There were many doubts about his trip earlier this year, in going to Cuba. One of his ideas was to import Cuban doctors into Belize to serve in remote rural needy villages of Belize. The idea was greeted with some skepticism in some quarters, including my own. Mainly, because Jamaica, who also has a history of importing Cuban doctors, had recently complained of their lack of qualifications. They were refusing to recognize their credentials, saying that the quality of training had dropped since the breakup of the Soviet Empire and lack of support for Cuba from Russia.
Belize has about 60 doctors. Of which recent newspaper articles said only around 5 of them complained about the importation of the Cuban doctors. To date, we have 20 new Cuban doctors in the country and it has been announced from the Prime Minister's office that a further 50 will be coming soon. With a population of around 220,000, the country of Belize badly needs this doubling of doctors. Belize provides both socialized medicine and private practice medicine. There are some Belizean born doctors, but subjective observations hint that most doctors come to Belize from other countries. Like Pakistan, Bangladesh, India, Poland, Colombia, Venezuela, Argentina, Mexico and other places. I do not know how it is now, but a couple of decades ago, the system allowed a doctor to enter the country, provided he, or she, spent two years in a remote area designated by the government. Usually, back then, this was the district towns. Considered a hard ship at the time, but not now with population and infra structure growth. This latest bunch of Cuban doctors en-mass, are slated for the more remote district villages. After their two years, the new immigrant doctors were then allowed to migrate whereever in the country of Belize they desired. Most headed for the larger towns, with a higher standard of living and with more chances to make money.
Subjective observations over the decades has indicated that the imported doctors covered a wide spectrum of capabilities. There were bad ones and good ones. The good ones seemed to quickly acquire a repeat clientele and were so busy, they never lacked for work. The bad ones, whether by lack of training, personality or character; usually gravated to the larger towns, particularly Belize City and because in such a small society, news travels fast, they became quickly known for greed and incompetence. They suffered from lack of clients and thus branched out into alternative money making ventures, such as drugstores, clinics, testing services, government hospital service contracts and so on. Based for the most part on the USA model.
In proportion, and this is a subjective generalization of no empirical value, about 25% of the doctors would fall into the good expert category. The rest fell along a spectrum of valuations. Belize therefore, definitely needed more doctors of a better quality. Many of the doctors, served for a time on assignments in the socialized medicine district capital (towns) hospitals, which are government owned, paid and run, on the British style of medical service.
Some of these doctors were outstanding for public service and indeed the better ones, went on to build excellent practices. The worst ones were noted for various type scams, double billing, using government medicines and facilities which were supposed to be free, or low cost and charging the public for them and so forth. For a generalization, there are probably just as many incompetent crooked doctors on a percentile basis in the USA, as there are in Belize. It seems to be more of a human nature genetic problem, than environmental. A question of character!
In the villages, the medical services are usually provided by a clinic building and a registered nurse. The clinic usually consists of a small one bedroom efficiency, a one room clinic and sometimes another larger room that can be doubled as a multi- purpose use, for both clinic and community center activities.
Many villages did not have nurses and the system worked sometimes, but more often not. In the more difficult remote southern areas, nurses would handle a number of villages from one location. The difficulty with this situation, is that with centralized control, nurses were pretty much limited to bandages, and pre-natal care for pregnant mothers, by the jealous bureaucratic centralized authority. Any serious wounds had to go to district hospitals, or private doctors for pay. Nurses were notoriously underpaid. Medicines, both in government hospitals and equipment was next to none, or rare. Most people, went to private doctor care, which required considerable travel time, either in many hours, or in some cases several days. Bush doctors and home remedies were the norm. Depending on the severity of the injuries, a patient could be in serious trouble. In many cases, bush doctors ( unlicensed ) were often more successful than the government hospitals.
From my own experiences over the years, most of the time we did our own operations. I was a fisherman and tourist guide along the Barrier Reef Islands and Atolls for 40 years. Most fishermen could cut out a fishhook, or harpoon, or repair a fish bite, or some other gash. This was usually done with pliers, sail repair needle, and the rusty fish fillet knife. As bad as this may sound, there were never any complications that I heard of. The reason being, that Belize is at the end of the equatorial current flow from Africa and the sea piles up on the shore carrying a concentration of salts and minerals, somewhat 17% more salty than even Florida. This salt acts as an antiseptic. A regular salt water rinse, dry bandage ( old t- shirt, or piece of canvas sailcloth) done a couple of times a day, saw most wounds completely healed in 3 days. On the mainland, bush doctors did the repairs. Midwives delivered babies, though the loss in cases of complications was high. Vitamins for young children was a Godsend to public health, introduced back in the late 60's or early 70's.
