CONCEPTUAL, INSPIRATIONAL, EDUCATIONAL
PERSPECTIVES, GUIDANCE.
The moment you say something in favor of Cuba, people consider you as a communist! I am neither a communist, nor congress or BJP, but I am a humanist or socialist, hence requesting the readers not to read in between lines or beyond the lines on what I write here. My visit to Cuba was part of my eagerness to explore diet and lifestyle of people across the world, their health status and the health systems they have. In the meanwhile, I came to know something about the Cuban model, after watching a movie named SICKO, which said that the poor Americans who cannot afford the huge premium for insurance and are denied treatment in USA, go to Cuba for affordable and better treatment. There were also some reports on the health status of the Cuban people, which said that their indices of health are better than the best in the world. Thus, I had the desire to verify all these myself somehow or other to get a first-hand information.
The desire to visit Cuba became stronger after seeing the knee jerk response of some state government authorities, citing Cuba as an example, in starting liver transplant centers in Kozhikode and Trivandrum medical colleges as a priority, when several other priority issues were looming large, which came as a surprise to me. It is true, like our state authorities, I too never expected that a low resource country like Cuba, poorer than India, to have that facility even. The argument raised for starting liver transplant facility in the medical colleges was that, if a low resource country like Cuba can have liver transplant in government sector, why not we? I could accept that logic only with a pinch of salt, since for the last two decades I had been studying health systems across the globe, their goodness, pitfalls and tried to understand the failed USA model, which India had been following for long. We now have the mindset that everything in USA is perfect and the best, be it health care, education, treatment, research or anything, but forgot to realize that such a mindset is the result of their aggressive marketing strategies to sell something or other in India. India is one of their largest market for their products and their high-end corporate hospitals, where our political leaders are somehow or other attracted to go for their treatment at government expense. USA is controlled by people who consider dollar as their God and the country itself is designed and run for such interests only. After studying health systems in all the countries like USA, UK, Canada, Australia, Denmark, Sweden, Netherlands, China, Japan, Singapore, Sri Lanka, South Africa, Japan and all the gulf countries including Dubai, I found that the worst model is in USA but India is just copying that only. Another incident which ignited my desire to visit Cuba was the reply of a learned finance minister in an open discussion at Calicut when I raised my point that medical tourism at the moment is not going to help in the progress of our health care, instead it will only adversely affect us. In reply to that the minster argued, if a country like Cuba can have medical tourism why not we? Even otherwise I had adoration for Fidel Castro as a world leader, who stood miles apart for his courage and vision for the people, his boldness to fight against the policies, the sanctions and restrictions imposed by USA, is not a small issue. Cuba is only miniature country in comparison to any other nation, and is sitting under the very big nose of the huge giant USA which is five times the size of India. The distance from Florida to USA is like Rameswaram to Sri Lanka in the Indian subcontinent.
