Editorial

Family medicine in Sancti Spíritus, its 35th anniversary

Maricel Hernández Díaz^{1  *} 

Ángela I. Ramos Carmenate² 

¹Policlínico Rudesindo García Rijo. Sancti Spíritus. Cuba.

²Universidad de Ciencias Médicas de Sancti Spíritus. Cuba.

The Program of the Family Doctor and Nurse is already 35, this one has been one of the most excellent and suitable ideas related to public health that the commander in chief Fidel Castro thought in 1984. It emerged from the need of bringing medical care closer to the community and the family, also to achieve changes in the health status of the population; this program is considered the cornerstone of the national public health system (SNS), the highest level of primary health care (PHC), which replaced the sectorial care of the polyclinic at that time.

The epidemiological and social clinical method is pertinent at this level, to provide comprehensive medical care where the prevention and promotion of health are the fundamental elements; it is the patient's first contact with the SNS.

The experience in the province began with six doctors located in the hilly municipality of Fomento in the Escambray, many of us asked: how to perform in such a novel practice if the acquired training was purely hospitable? It was on October 24^th, 1984 those first doctors were presented in the communities where they would develop their activities.

From the beginning, an unprecedented acceptance of the population was experienced which felt assured of having medical assistance in their own neighborhood; thus, a path of sacrifice, effort, responsibility and learning was initiated, by just doing. Family health records (called files in those first years) were modified several times; concepts and modes of action without precedents were incorporated by doctors and nurses, guided by excellent professors who also started in this experience; we learned to share with each patient and their families every reality, to lead them almost by the hand through the system, from the interconsultation to the hospitals in the necessary moments, we learned to take care of the patients in terminal stage at their home, surrounded by their family, to which we taught in many cases to accept the reality, many of us became their confessors and sentimental guides, friends as well as doctors.

When we exchange with the initiators, they invariably agree: "I was a happy family doctor, loved by the population, well led by my teachers and the polyclinic and supported by the community ... from that time; I keep the best memories of my working life."

During the 1985-1986 academic years the new curriculum for the training of a basic general practitioner oriented towards Primary Health Care was put into effect.

In 1986 the experience was extended to the Sancti Spíritus municipality, adding up to date 35 medical offices that were increasing until reaching 100 % care coverage in 2006. Upon reaching the first decade of the program, the province had 96 family doctors and their respective nurses; 20 years later in 2004, more than 1500 of the graduated nurtured the family medicine program in the territory. Some graduates were also placed in schools, day care centers, work and social assistance centers.

Today in Sancti Spíritus there are more than 1,900 family doctors, 462 doctor's medical offices, 23 polyclinics and 36 basic work groups, which contribute to raise the assistance, scientific and academic professional level in the sector.

Cuba shows health indicators from the first world countries mainly due to the strengthening of the primary level of medical care and the application of the concepts and principles of primary health care in the social development of the country, and specifically in the health sector, long before they were exposed at the Alma Ata conference in 1978.

In Sancti Spíritus at 35 years old, low infant mortality stands at 3 per thousand live births and a life expectancy at birth above 78 years. The growth of health actions provided by the basic health teams is remarkable, here we show some indicators at the end of 2018: 4 401 662 outpatient consultations, 784 924 lots were carried out by the basic health team, attended to the guard corps of the polyclinic 416 371 cases, 23047 minor surgeries were performed, 23 specialties are projected to the community.

The program has developed the training of its human resources from the specialization, the Comprehensive General Medicine of First and Second degree, as well as the permanent improvement, through updating courses, implementation of new technologies, workshops, training, graduates, masters, doctoral training strategies. There are 346 teaching specialists (133 instructors, 166 assistants and 47 assistants) who take the undergraduate course of Medicine and the Comprehensive General Medicine residence. In addition to a score of specialists of second degree, more than 200 master's degrees and more than 50 in the potential to doctors in science, some of them have participated in the predoctoral degree as a concrete action of the referred strategy.

The medical collaboration in Sancti Spíritus could not show the current results without the participation of the primary care doctors, who up to date, more than 2000 have collaborated in more than 40 countries, some have repeated their collaboration in different missions and stages, with excellent and dissimilar contributions that go from the doctor in community, to directors of different missions, consultancy of the program in different countries like Brazil, Angola, Venezuela and the countries with the comprehensive health program; university contributions such as teaching secretaries, authors of the medical training program in Venezuela, among others, training sessions for MGI specialists from different countries and faculty members from different countries in Africa and America.

The Cuban society of family medicine in the province since its creation was one of the most numerous and active in the country, with delegations that participated in each seminar and international congress, showing the research results of the specialty, which were selected from the municipal and provincial basis working days (policlinics), and make them remarkable after the selection of the different courts composed by the most prestigious and scientifically prepared professors. Each municipality participated in the provincial, not only with scientific works but with initiatives that responded to the characteristics of each place.

The working days turned into true celebrations resulting from the family medicine, in which updated subjects related to the task of the specialty were presented, they were also invited professors from other specialties; those days were competences from all the edges to develop the specialty.

The Society promotes scientific development through workshops, courses, panels, conferences in the periods between one day and another.

Several of the founders and first doctors of the program are part of the national government board and participated in different stages of the development of the specialization programs, they have been collaborators of the basic text of the specialty and authors of scientific articles and support teaching materials for the formation in the Medicine career, the also collaborate in the implementation of the new curriculum.

From the authors´ opinion it is considered that for more than three decades of experience the guarantee of the success of the National Health System and specifically of its primary level is still in its dialectical character, which is transformed in the middle of a social context that adheres to the principles of the as a global strategy to continue giving the best possible response to the health needs of the Cuban people and other peoples of the world.

The integration of the provincial group, the scientific chapter and the primary care department work to rescue the foundational concepts of the family doctor and nurse program with creative and renovating actions. Joint tours are made to the municipalities and more than two clinics are visited, to which we incorporate the founding doctor, resulting in a new meeting with the community, where frank displays of community participation and intersectoriality are seen as axes of primary care, which ends with an asset with all family doctors and nurses and their teachers, where exchange is facilitated, updated lectures by prestigious colleagues are taught, the moment is used to stimulate the best and leave the commitment to keep the program rescuing the positive of its beginnings which, strengthened with the development of human and material resources, contributes to a higher quality of care with the consequent satisfaction of the population. (Appendices)

Received: April 04, 2019; Accepted: April 06, 2019