MyLifePath.com
May 8, 2001
By Barbara Jamison

The Polyclínica Moncada is a former luxury estate set back from the street behind tall, elaborate wrought-iron gates. The clinic is located on Avenida 23 in the Vedado district of Havana, Cuba, known for its broad leafy streets and its mansions, once privately owned, that now function as state-run dance studios, psychology clinics, and writers' organizations. As you pass by the clinic in the early mornings, it is common to see a group of 10 or 12 elderly women performing Tai Chi exercises in the adjacent schoolyard. They're members of a government-sponsored organization for older people who suffer from hypertension, diabetes, and other chronic illnesses.

On an unusually chilly morning for this tropical capital, the women, dressed warmly in worn sweaters and pants, stand in circular formation as they bend and stretch, enacting for each other the elegant poses of the Asian discipline. Beyond the fenced-in yard, the city of Havana heats up for its usual frenetically paced day as people of all ages, on their way to work, crowd around vendors dispensing morning coffee from steaming thermoses. A few feet down from the Moncada clinic, a young man plies his trade with business fixtures consisting of an aerosol canister, what appears to be a child's desk foraged from a school classroom, and a single chair. On the desk is a hand-painted sign: "Se llenan fosforeras." For a few pesos, this small-time entrepreneur will refill your throwaway lighters. The impulse to recycle things that denizens of the First World toss out at the first sign of malfunction has been a tradition in this tiny socialist country since the 1959 revolution, but it's also a testament to the inventive survival skills that keep the nation going.

Cubans will typically shrug off praise of their achievements, attributing them to the "invento," best translated as "ingenious invention in times of economic necessity." Perhaps nowhere else is this uniquely Cuban principle so clearly in evidence as in the current overhaul of the national health care system.

Throughout this island country of 11.5 million inhabitants, whether you have to be rushed to a hospital emergency room or are simply visiting your neighborhood clinic for a checkup, you're likely to be treated with a blend of traditional and alternative medicine. Virtually every medical facility on the island has an adjunct alternative clinic, including pharmacies that dispense medicine based on herbal remedies. In the Hospital Ortopédico in Havana, a large teaching institution, you'll notice alongside conventional medical wards entire wings in which patients receive the latest in mud therapy, massage, and acupuncture for osteoporosis, arthritis, and other degenerative diseases.

On other floors, patients lie back in spacious dermatology clinics to receive cutting-edge therapies using algae-based skin treatments for problems ranging from severe burns to adolescent acne. In the waiting room, brightly colored diagrams of Chinese acupuncture systems chart the complex routes of "chi" (the Chinese word for life force or energy) through the human body. As you wait, a nurse may try to ease your pain by pressing on acupressure trigger points -- maybe stealing a look at the chart every now and again to refresh her memory.

So pervasive has alternative medicine become that children begin studying the multiple uses of medicinal plants as early as elementary school. First, they learn to grow and tend their own plots of aloe, chamomile, and mint, and later they conduct scientific studies about their uses. Acupressure has entered Cuba's everyday vocabulary, with radio and TV programs instructing people on how to relieve common stomach upset and headaches by pressing key points.

How did Cuba bring about such a radical shift in its primary health care? This question was among those explored at the first-of-its-kind international conference on alternative medicine in Havana in late 2000. Not surprisingly, the answer is linked to U.S.-Cuba relations. When the United States embargo tightened up soon after Cuba lost the former Soviet Union as a trade partner in the early 1990s, the island was set adrift. U.S.-made medicines and equipment stopped coming into the country, and the economy went into a tailspin. The Cuban Ministry of Health had no choice but to look for less expensive medical alternatives. The system they came up with integrated alternative and Western medicine; now, 10 years later, some developing countries are looking to Cuba's plan as a blueprint for health.

For three decades before the embargo, the Cuban health care system had been the envy of Latin America and more developed nations alike. Life expectancy soared and infant mortality plummeted, Cuba's success rates rivaling -- and even exceeding -- those of much more affluent countries. But the loss of its major trading partner and the heightened embargo pushed the high-functioning Cuban health care system over the brink in the space of a mere two years.

