the island, and a number of specific and general remarks by members of the group about their activities and impressions of Cuba. It is important to state that, although a few delegates had been to Cuba before (including one that had a more extensive relationship with the island), most group members hadn't visited Cuba, did not speak Spanish fluently and knew little about the country and it's health system. We've made a careful attempt to report honestly and accurately on what we've learned; however, we know that errors, both factual and interpretive, may exist and ask the readers' pardon in advance.

V International Congress of Traditional, Natural Medicine and Bioenergetics "It was rewarding to experience first-hand the absence of political boundaries between doctors, healers and researcher in the scientific and academic community." --Delegation Member

The V International Congress of Traditional, Natural Medicine and Bioenergetics took place at the Mariana Grajales Coello Faculty of Medical Sciences in Holguín with approximately four hundred delegates from Cuba, Latin America, the United States and Australia, among other countries. Simultaneous translation was provided for the plenary sessions and translation, with varying degrees of excellence, was provided for each of five topics per time slot. Members of the group attended the following sessions: Neural Therapy Effects, Action, and Mechanism—discussing a new neural therapy using needles similar to acupuncture needles to harmonize neural functions in order to treat pain. Human Energies: The Challenges—describing the present understanding of the physics of body energies and how these may relate to the mechanisms of treatment of several MTN therapies. Bioenergetical Psychology: Myths and Facts, A Scientific Approach—relating MTN's bioenergetic fields, and specifically Chinese medicine, to psychology and to mind/body connections. Treatment of Asthma Using Traditional Chinese Medicine—describing the different Chinese medical diagnoses related to asthma and the acupuncture points to treat each distinct diagnosis. Treatment of Addictions, Recovery and Stress through Natural Chinese Medicine—discussing the National Acupuncture Detoxification Association's five auricular acupuncture points used to treat drug, alcohol and tobacco addiction, its successes and protocols. Preventive and Community Yoga—discussing the benefits of Yoga and how it can be used to treat specific illnesses; the history of Yoga; the role of the Cuba Yoga Association in teacher training; and demonstrations of yoga poses. Physiological and physiopathological Basis of Neurological Restoration on Atraxia Type SCA2—Ataxia is an incurable genetic neural degenerative disease. The rate of Ataxia worldwide is 1 or 2 cases for every 100,000 people, but in Holguín there are 43 cases per 100,000. This session covered the research into MTN treatments for the disease. Qi Gong's Influence upon Psychoneuroimmunology and Endocrinology—describing the neurochemicals produced by different parts of the brain, the impact of these on health and illness, and, using the production of these neurochemicals when a patient is under stress as an example, the effect of Qi Gong on the brain and the production of these neurochemicals. Diagnostic and Therapeutic Scope of Applied Kinesiology. Tui-na in Pediatrics—presenting research on the use of Tui-na, a form of massage used in Chinese medicine, in the treatment of strabismus (infantile weakness in the eye muscle). Vibrational Medicine and Biofeedback Technology for Diagnosis & Treatment—reviewing various technologies. The Scientific Bases of Homeopathy—discussing the bioenergy that can be detected deriving from a range of different metabolic processes and how Homeopathy works to activate the body's healing. Present State of Natural Products in Cuba and Strategies for their General Application in the National Health System—presenting on the integration of MTN and on the production of MTN remedies in Cuba. Cuban Homeopathy and Notes on its Historical Evolution. Aboriginal Traditional Medicine and Aboriginal Australian Herbs—describing a wide array of plants used by Australian Aborigines healers to treat diseases such as diarrhea, fever, infection, parasites, hepatitis and malaria.

The group visited the following healthcare facilities in Holguín:

The Alcides Pino Arudes Polyclinic where the group heard a presentation on Cuban medicine and the integration of MTN within it. The polyclinic serves 400,000 people from both rural and urban areas encompassing three Health Areas and sixty-four Family Doctor offices. The polyclinic's purpose is to shorten the distance between patients and the specializations usually found in hospitals by providing many of the same services, e.g. specialists, minor surgery, ultrasound, traumatology, 24-hour emergency care, 24-hour dentistry, x-rays and the like. In addition the polyclinic has a library for professionals, as well as a computer used by medical personnel to access medical information.

Family Doctor/Nurse Office: A doctor and nurse live in a three-story building: the medical offices are on the first floor, the doctor's apartment is on the second and the nurse's is on the third. The office the group visited serves 712 people living in the neighborhood. Specialists come to this particular office every fifteen days or so (a rotation) for appointments with patients. The primary role of the Family Doctor is the promotion of preventative medicine, working with the community to achieve this goal. The Family Doctors have health education programs for each age group in the community and MTN is included in these groups. The most common MTN therapies used by the Family Doctors are acupuncture, apitherapy and herbal medicines.

