Editorial

Fidel and his contribution to the Latin American Medicine

Ismaray Pérez Candelario^{1  *} 
http://orcid.org/0000-0002-0672-0354

Irma Castro Gutiérrez¹ 
http://orcid.org/0000-0003-1579-7609

¹ Clínica Estomatológica Provincial, Sancti Spíritus, Cuba.

The guarantee of free medical attention to all the Cuban population became, from the first moments of the triumph of the Revolution, one of the fundamental social paradigms. This corresponds to the humanist and social justice essence that characterizes the Cuban revolutionary process.

From the revolutionary triumph itself, the work began with the creation of the National Health System that implemented the action of the health worker to the most remote places. The created system began to carry out important reforms from the 1960s, as a fundamental part of the transformations of the revolutionary period and in response to the most absolute respect to one of the fundamental human rights of every citizen.

In the pre-revolutionary stage, medical and hospital care was characterized by the predominance of private and mutual services. This modality in the health services inhibited the access to the lowest-income people, who had as their only option the Relief Houses, which mainly attended emergency cases. The facilities and medical personnel were located mainly in the capital of the country, where 65 % of the doctors and 62 % of the existing beds were concentrated. In rural areas, there was practically no medical care and there was only one rural hospital. ¹

Primary health care in Cuba has set precedents in international public health, due to its novel and futuristic nature, especially with the introduction and development of the family medicine care model since 1984.

During the period 1990-1996, the Cuban Health System suffered the restrictive effects on the availability of resources due to the world economic crisis and the disappearance of the former USSR and the countries of socialist Europe, the consequences of the application of neoliberal policies in Latin America and the intensification of the economic blockade imposed by the US government. In these conditions, keeping the health care of the people as a priority, it has been a challenge and a strategic objective for the entire society and the state.

The internationalist tradition of Cuba, which was perceived from the same year 1959 when the rising Revolution considered it an elementary duty to pay its "debt of gratitude to humanity", had a radical impulse after the tragedy caused by hurricanes Mitch and George in Central America, in 1998. In response to the disaster, which devastated the region and left thousands of deaths, Cuba conceived a Comprehensive Health Program to help forge a primary system of assistance, non-existent or very precarious in those countries. Doctors and nurses then reached the most affected communities not only by hurricanes but by centuries of inequality and omission.

At the same time, Fidel proposed a health program with a vision that exceeded the emergency situation to become a model of cooperation and solidarity with the Third World countries, particularly Latin America.

Fidel, in a public intervention on November 21 1998, said: "[...] And there is only one thing missing: not to limit ourselves to sending 2 000 or 2 500 or 3 000 doctors; there is one more important thing and that is that together with the offer to send doctors we have offered a training program for Central American doctors in Cuba [...] ". ²

It was the announcement of another foundational birth: the Latin American School of Medicine (ELAM) inaugurated a year later, under the idea of training young people from those countries free of charge as doctors, who would later return to make health care a sustainable project over time. ²

At the inauguration of the school, the leader of the Revolution explained to the young students his vision about the future: "The most important thing will have to be their total dedication to the noblest and most human professions: saving lives and preserving health. More than doctors, they will be jealous guardians of the most precious of the human being, apostles and creators of a more human world." ²

"In the sectors with the greatest lack of doctors in Latin America and the Caribbean, more than a million people are dying every year, 500 000 of them children, from predictable and curable diseases. Tens of millions of Latin Americans do not have any access to health services. This happens even in a country as immensely rich as the United States. Those who are going to die cannot wait, "said Fidel in his brief but emotional speech. ²

And he added: "The example of you, dear young people who are already studying at this School, will create awareness and will be followed by the professionals who, in large numbers and with excellent quality, have formed the universities of Latin America. Saving millions of lives, providing safe and optimal health for the 511 million inhabitants of Latin America and the Caribbean can only be the task of hundreds of thousands of doctors; most of them are already technically prepared for it." ²

The ELAM laid the foundations for a new Latin American medicine in favor of those most in need and thus complemented, in the people's roots, all the subversively solidarity projects that Cuba has promoted: the medical brigades throughout the continent, Operation Miracle to restore vision to millions of people, the Henry Reeve Brigade to act in disasters. In 2016, 117 countries from practically every continent were part of the ELAM, dreamed and created by Fidel, until that date more than 25 thousand doctors from 84 countries graduated. ²

Internationalist cooperation, through which thousands of Cubans save lives on all continents; the creation of the Latin American School of Medicine (ELAM), where future doctors from different countries are formed; or the development of the investigations, all were initiated by the leader of the Cuban Revolution.