In the meanwhile, I got an invitation to present my research on Vitamin D in Toronto and thus decided to visit Cuba too from there. Me and my wife Jyothi reached Toronto on 10th August 2016, there also we had several surprises. The people in Canada were a lot more friendly, warm in behavior, not aggressive, not suspicious of our intentions, true to heart, helpful, they enjoy helping others; be it police men, or anybody; we started experiencing the difference from the airport itself, as compared to the neighboring USA, which we had visited thrice. We enquired about the parking area for the hotel pick up, the lady sitting there willingly and cheerfully explained the place and then gave a chit for us to verify; the shuttle service bus of the hotel also came promptly at the designated area, we indicated to the driver that we are waiting for the Holiday Inn pick up service, he politely and smilingly asked, ‘which Holiday Inn?, and then he went on to explain-‘there are three Holiday Inns around’- We felt the warmth and friendliness of the people always, whenever and wherever we moved around in Canada, without any suspicious, sarcastic looks or questions and sarcastic smiles. Instead we saw an all-inclusive tolerant people as in Denmark- where human rights are genuinely protected in the best natural way as possible, and not just as pretensions. The people belonging to all religions enjoyed the same status and respect and, in the airports, they are not interviewed or looked at as if they are all criminals. Besides I observed that they are a lot healthier than the US counterparts, because they are leaner than them. But one bad thing I observed is that they too were found to smoke in public, even seen smoking and driving. One good thing about USA is that they have banned smoking in public places and anyone found smoking in public places, including inside hotel rooms, is fined 200 USD. As in any other western countries, in Canada too, alcohol is liberally available ( that does not mean that we should also go that way!) but no one drinks it in the manner as our people do in India. The day after my presentation on Vitamin D we went to Hamilton, a small beautiful city in Canada, to visit my friend who is a Professor of Internal Medicine at Mc Master University. We travelled by the ‘UP Express’ to reach the union railway station and then by the three-tier train ‘Go Express’ to reach Hamilton. My friend’s house, a spacious one, overlooked a beautiful bushy garden with rare trees and plants. He was once serving in the government medical college service in Kerala, later went to Dubai to work for a corporate hospital and not satisfied with the corporate culture, and since by this time lost the job in Kerala government, he migrated to Canada.
From my friend, I came to know that the health system in Canada is for the people, unlike in USA or India where it is for the doctors and the industries. In Canada, like most other countries, the most important doctors in the society are the family doctors. After completing the UG course (like our MBBS) and after one-year of compulsory internship, those who opt for the stream of family medicine have to undergo a PG training for three years to become a full-fledged qualified family doctor. No one is allowed to do independent practice as family doctors, without this mandatory training for three years. No doctor, anywhere in the world, is allowed to do independent practice soon after the UG training. The same is true in all the countries where the health system is designed for the people. The family doctor stream is a separate one, they have equal status and ample opportunities to go academic or do research and enjoy the same status and obviously more satisfaction as compared to the specialists. It is the aptitude, or the lack of it, that decides which stream the doctors there choose. The specialty stream is separate, after UG training hardly 20-30 percent of the doctors go for it and the health system is under government control with no scope for exploiting the people. All the people irrespective of their age, gender, and health status, have to register with one GP of their choice. Even the specialist doctors practicing in these countries have to register with a GP and go to them only for all their illnesses, unless it is an emergency. They have no direct access to specialist doctors, and the same practice is happening in all the other civilized societies. No doctor-shopping is possible in these countries, a culture, which is vigorously encouraged by us.
After completing our academic activities in Canada, we visited the Canadian National Tower, the tallest structure there and the Niagara Falls. Niagara water falls from the Canadian side is a visual treat in all respects and we went around and watched it from the Skylon tower adjacent to it. We also enjoyed going for an adventurous wet-boat ride to see the water falls from below the water falls as well. All throughout our Niagara trip we got the company of an Italian couple. They were not married but were going together everywhere, almost living together for the last one year. When we asked when they would get married, both replied in one voice that they are yet to decide and that they will see after some more time. All throughout we were discussing about their health system in Italy, there also GPs are given equal status and are more in number.
Our country, or any country will progress only when we start accepting and adopting all the good things from all over the world, even if it is from our enemies, and avoid all the bad things of everyone, even if it is our closest associate. We also need to have the wisdom to differentiate between the good and the bad. My search for the good and the bad in health systems of different countries started with my first visit abroad in 2004. My desire to visit other countries including Canada and Cuba also sprang from that interest only. I had the burning desire to do my share of work to transform India to give happiness and health to all. One thing I am certain that a bloody revolution will never work in a country like India; but I am confident that if we all work together we can transform the mindset of the people by making them aware of the realities regarding what they genuinely need for health and health care. That needs transforming the mindset with good primary educations and school health programs too. That would in turn enable them to elect people with vision, who will provide them genuine social security and human development.