Ataxia Rehabilitation Clinic: The clinic does research on and provides treatment to patients with Ataxia. The group toured the facility, spoke with personnel and patients, and saw treatments, including MTN treatments, used.

Provincial MTN Teaching Hospital: A 58-bed hospital inaugurated in February 1998, which has treated approximately 152,000 patients—2,600 of these in-patient—using MTN therapies from music therapy to physical therapy to acupuncture and more. Psychological counseling is also available to the patients. An open, airy facility, sunny and alive with colorful walls and lots of artwork displayed. Meals and herbal medicines are prepared daily for the patients. Good nutrition is seen as a key component of healthcare. Medical students at this facility learn the MTN therapies, as well as how to produce the medicines. They work in the organic farm and medicinal garden before attending classes for the day. The group toured the facility and visited the music and aromatherapy rooms, as well as an acupuncture suite.

The Cuban Health System "It is difficult to compare health care systems and economies between two such different countries. Although it would be much more meaningful to compare Cuba's health care system with those of Caribbean and Central American countries, what becomes apparent is that Cuba is by far the healthiest poor country as well as the poorest healthy country." --Delegation Member

Cuba's constitution states that health care is a right, that it should must be universal, free and accessible to all, regardless of race, religion, sex or geographic region—and it is. Prevention is the basic tenet of Cuba's National Health System, and it seems to have worked: Despite its poverty, Cuba's health statistics compare with those of the developed nations. Life expectancy in the US and in Cuba are the same: approximately seventy-six years. The leading causes of death in Cuba are the same as those in a wealthy country: heart disease, malignant neoplasm, strokes, influenza/pneumonia, accidents, etc. Cuba's infant mortality rate is 6.3 percent, and 99.2 percent of children survive past their first five years. In 2003, Cuba had a maternal mortality rate of 39.5 per 100,000 and a 6.9 percent mortality rate by infectious disease. Cuba has an active child vaccination program, as well as other vaccinations for all ages, and has eradicated polio (1962), diphtheria (1969), TB, meningitis (1971), congenital rubella syndrome (1989), newborn tetanus (1972), meningitis post mumps (1989), measles (1993), rubella (1995) and mumps (1995). Hans Rosling of Sweden prepared the World Health Chart 2001, which plots Gross Domestic Product (GDP) against child survival rates. The chart clearly shows that the wealthier the nation, the more its children survive past the age of five. Cuba is the striking exception: Its GDP is low, yet its child survival rate rivals the wealthy nations. If Cuba's life expectancy is the same as the US's, how they each produce this circumstance differs radically. The US spends a larger percentage of the GDP on health care—13.3 percent as compared to 9.6 percent, and the dollar amounts that these percentages represent are significantly different: the US spends several thousands of dollars more per resident than Cuba. Much of this can be attributed to the great differences in the costs of salaries for health professionals, of hospital construction and maintenance, of pharmaceuticals, of high-tech applications and the like. Cuba makes up for this huge disadvantage in dollars and resources in many ways, including placing an emphasis on prevention and early detection; ensuring pre- and post- natal screening and care; encouraging screening for early signs of chronic diseases; educating the population about and encouraging healthy habits. Another important factor is the way Cuba has developed its human resources: Cuba has fourteen medical schools, which have produced 67,128 doctors, a ratio of 5.3 physicians per 1000 people, almost double the US rate of 2.7 per 1000. If this success rests on Cuba's commitment to preventive medicine, then this commitment rests on how Cuba structures its health system, beginning with the Family Doctor Program. Family Doctor/Nurse teams live in the neighborhoods in which they practice, serving between120 to 200 families per team. In Cuba, the Family Doctor Program covers 99.1 percent of families. Family Doctor/Nurse teams get to know the social, physical, and emotional circumstances of the individuals under their care and can help prevent illnesses through targeted education and treatment, a lot of which is based on good nutrition and other MTN. Every fifteen Family Doctors form a Basic Working Group, which facilitates continuing education. Two to three of these Basic Working Groups form a Health Area, and each Health Area hosts a polyclinic. The Health Areas are under the supervision of the Municipal Health Office, which lies under the Provincial Health Office and Provincial Assembly. At the top are the Ministry of Public Health (MINSAP) and the National Health Assembly. In addition, Cuba has several National Programs that organize the global development of specific services, such as the Programa Nacional para el Desarrollo y la Generalización de la Medicina Tradicional y Natural—the National Program for the Development and Generalization of Traditional and Natural Medicine (PNDMTN). In addition to its commitment to provide quality health care for its citizens, Cuba has a policy of providing medical aid to countries throughout the world. Between 1963 and 2003, 58,000 Cuban healthcare professionals have worked in 92 different countries. There are 9.134 students currently enrolled in Cuba's Latin American School of Medicine, representing 27 different countries, including the US.

