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Vital Signs with Dr. Sanjay Gupta

Cuba's Health Care System Examined; Possible Impact of American Tourism on Cuba Explored. Aired 2:30-3p ET

Aired November 26, 2016 - 14:30   ET


[14:30:12] DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Cuba is roughly 90 miles off the coast of Florida, but it feels a world away. The old cars, the architecture, the music, it's the sights and sounds of Havana. This is "Vital Signs." I'm Dr. Sanjay Gupta.

Despite being one of the poorest countries, Cuba has a relatively strong health system. As you might guess, a lot of the focus is on prevention. That's because it's easier to prevent disease and cheaper than to treat them. So there are screening program starting at a young age for vision and for hearing. There's also a very robust vaccination program.

But keeping track of 11 million on the Caribbean's largest island often requires a personal touch.

This is a family doctor's clinic in Havana. They are known as polyclinics and they are the primary facilities of Cuban health care. Dr. Marta Beatriz Diaz Dehesa runs this clinic and is responsible for the surrounding neighborhood.

How many patients do you care for here? How many patients come to this clinic?

DR. MARTA BEATRIZ DIAN DEHESA, FAMILY PHYSICIAN (via translator): We have a total population of 1,143 inhabitants. Programs usually cover 1,100 to 1,500 people.

GUPTA: What is the most common types of things that you see here?

DEHESA: The diseases that we see more often in our population are high blood pressure, diabetes, heart disease, asthma, and chronic obstructive pulmonary diseases.

GUPTA: In the morning Dr. Dehasa sees patients in the clinic. Then in the afternoon she heads out to make house calls. We are going to be tagging along with her visiting patients in their homes. To understand why that is important here, let's first take a step back.

A pivot toll moment in Cuba's history came on January 1st, 1959, when Fidel Castro overthrows U.S.-backed President Batista, the combination of the Cuban revolution ending one dictatorship and starting another. Two years later, January, 1961, Cuba and the United States end diplomatic relations. Cuba turns to the Soviet Union for economic support but sees its economy crash with the Soviet Union collapses in the early 1990s. With the U.S. embargo still in place and the centralized Soviet-style economy, Cuba struggles. And for its free government-run health care system, that means a need to keep costs low.

Preventing disease, as I said, is cheaper that treating it, so Cuba focuses intensely on preventive care. The U.S. trade embargo also means limited access to resources, even medications. In this clinic, you can see how bare it is, just the essentials here -- an old Chinese made scale, cabinet with medication organized into plastic cups, a single bed.

Sometimes you hear that it is difficult to get medications. Is that true? Have you found that?

DEHESA (via translator): Well, you know, we're a country which has been located, and the number of medications we can import are not as many as needed. But we do have those that are essential in the local offices. Remember, this is a primary health assistance office. Here we focus on health prevention and promotion. If the patient needs other kinds of medications and assistance, they'll go to the secondary institutions, which are the hospitals, where they can find other drugs that are needed by the patients at the time.

GUPTA: Time for house calls. The first patient is a baby boy. To our surprise, we take a left out of the clinic and then straight up the stairwell.

So literally next door to where the office is, is the first patient of the afternoon. A little baby is what we're hearing.


GUPTA: Are you worried about anything or just a routine visit?

DEHESA (via translator): No, no. We plan field visits. We see them once a month in the office and once a month in the field. If the child is ill, we come more often until we discharge them.

GUPTA: Dr. Dehasa talked with Nolan's diet about everything from his diet to his teeth and his motor skills.

DEHESA (via translator): This is the height and the weight curve that we record on each visit. And this measures the baby evolution as a percentile.

[14:35:02] And here we have the foods with information to the families and what has to be eaten month by month. Here are the vaccines that reflects follow-up of the child's development.

GUPTA: So healthy, baby is healthy?

DEHESA: Very, very healthy.

GUPTA: A clean bill of health and it's time for the next patient.

So this is a bit of an unusual sight, but you see a doctor and a nurse just walking down the sidewalk making house calls in this neighborhood.

A few minutes later we arrive at the home of a woman suffering from Alzheimer's dementia.

Does she have a caretaker, somebody that lives here with her?

DEHESA: He is her caretaker, and she is here eight hours until her daughter comes home from work.

GUPTA: How often do you see her?

DEHESA: I see her almost every day.

GUPTA: On average Cubans have a long lifespan, nearly 80 years. The focus on preventive health care has contributed to that. It also means a growing aging population. Diseases like Alzheimer's are becoming more common here.

Along with a focus on preventive care, Cuba also places a heavy emphasis on prenatal care for babies and their mothers, boasting one of the lowest infant mortality rates in the region. Now keep in mind, these numbers are coming from the Cuban government and we can't independently confirm them. But the World Health Organization validated the Cuban health system a few years ago, calling it, quote, "A model for the world."

