Staying up to date on global disease trends and novel approaches to health care is integral to UCSF Fresno’s commitment to improving health and reducing the burden of disease in vulnerable populations, and to that effort, a team recently traveled to Cuba on an information-finding trip to study the country’s public health care system.
One of the takeaways from the trip is that Cuba has well-established community-based health care programs, said Michael W. Peterson, MD, UCSF Fresno associate dean of Undergraduate Medical Education and Research. “Cuba is a country with limited resources, but health care is a universal right, and they are doing their best to have primary care available to everyone.”
Patients in Cuba are seen by primary care physicians who live in their neighborhoods. If the patient needs further non-emergent care, there are polyclinics (policlínicos) located throughout the country, where patients can have laboratory and diagnostic tests completed, immunizations, and rehabilitation, among other services. Patients with conditions too severe to be treated at neighborhood clinics are referred to a hospital.
Cuba has 8.3 physicians per 1,000 people, according to the World Health Organization’s 2017 Health Workforce Statistics. In comparison, the United States has 2.6 physicians per 1,000 people.
Many of the Cuban physicians practice primary care or family and community medicine, and “everyone knows the doctor who lives in the neighborhood,” said Steven Stoltz, MD, a UCSF clinical professor of Medicine at UCSF Fresno specializing in hospital medicine. Dr. Stoltz was a member of the information-finding team who spent eight days in Cuba this fall.
Increasing access to primary care in the San Joaquin Valley is a foundation at UCSF Fresno, which was established 47 years ago with that purpose. According to the California Health Care Foundation California Physician Supply and Distribution report, there are 39.4 primary care providers per 100,000 population, among the lowest ratio of physicians to patients in California, where the statewide ratio is 49.8 physicians per 100,000.
“There are two parallels to UCSF Fresno’s mission with that of Cuba’s – an emphasis on primary care and a dedication to education,” Dr. Peterson said.
The information-finding team visited with three American medical students studying at the Cuban government-run Latin American School of Medicine ELAM (Escuela Latinoamericana de Medicina) in Havana, which trains medical students from Cuba, Africa, Asia and the Americas, including accepting students from the United States.
Primary care and education are free in Cuba, but it is a communist state. The goal is not to copy its health care system, but information can be useful to share with learners, said Ryan Ernst, MD, who was a member of the information-finding team. Dr. Ernst is director for Global Health Education at UCSF Fresno and oversees a Global Health Curriculum that provides a unique, multi-disciplinary forum for practitioners to teach others about their international health care experiences. A newly approved global emergency medicine education fellowship has been approved at UCSF Fresno that will start its first fellow in 2023.
Currently, UCSF Fresno’s primary partnerships are with the IGSS Emergency Medicine (EM) Residency in Guatemala City, Guatemala; Aga Kahn EM Diploma in Nairobi, Kenya and Cho Ray EM in Ho Chi Minh, Vietnam. However, UCSF Fresno is open to new opportunities to expand global experiences.