To see Hans Roslings' World Health Chart 2001, visit www.gapminder.org. To learn more about Cuba's Health System, visit www.infomed.sld.cu, www.PAHO.org/english/sha/prflcub.htm, and www.cubasolidarity.net.

Medicina Tradicional y Natural (MTN)

"Medicine is one; healing is the goal." --Delegation Member

Cuba's medical system developed using the western medical model, although Cuba also has a history of using native plants as medicines. In the 1960s doctors in Cuba began to practice acupuncture; however, until the late 1980s, when the Ministry of Public Health (MINSAP) established the first plan to develop MTN, both medicinal plants and eastern modalities were used in an individual and isolated manner. This initial plan had various positive outcomes, chiefly with regards to the scientific study of herbal medicines and their expanded cultivation. In the early 1990s, the severe economic crisis engendered by the implosion of the Soviet Union and the strengthening of the US economic blockade against Cuba began to negatively affect Cuba's National Health System. MTN—the use and concurrent scientific research and evaluation of—was one of the areas targeted for rapid expansion to meet this challenge. In 1995, the National Health System was directed to integrate MTN into the health system, and by the late 1990s, the Programa Nacional para el Desarrollo y la Generalización de la Medicina Tradicional y Natural (PNDMTN) was established, asserting: The integration of MTN into professional medical practices stands out within the general trends in Contemporary Medicine today, not just as an alternative way to solve supply problems caused by economic factors, but as a legitimate scientific discipline, a discipline that, due to its ethical and scientific advantages, must be studied and developed on a permanent basis. (Programa Nacional de Medicina Tradicional y Natural, p. 7. Ministerio de Salud Pública, Septiembre 1999.) The PNDMTN defines MTN as a medical specialization that analyses and treats medical problems in an integrated and holistic manner, employing various methods to promote health and to prevent, diagnose, treat and rehabilitate illnesses and injuries, including Traditional Asian Medicine (acupuncture and its multiple variants; moxibustion, massage and traditional exercise regimens), hypnosis and relaxation techniques, Natural Medicine (Diet therapy, Phytotherapy, Apitherapy, etc.), and makes use of therapies from other specialties, such as Physical and Rehabilitative Medicine. It also includes Homeopathy and other therapies, such as Flower Therapy, Thermal therapy and mineral baths, mud therapy, ozone therapy, the use of magnetic fields and other sources of natural energies. The general aim of the PNDMTN is to provide the bases for the full integration of MTN throughout the country to improve the quality of medical attention offered the population and the satisfaction of the population with those services. Four guiding principles ask that MTN be scientific, integrative, systematic and professional. The plan defines four areas of development: 1) empowering human resources, 2) research, 3) organization of MTN into the network of the National Health System, and 4) production, storage and sale of MTN products and supplies, and it sets out detailed steps to be taken in each of these areas. Natural medicines are produced in thirty-two labs and eighty-six pharmacies. Since 1992, MINSAP has approved 233 phytopharmaceuticals and 15 apipharmaceuticals. MTN is part of the curriculum at all medical schools and is a medical specialization that students can choose to pursue after finishing their studies. The push to integrate MTN has provided new sources of employment in areas such as the cultivation, production and distribution of herbal medicines, the training of people who, in turn, train others as herbalists, acupuncturists, etc., and in the production and distribution of educational materials. In 2003, MTN made up fifty percent of patient visits and was used in twenty-five percent of hospital visits and twenty-two percent of emergency visits. MTN is now used in 29.4 percent of dental visits; 8.7 percent of surgeries use some acupuncture anesthesia, with 4.6 percent only using acupuncture anesthesia. The United Nations selected Cuba's Program for the Development of Natural and Traditional Medicine as one of the five most important programs worldwide.