Making the rounds, you can tell this is a personal doctor- patient relationship. Dr. Dehasa knows her patients and this neighborhood, providing consistency as well as care. It's a unique system that does seem to be working here.

For Cuba, a country cut off from the United States for so many years, finding these unique solutions has led to some impressive innovations. So next, we're headed to a research center developing Cuba's own vaccines, including one for lung cancer.


[14:40:32] GUPTA: According to the World Health Organization, the United States spends more than five times the amount of person on health care as compared to Cuba. The island's state run health system is the only one that's permitted here, so with fewer resources and the lack of access, Cuba has had to improvise through innovation. Much of that happens here at the Center for Molecular Immunology.

Do you think it makes it so that you can create these drugs that then get exported to other countries?

GUPTA: In this building Cuban researchers like Camilo Rodriguez have made their own vaccines for everything from hepatitis to meningitis.

CAMILO RODRIGUEZ, DIRECTOR OF CLINICAL RESEARCH, CENTER FOR MOLECULAR IMMUNOLOGY: We are producing more than 70 percent of the medication we need for our population.

GUPTA: There is one vaccine in particular here that has caught the attention of countries all over the world, including the United States. The vaccine is for lung cancer, and it's called CimaVax.

RODRIGUEZ: Lung cancer is the first cast of this cancer. It means we have more of a chance to help a patient with lung cancer patient each year. And in the same period of time, they say patients die from this cause.

GUPTA: Is it the lifestyle, like pollution, smoking, cigars?

RODRIGUEZ: You know in Cuba is a very common habit because we are mainly a producer of tobacco.

GUPTA: Orelve Alberto Sanchez Leal is 77-years-old. He was a smoker all his life, starting at age seven, saying he smoked as much as a box of cigars every day. In 2007 he was diagnosed with lung cancer.

When they told you that you had lung cancer, were you surprised?

ORELVE ALBERTO SANCHEZ LEAL, PATIENT: Yes, yes. It was like a house fell on top of me. It hit me really hard. But thanks to the help that I have had from my doctors, especially the doctor here, she gave me the treatment, the chemotherapy, and then invited me to the clinical trials with the vaccines.

GUPTA: The critical distinction about this treatment is that the word "vaccine" is actually a bit misleading. In its current form, it does not prevent disease like a traditional vaccine but rather keeps diagnosed tumors in check by inhibiting their growth. It's a form of immunotherapy, harnessing the power of the body's own immune system.

This is completely free?

RODRIGUEZ: Yes, in Cuba is it's completely free.

GUPTA: Other countries are participating in clinical trials for the vaccine, including Japan, and some in Europe. Published data shows patients younger than 60 lived on average 11 months longer than those who did not receive the vaccine.

CimaVax is expected to start FDA clinical trials in the United States later this year. It's all part of a newly formed health collaboration between the United States and Cuba, signed just a week before our visit to Havana.

After 54 years, the United States and Cuba normalized diplomatic relations last July. But not all contact had been cut off between Americans and Cubans before that. In fact, outside Havana there's this medical school with a unique mission -- take people from impoverished areas, train them to be doctors, and then send them back home to provide medical care. Since it opened in 1999 it has trained 25,000 doctors from all over the world in 84 countries around the world, including the United States.

One of the biggest draws of the Latin American medical school is the cost, as in there isn't any cost. It's free. In fact, the students actually receive a small stipend to attend the six-year program. The only agreement they make is that they return to their home country and serve impoverished communities in need of medical care.

That's the other important thing to realize. Though Cuba pays for this training, the doctors don't actually stay in Cuba.

How many of you are from the United States? Almost all of you. How many of you had ever visited Cuba before coming to medical school here? Just two of you. How many of you plan on going back to the United States after finishing your school? All of you. All right.

[14:45:00] I spent some time just now with many students from the United States. They don't pay to come to school here, and when they're done, they're going to go back to the United States. What does Cuba get out of that relationship?

ANTONIO LOPEZ GUTIERREZ, PRINCIPAL, LATIN AMERICAN SCHOOL OF MEDICINE (via translator): This university was founded in 1999 because of several problems that occurred in Central America related to hurricanes Mitch and George. But sending Cuba medical teams couldn't be the definite solution.

GUPTA: The idea of medical diplomacy has been a running theme in Fidel Castro's Cuba. Cuban doctors often go on medical missions to other countries, and Cuba sent hundreds of health care workers to West Africa to fight Ebola. They have also exported doctors to other Latin American countries in exchange for badly need oil and hard currency, which some Cubans complain has led to a shortage of experienced doctors in their own country.

I left the Latin American medical school impressed by these students who took such a huge leap of faith to come to a country most of them had never even visited to study medicine in a foreign language and to give a true commitment to this style of health care.

That's pretty good.

Next, we take a ride for a classic tour of this historic city.


GUPTA: According to the World Bank, life expectancy here in Cuba is 80 years old. That's one of the highest in the world. To give you some context, the United States is 79 years old, Brazil is 75 years old.

