ss37 wednesday 315 - ascls...4.population-wide weight loss and regain in relation to diabetes burden...
TRANSCRIPT
7/24/2018
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Disclaimers
• The content of this presentation is intended as a continuing education offering for meeting participants only. Views and information presented are that of the speaker and do not represent official positions of Ortho Clinical Diagnostics.
• Discussion of methods and vendors does not imply endorsement and is simply for educational purposes.
Many thanks!
Donna Dayton, MT (ASCP)
Laboratory Manager
Indiana University Health Center
Bloomington, IL
Donna was one of the delegates and her input for this presentation is greatly appreciated.
Objectives
• Provide overview of Cuban life and culture
• Explain the National Health Care system and education in Cuba
• Describe laboratory practice and Cuban resources
• Compare Cuban statistics and health care practices with those of the United States
October 9‐14, 2017ASCLS Delegation to Cuba with Laboratory Management
How did we get there?
• ASCLS Past President was invited to lead delegation by Professionals Abroad
• Destination discussed 1.5 years before departure and agreed upon by EVP and PP
• Invitation sent to all members
• Delegation of 8– Trip was almost cancelled
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Difficulties
• Hurricaines
• President’s warning regarding travel to Cuba
• Zika
• Embassy “illnesses”
Airport workers
Prep/orientationMap of Cuba
Accommodations
• Hotel Melia Cohiba
• Private bus
• Local tour guide, bilingual
• All meals pre‐arranged
• Previous trips to Russia, China, South Africa and Egypt
Hotel and view
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Room Lobby Views
First lunch Everything has a use
Souvenir marketDogs & Cats in Cuba
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Cuban History
• In 1959, the Cuban revolution resulted in massive social and political change
• The Cuban health care system was dismantled and a new system put in place with the aim of decreasing disparities
• 1962‐US embargo‐‐trade with Cuba ceased
• 1991‐1995‐”special period” Cuban loss of Russian support
• Population provided with free access to health care
Food Rations
• Each Cuban citizen gets a ration book monthly that has about 11 staple items, for example, 5 lbs. of rice, sugar, etc.
• It is often not enough food to cover a full month so much of their income goes to feed their families.
• 60% of Cuban salaries may go for supplemental food
• When a delivery comes in, often news spreads by word of mouth.
Cuban Info• Baseball is the most popular sport in Cuba. Boxing is also a dominant and
popular sport
• Music in Cuba is a very important part of the culture and has worldwide influence
• Dance is also very important – The Bolero, Mambo and Cha Cha invented in Cuba
• Until 2008, Cubans were not allowed to own cell phones – many still do not have access to the internet
• Working new mothers get 12 months off with 60% salary, paternity leave being addressed
Life in Cuba
• Many multi‐generational families share one housing unit
• Very unusual to own one’s own home
• Many servants “inherited” a home when owners fled Cuba
• Income very low but many have government provided homes
• Health care and education is free of charge
Water
• Valuable resource
• Many do not get water from city daily
• Cisterns on most homes
• All boil water
Additional info
• No car dealerships in Cuba‐‐150,000 vintage American cars still running in Havana– Cannot get parts
• Home eviction is illegal in Cuba
• Abortion is legal and free since 1965
• Same sex marriage is forbidden by constitution
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Many mansions exist Sharp contrast to usual living conditions
Old Havana Oh, the cars!!