The day to visit Cuba came, we planned to go from Toronto to Cuba via Mexico. Most people raised their eyebrows on listening to our plan to visit Cuba. When I enquired with my friend in Canada about his opinion on Cuba, he also was shocked to hear our plan, even expressed his anguish and concern regarding personal safety and tried to discourage us from going there. He even cautioned that we need to be careful, because he ‘felt’ that crime rates ‘must be’ high in Cuba; It clearly indicated that the rest of the world takes Cuba in a negative manner, later we realized that it is all due to the wrong propaganda against them. This kind of negative impressions, against individuals and countries, are now purposefully generated and spread, by people with vested interests, and that has become a routine now, especially so when it comes to communist countries; this is my impartial observation as a human being. The world has come to believe only what America says, and that prompted me to write the article ‘The American Attitudes and its impact on Global Health and Human behavior’
We boarded the flight from Toronto to Mexico and then to Havana, the capital of Cuba. It was displayed as Habana, and we had a doubt whether it meant the same place or not. They pronounced it Habana too. On the way and back we had a feel of what Mexico is; The landscapes from sky resembled India except that the buildings were all painted red on top giving a unique sky experience. At the airport it was very obvious that Mexico is probably a country in a mess, even worse than us, at least our airports are very efficient and well planned; We had to go through a very painful and exhaustive security checking, searching each and every bag separately for drugs and other prohibited items and then a long wait; to add to that pain trolleys in the airports needed payment as in US. Though the people appeared simple and straight forward, they were not comparable to the mature and professionally sincere attitude of the Canadian people. The comparison I got between Canada, Mexico and Cuba in one trip made me feel that, when socialism is missing, crime rates will be high, no one will be healthy, all the bad trends will trickle in, it needs only common sense to understand the relation between socialism, health, law and order. Finally the long waits in immigration and customs were over and finished the security check at Mexico and was ready for boarding to Cuba; Next was the long wait for the Aero Mexico flight to Havana, the waiting hall in Mexico airport, looked very much like our Patna airport in terms of the ambience, though it had the infrastructure
Our first trip in Cuba was to their tertiary care facility in Miramar, CLINICA CENTARL CIRA GARCIA under the Servicios Medicos Cubanos (SMC). Before our arrival, the CEO of SMC was contacted by the embassy saying that two doctors from India are visiting Cuba, which is a rare event there by any counts, and they would like to visit some hospitals. The CEO had arranged the plan for our visit, and his objective was to show case their facilities including that for treatment and education, which are being sold to other countries. SMC was founded in 1987, formally known by the name of servimed, which was merged into SMC, which is now a private company under the government to run tertiary care hospitals and to provide all tertiary care needed for Cuban citizens, free of charge, and paid services to people from other countries as a medical tourism. They promote medical tourism to attract patients from other countries including USA, where the poor patients who canto the afford the huge premium go for treatment and the money collected thus goes to the Cuban government. Thus Cuban medical tourism is for raising revenue for the Cuban government. We came to know that everything, including tertiary care, is given free to Cuban citizens and the same services, are sold to outside world to raise revenue for the nation. If we do not provide genuine health care, do not provide proper social security and human development and as a consequence when diseases are multiplying disproportionate to population growth, how can we afford to promote medical tourism citing Cuba? Still it could have been justifiable if the people from other countries had come to take the treatment from our government hospitals. Here our government hospitals are neglected and our medical tourism happens only in private sector. We have no right to promote medical tourism in private sector or government sector, till we have made available affordable and efficient services to all our citizens. In Cuba they have arranged all facilities in their hospitals to provide any kind of care to all the Cuban citizens. One more thing to remember is that, any health system is sustainable only when the disease burden is low as in Cuba. The very same facilities for education and treatment, provided free of charge to all Cuban citizens, are being sold for a price to outsiders. The income form medical tourism thus goes only to the government. We had a long interaction with the professor and head of paediatrics and of the ICU, and with the CEO of SMC (Servicios Medicoc Cubanosa, www.smcsalud.cu)
