EDITORIAL
Family Medicine in Cuba, a dream come true
La Medicina Familiar en Cuba, un sueño hecho realidad
José Fernando Placeres Hernández 1*, https://orcid.org/0000-0001-6285-5029
Yonathan Estrada Rodríguez 1, https://orcid.org/0000-0001-9161-6545
1 University of Medical Sciences of Matanzas. Faculty of Medical Sciences of Matanzas “Dr. Juan Guiteras Gener”, Matanzas. Cuba.
* Corresponding author: placeres.mtz@infomed.sld.cu
Received: 19/02/2024
Accepted: 21/02/2024
How to cite this article: Placeres Hernández JF, Estrada Rodríguez Y. Family Medicine in Cuba, a dream come true. Med. Es. [Internet]. 2024 [cited access date]; 4(1). Available in: https://revmedest.sld.cu/index.php/medest/article/view/214
Dear readers:
The Alma Ata Conference (1), Kazakhstan, has probably been the most important health meeting ever held, due to the richness of its political, economic, social and scientific content in relation to medical care. The Declaration and the recommendations of the event should have launched, in 1981, the fulfillment of the political and social goal of achieving Health for all in the year 2000. It was convened by the World Health Organization (WHO) and the United Nations United Nations Children's Fund (UNICEF) and had the participation of 134 countries, 67 international organizations and numerous non-governmental organizations.
Cuba, then, had already achieved the health indicators agreed upon by the participating governments, and was one of the countries that showed the world its care model in which the population was a fundamental agent in the production of health. Experiences selected for their significance in terms of size and complexity, implemented in China, Tanzania, Bangladesh, India, Venezuela, Yugoslavia, Niger and Nigeria were also presented.
At the end of 1983, Commander in Chief Fidel Castro Ruz conceived the idea of providing the Cuban health system with a new type of doctor, capable of providing assistance to pregnant women, taking care of their risks, their evolution and the outcome of childbirth; then follow the child's development and behavior at home and school and, as an adult, ensure her healthy functioning in her family and social life, as well as ensuring that she received proper care during old age. This initiative began with the selection of ten young doctors with outstanding academic student careers, who began on January 4, 1984, in a health area in the Lawton neighborhood of Havana, the Family Doctor and Nurse Program in Cuba, known then as the 120 Families Doctor's Plan.
Ten duos of doctors and nurses constituted the first ten Basic Health Teams (EBS) of the program, which generated an important change in the organization and methods of the system and became the team responsible for the health care of individual’s families, the community and the environment.
It was also Fidel, who suggested developing a program for the specialty when he said that, fortunately, there would be a specialty of great value, importance and prestige, which could become massive, because it would be the type of doctor that is needed almost everywhere, which is the comprehensive general practitioner. He argued that we would have a general practitioner who would be a specialist, who would do his career, and three years of residency, with a total of nine years of training, including practice. The first 19 First Degree Specialists in Comprehensive General Medicine in Cuba graduated from the Plaza de la Revolución Polyclinic, today the Dr. Cosme Ordóñez Canceller University Polyclinic, in 1986.
Likewise, the first texts were published provisionally between 1985 and 1986. Later, in 2001, others began to be used, whose main author and almost all of the authors are family doctors, which has had four editions, the last one in 2022. Its main author has been Dr. C. Roberto Álvarez Sintes, the first Second Degree specialist of the specialty in the country, since 1995. In 2023, the book Fundamentals of Comprehensive General Medicine was also published, for undergraduate training.
In 1994, the First National Congress of Family Medicine was held, also with the presence of Fidel, and from then on, the Cuban Society of Family Medicine (SOCUMEFA) emerged, with the purpose of contributing with scientific activity to the elevation of the level of health of the population in Primary Health Care (PHC), disseminate the main research results, organize scientific events, collaborate with health administrative directorates in the successful development of work programs and strategies and advise on training plans and scientific-technical development of the specialty, among others. SOCUMEFA is a full member of the Ibero-American Confederation of Family Medicine (CIMF) and the World Organization of Family Doctors (WONCA).
In 2024, a new postgraduate training program is to begin, which has changed its name to First Degree Specialty in Family Medicine. New objectives are included in it, which give continuity to training from undergraduate.
Matanzas, began the Family Doctor and Nurse Program on November 6, 1984 at the Carlos Juan Finlay Barré Polyclinic in the Colón municipality. The following year, it was extended to the Matanzas municipality and little by little universal coverage was achieved throughout the Yumurino territory. (2)
Although the results obtained are notable, new challenges are yet to be overcome as an active part of the actions planned in the necessary transformations of this important program. Above all, to be able to achieve greater permanence of the members of the EBS in each office and strengthen their functions; achieve greater participation of teachers from the Basic Work Groups (GBT) in teacher-care consultations and in actions that allow for positive modification of health indicators; improve infrastructure, increase the quality of life and achieve total satisfaction of individuals, families and the entire population, which is served in each community.
Likewise, they constitute challenges to continue improving the work of the Matanzas Chapter of SOCUMEFA, to perfect the professional improvement of its members; that a greater number of professionals can obtain the title of Second Degree Specialists, considering the potential that exists and the competencies achieved by many of them. Another aspiration is to develop and propose for approval, its own master's program.
Likewise, purposes are also to stimulate greater participation of Student Scientific Working Groups in research on Family Medicine and PHC, to increase the number of professors with main teaching categories and with researcher categories, and to increase the number of Masters and Doctors in Sciences.
Based on the development achieved, the experience accumulated and the improvement achieved in the services, it is important to continue the work to revitalize the PHC, in the current context, taking into account the characteristics of each territory. 40 years have passed since the beginning of the program. It is impossible not to recognize today the work of its founders, the participation and effort of all the family doctors and nurses and the members of the GBT in Matanzas and Cuba, to achieve positive health indicators in each of the national prevention, diagnosis, evaluation and control programs, developed by the National Health System. For all these reasons, Family Medicine in Cuba and Matanzas is, without a doubt, a tangible dream come true.
BIBLIOGRAPHIC REFERENCES
1. OMS-UNICEF. Declaración Alma-Ata. Conferencia Internacional sobre Atención Primaria en Salud Alma-Ata; URSS, 6-12 de septiembre de 1978. [cited 18/02/2024]. Available in: http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=19004&Itemid=270
2. Placeres Hernández JF. Treinta y cinco años del Programa del Médico y la Enfermera de la Familia. Rev Méd Electrón [Internet]. 2019 [cited 18/02/2024]; 41(4). Available in: http://www.revmedicaelectronica.sld.cu/index.php/rme/article/view/3073/4401
STATEMENT OF AUTHORSHIP
JFPH: Conceptualization, research, methodology, project administration, validation, original draft writing, review, editing.
YER: Conceptualization, research, methodology, validation, writing of the original draft, review, editing.
CONFLICT OF INTERESTS
The authors declare that there are no conflicts of interest.
SOURCES OF FUNDING
The authors did not receive funding for the development of this article.