Fusterlandia
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Fusterlandia Post hurricane repairs
Hotel Nacional Hotel Nacional
HEALTH CARE SYSTEM, EDUCATION, AND ORGANIZATION MEETINGS
Representatives of the Pan‐American Health Organization (PAHO)
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Goals of the Cuban Pan American Health Organization
• Established in 1902; carries same weight as other member countries in PAHO
• Health Promotion
• Universalization of Education
• Strengthening of municipal health systems
• Key projects include:– Zika and arbovirus (mosquito borne illness) outbreaks
– Maternal and children’s health
– Efficiency of healthcare system
Diseases eradicated in Cuba
• 1962 – Poliomyelitis• 1967 – Malaria• 1972 – Neonatal Tetanus• 1979 – Diphtheria• 1989 – Postparotitis meningoencephalitis• 1989 – Congenital rubella syndrome• 1993‐ Measles (rubella)• 1994 – Pertussis• 1995 – Rubeola
Discussed the National Health Care System with the Cuban Minister of Health
National Health Care System
• After the revolution, the population in Cuba provided with free access to health care
• 1962‐US embargo forbade trade with Cuba made it difficult for Cuba’s NHS and its outcomes to be thoughtfully considered by the US media, public, or policymakers
• Despite the hindrances, there have been consistent improvements in the population’s health status, to the extent that today the country’s health indicators resemble those of industrialized nations
Facilities Data shared by Cuban Ministry of Health for 2016 (October 11, 2017)
Maternity and Elderly Facilities in Havana
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Human Resources as of 2015
• 82,967 Nurses
• 90,161 Medical Doctors
• 12,883 Family Doctors covering 100% of the population
• 16,852 Dentists
• 78,492 Health Technologists
Structure of Cuban Health Care System
• Three levels of care• Level I (Primary care): Family doctor program
• Clinic or health post with free government housing provided for doctor and his/her family
• General doctor training focuses on disease prevention and health promotion
• Three primary care areas:• Maternal care/Gynecology• Internal medicine• Pediatrics
Visited One of 24 Family Doctor’s Office’s (consultorio) in Playa Municipality
Family Doctor’s Office Exam Room/Area
90% of lab employees and 60% of physicians are women Structure of Cuban Health Care System
• Level II (Secondary care): Polyclinic• 465 in Cuba• Family doctor or hospital specialist orders test • Range of diagnostic tests and treatments
available• Serve as emergency centers• Biopsy and some OP surgeries • Outpatient Laboratory (34 tests available)• Ultrasound and X-ray• Vaccination center (13 vaccines given from
birth to age 14)
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Polyclinic located in Playa Municipality Polyclinic Vaccination Area
Polyclinic Level II Care: Poster and Patient Beds Structure of Cuban Health Care System• Level III (Tertiary care): Hospitals• Different levels of care and
clinical specialties
Level III Hospital specializing in Cardiology General Calixto Garcia Hospital
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Laboratory Professionals: Education in Cuba
• Physicians in clinical laboratory science • 6 years + 2 (validation and quality control manager)• Pay = 80 CUC’s/month ($80)
• Health technologist • 5 years (comparable to BS
in Medical Laboratory Science)• Pay = 40 CUC’s/month ($40)
• Lab technicians• 2 years (Medical Laboratory Technician degree in US)• Pay = 24/CUC’s/month ($24)
General Calixto Garcia Hospital Teaching Auditorium
Laboratory Students of Medical SciencesMet with Dean/Faculty of Medical Sciences at
Salvador Allende University
• Post‐Graduate degree in Medical Sciences
• Students mainly from Cuba, sub‐Saharan Africa and Latin America—some from the US
• Includes a teaching hospital at the tertiary level with 500 beds and more than 5,000 students
• Other scientific degrees: laboratory medicine and pharmacy
International Student Admission Professional Collaboration: Michigan
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Professional Collaborations Cuban Society of Clinical Pathology
Cuban Society of Clinical Pathology (CSCP)
• Member of International Federation of Clinical Chemistry and Laboratory Medicine (IFCC)
• Composed of pathologists, technologists and biochemists
• Voluntary membership: currently 692 members