When the economic crisis Cubans refer to as the Special Period hit in the early 1990s, the entire system came to a grinding halt. Even the most rudimentary medicines and vitamins became unavailable, including pain relievers, anti-inflammatories, and common antibiotics.

"All of a sudden we were in a situation of having only two shots of morphine for an entire ward. The majority of operations had to be performed using acupuncture as anesthesia," says Marcos Díaz Mastellari, M.D., a psychiatrist who organized an international conference in Havana last winter known as BIONAT 2000. "It's lucky that there was a parallel alternative health system that had been marginalized, yes, but steadily functioning since the 1960s. We expected its practitioners to step into the breach. There was no other choice."

Meanwhile, Cuban doctors were overwhelmed with a health crisis in the making. Without seeds, without gasoline for its tractors, the country was unable to plant sufficient crops. There wasn't enough food in the markets or on the tables. Many people survived on semi-starvation diets, enduring up to 12-hour-long blackouts and water shortages. More than 50,000 Cubans, particularly children and old people, developed nerve-related disorders (neuropathies) from lack of vitamins.

China tried to help out by shipping two million bicycles to Cuba at the beginning of the Special Period. Normally cycling would be good exercise, but it is not recommended on an empty stomach. "It was the drastic reduction of calories combined with increased physical activity that created the severe health crisis in the Cuban population," says Mastellari. "People were walking or riding bicycles for miles on little or no food to get to and from work. We are still dealing with the neuropathies that developed in large sectors of the population at that time. But at this time it's no longer an epidemic."

Mastellari, who is also the chair of the Oriental Medicine Department at Havana's International Center for Neurological Restoration, recalls that during the Special Period he often had to make his principal meal of the day a bowl of broth and herbs. Then, to quiet his hunger in order get to sleep at night, he would drink water laced with plenty of sugar. When asked how the trade shortages affect him professionally, Mastellari shrugs, his careworn face a mask of Caribbean-style stoic imperturbability. "Well, for instance, just the other day my endoscope broke. Now imagine, it should be a simple thing to have it repaired. But, lo and behold, one of the tiny components is American-made. End of endoscope. Now multiply that to every sphere of Cuban life."

At hospitals and clinics throughout the country, clinical trials are being conducted to test the efficacy of alternative treatment modes. For instance, at the 10 de Octubre Clinic in Havana, a 12-week study was recently undertaken to study the effects of homeopathy on mild to moderate hypertension. Overall, there was an 82 percent success rate for bringing hypertension within normal range using nothing but homeopathic remedies. Elsewhere, researchers are attempting to quantify the success of acupuncture in alleviating pain related to various conditions -- from osteoarthritis to duodenal ulcers -- and when used as a substitute for anesthesia in surgery. In the year 2000, acupuncture was successfully used as an anesthestic in 1,412 operations in the city of Havana, according to a study at the city's Hospital Ortopédico.

Ironically, it is an American who is credited with helping to implement the integrative model that has essentially saved the Cuban health care system: Ralph Allen Dale, an 80-year-old acupuncturist and educator from Miami, Florida. During the course of his successful career as a symphony musician, Dale developed Meniere's disease. After successfully treating himself with acupuncture, Dale became a leading figure in the field of Chinese medicine in the United States. He went on to develop an innovative acupuncture system using the hand, derived from Paul Nogier's research into the ear as a micro-acupuncture system. According to Dale and other contemporary thinkers in the field, each single part of the body acts as a microsystem for the whole.

"What's so incredible about the Cubans is that they'll take an idea of yours and apply such creativity to it that pretty soon, you hardly recognize it as yours," Dale says. "And they make utmost use of everything. I find that one of my books I donated 10 years ago has been turned into a teaching chart for medical students in a clinic in Matanzas. Nothing goes to waste here. It's very gratifying.

"During coming decades, what Cuba is creating can become a model for health care the rest of the world can follow," Dale adds. "Cuba has a true health care system, not a sick-care system, because sickness is not a business here."

-- Barbara Jamison is an award-winning poet and writer who edits regularly for Consumer Health Interactive. Her stories on health and medicine have appeared in Hippocrates, WebMD, the Nation, and many other outlets.

Article reviewed by C.E. McLaughlin, MD, a member of the guest faculty at the University of California at Berkeley.