Vital Signs: Cuba
PREMIERS MARCH 30, 2020 AT 6PM
Even though it is only 90 miles from the coast of Florida, Cuba feels a world away. The classic cars, the architecture, the music, and the people all combine to create the sights and sounds of Havana.
Dr. Sanjay Gupta traveled to Havana to learn more about the Cuban healthcare system. Despite being one of the poorest countries, Cuba’s healthcare is relatively strong in many ways.
From a big emphasis on screenings and preventative care, to vaccine innovations, Cuba has a lot to offer the medical field. Make the rounds with a family doctor through the streets of Havana’s neighborhoods and visit the lab where researchers created a lung cancer vaccine, sparking interest in the United States. And take a ride through Havana’s old town in a classic car – the best way to see this historic city.
Vital Sings: Cuba
Premieres: March 30, 2020.
As Run Script – Distribution version
DR. SANJAY GUPTA, CNN Chief Medical Correspondent
00:22 Sanjay Gupta:
Cuba is roughly 90 miles off the coast of Florida, but it feels a world away. The old cars, the architecture, the music. It’s the sights and sounds of Havana.
This is Vital Signs. I’m Dr Sanjay Gupta.
Despite being one of the poorest countries, Cuba has a relatively strong healthcare system. As you might guess, a lot of the focus is on prevention. That’s because it’s easier to prevent disease and cheaper, than to treat them.
00.48 So there are screening programs starting at a young age for vision and for hearing. There’s also a very robust vaccination program. But keeping track of 11 million people on the Caribbean’s largest island often requires a personal touch.
01:04 This is a family doctor’s clinic in Havana. They’re known as Polyclinics and they’re the primary care facilities of Cuban healthcare.
01.13 Doctor Martha Beatriz Diaz Dehesa runs this clinic and is responsible for the surrounding neighbourhood.
Sanjay Gupta: How many patients do you care for here, how many patients come to this clinic?
Dr Martha Beatriz Diaz Dehesa, Family Physician
01.25 Martha Dehesa (translated voiceover):
We have a total population of 1,143 inhabitants. Programs usually cover 1,100 to 1,500 people.
01:35 Sanjay Gupta:
What is the most common types of things that you see here?
01.39 Martha Dehesa (translated voiceover):
Diseases that we see more often in our population are high blood pressure, diabetes, heart disease, asthma and chronic obstructive pulmonary diseases.
But our population is of an advanced age. They have lived for a very long time, there’s an elderly population between 80 and 90 years’ old and even older.
02:03 I have been in this office for 25 years, so I have been able to enjoy what the evolution has been of all my population since they are born until they live to old age.
02.12 Sanjay Gupta:
In the morning, Dr Dehesa sees patients in the clinic. Then, in the afternoon, she heads out to make house calls.
We’re going to be tagging along with her, visiting patients in their own homes.
To understand why that’s important here, let’s first take a step back.
02:29 A pivotal moment in Cuba’s history came on January 1st, 1959 when Fidel Castro overthrows U.S.-backed President Batista, the culmination of the Cuban Revolution, ending one dictatorship and starting another.
02.44 Two years later, January 1961, Cuba and the United States end Diplomatic relations. Cuba turns to the Soviet Union for economic support but sees its economy crash when the Soviet Union collapses in the early 1990s.
03:01 With the U.S. embargo still in place and a centralised, Soviet-style economy, Cuba struggles and for its free government-run healthcare system, that means a need to keep costs low.
03.15 Preventing disease, as I said, is cheaper than treating it, so Cuba focuses intensely on preventative care.
The U.S. trade embargo also means limited access to resources, even medications.
03:30 In this clinic, you can see how bare it is. Just the essentials here. An old Chinese-made scale, a cabinet with medication organised into plastic cups. A single bed.
Sometimes you hear that it’s difficult to get medications. Is that true? Have you found that?
03.48 Martha Dehesa (translated voiceover):
Well, you know, we’re a country which has been blockaded and the number of medications which we can import are not as many as needed, but we do have those that are essential in the local offices.
04:05 Remember this is a primary health assistance office. Here we focus on health prevention and promotion. If the patient needs other kinds of medications and assistance, they’ll go to the secondary institutions, which are the hospitals, where they can find other drugs that are needed by the patients at the time.
04.25 Sanjay Gupta:
Time for house calls. The first patient is a baby boy. To our surprise, we take a left out of the clinic, and then straight up the stairwell.
04:36 So, literally next door to where the office is, is the first patient of the afternoon. A little baby is what we’re hearing.
Please, come in. Nolan!
Are you worried about anything, or just a routine visit?
04:58 Martha Dehesa (translated voiceover):
We plan field visits. We see them once a month in the office and once a month in the field. If the child is ill, we come more often until we discharge them.
