In the Cuban Constitution, it is stated that “Access to health care for all, is a basic human right”! The Socialistic government therefore established a health care system that is free for all Cuban citizens. Here we will take a basic look at the structure of the current health care system in Cuba.
Basic components:
Primary Level Health Care
- Family Doctor Unit
- Poly Clinics (includes dental care)
- Specialty Institutions
- Mothers Homes
- Grandparent Homes (not nursing home setting)
- Community Mental Health Clinics
Secondary Level Health Care
- Inpatient Hospital
- Inpatient nursing home type care
Let us first take a look at the primary level of care. The Family doctor unit is a single physician with a team of nurses, statisticians, technical assistants that care for a set amount of the local population within their community. The average number of patients is approximately 1000 patients per unit. The physician in each unit has been trained to care for the entire group assigned to him. This includes home visits, specialty care after consulting with specialists in the poly clinic, office visits, acute illnesses, long term care in the home, and ultimately keeping his patient population out of the secondary level of care (hospitalization).
Poly Clinics are larger clinics that include multiple specialties, Dental, Rehab, Urgent Care, and Emergency Services accessible by all in the community. Generally this is done by consultation request of the family unit doctor, but per the Cuban health officials, all may enter the poly clinic on their own if so desired. The patient is referred to the poly clinic. After consultation, the specialist will recommend treatment options to the family unit physician. The family doctor will then resume care consulting with the specialist for continued needs of the patient.
Specialty Institutions are also available if further specialty care is needed. For example, if a cardiac patient needed further testing done such as a stress test, the patient would be referred to the Cardiovascular Institute for further care. Some testing due to limited resources must be done at the Hospital itself. This varies from procedure to procedure and resource availability at the time of need.
Mother’s homes are maternity homes for pregnant mothers who are considered at risk based on a limited number of criteria. This would include mothers on bed-rest for early labor or hypertensive status. Also included would be expecting mothers with nutritional deficiencies. The mothers can be admitted at any point during their gestation period for proper nutritional support by exercise and diet management. Another category would be expecting mothers that live geographically far from a Hospital maternity ward. These patients are also admitted later during their pregnancy to be in closer proximity to the facility at which they will deliver.
Grandparent Homes sound like American nursing homes. This is what they are not! Grandparent homes are actually Adult Day Care centers where the families can bring the elderly during the day while they work etc. The senior adults are cared for and fed and have a chance to mingle with other senior adults from the community. Elderly care is promoted at the home as part of the Cuban culture. Families are encouraged to care for the grandparents with supervision of the family unit physician team. This team also includes social workers.
And finally we will talk briefly about Community Mental Health Centers. The centers are located sporadically around the community. The centers are comprised of Psychologists, Psychiatrists, Nurses, Technicians, and Social workers. The mentally ill patients and families are cared for by this team. Optimally the whole family is involved. Group sessions with patients and families are held daily at the center. For example mothers of children with ADD are able to network together and lean on each other for support. The clinical psychologist in charge of the center we visited was very passionate about her work. She shared with us an appreciation for her nurses and other members of her team. I was moved by the sincerity in her voice for the services she provided for the community.
Tomorrow I will be writing about the Secondary level of care, which exposure to this was very limited. Please feel free to comment or to ask questions.
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