These 70 Cuban doctors going to remote villages are going to be in for a shock! Especially in the high rain fall areas of the Toledo District. Lack of basic equipment, such as surgical kits, microscopes and slides. medicines, oxygen bottles for blue babies, antibiotics, petri dishes and such will be a serious shortcoming. They will be basically expected to perform medical services in line with an Army medic, alone on the frontlines of a war. A little cleaner than a muddy foxhole and with less equipment, but still very primitive capability. They will need all their skill and character.
An interesting observation on Cuban Doctors has been forthcoming from the debate on the Belize Culture list on the internet e-mail. ( firstname.lastname@example.org ) It has been said, that a lot of the Cuban doctors coming to Belize are well qualified. It has been pointed out, that many of them stayed in the training teaching hospitals, taking courses and specialties, one after another. The reason was, that a doctor in Cuba that stopped learning and went to work for the Cuban government, got paid next to nothing. ( About $100 USA per month, last time I heard ) By staying in the teaching hospitals, the financial rewards and stipends were better.
Whatever the truth of the matter, they have to be better than 75% of the doctors already in Belize and certainly better than the enforced regulated capabilities of the registered nurses who were currently handling the difficult task of rural village preventive medicine. What happens in two years, when these doctors head out for the larger towns is unknown.
The shortage of medicines and equipment is a real one. It is certainly something that can be tackled by the British High Commission Small Grant program. Japan also has a small grant program for third world countries. Required would be someone, an NGO perhaps, to write the Grant requests and see to the fair distribution of a set of doctor kits to these 70 Cuban doctors. We also have a list of Grant sources including medical supplies, on the Belize Digital Electronic Resource and Development Library. (http://www.ambergris.com/BzLibrary. )
We could probably arrange to do this type of distribution from the Belize Development Trust, but the costs of internal transportation and supervision would probably be more expensive than other means. The only reason for us to distribute any grant medical kits, would be to ensure delivery. The major difficulty of doing this through government channels is corruption. The elected representatives and cabinet ministers are notorious, as are the department centralized bureaucrats, for sidelining donations and gifts intended for rural constituencies. I have seen it myself in the Education Department many times and the newspapers in the last year have had articles, of politicians scrabbling for an unfair share of donated container loads of donated medicines and equipment. The stuff rarely gets to where it is intended. Distribution is going to be a problem. The needs of district hospitals are so great, that the temptations to pilfer and sidetrack supplies intended to outfit these 70 Cuban doctors with the needed supplies is too much for many government people to withstand. Politicians want credits for votes in their areas and bureaucrats are often too lazy to arrange distribution to difficult places that are hard to access, in more than one half day of travel. Most of the destinations of these Cuban doctors are way out in the boonies and transportation of supplies will take several days and travel transportation options to many of these locations. Thinking about it, from our perspective in delivery, I could estimate probably, two to three weeks to cover the country.
There are several Cuban doctors in Belize, that have been around several years. The word on the Belize Culture List debate forum, indicates that their qualifications and abilities, are indeed held in high regard. Enclosed are a couple of e-mail messages below, with permission of the writer.
At 06:25 PM 5/25/99 -0500, you wrote: >Peter: it's also my understanding that Cuban medical professionals are some of the best in the world with respect to natural medicines - guess they had to be, cut-off as they have been for so long by the US and the US drug companies. Mary
Not that I have noticed. They "prefer" to use conventional medicine and do not trust alternative medicine. But they are much better at this than Mexican or Belizean Docs -- much better!!
For instance, they know enough not to give antibiotic injections as a knee jerk reaction to sickness. They will ask for a malaria test (or do this themselves if their clinic has a microscope) before starting antibiotics.
Oh -- I could go one for days on this subject. I remember a 10 month old boy that was dying from shock last year -- this because the Belizean Doc mixed 3 antibiotics together (charging the parents $160 BH for his version of miracle medicine) and shot the baby with the resulting mixture. This is called "shot gunning" and is very condemned in modern countries. He told the parent the child was suffering from E-coli infection.