[14:50:00] A lot of that likely has to do with what they don't eat here, but also with what they do eat. The vegetable markets like the one you're looking at here weren't even able some 10 years ago. And even today, to buy cumbers, for example, two cucumbers would cost more than a day's salary for the average Cuban.

The cost of living is a common theme we heard from nearly everyone we spoke to. In fact, many look for a second job to supplement their state salaries, which averaged $20 to $25 a month here. For doctors, we're told it's a bit higher, roughly $50 to $60 a month. We heard stories of some doctors and nurses occasionally taking supplies to resell on the black market, or patients bringing gifts to appointments to ensure access to those limited supplies.

So as much as things may be improving here, there's still a long way to go. With people looking to increase their income, tourism appears promising. As the United States and Cuba further improve diplomatic relations, that means more American tourists. And one of the first things they want is a tour of the city in a classic American car. Several of the drivers we spoke to had other jobs. Some were chefs, some were engineers, and they said a few of the fellow drivers were in fact doctors. We didn't find any full-time doctors who were also part-time drivers that day, so I hitched a ride with Rudolpho (ph), a 43-year-old Cuban who has been driving these cars for 20 years.

Hi, Rudolpho (ph), nice to meet you.

UNIDENTIFIED MALE: Nice to meet you, too.

GUPTA: What kind of car is this?


GUPTA: I'll sit with you. What kind of car is this?

UNIDENTIFIED MALE: It's a 53 Chevrolet.

GUPTA: A 53 Chevrolet. It's safe?

UNIDENTIFIED MALE: Yes, of course. OK, let's go.

GUPTA: Let's go. Read to roll.

As far as careers in Cuba go, this is a pretty good career. You're making good money doing this?

UNIDENTIFIED MALE: Yes, of course. It costs us $25 to rent this car for about an hour, so in one hour Rudolpho (ph) makes as much as the average state salary for a month.

How is the health care system here?

UNIDENTIFIED MALE: It's very good. In my opinion, it's very, very, very good, because it is free for everyone.

GUPTA: What is the worst thing about the health care system?

UNIDENTIFIED MALE: The system is very good. The problem is, for example, for the medicine, they 100 percent medicine for everyone in Cuba because of the American embargo. We know that. That is impossible to send to another country everything day for the Cuban citizen.

GUPTA: On our drive we passed Cuba's Revolution Square.

UNIDENTIFIED MALE: This is the revolution square. GUPTA: Revolution Square.

And the American embassy with the flag flying high out front. That's a recent addition here in Havana.

UNIDENTIFIED MALE: This is Monaco, the most famous avenue. And in the front is the American embassy.

GUPTA: There it is, and the flag. Does it make you happy to see the flag go up?

UNIDENTIFIED MALE: Yes. We are looking here now, oh, my God, look at the American embassy. That is possibly in Cuba? Yes, it's quite possible. After 50 years that is possible.

GUPTA: Cuba, the people live a long time in Cuba. Life expectancy is 80 years old here. And the United States, 79, lower in the United States than Cuba. Why do you think?

UNIDENTIFIED MALE: In my opinion that's happened maybe because we live more quiet, more free in spirit. Given the spirit is free, because Cubans in this country have to work for a living. We don't have violence and don't have crime in the street.

GUPTA: No violence, no crime.

UNIDENTIFIED MALE: No. Very, very low percent we have in this country of the crime and the violence. For example, in Cuba, you can see the child in the street playing from 6:00 in the afternoon to 12:00 midnight, and no happen, nothing.

GUPTA: No worries.

UNIDENTIFIED MALE: No happen, nothing. They play very, very happy because it is a very safe country for living. That is the one reason between any one Cuban live better.

[14:55:02] GUPTA: What other reasons do you think?


UNIDENTIFIED MALE: For example, the food in Cuba natural.

GUPTA: Natural.

UNIDENTIFIED MALE: Yes. The Americans use so many chemicals in their food. Not just in America. Around the world, people use so many chemicals in the food, yes.

GUPTA: Yes, I think you're right.

How about fixing the car if it has a problem?


GUPTA: You fix it yourself? UNIDENTIFIED MALE: Yes.

GUPTA: You a mechanic?

UNIDENTIFIED MALE: So-so. In Cuba when you talk about the Cuban people, you can get see, when you heard somebody tell me we are music, poet, and crazy, because we all make everything.

GUPTA: As we drive around this beautiful and fascinating place, I can't help but think of what these classic cars really represent. Rudolpho's (ph) 1953 Chevrolet has the original engine with some makeshift parts added on like the battery. It probably shouldn't work, but it does thanks to ingenuity from a self-proclaimed so-so mechanic and a tremendous amount of pride.

Like these old cars, Cuba is also doing more with less and has been for decades, a country on the brink of change with potentially a lot to gain and a lot to offer.