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Sunday, May 27, 2007

The Fidelity Of Cuba


Dr. Lester CN Simon

Arguably, one of the most unacceptable ways to mount a revolution in this country, in this century, is to see a major problem coming and disregard it until it literally erupts in your face on the front page of The Daily Observer. A major revolution in medicine is brewing in Antigua and Barbuda and Cuba is at the heart of it.

The first Antiguan and Barbudan Cuban trained medical doctor went to study in Cuba in 1980. Two more medical students followed in 1982 and one in 1984. With varying numbers trained over the ensuing years, a maximum of 20 Antiguan and Barbudan medical students left for Cuba last year. Remarkably, not a single scholarship to study medicine in Cuba will be offered this year. Poor planning or, correctly, no planning whatsoever has resulted in doctors returning from Cuba with no jobs available for them.

The yawning gap between the demand for jobs and the surplus of doctors will widen. Allegedly, 12 additional Antiguan and Barbudan doctors will return home this year from Cuba and about 6 or 8 will add to the rising dam next year. The gravamen of the problem is that the internship done by our doctors in Cuba is considered inadequate for our purposes. Two different health systems are in unprepared conflict.

Internship is the immediate period after you graduate, during which you gain first-hand, practical experience working under supervision as part of your training. Interns from the University of the West Indies (UWI), work for 18 months on hospital wards and in the community as part of a firm. The intern is the first person to see the patient admitted to the firm. Internship is a trying, eye-opening period with many sleepless nights.

The Cuban system has a 10 month internship but the intern has to compete with medical students and senior doctors to have as much direct access to the patient and as much hands-on management of the patient as the UWI trained intern. For the Cuban national, the internship is quite suitable because after internship, the Cuban doctor fits into a tightly knitted network of referrals and gains tremendous experience. When our doctors return home, they enter a completely different system from their Cuban counterparts.

In many countries, such as Jamaica, an intern gets a legal, provisional registration until successful completion of the internship, when full registration is offered. Thereafter, attendance at conferences and other forms of continuing medical education are requirements for yearly continued registration.

After observing the Cuban trained Jamaican doctors in practice and a fact finding mission to Cuba, the Medical Council of Jamaica, the registering body, mandated that Cuban trained Jamaican doctors must do a one-year, UWI style internship and pass an examination afterwards to be legally, fully registered.
Partly because we do not have a history of training doctors here and because some aspects of medicine here are marching backwards as others advance, we have only one type of registration: full registration. Any doctor, local or visitor, no matter how inexperienced, can legally open a private office after registration.

Because of the humongous demand for, and supply of medical scholarships, the exponential increase in the number of medical students in Cuba has resulted in a falling off of the quality of training. Quite simply, there are too many pairs of eyes, ears and hands to benefit from a patient during the Cuban internship. Some eager students will go the extra mile to see, hear and feel all that is available but the average student will not be able to do so. The best student might become frustrated by inadequate provisions for the unique, practical demands of the increasing numbers of overseas students returning to a different health system.

Many CARICOM states are following Jamaica and are making provisions for some form of additional, more hands-on type of internship and a common exit examination before full registration. This revolution requires dedicated specialist doctors in many fields to guide young doctors, a modern medical library and, inter alia, the foresight and will to turn our problem into a golden opportunity and devise and activate a health plan to solve our health needs. In the while, we cannot be overzealous and take all that Cuba generously offers if we know we cannot handle the consequences of excess. This is a lesson we learn at Carnival time.

While we are looking at our local doctors trained in Cuba, we must also look at the other doctors who have been fully registered. These doctors practise medicine under a life-long registration with no legal regard for continuing education as a requirement for continuing registration. Some registered-for-life doctors look askance at our Cuban trained doctors. They are so anti-Cuban, they lack fidelity (and a sense of humour).

Many students want to study medicine. It is a noble profession and it appears to attract a lot of money. Unbeknownst to most prospective doctors, the money that was once associated with being a doctor was old money and the new money came on top of a parental, grandparental or even great grandparental deposit. These days, the obverse is that the extended family is dependent on the doctor’s financial withdrawals. The immediate fancy car, fancy house and bags of money right after graduation is a disillusion-in-waiting.

We cannot allow our returning doctors to become frustrated, despondent and depressed. They will eventually leave. And guess who will fill the void, amigo? We must push the medical registration board, the medical association and the government to get off their backsides, enact tiered registration and devise a plan in which public and private health facilities can network to accommodate our returning doctors.

President Castro said that a doctor is like a shepherd, a priest, a missionary and a crusader. Inarguably, it is obscene to train young doctors and leave them out in the cold. History will not absolve us of the medical negligence of our best and brightest minds whilst we celebrate diversity. !Venceremos! We shall overcome!


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