Peace, health care and Cuba

Dr. Bernard Lown’s work, both political and medical, has been dedicated to peace. He developed the cardiac defibrillator to restart arrested hearts and invented cardio-version to fix cardiac rhythm disturbances. To help prevent nuclear war ― and death and destruction ― he co-founded International Physicians for the Prevention of Nuclear war, and earned a Nobel Peace Price in 1985. In all of this, Lown’s aim has been to stave off death and sickness.

At ceremonies in Maine last year, a bridge over the Androscoggin River joining Lewiston and Auburn cities was renamed the “Bernard Lown Peace Bridge.” Lown attended Lewiston High School after emigrating from Lithuania with his parents at age 13.

Health care for all preserves life, too. That notion has apparently been part of Lown’s work for peace, at least as indicated by his exchange with Christopher Lydon displayed Jan. 10 on the latter’s radioopensource.org web site. Lown was responding to Lydon’s unplanned interview with three U.S. women attending Cuba’s Latin American School of Medicine. Their comments on health care and medical education appeared on the web site.

Established in 1998, the Latin American School of Medicine graduates 1,500 new physicians every year. Students come from almost 30 countries for a six-year, no-cost course of medical study preparing them to deliver health care where they are needed, in their own countries.

“That is one of the things [the Cubans] got right on the nose,” said Keasha Guerrier, “medicine with a community base in training and practice. The people who instituted this program,” she continued, “saw how it works in Cuba … and they compared Cuba’s situation to countries in Central and South America or third world countries, Africa, Haiti. And they saw how they can make a difference. Here, you do a lot with a little bit … What they are trying to teach us is that you don’t have to be confined to working for a paycheck. But using all the things that you know, you can help a broad base of people. In that respect, I think that the intentions are pure.”

Kereese Gayle grew up in Louisiana and Florida. “We’re here at a very important time in the history of the world,” she said. “We’re getting the type of education that I think people are looking for. More and more people are thinking very seriously about the idea of universal health care, about the idea of rights for everyone to basic access to health care. I think we’re going to be a huge part of that.

“We learn how to diagnose our patients with our hands, our ears, our eyes more so than with technology ― X-Rays, CT scans ― because you don’t end up doing those kind of really costly labs as often here,” Gayle said. “So we definitely have that as an advantage … We learn how to interview our patients thoroughly and how to do a really thorough physical exam and do it well, and be comfortable with that … Doctors here not only do house visits but they go into homes: they have a form that you fill out to check off what risk factors the person has [in their home].”

“Here, as someone’s primary physician, you can see not only the physical medical aspects but the psychological medical aspects as well,” she added. “Do you feel tension the minute you walk into the room? Are people in a mentally healthy environment, or do we need to get [them] to a psychologist? There are so many advantages to the system that we can take back and apply to the communities where we live.”

Akua Brown observed, “The education system here is excellent; there is very little homelessness. Everyone has a right to free health care … up to the most specialized needs. Neurosurgery, open heart surgery, cost nothing to the people. And the fact that a government with so little financial resources is able to do this says that the United States can do so much more … And without the debt that most medical students graduate with, we won’t be afraid to start our own projects and programs without necessarily needing the money to pay back the loans and the things hanging over our heads.”

Commenting to Lydon on the students’ ideas and experiences, Lown e-mailed, “I have been to Cuba six times and learned much about doctoring in Cuba. Their thinking on social determinants of health, on the primacy of public health and the vital role of prevention strategies are unmatched in the world. With spending of less than $200 per person per year for health care, they have achieved health outcomes no different than in the USA where expenditures now exceed $7,000 per person annually!”

“These young articulate women got the essence, Lown continued. “If impoverished Cuba can provide first-class health care for its people so can other developing countries. Perhaps it is even possible for rich USA, if only it ceases viewing medicine as a marketable commodity.”

Lown was impressed with “how much hidden talent and bursting idealism exists in this country. It was a mere accident that Keesha Guerrier, Kereese Gayle and Akua Brown discovered the possibility of gaining a medical education without burdensome expense.

“For me very striking was the difference between fourth-year American med students and the Black women you interviewed. By the time students here reach the end of med school, their idealism is largely tarnished. This is shown in a concrete way. Nearly none wish to enter primary care. The preferred choices are dermatology, ophthalmology, orthopedic surgery and cardiology. These are astronomic money-making specialties. For example, in cardiology the starting salary is about $400,000 annually.

“It would be interesting to repeat the interview after these young doctors return to the USA. How do they uphold their intense idealism against the tsunami force buffeting of market medicine?

The principles and purposes of health care outlined by Lown and the medical students gain special relevance during the current struggle over health care change in the United States. They are suggesting that health care as a human right will never be realized under health care systems mediated through profiteers.

When resources are divided between people needing care and the unbridled demands of wheelers and dealers, the outcome is clear. The poor and unfortunate will be abandoned, or left to the mercies of second-class modes of care, short on funding and long on patronizing attitudes.

Where resources and services are allotted strictly according to people’s needs, as in Cuba, provider loyalties are undivided, their principles preserved, and an arena of peace created.