After the tragedy caused by Hurricanes Mitch and George in Central America in 1998, Fidel gave the final push to what is now an inseparable part of the Cuban medical system: internationalism. ³

In response to material disasters and the thousands of victims caused by weather events in the region, Cuba conceived a comprehensive program to help forge a non-existent primary health system in those countries; thus, doctors, nurses and other professionals in the sector reached the most affected communities. ³

In 2005 the governments of Venezuela and Cuba proposed the graduation of 200 000 doctors, to satisfy the health demand in poor countries; 14140 students from 20 nations: Bolivia, El Salvador, Venezuela, Argentina, Peru, Brazil, Mexico, Colombia, Nicaragua, Ecuador, Paraguay, Guatemala, Timor Leste*, Honduras, Pakistan*, Guyana and some others.

Distributed in the provinces of: Pinar del Río, Cienfuegos, Matanzas and the Isla de la Juventud Special Municipality.

*Timor Leste: Although it is in Oceania 72 km north from Australia, it is included in this program by agreement between the government of Cuba and Timor; to solve the serious problems in the latter's health area.

*Pakistan: Following the earthquake in Kashmir, the Cuban government sent a contingent of more than a thousand Cuban internationalist doctors named Henry Reeve (in honor of an American who fought for the independence of Cuba in the 10-year War 1868-1878) due to the lack of medical assistance because of the absence of health professionals, an agreement was reached with the government of Pakistan, currently a group of young people are studying Medicine on the Caribbean island.

In 2014, the country had doctors on permanent or semi-permanent missions in Latin America: all ALBA countries, Guatemala, Haiti, Uruguay (José Martí Hospital); Africa: Algeria, Angola, The Gambia, Guinea-Bissau, Namibia, South Africa, Cape Verde; Oceania: Kiribati, Timor Leste. ⁴

The arrival of students from Latin America to study Medicine in Cuba is habitual, in fact, agreements have been signed to change studies for food. In addition, added to the students who studied at the Latin American School of Medicine, around October 2008, Cuba broke a historical record in the training of doctors, with 200 000 students enrolled nationally and from other nationalities. ⁵

On December 3, the Latin American Medicine Day is celebrated in tribute to Carlos Juan Finlay (1833-1915), discoverer of the yellow fever transmitter, the Aedes Aegypti mosquito, therefore, for Latin American doctors, recognition and admiration they deserve every day and for the eternal Commander Fidel, the gratitude for making Cuba a wellspring of specialists, scientists and researchers who are examples and references for the entire world. ⁶

Cuba is for the world an example to follow for the achievements made in health, for the help it systematically provides to the neediest in the most difficult moments in a disinterested way. The doctors trained on this island, even knowing that they risk their lives, do not hesitate to step forward each time they have been called. To conclude, we quote the words of Fidel in his speech delivered at the Latin American School of Medical Sciences: “I ask you to fight in the front row against trends and evils that under no circumstances can we allow them to prosper in our country. Long live the health services that can help save humanity!” ⁷

We do not want to end without mentioning the importance of keeping alive the legacy of the eternal Commander-in-Chief and continuing the fighting for bringing health to the neediest in every corner of the world and in turn to provide them with knowledge. Instilling the values of internationalism, altruism and solidarity to the youngest is a duty of every Cuban health professional. Medical training in universities requires greater preparation from each of the teachers to help each young person who is educated on the island to acquire the knowledge and skills that our Fidel wanted so much.

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Received: March 06, 2020; Accepted: March 24, 2020