If You Give a Doctor an Idea

By Christina La Fleur

In 2016 and 2017, University of Illinois Cancer Center doctors and a team of Cuban Ministry of Health representatives observed healthcare practices in each other’s countries with the hope of addressing maternal and child healthcare in underserved Chicago communities.  

Dr. Robert Winn of Chicago had been looking for a solution to solve community health problems with few resources. In Cuba he saw the scarcity, but he also saw low infant mortality and high community trust, which was accomplished through the Cuban home visit system. 

In Cuba, primary care physicians “try to solve the problems of the community because they live in the community,” says Dr. Jose Armando Arronte Villamarin, a Cuban primary health professional. Cuba’s healthcare system has a  pyramid focus, from the individual to the family to the community, that starts with a visit to patients’ homes.  According to Dr. Armando, during the visit individuals are put into one of four groups – healthy, at risk, sick, or living with a disability – and are seen in the local office for care. A community-level health assessment is made every year.

In Chicago, the visiting doctors instructed the American team on how to conduct 45-minute home interviews, which include questions on health directly, but also on living conditions that could have an impact on, or represent a barrier to, maternal and child health. When the flyers for the program went up, women started contacting the team directly, and, surprising the -unaccustomed Americans, welcomed them into their homes. The interviews have been used to assess individual and community needs, and follow-ups will be based on which of four groups the women were placed in.  

While the doctors are thrilled with the results in Chicago, both the American and Cuban sides had to go out on a limb for and in the program in more ways than one.  

For Dr. Tossas-Milligan and the rest of the UIC team, earnest ignorance was bliss when it came to starting a collaboration with a country the United States has blockaded for half a century. “The impossible just takes a little longer,” she said of her persistence in dealing with officials on both sides of the straits.

Through frank conversations and support from lawmakers at every level, the UIC team established a working relationship with the Ministry of Health and the Cuban embassy. Looking for project approval from the Office of Foreign Assets Control, the team’s inquires spurred amendments to the Cuban Assets Control Regulations, easing the process of arranging medical research collaborations (see part one [LINK] Context for more information).  According to Dr. Tossas-Milligan, the Cuban delegates to the UIC project received the first ever J-1 work and study exchange visas awarded to Cuban Ministry of Health representatives.

With these strides, American researchers have seen the achievability of working with Cuban medical professionals in US communities where their healthcare methods are needed. However, it took a certain level of trust and humility for the Americans to “show [the Cubans] our drawers.”  In turn, the Cuban government had to send top talent “into the belly of the beast,” in the words of Dr. Tossas-Milligan,  their eternal neighbor and long-time enemy.   

For the Cuban doctors, the working conditions in the United States were also fundamentally different from most other Cuban medical diplomacy missions.  When Dr. Armando was working in Namibia from 2004 to 2007, he personally saw patients and his office was in the same building as the minister of health. His job was to oversee the health of the community, and also to advise the minister. In Chicago, the visiting health professionals advised within the project and had no role in policy.  The project was an academic collaboration, and so demonstrates the flexibility of Cuban medical diplomacy to accommodate a range of relationships and medical environments.  

While their work during the Ebola crisis helped Sierra Leone recover from an emergency, and their work in Brazil provides Cuba cash flow and Brazil long term support, the Cuban Ministry of Health representatives in Chicago were able to build a scientific relationship with local doctors to address systemic health issues within a policy and cultural environment very different from their own. The project showed, Dr. Armando says, “it is possible to do it together.” At the same time, as with other missions, the doctors built an “impossible to break” relationship with the Chicago community.

The collaboration has strengthened ties between the US and Cuba by establishing connections between the doctors, shaping patients’ understanding of Cuban medical care, putting a new mile marker down for Cuban medical diplomacy, generating interest in new partnerships, and forging a path for researchers to beat down any bureaucratic doors on the way to establishing those partnerships.

The project has led to some immutable changes in the US-Cuban relationship, but the rapprochement that began under President Obama may be walked back with the new administration (for more on this and other issues facing future US-Cuban medical collaborations, see the last article in the series, “Studying the Horizon”). American national policy changes could still leave medical diplomacy programs between US institutions and Cuba in limbo.

In the next installment of this series, we will look to the future – for this program, US-Cuban relations, and medical diplomacy.

The content of this piece and series is based on interviews with medical doctors involved with the UIC-Cuban Ministry of Health program.

Christina La Fleur graduated in 2015 with a B.A. International Relations and Political Science at Boston University.