Self-Directed Learning Project 

by Megan McDonald

The topic of my self-directed learning project is the structure of the Cuban healthcare system. To inform my topic, I spoke with a Cuban medical student, spoke with our host family and their experience, and incorporated learnings from our time at the CENESEX and neighborhood health clinics we visited as a class.

To provide an overview of the Cuban health care system, there are three levels of care, like the United States. The first is neighborhood clinics where both family practice doctors and specialist services are available for preventative care and acute, minor issues. The second level is hospitals for emergency care and more complex procedures that cannot be completed in a clinic. The third level is specialty centers (cardiology, oncology, hematology, etc.)

A few highlights were that patients can move freely throughout the system. Because insurance coverage a factor of coverage, patients don’t have to worry about following a referral process or out of network issues and can be seen by any provider at any facility. Patients also do not have to use their designated neighborhood clinic. They are free to travel to other clinics if they prefer. Finally, med school students start working with patients on day 1 of medical school.

There were many surprises that I observed. First, due to supply shortages caused by economic sanctions and the embargo, there is a deficit of general anesthesia. For scoping procedures like bronchoscopies and colonoscopies, anesthesia is not usually used due to the limited supply. Another surprise that I cannot even fathom as a healthcare worker, is that they do not use electronic medical records. If a patient needs an x ray, they take a paper copy of their medical record over to the hospital to get that scheduled. And finally, a huge surprise was that Cuba produced five COVID vaccines, all showing >90% efficacy, but none of them are recognized by the World Health Organization. If a fully vaccinated Cuban is trying to enter a country with a COVID vaccine requirement, their Cuban vaccines do not count.

Our course was about the cultural context of leadership and this was present in relation to Cuba’s healthcare system. Normalization of preventative care produces positive patient outcomes and reduces the stigma associated with diseases. Prioritizing preventative care is a critical leadership decision for all healthcare systems. Even with limited resources and the tough decisions providers are forced to make in the face of scarcity the Cuban healthcare system is not cutting corners with fundamental care services that promote health for Cuban people.