05.08 Sanjay Gupta:
Dr Dehesa talks with Nolan’s mother about everything, from his diet to his teeth and his motor skills.
05.22 Martha Dehesa (translated voiceover):
This is the height and the weight curve that we record on each visit, and this measures the baby evolution as a percentile.
05:32 And here we have the foods with information to the families and what has to be eaten month by month.
Here are the vaccines. That reflects the follow-up of the child’s development.
05.44 Sanjay Gupta:
So, healthy? Baby’s healthy?
Martha Dehesa (translated voiceover):
Very, very healthy.
05.50 Sanjay Gupta:
A clean bill of health, and it’s time for the next patient.
So, this is a bit of an unusual sight, but you see a doctor and a nurse just walking down the sidewalk, making house calls in this neighbourhood.
06:05 A few minutes later, we arrive at the home of a woman suffering from Alzheimer’s dementia.
06.15 Sanjay Gupta:
Does she have a caretaker, somebody lives here with her?
Martha Dehesa (translated voiceover):
She has her caretaker, and she’s here for eight hours until her daughter comes home from work.
06.23 Sanjay Gupta:
How often do you see her?
Martha Dehesa (translated voiceover):
I see her almost every day.
06:29 Sanjay Gupta:
On average, Cubans have a long life span – nearly 80 years. The focus on preventive health care has contributed to that. It also means a growing aging population. Diseases like Alzheimer’s are becoming more common here.
Our third and final visit today is to visit a pregnant woman.
06.48 Martha Dehesa (translated voiceover):
She’s 21 years’ old. She has no pathologies, no history. This would be the first house call right after she found out about it.
If patients find this intrusive at all, they don’t seem to show it. She just let us right into her home.
07:07 Cuba does have Zika virus circulating here, so Dr Dehesa recommends her young pregnant patient takes certain precautions.
07.17 Martha Dehesa (translated voiceover):
At this stage, it is very important for you to protect yourself. To use insect repellent, or that you sleep with long pants, even if it’s hot, but you have to protect yourself from mosquito bites. Is that ok?
07:31 Sanjay Gupta:
Dr Dehesa’s patient tells me she’s going to receive weekly check-ups here in her home throughout her entire pregnancy.
Along with the focus on preventive care, Cuba also places a heavy emphasis on pre-natal care for babies and their mothers, boasting one of the lowest infant mortality rates in the region.
07.48 Keep in mind these numbers are coming from the Cuban government and we can’t independently confirm them.
But the World Health Organisation validated the Cuban health system a few years ago, calling it “a model for the world”.
08:04 Making the rounds, you can tell this is a personal doctor/patient relationship. Dr Dehesa knows her patients and this neighbourhood, providing consistency as well as care. It’s a unique system that does seem to be working here.
For Cuba, a country cut off from the United States for so many years, finding these unique solutions has led to some impressive innovations.
08:28 So next, we’re headed to a research centre developing Cuba’s own vaccines, including one for lung cancer.
08.37 According to the World Health Organisation, the United States spends more than five times the amount per person on healthcare as compared to Cuba.
08.44 The island’s state-run health system is the only one that permitted here so, with fewer resources and a lack of access, Cuba has had to improvise through innovation. Much of that happens here at the Centre for Molecular Immunology.
09:01 Do you think it makes it so you can create these drugs that then get exported to other countries?
Camilo Rodriguez: Yes, yes.
09.07 Sanjay Gupta:
In this building, Cuban researchers like Camilo Rodriguez have made their own vaccines for everything, from hepatitis to meningitis
CAMILO RODRIGUEZ, Director of Clinical Research, Centre for Molecular Immunology
0915 Camilo Rodriguez:
Cuba is producing more than 70% of the medication we need for our population.
09:24 Sanjay Gupta:
There is one vaccine in particular, here, that has caught the attention of countries all over the world, including the United States. The vaccine is for lung cancer, and it’s called CIMAvax-EGF.
09.34 Camilo Rodriguez:
Lung cancer is the third cause of disease by cancer here in Cuba. It means that we have more than 4.5 thousand patients with lung cancer each year. And in the same period of time, the same amount of patients die from this cause.
10:01 Sanjay Gupta:
Is it the lifestyle? Pollution, smoking… cigars?
10.06 Camilo Rodriguez:
In Cuba, the smoke habit is a very common habit, because we are mainly a producer of tobacco.
10.14 Sanjay Gupta:
Orelve Alberto Sanchez Leal is 77 years’ old. He was a smoker all his life, starting at age seven, saying he smoked as much as a box of cigars every day.
10:26 In 2007, he was diagnosed with lung cancer.