• Functions similar to professional laboratory organizations in US
• Provides educational materials, communicate their work to physicians and health care policy makers
• Promotes the image of the profession to members, the biomedical industry and worldwide
CLINICAL LABORATORIES
Center for Control/Oversight of Medical Equipment, Devices, and Medications
CEMED Building
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CECMED
• CECMED publishes Good Practices for Clinical Labs
• Inspection of lower level laboratories is voluntary, but in order to receive certification the lab must be inspected
• Higher level labs are inspected by members of the Cuban ministry of health – inspections conducted every 2 years
Mission of CEMED
• Promote and protect the health of the Cuban population
• Effective and transparent regulatory system
• Control and health surveillance
• Safety, efficacy, and quality of drugs, medical devices, services, and other products intended for human use
Polyclinic Phlebotomy area Phlebotomy supplies
Processing area Chemistry analyzer: Mindray BA‐88
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Mindray BA‐88
• Small laboratories; Pet hospitals
• 7.0” touch‐screen & pop‐up keypad
• Two test modes: flow cell or cuvette
• External keyboard or mouse support via USB
• User‐friendly interface and multi‐language operation software ∙ Built‐in thermal printer
Mindray test menu
• ALT, AST, ALP, ACP, GGT,LDH, CK, AMY,TG,TC, HDL‐C, UA, UREA, Cr, Glu, TP, Alb, T‐bil, D‐Bil, TBA, NH4+ , HCO3‐, Ca, Mg, Cl , Na, K, apoAI ,apoB, Lp, C3, C4 , lgG, lgA, lgM, HbA1c, Alcohol, Common drugs of abuse
Chemistry Reagent kits
Hematology Staining area and lab refrigerator
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Hospital laboratory processing areaChemistry analyzers
Chemistry analyzer awaiting validation Chemistry analyzer
No words… Hematology
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Hematology Reference area
Microbiology Blood Cultures and media storage
Blood Bank Autoclave room
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So…..
Despite differences between health care practice and delivery in Cuba and the US…
Health Comparisons: Cuba and the US, 2015 (WHO)
Cuba: Diabetes and sugar Consumption US: Diabetes and Obesity
Cuba United States
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Mortality Ranking in Cuba (2016) and US (2014)
References: Cuba: Ministry of Public Health, Medical Records and Health Statistics Bureau, 2016;United States: National Vital Statistics Reports, Volume 65, Number 4, (06/30/2016)
JMS
Cuban Health Care Innovation and Success
1) Very successful community‐based primary health care model emphasizing prevention and health promotion
2) Equity based preventative care system‐accessible to all regardless of age, income, ethnicity, or geographic location (urban/rural)
3) High doctor to patient ratio‐train large numbers of doctors for use in own country and for export
4) Claim “Cure” for diabetic foot ulcers (Heberprot‐P®)5) Developed treatment and/or prevention
for lung cancer (Cimavax)6) Developed drug therapy for head and neck
tumors with less toxicity (Nimotuzumab)
http://hyberprot‐p.cigb.edu.cu
“Cubans are resourceful people
and have the stubbornness of
HOPE”
Yoseti (Cuban guide and
interpreter)
Thank You!
Questions?
References
1.Primary Health Care in Cuba: The Other Revolution, Linda M. Whiteford and Laurence G.Branch, 2008.
2.Ministry of Public Health, Medical Records and Health Statistics Bureau, 2016.3.United States: National Vital Statistics Reports, Volume 65, Number 4, (06/30/2016)4.Population-wide weight loss and regain in relation to diabetes burden and cardiovascular mortality
in Cuba 1980-2010: repeated cross sectional surveys and ecological comparison of secular trends, BMJ, 2013.5.https://www.worldatlas.com/articles/the-highest-literacy-rates-in-the-world.html6.Family Medicine in Cuba: Community-Oriented Primary Care and Complementary and Alternative Medicine, JABFM, 2005.7.https://www.theguardian.com/world/2013/apr/09/hard-times-heart-disease-diabetes-cuba8.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960704/9.Health United States, 2016, US Department of Health and Human Services, CDC.10.Cuba Has Made at Least 3 Major Medical Innovations that We Need, Healthy Living, 3-15- 2016.11.Yoseti, Cuban guide and interpreter.12.Mindray website