Visiting cuban Seniors at a Community Mental health Center

“Many men can draft many laws. But few have the piercing and humane eye, which can see beyond the words to the people that they touch. Few can see past the speeches and the political battles to the doctor over there that is tending the infirm, and to the hospital that is receiving those in anguish, or feel in their heart painful wrath at the injustice which denies the miracle of health to the old and to the poor. And fewer still have the courage to stake reputation and position, and the effort of a lifetime upon such a cause ….”
– President Lyndon B. Johnson on the signing of Medicaid Bill, 1964 -

Put simply, my fascination with the Cuban Health System stems from the similarities of their system, and our system of Medicaid and Medicare, and how Cuba has succeeded at making sure that Health care is a human right rather than a product for economic profit. Therefore, all Cubans have equal access to health services, and all services are free.
As we know, Medicaid was introduced for two reasons: 1) providing medical insurance to people with incomes low enough to qualify for cash assistance, and 2) to complement Medicare by paying for long-term care for people with the means to do so for themselves. Yet it remains a dream unfulfilled.
Not only are half of all bankruptcies in this country caused by medical expenses, the typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone. Adults in nearly every state saw their access to health services worsen during over the past decade, with Tennessee, Florida and Georgia having the greatest increase in people reporting having an unmet medical need, according to a study released by the Robert Wood Johnson Foundation.
I have always envied how Cuba is able to provide high quality care to a poor population, with limited financial resources. Yet, the Cuban people enjoy better health outcomes in every category of measure: low infant mortality; low rate of depression and sickness in the elderly; and almost everything in between.
My interest was particularly focused on some of the more glaring similarities between the two countries in regard to aging and the elderly in this country:
1. Cuba is a poor country with limited resources.
2. Cuba’s elderly population is large, and growing. An estimated 54 percent of Cubans over 60 are retired.
3. Depression is a widely under-recognized and undertreated medical illness. About 1 – 5% of elderly Americans suffer from depression.
4. Poor and the underserved, (including many people of color) in this country suffer disproportionately, have poor health status.

Medicaid is at the foundation of our nation’s commitment to insure equal opportunity for all people, regardless of income, disability, age, or race.
Over the past decade, I have traveled to Cuba many times, speaking and lecturing at different health and medical conferences. Each time, I marveled at the numerous examples of success in providing healthcare, and training of doctors, and other medical professionals.
A couple of weeks ago, I was a part of an academic research program, looking at Cuba, and its’ aging population. The specific purpose was to examine and observe how Cuba is handling it’s aging population within the context of its’ healthcare system.
The trip was organized by MEDICC (Medical Education Cooperation with Cuba), a non-profit organization working to enhance cooperation between the US, Cuban and global health communities aimed at better health outcomes.
The older U.S. population (persons 65 years or older) numbered 39.6 million in 2009 (the latest year for which data is available). They represented 12.9% of the U.S. population, about one in every eight Americans. By 2030, there will be about 72.1 million older persons, more than twice their number in 2000. People 65+ represented 12.4% of the population in the year 2000 but are expected to grow to be 19% of the population by 2030.
Like the rest of the world, the US is an aging society. This will place substantial additional pressure on publicly funded health, long-term and income support programs for older people.
Poor and uninsured American adults have greater difficulties not just with health care costs, but finding doctors who would see them.
About one third of 41 million uninsured adults delayed getting care due to costs in 2010, compared to 25 percent in 2000, the study found. Nearly half the uninsured said they had an unmet medical need in 2010, up from 33 percent in 2000.
As I visited many different parts of the healthcare system devoted to care of the elderly in their society, I paid close attention to the “take-aways”, that I felt were of particular interest to the challenges we face here in the US.
One of the biggest problems found in elderly Americans is depression.
Depressive disorder is not a normal part of aging. Emotional experiences of sadness, grief, response to loss, and temporary “blue” moods are normal. Persistent depression that interferes significantly with ability to function is not.
Many health professionals in this country seem to mistakenly think that persistent depression is an acceptable response to other serious illnesses, and the social and financial hardships that often accompany aging – an attitude, unfortunately, often shared by older people themselves. This contributes to low rates of diagnosis and treatment in older adults.
While in Havana, I saw hundreds of elderly people full of life, and looking forward to a meaningful, productive years in their family, their neighborhoods, and their general communities.
I visited clinics; “senior centers’; a Rehab Center; and a Family Medicine Office (primary care). I was even able to join a doctor for her regular visit to the home of one of her patients.
After my interviews with professionals and elderly Cubans in the community, I found a vibrant, healthy, and active elderly population, with healthcare providers organized, and structured, in a way to allow healthcare to be delivered to met the needs of the elderly.
I also conducted interviews in Spanish (with the help of Georgina Gómez Tabio, our translator) with health officials and medical leaders as part of a itinerary planned by officials of the Cuban National School of Public Health; and was free to deviate from this itinerary at will, which I did on numerous occasions, to pursue inquiries of particular interest to me.

The Cuban health care model is a public health/holistic one. In other words, health care includes the whole person; the physiological, psychological, emotional, social (including family relationships), and environmental aspects of the person. The services are distributed in a public health triage model. If ten people are waiting to be served, rather than be seen on a first-come-first-serve basis, they are taken in the order of need.
Cuba possesses specialized geriatrics services throughout the country, as part of the actions to prolong, with quality, the life of its inhabitants.
Cuban health authorities give large credit for the country’s impressive health indicators to the preventive, primary-care emphasis pursued for the last five decades. These indicators – which are close or equal to those in developed countries – speak for themselves.
Cuba’s physician per population ratio is 1 per 255, as compared to 1 to 430 in the United States. With a life expectancy of 76.9 years, Cuba ranks 28th in the world, just behind the US. However, its spending per person on health care is one of the lowest in the world, at $186, or about 1/25 the spending of the United States. Health care spending increased tenfold between 1980 and 2011, when it reached $2.6 trillion and accounted for 17.6 percent of the U.S. economy. All that spending isn’t bringing Americans the best care in the world, either.
Yes, I am convinced; it’s possible to take care of the poor and underprivileged without bankrupting America. I left Cuba with a new sense of optimism about what is possible…if only we have the “Political will”.