To view the PNDMTN (in Spanish), visit www.sld.cu/sitios/mednat

Yoga in Cuba

"My involvement in Cuba has been through a lively cultural exchange in the Yoga world, and yet it was hard to avoid, on this my seventh visit, the poignancy and sadness that has arisen with the recent and ongoing aggression by the United States." --Delegation Member

A member of the delegation, Yoga teacher Mary Paffard, has an extensive relationship with Yoga in Cuba. The following remarks are taken from her notes. The first translation of the Bhagavad Gita into Spanish occurred in Cuba in the mid-19th century; the Theosophical Society has had an influence here since the early 1900s; and the Self-Realization Association has been in existence since 1957. There is a Cuban Yoga Association (AYC), which is guided by Eduardo Pimentel, and the AYC has been part of various yoga exchanges with individual teachers and associations in the US. By 1998, the AYC had twenty persons at different stages of teacher training, and about 8000 people had attended Yoga classes in Habana. In 1999, the AYC, the International Association of Black Yoga Teachers and the City of Habana co-sponsored a Yoga festival, "Lifting the Embargo on Our Hearts," which created a tremendous energy for Yoga, an energy that has continued to blossom. Ms. Paffard's small group, the Cuba-US Yoga Exchange (CUYE) evolved at that time, and the group has since helped to bring teacher-training and educational materials to Cuba. During a trip to Cuba in 2000, she met with a small group of people in Holguín who were beginning to study Yoga. It was during that visit that she was invited to participate in the V Congress in July 2004. Her workshop at the Congress was well attended. Over twenty of the participants were doctors and health administrators, which allowed for an interesting discussion in which these health professionals said that, since their primary goals are prevention and sustainability, they're interested in how Yoga can be absorbed into the overall health system to help bring harmony and relieve suffering. Yoga is part of the general flowering of alternative health modalities that is occurring in Cuba. The AYC has considerable recognition by the government—there's been Yoga on television and radio; Eduardo and his teachers are often asked to help train sports professionals; health clinics offer Yoga classes; a psychiatric clinic in Habana has been using Yoga as part of its treatment for more than a decade; a group of Yoga teachers and artists work with child patients and their families at the Oncology Hospital in Habana. Despite this, the AYC is not officially recognized, which means that Yoga teachers are not licensed, as are massage practitioners, physical therapists, even tai chi instructors.

Final Words

Here follows some of the general impressions and summary thoughts of delegation members, in their own words:

"Before I went to Cuba, I had heard only a little about their achievements in the area of health. I had thought that the system was based more on the Soviet system, which I believed was based heavily on the training of doctors, and, specifically, specialists. It was very interesting to me, as a family practitioner here in the USA, to find the basis of their system is in their local, community, family practice clinics. As a physician who has worked at a clinic in the USA that attempted to integrate "alternative" (MTN) with allopathic/western medicine, it was wonderful to see the extent of the integration in Cuba and that MTN was available to all. ...I have greatly increased my knowledge about health care and MTN in Cuba in our week visit. I realize, though, that I still know only a small protion about the overall health system, their health achievements and MTN. I know little about other factors that contribute to their outstanding health statistics, such as their education system, their agriculture industry, and their social support system. ... I strongly belive that it is very important to remove the travel restrictions on US citizens so that professional interaction, such as we experienced, can flourish. ..."

"During one of the presentations, the speaker told us, 'We are all Americans.' It was a beautiful moment, because in that instant, everyone—Latin Americans, Central Americans, and United States citizens—all realized that it's perfectly true. That realization is one of the strongest memories I bring away from this conference. We are all American; we are all striving for the same goals; and we all wish for a world where we can achieve them together."

"If you ask me to describe my impressions of Cuba, my response would sound much like the parable of the Six Blind Men of Indostan who each try to describe an elephant by grasping one small part of the beast. The elephant is, in turn, described as a wall, a spear, a snake, a tree, etc. Thus each description is partly in the right, but none encompasses the whole. My experiences on my July 2004 trip to Cuba taught me firsthand that Cuba is both rich and poor, modernized and old-fashioned, restored and run down, unfettered and restricted, liberal and repressive, elegant and egalitarian, successful yet struggling to survive. ... ...And most of all I owe many thanks to the Cuban people, who despite suffering from a forty-year trade embargo imposed by the US and even more recent stricter restrictions designed to tighten an economic noose around the Cuban economy, still manage to love the citizens of the US. I was welcomed and engaged in conversation by almost every Cuban that I met. I found the Cuban people to be well educated, friendly and eager to learn as much as they can from all foreign travelers. I hope that soon the embargo will end, and we can trade with Cuba as readily as we trade with China or Vietnam.