Encouraging private institutions in India had led to mushrooming of private hospitals and private educational institutions all over the country. These private institutions now attract all our rich people, the government servants and their children; What more, now the poorer people too are abandoning the government hospitals and institutions and depend on the private establishments, for education and for illnesses, including for their primary care, selling property and ending up in debt traps, with consequent erosion of our education, health care and economy. Sometimes the poorer people, after getting admitted on their own in a private set up, approach the professional philanthropists for treatment expenses or educational expenses and they raise money by donations, mega shows and events, all in the name of charity, to pay the huge bills of these private establishments. Sometimes the government too is pressurised to reimburse the private expenses, they often happily yield to the pressures or do it voluntarily to win the applause. All these effort and money could have been diverted to develop of the government establishments or more importantly in providing the social determinants of health, which we have failed to provide. All of us forget the truth that the genuine health care lies in preventing diseases by making available all the social determinants of health to all individuals but the results would be slow to manifest and no one would be able to take the credit of that action, because the results are not only slow to manifest they are not easily measurable too. We also forget the fact that after the development of a disease, cure is possible only in a minority. Every patient represent the symptom of a social issue in the society, correcting that social issue behind the diseases alone is genuine curative treatment.
Before proceeding with this journey, we had contacted the Cuban embassy in Delhi, hence we had a very useful interaction with Cuban doctors in Havana. Since they did not have any idea on the purpose of our visit, they had arranged for show- casing their tertiary care facilities, which they do routinely whenever health care people from other places visit their country. But we had planned our interview and had some prepared questions which we kept on asking and recorded the conversation; the questions started with Fidel Castro who turned 90 years on 13th of August 2016, the day we arrived in Cuba; he lived in a high security area, which we had no permission to visit, we saw it passing by only. We were told by the doctors there that, though the area where Castro lived was a high security one, with all the paraphernalia needed for tight security, his house was just an ordinary one, he slept in a simple room as he used to do before coming to power. All individuals in Cuba were of full praise for Fidel and the present ruler Rouls too, and they all adored them, because the people are looked after well by the administration, everything is free for all the citizens. Externally too everywhere the places looked neat, all the streets looked neat and beautiful like any other developed nation, but the roads do not have any BMWs or Mercedes; the costliest car we could see was an older model of Toyota Corolla. But during our stay we came to know the answers to our questions; why Cuba has the highest life expectancy at birth, the secret is that the available resources are distributed well, not allowed to be wasted, effectively run, rather than nurturing a few stingingly rich people on one side leaving the others begging for basic amenities; they have achieved high social security and human development and the indicators are the good health of the citizens. We were surprised to see the healthy looking cheerful and helping people all around. The streets were all very much like any other developed country, we travelled even to some remote areas to get a feel of the places concealed from the eyes of visitors. They had three types of neat looking waste- baskets, kept on all the roads and streets at regular designated places. We visited the house of our taxi driver; we could not believe our eyes, the two smart and beautiful children and his beautiful wife, if you say that they are the princess and her daughters, any one would believe that; all of them including the taxi driver looked like any other affluent persons in UK or USA. The same was true about allthe people we met in Cuba. The majority of the people are the whites, who are the original inhabitants and then came the Africans immigrants. The majority were Christians but there were enough Muslims too. We could not find any churches or mosques around, it was obvious that they do not give too much importance to religion, but all were proudly identifying as communists. All enjoy equal status in Cuba. Everyone there has equal access to all the basic needs like housing with basic amenities, besides education and treatment which are made available free to all the citizens. Education up to any level, treatment facilities and other basic facilities are given free to all the citizens. But they need to work, either to maintain their day to day living or for nation building. In such a setting there is an opportunity for the passionate and creative workers to bring out their maximum potential for the benefit of the society. For argument sake we can say that won’t such a situation make the people lazy and make them do nothing? Then I realised the importance of primary education, if it is well organised, it will transform each child into good human being with full potential and creativity who cannot afford to be lazy and would certainly work for nation-building. This is what we should be dreaming of. What Cuba has achieved, even USA has not achieved, only the Scandinavian countries are the exception. What if the roads are not adorned by super luxury cars?. The antagonists of Cuba project only the old cars in Cuba to the outside world to say they are backward.
