From Socialism to Capitalism: A Doctor’s Perspective on the Health System

Fidel Castro once said, “We weren’t offering money; we were offering doctors to help save lives, and that offer stand today and tomorrow and represents Cuba’s attitude towards any of the World’s peoples.” Being a medical student in the Republic of Cuba I was exposed to a much more advanced health system as compared to the other Caribbean Islands. The primary, secondary and tertiary health hierarchy is organized in such a way that it guarantees complete access to free health care services, training of health professionals at every possible level and education at every university hospital, polyclinic, clinic and institutions. From the third year of medical school, you’re introduced to the clinical arena until the sixth year which is an internship. This gives one enough exposure to thrive in any environment. I must admit that we had it easy as medical students. The broad range of specialties and sub-specialties is remarkable. As a general practitioner, you’re respected to the point wherein spite of the fact that you’re capable of performing basic nursing skills it’s not an obligation. Each health professional has their own duties and that’s highly esteemed. However, there are disadvantages of such a system. It doesn’t teach you to be integral; one becomes too dependent on the access to other specialties. For instance, I’d never be obligated to treat something as simple as Acute Otitis Media I’d refer the patient to otorhinolaryngology. The ER management is rather different compared to Dominica. For example, a multiple injury patient has to be evaluated by general surgery, neurosurgery, ENT, maxillofacial, ophthalmology etc. in dependence of the location of wounds. It’s rather difficult to work in a hospital where there’s a shortage of consultants or rather departments. In Dominica, we lack the basic of the basics neurosurgery, angiology, ENT, and the list goes on. The deficiency of access to essential imaging apparatus (MRI, CT, PET scans) and even though the MRI and CT scans exist there’s no one to maintain the equipment when they have mechanical problems. This becomes difficult for doctors to manage cases who require access to such services. It’s rather costly to transfer patients to neighboring islands for health care.

Moreover, the shortage of staff in Dominica is overwhelming. In Cuba each consultant is assigned to medical students, interns and residents who all form part of the workforce. There are more hands-on deck and this facilitates the work process regardless of the long hours. In the last hospital where I completed internship we were on-call every 5 days. That’s a really easy schedule compared to being on call every other day right now. I know that medicine is tough everywhere however I think it’s absolutely illegal for anyone to work an 80-hour shift. The conditions are rather harsh and adapting to this environment has become difficult for me. I love to look at the positive aspect of every situation and I must admit that I’m learning a lot in the clinical/practical sphere in this tough setting. I’ve received way more exposure to surgical skills as compared to Cuba where the hospitals are crowded with students, interns, and residents who are all competing to learn. So being less in number has its perks especially for doctors like me who are interested in surgical specialties.

In conclusion, the contrast in the health systems to which I was exposed has taught me that adaptation is indeed an outward expression of one’s intelligence. The Stone Age medical systems should be changed and improved with access to the highest forms of medical technology.

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