CUBAN DOCTORS
A delegation from CU Anschutz and Children’s Hospital Colorado visited Cuba this month. They were the first group of pediatricians to visit the island since the U.S. normalized relations.

 

When Dr. Stephen Berman stepped off a plane in Havana earlier this month, he wasn’t just leading a historic medical mission to Cuba, he was in many ways coming home.

Berman and his wife Elaine have been inextricably tied to the island nation for generations. Members of their family had fled the pogroms of Tsarist Russia for Cuba in the early 1900s.

They arrived penniless on a creaking ship, learned to sew and eventually started a successful retail business. An old black and white photo on Berman’s office wall shows Elaine’s grandfather, a leader of the Havana Jewish community, standing beside Albert Einstein during his visit to Cuba in 1930.

Over the years, Berman has gone back and forth to the Caribbean country but this was different.

This time the director of the Center for Global Health at the Colorado School of Public Health was leading the first delegation of pediatricians to visit Cuba co-sponsored by the American Academy of Pediatrics and the Pan American Health Organization since the U.S. normalized relations. It was a historic trip, one aimed at reestablishing ties between medical professionals at a time when relations between the two nations seem to be thawing.

“They saw our arrival as a sign their world was changing,” he said. “And in a very real sense it is.”

Enduring legacy of trade embargo

Berman co-led the delegation with Dr. James Perrin of Harvard University and Massachusetts General Hospital. Both are past presidents of the American Academy of Pediatrics.

The dozen or so travelers included top specialists from CU Anschutz and Children’s Hospital Colorado, eager to see how Cuba had been faring under a half-century trade embargo and what they could learn from each other.

What they found were like-minded professionals – proud and highly trained – making the best of what they had. Medications, blood pressure cuffs, monitors and microscopes were all in short supply, yet medical outcomes were in some cases similar to this country.

Local reporters, keenly aware of the significance of the visit, swiftly descended.

“They asked if the trade embargo would be lifted,” Berman said. “I said it would require an Act of Congress and during a contentious presidential election year that would be difficult.”

The embargo took effect in 1960 at a time of escalating tensions with the Marxist regime of Fidel Castro. The result has been an isolated and impoverished nation 50 miles from Miami Beach. Many, including Berman, consider the embargo a Cold War relic out of step in today’s world.

“The embargo is not in the best interests of either country,” he said.

CUBAN KIDS
An infant receiving treatment in a Cuban hospital.

Lectures and illustrations

The group traveled the island, getting a feel for Cuba’s overall health care system. They spent time at the William Soler Children’s Hospital in Havana, one of the best hospitals in Cuba. The daughter of Che Guevara, Castro’s late comrade and famed revolutionary, is a nurse there.

Dr. Frederic Deleyiannis, chief of pediatric plastic surgery at Children’s, was giving a presentation on treating cleft lip and palates when his Cuban colleagues asked if he could draw the procedures.

“I spent a fair amount of time drawing the operations on a chalkboard,” he said. “Their surgical techniques were similar and the questions they asked were very sophisticated. They were glad to hear that the way they do things is very much like the way we do things.”

Yet more complex craniofacial operations remain unavailable in Cuba, Deleyiannis said, and other methods of reconstruction, such as microvascular surgery, are hard if not impossible to come by.

But overall, he said, the Cuban doctors did extremely well under often difficult circumstances.

The CU Anschutz  physicians gave lectures on a range of subjects. Edward Goldson talked about delayed development in children. Amy Brooks-Kayal discussed treating epilepsy. Jim Todd held a session on staphylococcal infections. Stuart Cohen lectured on pertussis, Adam Rosenberg on care of preterm babies and Joe Wathen on emergency medicine. And there were plenty of others.

Cuban physicians told Dr. Kenny Chan, professor of otolaryngology and chair of the Department of Pediatric Otolaryngology at Children’s, that they did not have an operating microscope at the children’s hospital in Cienfuegos.

“That is like otolaryngology in 1940s America,” Chan said. “My heart goes out to them. Even though certain segments of their health care are really advanced, this brings home the fact that health care in Cuba outside of Havana may not up to par with developed Western countries.”

Cuba also lacked universal hearing screenings for infants, usually not testing a child until age three.

“If you wait until a child is three to test for hearing loss you will miss a lot of infants that could have been helped with hearing aids,” Chan said. “Dr. Berman and I spoke to pediatricians at William Soler Hospital about whether Cuba could adopt some sort of universal infant hearing screening. We would be happy to help them come up with a program if they are interested.”

CUBAN GIRL
A young patient in a Cuban hospital.

A commitment to children

Yet there were bright spots as well. Premature birth rates are low in Cuba due to universal prenatal care. There is one doctor for every 300 people, focusing specifically on caring for pregnant women. And health care is free.

“If problems develop in pregnancy the mother is sent to a maternity home and stays there until she gives birth,” Berman said.

While visiting an intensive care unit, the doctors saw babies with irreversible neurological damage on ventilators. The hospital planned to keep them on life support until they were old enough to go home where care would continue.

“I thought that was incredible,” Berman said. “They were ventilating these babies over the long term. With very few resources they were committing what they had to their children.”

He called the trip a `great first step’ and hopes someday for regular exchanges between Cuban and American doctors.

“We came away with a genuine admiration for what they were able to accomplish,” Berman said. “I think the trip really opened the eyes of both Cuban and American pediatricians.”

Dr. Berman will conduct a panel discussion March 23, 2016 entitled `Reflections on pediatric health care in Cuba’ at Ed 2 North, Room 1103 from noon until 1 p.m.