Even in India our roads are now full of BMW, Benz and the costliest luxury cars of different brands, and some houses in India are like palaces- but along the sides of the road, or on the foot path, we will see slums having houses with no protective walls or perfect doors, with no toilets or water supply and we will also find people sleeping on footpaths, the footpaths themselves are not well planned and constructed, or even if they are there, they will be adorned by dumped wastes of all shades and colour, or they would be occupied by street venders or beggars. The issue that we need to address is how do we raise the resources for national growth and how do we spend our money and resources as a nation; it also means how do we allow our people to earn money and how do we allow them to spend it, or in general how do we distribute all kinds of resources in the society?. We have not been seriously considering the welfare of the people around us as our own responsibility, or we were not even bothered about the ‘other persons’ in the society. Finally some acts of kindness and philanthropy by individuals and the corporate companies (in the sweet name of CSR, corporate social responsibility), to destitute and marginalised people, the opportunities for it are abundantly available everywhere in India, for want of adequate social security and human development, are reported as extremely kind humane behaviour and projected for awards and medals, because acts of kindness and concern for others has become a rarity here rather than a routine. Now we have organisations working like corporate companies to do charity work, making it even a profitable business.
Cuba has historically, both before and during Communist rule, performed better than other countries in the region on infant mortality and life expectancy. In 2016, the World Health Organisation reported the average life expectancy at birth for Cubans as being 77 years for males and 81 for females, which is higher than that of the United States. The Cuban government operates a national health system, which assumes fiscal and administrative responsibility for the health care of all its citizens. Medical tourism in Cuba is for raising resources for the government because all the hospitals are run by the government. Whenever foreign nationals visit, including ministers, they show case their tertiary care facilities only to them, for marketing purposes and the same had been done to our minister and secretary who visited Cuba. They will never show-case their efficient primary care because it is meant for their citizens, but we fail to explore that or fail to learn anything from it. Even USA has a very good primary care set up though everything is in private. Our ministers, rich people and public figures going to USA for treatment is comparable to a situation of our poor people going to the corporate hospitals in India, selling their properties. It is not because the same treatment is not available in the government hospitals, but because of the intensive marketing strategies of the corporate hospitals, people are made to believe that it is superior and perfect. Hospitals in USA are all in private sector, they know how to market them, even using Indian doctors working there, and get clients from India to increase their profit. Having known the health systems and health economics, I would even say that no responsible or sensible person should go to USA for their treatment, if we want this country to progress.
It is entirely under the government and there are no private hospitals or private doctors. Their health system is very strong with large number of family doctors working in the community setting. Cuba's national health system is made up of multiple tiers: 1) the community-based work by family doctor-and-nurse teams, with their basic work force, 2) community polyclinics, 3) referral hospitals, and 4) medical institutes.
The Family Physician and Nurse teams serve individuals, families, and their communities. Each family doctor has been assigned 120 families, and the doctor concerned has to visit each house periodically to verify the health status and availability and the quality of social determinants of health. They live in their government-built family medicine offices; and work to improve the public health concerns in the environment of the families under their care and also provide medical care. They monitor individual and family health by examining community and home environments, current health, and medical history. The teams make home visits to each family to assess and evaluate their health. These teams' role combines both public health and clinical medicine.
There are community-based Polyclinics (like our CHCs) that house primary care specialists. They exist in every Cuban community and are well-acquainted with the people and the communities they serve. They also monitor the social determinants and environment that affect the community's health, enhancing their ability to serve their patients. Specialists at the polyclinic are available to support primary care physicians when they are needed.