10.28 When they told you you had lung cancer, were you surprised?
10.33 Orelve Alberto Sanchez Leal (translated voiceover): Yes. It was like a house fell on top of me. It hit me really hard. But thanks to the help that I have had from my doctors, especially the doctor here. She gave me the treatment: the chemotherapy, the radiotherapy, and then she invited me to the clinical trials with the vaccines.
10:53 Sanjay Gupta:
The critical distinction about this treatment is that the word ‘vaccine’ is actually a bit misleading. In its current form, it does not prevent disease, like a traditional vaccine, but rather keeps diagnosed tumours in check by inhibiting their growth.
It’s a form of immunotherapy, harnessing the power of the body’s own immune system.
This is completely free.
11.15 Camilo Rodriguez:
Yes, in Cuba it’s completely free.
Other countries are participating in clinical trials for the vaccine, including Japan, and some in Europe. Published data shows patients younger than 60 lived, on average, 11 months longer than those who did not receive the vaccine.
11:30 Orelve is an exceptional case. He and his doctors are convinced this vaccine saved his life.
It’s been nine years, now, since he was diagnosed. What is typical survival without the vaccine?
DR. ELIA NENINGER VINAGERAS, Orelve’s doctor
11.46 Elia Neninger Vinageras:
Without the vaccine, ten months to twelve months.
Ten months. And nine years later…
11.57 CIMAvax is expected to start FDA clinical trials in the United States later this year. It’s all part of a newly-formed health collaboration between the United States and Cuba, signed just a week before our visit to Havana.
12.09 After 54 years, the United States in Cuba normalised diplomatic relations last July. But not all contact had been cut off between Americans and Cubans before that. In fact, outside Havana, there’s this medical school with a unique mission: take people from impoverished areas, train them to be doctors, then send them back home to provide medical care.
12:30 Since it opened, in 1999, it has trained 25,000 doctors from all over the world, 84 countries around the world, including the United States.
12.42 One of the biggest draws of the Latin American Medical School is the cost: as in, there isn’t any cost. It’s free. In fact, the students actually receive a small stipend to attend the six-year programme. The only agreement they make is that they return to their home country and serve impoverished communities in need of medical care.
13:01 That’s the other important thing to realise: though Cuba pays for this training, the doctors don’t actually stay in Cuba.
How many of you are from the United States? Almost all of you.
13.15 How many of you had ever visited Cuba before coming to medical school here?
Just two of you?
13.23 How many of you plan on going back to the United States after finishing your school?
13:29 All of you.
I spent some time just now with many students from the United States. They don’t pay to come to school here, and when they are done, they are going to go back to the United States.
13.43 What does Cuba get out of that relationship?
ANTONIO LOPEZ GUTIERREZ, Principal, Latin American School of Medicine
13.48 Antonio Lopez Gutierrez (translated voiceover):
This university was founded in 1999 because of several problems that occurred in Central America related to hurricanes Mitch and George, but sending Cuban medical teams couldn’t be the definite solution.
14:03 Sanjay Gupta:
The idea of medical diplomacy has been a running theme in Fidel Castro’s Cuba. Cuban doctors often go on medical missions to other countries, and Cuba sent hundreds of healthcare workers to West Africa, to fight Ebola.
14.17 They’ve also exported doctors to other Latin American countries in exchange for badly-needed oil and hard currency, which some Cubans complain, has led to a shortage of experienced doctors in their own country.
14:30 What made you decide to want to come here?
14.33 Medical student #1:
My goal is to go back and to serve African Americans and the Latino community primarily, so when I found out about the programme, it would allow me the opportunity to not only become more proficient in Medicine, learn from some of the best doctors the world, but then also improve my Spanish at the same time. It was a perfect match.
14.50 Sanjay Gupta:
I left the Latin American Medical School impressed by these students who took such a huge leap of faith to come to a country most of them had never even visited to study medicine in a foreign language and to give a true commitment to this style of health care.
15:10 Next: we take a ride for a classic tour of this historic city.
15.19 According to the World Bank, life expectancy here in Cuba is 80 years’ old. That’s one of the highest in the world. To give you some context, the United States is 79 years’ old, Brazil is 75 years’ old.
15.32 A lot of that likely has to do with what they don’t eat here, but also with what they do eat. The vegetable markets, like the one you’re looking at here weren’t even available some ten years ago.
15.43 And even today, to buy cucumbers, for example: two cucumbers would cost more than a day’s salary for the average Cuban.
15:53 The cost of living is a common theme we heard from nearly everyone we spoke to. In fact, many look for a second job to supplement their state salaries, which averages $20 to $25 a month here. For doctors, we’re told it’s a bit higher, roughly $50 to $60 a month.
16.09 We heard stories of some doctors and nurses occasionally taking supplies to re-sell on the black market, or patients bringing gifts to appointments to ensure access to those limited supplies.
