Doctors in the house

Aug 14, 2013 Editorial

According to one report, Guyana only had 90 registered doctors prior to 1992, and more than half of them were Cubans. By 2002, confronted with the still critical shortage of medical doctors in our health system, former President Bharrat Jagdeo and Cuban President Fidel Castro inked an agreement for 500 doctors to be trained by that country. Even though by last year the number had increased to approximately 400, augmented by 69 who had returned from the Cuban programme, the overall per capita doctor/population ratio was still less than one quarter that of our neighbour Trinidad.
Against this background, we can perhaps more fully appreciate the recent news that another 278 doctors trained in Cuba, have joined our medical system. This training of doctors for poorer countries is one of the more stellar achievements of the Cuban Revolution that has not received enough publicity in the media. Cuba had made the provision of health care to its people a right guaranteed by its constitution and corollary training of doctors a centrepiece of its educational system.
Because of success in the latter endeavour, it has sent over 100,000 of them on service missions to countries in need, including Guyana since the 1970s. It also offered medical scholarships to friendly countries from which Guyana has also benefitted early on. In 1999 it converted its national naval academy into a medical school that became the world’s largest – the Latin American School of Medicine (ELAM), in Havana. In the wake of 1998 Hurricane Mitch, ELAM’s mission was to provide enough medical personnel for the region.
Approximately 1,500 students enrol at ELAM each year, and to date over 10,000 doctors, mainly from Latin America and the Caribbean, have graduated following a six-year programme. But this year, 10,500 doctors will have graduated, with almost half of them from 70 other countries. Guyana was one of nine countries with more than 100 graduating doctors. The magnitude of this influx of medical training is astounding when it is compared with the approximately 30-35 that our UG medical programme produces annually.
For us in Guyana, the medical training in Cuba should also be paradigm-changing for doctor-patient relationships, which up to now has tended to be very hierarchical. Whether by design or accident, the western-trained doctors that dominate our health system tend to deal with patients with what has been called a “God Complex”, even though they have all taken the Hippocratic Oath to serve patients. With the Cuban-trained doctors, there is an additional basic stipulation: students make a moral commitment to work with the underprivileged and those most in need of medical care after graduation.
While some may see it as a negative, it must be pointed out that Cuban medical training also insists on solid diagnostic skills, since access to high-tech equipment abroad – from basics such as X-ray machines to scanners – can be extremely limited. The authorities have pointed out the obvious that these newly trained doctors will have to undergo a period of mentoring by the senior doctors in the system. This brings up the larger question of ensuring that the supporting system of nurses, facilities, equipment (including operating theatres etc) is in place to make these doctors effective.
The increase in the number of doctors in the system, in and of itself, will not have the desired effect as it is not part of a comprehensive plan. We have noticed that the need for an increase in specialist medical skills has been recognised and we hope that we will not only depend on the expected offer of Cuba. Such programmes will have to be introduced at our UG medical schools. The number of specialist nurses will also have to be increased exponentially. What this means at the very least is that the budget for the health sector will have to be increased appreciably in the next budget.
Finally, on behalf of all Guyana, we must thank the government and people of Cuba for the free training of so many medical professionals.

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Doctors in the house

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