Cuba's healthcare system persists, in part, due to its efficient medical education system. The medical university is not a separate entity from health services, but it exists within the system. Medical and nursing students are mentored within the national system from the first year onwards of their training, especially within the primary care facilities rather than in hospitals. This creates a community-based teaching method rather than a typical hospital-based teaching method. Primary care, being the first level of contact to a patient, is closely located close to the patient's home and work. Here, students are exposed to medicine and the social, economic, and political factors that influence health. At primary care facilities, ethics and values are taught as a large part of the healthcare system alongside science and technology. Students graduate with a commitment to providing and preserving quality and equity within healthcare for their communities. Their commitment to patient care is obvious from the fact that Cuban doctors have been part of free medical aid and services to the international community (especially third world countries) following natural disasters.
Health tourism in Cuba: Cuba attracts about 20,000 paying health tourists generating revenue for the Cuban economy. Cuba has been serving health tourists from around the world for more than 20 years.
Praise for the Cuban Health Care: In 2001, members of the UK House of commons travelled to Cuba and issued a report that paid tribute to "the success of the Cuban healthcare system", based on its "strong emphasis on disease prevention" and "commitment to the practice of medicine in a community". In 2006, the BBC flagship news programme ‘Newsnight’ featured Cuba's Healthcare system as part of a series identifying "the world's best public services". In spite of low resources, healthcare, however, is a top national priority" The report stated that life expectancy and infant mortality rates are nearly the same as the USA's. The report concluded that the population's admirable health is one of the key reasons why Castro is still in power. Its doctor-to-patient ratios are comparable to any country in Western Europe. But its annual health expenditure per head, is only $251 just 10% of what UK spends. In 2000, Secretary General of the United Nations stated that "Cuba should be the envy of many other nations" adding that achievements in social development are impressive given the size of its gross domestic product per capita. "Cuba demonstrates how much nations can do with the resources they have if they focus on the right priorities like health, education, and literacy. The principal reason that some health standards in Cuba approach the high American level is that the Cuban system emphasizes early intervention using the family doctors. Clinic visits are free, and the focus is on preventing disease rather than treating it.
We had gone to Cuba with sufficient money and a Forex debit card, but we exhausted the currency in US dollar that we had by 3-4 days, and were hopeful of getting money with the debit card, but to our surprise we came to know that the visa cards and master cards will not work in Cuba, the residual effect of the American sanctions, finally we had a tough time ahead. We went to their national bank to get some currency with our cards but they were also helpless, they advised us to go to the Indian Embassy for help. We soon reached the Indian Embassy, but on reaching there only we realised that it was August 15th and the Embassy was closed, there was the Indian Flag flying high which was hoisted in the morning. Someone there came out and told us to come next day after 10.30 am, he did not even bother to ask us what was our problem. Next day we were apprehensive, if we did not get any currency we will have to sell our watch or other personal belongings to pull on, being apprehensive that day we were very careful in spending money even for food. Next day we reached Indian Embassy sharp at 10.30 am, on pressing the calling bell the locked automatic gate was opened by the person who noticed us. We were asked to sit in the spacious waiting hall cum library which had the pictures of Gandhiji, The President Pranab Mukherji and of our Prime Minister Narendra Modi. The consular officer came and enquired about the problem that we have, we told him that we do not have any more dollar or Cuban currency with us, and he also said it was not possible to get any with our cards. Then I enquired about the other option of transferring money to Indian Embassy and they giving local currency, but that was impossible because net connectivity was not that good at our hotel in Miramar (Chateau). Luckily with us we had some Indian currency which the consular officer was ready to accept in exchange of Cuban currency which he had at his home. Being a little bit apprehensive of our intentions, my wife Dr.Jyothi was asked to remain at the embassy and I alone was asked to accompany the consular officer, Mr.Ayush Sharma, to his house. His wife and daughter were very happy to see an Indian citizen, whom they rarely only see in Cuba, I can never forget that personal help he offered to save us from a crisis in Cuba. Thus, we could spend the remaining days in Cuba happily and could return with enough fruitful memories.