(This is interesting in itself -- as E-coli is the normal natural bacteria of our gut. However, at that time, there was a lot on the boob-tube regarding deadly parthenogenic E-coli in the US. This version was created due to abuse of antibiotic treatments -- which wipe out the good bacteria as well as the bad. So E-coli mutated to survive. The interesting thing about the mutated E-coli is that when it is confronted with antibiotic it releases toxins. These toxins dissolve the intestines -- hemorrhaging -- patient dies. The point being, at no time should antibiotic treatment be given for parthenogenic E-coli infection. Obviously the Docs here do not go beyond watching TV news broadcasts regarding furthering their medical knowledge!!
As it turns out -- we never have had a case (that I know of) of "deadly" E-coli bacteria here in Belize. Though I believe the Docs still use it as their standard excuse to give the patient that standard $50 antibiotic injection.
I asked a Cuban Doc about this -- and he knew the whole story already!!
Do you blame the Doc or the school that trained him?? Our Docs are all "American" trained.)
This because the child was not eating and had diarrhea. At that same time we were having a lot of Hepatitis A cases. This is a virus infection that passed through with no serious adverse reaction to the child, as long as you do not give anything to that child to aggravate the liver -- course, antibiotics should never be given to a baby with Hep A!! Anyway, the child went into deep shock and the parents came for my help. (I am Dr. Doom here!!).
The mother was holding the baby in her arms crying when I got there. I took one look at that child and thought he was dead. He sure looked it!!
But no, the husband said to check closely -- he was barely alive!! I got the immediate case history (the Doc the antibiotics) and rushed them to Corozal Hospital. God was with us, because the Cuban Doctor (a woman) was on duty. She immediately put the child on "drip" and began careful applying adrenalin. It was like a miracle occurred. In five minutes the child was crying.
I explained to the husband that he would have to stay with the child. The super of Corozal (I will not mention his name!!) was due on his rounds in a couple of hours and I was sure he would override the Cubans therapy and insist on giving antibiotics again. the next day this man told me he had to take his child out of the hospital when the Super got there. Because he did exactly as foretold -- demanding in a great temper that the child be injected with antibiotics immediately!! The father took the child right out of the Hospital. That Belizean Doctor told him that never again would his family be allowed in!!
That was one year ago -- the child is almost 2 years old now, and very healthy.
I can give you another example going back to April 1994.
Go to my WWW site at: http://www.tzabcan.com
The first case is a burned hand -- Pappy Reed. Go to the very last picture -- where he is holding his hand up and it is dated April 22, 1994. You will notice a recent scar almost totally circumscribing his arm below the wrist. 10 days before this picture, he had been caught thieving. The man that caught him in this act tried to kill him with a machete. But Pappy put up his arm to fend off the blow and the machete almost completely severed the arm.
I can back from my rounds at 8:00 that night and my housekeeper told me about this man hiding in my back yard. When I went to investigate -- there was Pappy cradling his arm -- which was in two parts but still attached.
He had lost so much blood he was white!!
I put him into the car, drove him to the police station -- where they already had a report. But when they saw his condition they did not want to lock him. I took one police officer with me and we went to Corozal Hospital. It was now 9:00PM.
The Doc on duty was a Cuban man. He motioned for us to lift Pappy onto the dolly. He then took out his little kit bag, which included an assortment of fine needles os varying shapes, scalpels, etc -- and a simple set of double lenses magnifying spectacles. He then commenced a micro surgery that was simply unbelievable!!
Pappy Reed was released to my custody and that is how you see that picture -- ten days later.
Pappy still lives today -- now in Belize city. Last time I saw him, 8 months ago, he was recovering after being shot by one 9 mm bullet through both lower legs. He still shows no scaring from the burn, no scaring from the arm chop -- and has total use of his hand.
Cascabel medicine looked after the "curing" -- but the Cuban Doc put that arm back together. I seriously doubt he could have got better treatment (especially recovery!!) in any hospital in the USA!!
People are always telling me I should be writing a book of my experiences in the medical profession here in Belize -- but that will be the day!! There is no way that I can compete with the propaganda that comes in over the boob tube. Better people believe what they want -- be it truth or fiction.
But having those Cuban Doctors here in Belize is the single greatest jump ahead Belize will ever experience!! If they had any brains at all here they would be doing everything in their power to furnish these Docs with all the equipments they require and stop our local Docs from telling them what to do in medical matters.
But if Belize does something that intelligent -- it would be a real first!!
The PUP -- again thanks so much for giving us this opportunity to stop the steady progression of failing health services here in Belize (And Mexico is just as bad!!) The rest is now up to the people of Belize.
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