“The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped.”

Various estimates have pegged spending on unnecessary tests at $200 billion to $250 billion each year in the United States, a phenomenon blamed on such factors as overcautious doctors who seek to avoid malpractice claims and patients who don’t realize how much their treatments cost.

Organizers of Choosing Wisely say the goal is not cutting costs, strictly speaking, but achieving the best value and the best care. If an expensive test is necessary, then full steam ahead. Conversely, some tests are cheap but still should not be done because they can subject the patient to needless anxiety and risky follow-up procedures that turn out to be unnecessary, the groups say.

Read more: http://www.philly.com/philly/health/20120404_A_medical_group_takes_up_the_fight_against_unnecessary_tests.html#ixzz1r7Zji5Wp

Just how much of the $100 your doctor charges for taking 30 minutes to investigate your stomach pain goes into his pocket? After paying the bills, he gets less than half. The
breakdown, according to Robert Lowes, senior editor at Medical Economics:

$3.50 for malpractice insurance

$3.50 for equipment, repairs, and maintenance

$6 for supplies, including gowns, tongue depressors, and copy paper

$7 for rent and utilities

$11 for office expenses, such as telephones, accounting fees, advertising, medical journals, licenses, and taxes

$28 for secretary, office manager, and medical assistant salaries and benefits

$41 Amount that goes into the doctor’s paycheck

Over the course of a year, that adds up to $155,000, the annual salary of the average family physician.

Asante sana,
Glenn

To start with, urine is the bodily fluid that transports waste from the system (the other waste removing systems are lungs; colon; and skin). Urine is formed in the kidneys and flows down the urinary tract into the bladder. Most of us think that at this point it flows right on out of the bladder. Actually, it accumulates in the bladder until the bladder fills up and then a nerve signal is sent to the brain communicating the need to urinate. When this happens, the bladder automatically contracts and squeezes the urine out into the urethra (this is the tube urine comes out of, whether you are a man or a woman). Some folks flex or tighten their stomach muscles to increase the pressure in order to help fully empty the bladder. There is a “back-flow” valve called sphincters, which prevent the urine from flowing back upward into the bladder. A weakened sphincter, which allows backup, is one contributor to bladder infections. Frequent urination with no increase in the amount of urine is a common symptom of bladder infection.

Most people urinate about 4 to 6 times a day.

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It’s ironic that modern hospitals, which ease suffering and save countless lives, can also be dangerous places that hurt the very patients they’re supposed to help. Each year at least half a million hospital patients are harmed or killed by mistakes that doctors, nurses, and other staff members make, according to recent estimates. At least 3 percent of hospital patients – probably far more – suffer an adverse event serious enough to lengthen their hospital stay. Roughly half of those events are preventable, according to a large Harvard study. Even by the lowest estimates, hospital errors are the eighth leading cause of death in the U.S., ahead of car crashes, breast cancer, and AIDS.

Some hospital dangers seem to go with the territory. Hospitals are breeding grounds for infection, including potentially deadly infections resistant to antibiotics. That’s because hospitals house many infected patients and many more who catch infection easily because their immune system is compromised or because invasive devices, such as needles and catheters, can carry germs into the body. Another important danger: Medication mix-ups. The average hospital patient receives ten different drugs; these often have look-alike labels or sound-alike names, and are prescribed by many different specialists who either don’t communicate with one another or who leave notes in handwriting that can be hard to read.

Human error – which exists everywhere – can be disastrous in hospitals. Doctors and nurses who fail to wash their hands between patients can spread infections. Busy nurses may mistake micrograms for milligrams and give wrong drug doses, or mistake one patient for another and give the wrong drug. Surgeons occasionally forget to remove a sponge or clamp before sewing the patient up; a few have even operated on the wrong side of the body.

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If you have two healthy kidneys, you have 100 percent of your kidney function. The human body is so amazing. This is more than you really need. That is why some people are born with one kidney, or give one of their healthy kidneys to a loved one, and are able to lead a normal, healthy life. So you see, even with declines in kidney function, you can still be healthy with 50 percent of your kidney function, if it remains stable. But many people with 50 percent of their kidney function have a kidney disease that will continually get worse. You will have some serious health problems if you have less than 20 percent of your kidney function. If kidney function drops below 10 to 15 percent, you cannot live long without either dialysis or a transplant. Damage to the kidneys may happen quickly, as the result of injury or poisoning. But most kidney diseases are slow and silent. It can take many years for the damage to become apparent.
Here are some of those slow, silent destroyers of healthy kidneys:

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Several types of alternative therapies exist, including herbals, vitamins, and dietary products. Many of the benefits from these products result from their antioxidant properties. Antioxidants have received much media attention in recent years regarding cancer prevention. A diet rich in fruits and vegetables, which are good sources of antioxidants, has been reported to lower a person’s risk for some types of cancer. Antioxidant supplements, which contain larger amounts of antioxidants than contained in food sources, have also been reported to decrease a person’s risk of developing certain types of cancer. Specifically, vitamin E and selenium supplements have been shown to reduce the incidence of prostate and colon cancer.

Antioxidants are also used by some patients during cancer treatment in the hopes of reducing the side effects of chemotherapy.

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