The people in Cuba are from all over the world, but mostly from Spain, followed by Africa, their language is Spanish. The SMC which is a private organisation under the government is to market their facilities under the government for a price, to the outside word. We noticed that they are not keen to show case their primary care to visitors, because it's is for their people, and not for sale. All doctors are getting equal respect and status. All citizens are getting equal status and respect too and they are proudly identifying with Cuba because, it seems, the government gives them everything. When the governments are genuinely working for the welfare of the people and to solve their problems, there would not be any terrorism, there would be lesser number of persons with diseases and the treatment can be made free for all. In Cuba everyone gets all the treatments free of charge and as in other countries 80% of the doctors are in primary care unlike in India, where more than 80% are now working as specialists. After UG training they too have one year compulsory residency followed by specialisation in family practice. The family physicians are specialists and are getting equal salary and status as the other specialists. They can also go academic into the teaching or research and become professor or get PhD. Off late there is increasing American influence on the system, they really have to be very clever and shrewd to prevent that system form being damaged by the pre-Obama and post Obama US model.
Wherever I travel, I study the individuals for their physique, health status by looks, their diet and lifestyle. Their physique in general was– lean/slightly overweight but starting to be overweight and obese, but they eat a balanced diet most often, looks healthy, no none looks malnourished anyway, their average life expectancy is above 80, better than the best in the world. Diet they eat invariably has fruits and vegetables. The food we got for lunch at all restaurants, were, healthy balanced and tasty, they seem to have awareness and concern about the components of the diet they have to eat. Whether Cuba would remain like this for ever is to be seen, since the bad trends have started trickling in through tourism including medical tourism. Some are also becoming overweight and obese, and the females are going into the tourism business with the natural disasters as in Thailand staring at them. Alcohol intake is very common, is available everywhere but is limited to social inking. Smoking is increasing all over the country.
The beautiful beaches of Havana was an unforgettable experience, they are silent and shallow without any waves, the stunning scenery with serene crystal clear water; people come to beaches for swimming and fishing. The blue colour of the sea and its silence was an invitation to get wet in it, since we did not know swimming and the fear of getting drowned in a distant place like Havana was a frightening thought to us. Lack of US support, the enmity they had and the consequent US blockade is still having an impact on tourism in Cuba, but it really helps to reduce the unwanted influences on their people too. It is going to be a great tourist destination in future probably with all its ill effects as in Thailand, unless the Cuban administration is very vigilant. The lack of easy access to Internet, the inability to communicate to outsiders, since they speak only Spanish, all were interfering with easy communication. Rarely only we found someone who could converse in fragmented English, except at two situations, one was in the tertiary care hospital in Miramar, Dr. Rinaldo Gomez who is professor and head of Paediatrics there, he explained the working of their health care system in detail, invariably all were full praise for their leaders Fidel and Roul. He confidently narrated that they have generated a system which provide everything free to each citizen… Education, house, medicare, if at all people need to work only for the daily needs, but they all have a larger interest, they all work for the country, because they belong to a society which has given social security and human development. In such a society the greed for money will be minimal or absent and whatever they do will have minimal or negligible vested interest and they will be devoid of corrupt practices too. If a person has creative outlook and potential, because of good education, whatever he does will naturally end up as a nation building activity. This is what I have observed in such places as in the Scandinavian countries and Canada too. Think of what could happen in a set up where every parent is responsible for all of their needs and of their children, they all would start working only for money, when such a person becomes successful, he would go on amassing wealth, thinking that it would make his children’s future secure; he doesn’t really know that money accumulated in any form is not going to make their future secure and that it is not going to last long. But can we blame that person for amassing wealth, or for depositing wealth as black money in secret places, or for buying unused land or gold or investing in real estate and building huge houses and finally making all the wealth unavailable for social upliftment? It is all due to system failure which we need to correct.