So, as much as things may be improving here, there’s still a long way to go. With people looking to increase their income, tourism appears promising.
16:29 As the United States and Cuba further improve diplomatic relations, that means more American tourists, and one of the first things they want is a tour of the city in a classic American car.
16.41 Several of the drivers we spoke to had other jobs. Some were chefs, some were engineers, and they said a few of the fellow drivers were, in fact, doctors.
We didn’t find any full-time doctors who were also part-time drivers that day, so I hitched a ride with Rodolfo, a 43 year old Cuban who’s been driving these cars for 20 years.
17:02 Hello, Rodolfo, nice to meet you.
Nice to meet you, too.
This is your ride? What kind of car is this?
Do you want to go in the front?
Yeah, I’ll sit with you. What kind of car is this?
’53 Chevrolet. Alright. Safe?
Rodolfo: Yes, of course.
17:26 Let’s go?
Sanjay Gupta: Of course. Let it roll.
As far as careers in Cuba go, this is a pretty good career? You’re making good money doing this?
Yes, of course.
17.38 Sanjay Gupta:
It cost us $25 dollars to rent this car for about an hour. So, in one hour, Rodolfo makes as much as the average state salary for a month.
17.47 I just want to make sure you understand. For a doctor who’s getting paid, well… cause I’m a doctor.
17.53 Sanjay Gupta:
I’m a doctor. A doctor gets paid… and I love Cuba. I love it here. But if you’re a doctor in Cuba you’re making, let’s say, $50, $60 a month. If you drive a car, you can get paid $25, $30 an hour.
Most doctors who have a car in Cuba don’t use it, because they don’t have money to buying, for example, petrol. It’s very expensive.
They can’t buy the gas.
But they can make a lot more money driving, like you are…
Sanjay Gupta: … than being a doctor.
Exactly. But it’s not only for the doctor. It’s for all professionals in Cuba. If you have another job with tourists, you live better with your salary than with your profession. That is crazy, but it’s real in Cuba.
18.40 Sanjay Gupta:
How is the healthcare system here?
It’s very good. In my opinion, it’s very, very, very good, because it’s free for everyone.
What’s the worst thing about the healthcare system?
The system is very good. The problem is with, for example, for the medicine. The government don’t have 100% medicine for everyone in Cuba, because of the American embargo.
That is impossible to send to another country everything for the Cuban health system.
19:26 Sanjay Gupta:
On our drive, we passed Cuba’s Revolution Square.
This is the Revolution Square.
Yeah. José Martí Memorial.
19.35 Sanjay Gupta:
And the American Embassy, with the flag flying high out front. That’s a recent edition, here in Havana.
This is the Malecón, the most famous avenue and, in front, we have the American Embassy.
There it is. And the flag.
Did it make you happy, to see the flag go up?
Yes, of course. Everybody who comes here goes, ‘Oh my God, the American Embassy! That is possible in Cuba?’ Yes. It’s possible.
20:01 Sanjay Gupta:
If that’s possible, then anything is possible.
After 60 years, that is possible.
Cuba… people live a long time in Cuba. Life expectancy – 80 years old here. In the United States, 79, is lower in the United States than Cuba. Why? Why do you think?
In my opinion, that’s happened maybe because we live more free in spirit.
Exactly. The Cuban spirit is free, because Cuba is the best country around the world for living. We don’t have violence and we don’t have crime in the street.
No violence, no crime?
No. Very, very low. Very, very low percentage we have in this country, of crime and violence.
20:53 For example, in Cuba, you can see the children in the street playing from six o’clock in the afternoon until midnight. And nothing happens.
Is that right? No worries.
Nothing happens. They play and they are very happy, because it’s a very safe country for living. Maybe that is one reason, among the many ones Cuban people live many years.
21:27 Sanjay Gupta:
What other reasons, do you think?
For example, the food in Cuba is natural.
The Americans use so many chemicals in the food. Not only in America. Around the world, people use so many chemicals in the food.
Yeah, I think you’re right.
How about fixing the car if it has a problem? You?
21.54 Sanjay Gupta:
You fix it yourself?
You’re a mechanic?
So-so. In Cuba, when you talk about the Cuban people, you can see and you can hear, when you hear somebody tell me, ‘we are musician, poet, and crazy[madman]’, because we know [a bit of] everything.
Right. That’s funny.
22:19 As we drive around this beautiful and fascinating place, I can’t help but think of what these classic cars really represent: Rodolfo’s 1953 Chevrolet has the original engine, with some makeshift parts added on, like the battery.
It probably shouldn’t work, but it does. Thanks to ingenuity from a self-proclaimed so-so mechanic, and a tremendous amount of pride. Like these old cars, Cuba is also doing more with less, and has been for decades.
22:46 A country on the brink of change, with potentially a lot to gain and a lot to offer.