With the present journey to Canada, and Cuba via Mexico, that too after a visit to USA in the previous year, I had to change some of my own views. The feeling that English is the most superior world language is a myth. I also realised that we can survive anywhere with the universal language of love, brotherhood and kindness expressed in gestures, emotions, and body language, if the people around us are good. I always considered that knowing English is essential to be a world citizen. I realised that it is not essential, but is good to know in the present scenario, initiated and nurtured by the British and the Americans. After learning English, we just had made our people slaves of the British and American culture. Only if they have a UK or US exposure, be it any field, they are considered more competent. It is anyway not the one who experiences the realities and develops innovative ideas and methods within the system. The result is that those who love India are often ignored, only those who know English are given higher status and positions.. Cubans, Mexicans, and several other countries speak only Spanish, they are not keen to make their citizens learn English, in spite of being geographically very close to USA. The Mexicans are food lovers, they are proud of their language, Spanish; no one speaks English there, their English is worse than in Cuba and China. Spanish speaking people consider their language as the most important, they might even wonder why we do not know it when we are in Mexico, Cuba or Spain. Why English is considered as a universal language? Who made it so, why do we believe that? Even if we accept that, should we become slaves of their mannerisms and ideas?. The Americans and the British want it that way for their selfish motives. We in India believed them blindly and imitated them for everything, including their ideas and plans which are made for their situation and for their people, and their system is purely for them only. At the same time we are at least 50-100 years behind them in social security and human development and their plans and ideas would not work here. The result is that we educate our people only to work abroad, not for our own nation building. We start medical colleges and produce large number of doctors only to transform them into specialist doctors, who offer specialist medical treatment to rich and affordable patients who approach them directly without any referral or they go out to work as specialists in developed countries, not to look after the health of our people. At the same time in the developed countries, our doctors fail to become good GPs as they do not have the necessary aptitude, skills or the mindset for it. In these countries their own doctors prefer to work more often as GPs or family doctors. Thus we do not produce any family doctors for our people but end up producing large number of specialist doctors for India and for the other countries. The curriculum for MBBS training in India is manipulated by people without vision for the country, transforming them into specialist doctors only, or they are systematically made unfit for India by plan.
Based on my travel experiences I can certainly say that India needs a reawakening, if it wants to progress, with tailor made programs and plans to suit our current situation, learning lessons from all the countries, accepting only their good things and rejecting all their bad things. We should not accept anything without a thorough analysis by ‘Indian experts nurtured in Indian set up’, not those settled outside, those who are in touch with the ground realities here, to assess whether any plan would work for the benefit of the people here. It is lack of awareness about the issues and the lack of tailor made solutions to our problems that prevent us form progressing. At the same time the imported plans and ideas without adequate homework, checks and controls is damaging our economy. To top it all the unnecessary and unwarranted influence of religion and the narrow minded thoughts due to unplanned and poorly structured primary education and the striking lack of primary care doctors and the uneven distribution of our resources all prevent us from progressing. We need to give up the strange practice of ignoring people who do not take sides with any particular power group, or of ignoring those who do not come under the banner of a power group, because at the moment principle centered people are denied opportunities to work for the people, even if they have brilliant ideas to solve our issues. To create awareness on these social issues and to provide a forum for educating the public and to bring together people from all walks of life, with creative ideas for nation building, we have recently started a movement, Social Health One Health Movement (SHOHM). All those who want to work for nation building, with a passion for creative ideas are welcome to this group irrespective of their caste, colour or creed.
Emeritus Professor,
Department of Family Medicine,
Govt. Medical College, Kozhikode
sasidharanpk@gmail.com
FAMILY MEDICINE & PRIMARY CARE
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