PNG-Cuba Health  Diplomacy in the Republic of Cuba

By: Dr. James Naipao

Republic of Cuba, in its very long history, were ruled by the Arabic Empire, followed by Spain, America-USA,  and Revolutionary Army in 1959 up to now.

Its people is made up of a small fraction of the original Aborigines, descendants of Spaniards living in Cuba is the majority, descendants of African Slaves who were brought to work in plantations, descendants of Chinese and Arabs. Now, the Cubans are living in Cuba, and they don’t know what colour is. A lesion the world over should learn from Cuban on the elimination of racial discrimination.
During the USA Trade Embargo on Cuba in 1959 up to now, the starved Cuba has survived the embargo to feed its people, cloth them and make the populace the healthiest in the world. All the food in the shelves and freezes are made in Cuba. Cuba is very good in agriculture, premium tobacco production and brewery. It is also a leader in primary health, biotechnology, and pharmacy.

The only historical and surviving living relics found from the revolution are the old 1940s to 1950s USA built cars and trucks seen on the roads in Cuba today and the old Spaniard Empire concrete buildings that are still standings and ready to come back to life. These two have become its national treasure and symbol beside its honour to its great writers, poets, farmers and revolutionary fighters and leaders.
From this visit, lesson learnt is; some explorers and colonisers in the early 1300s to early 1900s have conquered and built to permanently settle afar like Spain in Cuba while some have conquered, stolen and left with no permanent building structures to remember their past presence on the other continents and island.
Before the visit to Cuba, the following discussion points in Health were made in writing, petition and verbally discussed with relevant stakeholders;
a. In the past and present; high infant and maternal mortalities.

b. Low immunisation coverage.
c. Increase in non-communicable diseases.
d. Tuberculosis-malaria-AIDS seem to the frequent discussion points.
e. Run down health infrastructures and facilities from aid post to hospitals.
f. Rise in cancer and lack of management strategies to tackle this disease burden.
g. Rise in Trauma cases.
h. Poor Screening Programs.
i. Lack of health workforce. At present the country employs only 15, 000 health workers when the actual need is 55, 000. Doctor to patient ratio is 1 doctor: 17,000 people, and this ratio is the worst in the Oceania region including Australia and New Zealand.
j. Less or no doctors are based in the rural areas at the district hospital level.
k. The effective Health Extension Officer training in the past has lost its intended purpose, and this training program has also lost the grip of National Department of Health. It used to run this program in the past.
l. No revitalisation of the School of Medicine and Health Sciences Trauma Campus with manpower shortage and poor  renumeration, no new facility setup and no increase in the undergraduate intake over the years.
m. Governors of Provinces getting Provincial Health Authority on board when recipient Provinces are not fully being prepared for this concept.
n. The biggest challenge at our doorstep is that our population is doubling every 14 years, and our developmental milestones have not caught with this population pace.
o. The freezing of position creation in the public service by Department of Personal Management is having a burden in the Health Sector to employ health workers. There is an estimated 100 doctors who want to come to the public service but not able to do so because of the freeze.

Some positive Health Outcomes witnessed in the country so far are;
i. Revitalization of Community Health Worker (CHW) and Nursing Colleges, and new colleges are opening up,
ii. One or two good and effective Provincial Health Authority Provinces are in existence that the country can learn from,
iii. A few good hospital CEOs are improving the clinical and infrastructure development in the hospitals and provinces. These must be commended,
iv. Some provinces are placing doctors in district hospitals,
v. Number of nursing and CHW graduates is increasing,
vi. Some provinces are increasing rural health visits,
vii. Post-graduate Rural  Medicine Masters Program is deepening its roots. Support must be given to them to this program,
viii. More health policies has been tabled and passed than another departments so far,
ix. Immunization program is continuing,
x. Revitalization of a few healthy institutions,
xi. The need to revitalize the Schoolboy of Medicine & Health Sciences has been discussed with relevant authorities at the Taurama Campus, Department of Health and its Ministry, and recently with the Chief Secretary Ambassador Isaac Lupari and Prime Minister Peter O’Niell.

The National Doctors Association has been at the helm of putting this discussion point to the stakeholders.
In Cuba, visits were made to the medical institution, medical school, biotechnology institution and hospital, and the following were noted;
1. Cuba’s main priority is in primary health care, and the country is second to none in this one,
2. It has a tertiary health system whereby separate disease spectrums, paediatric, obstetric and gynaecology, transplant, surgical set of various surgeries are done in designated hospitals than what we do in PNG,
3. Immunization coverage is second to none in the world,
4. Leading player in the innovation of drugs in the treatment of diabetes,
5. Taking the lead in prolonging the life of cancer patients with better drugs innovation to treat cancers,
6. 70% of its pharmaceutical medical drugs used for medical use are produced in Cuba,
7. Cuba is leading in the innovation of vaccines,
8. Cuba has innovation patency to sixty drugs and vaccines,
9. Cuba has a very good training program and manpower in biomedical technology,
10. Cuba has learnt art of making organisms living symbiotically however, killing each other eventually, and thereby allowing a healthy and sizable agricultural yields, and minimizing the use of pesticides.

To pave the way for Cuba-PNG Health Diplomacy, a Memorandum of Understanding (MOU) was signed on 23/11/16 (Cuba time) between the two governments. The MOU includes the following categories;
I. Health Workforce. In the next three months, 20 to 30 primary health Cuban doctors will be deployed to at least ten district hospitals in the country where there are no doctors. An immediate deployment of a cancer specialist to Angau Hospital will be done, and  employment of some biomedical technologists. Provide Professors to the proposed new stand alone and revitalised School of Medicine and Health Science that will be done by the current Government, and it will be called the ‘PNG Medical & Health Sciences University’.
II. Health Research and Training. Assist PNG in Health Research and collaboration. Assist PNG in training its PNG Medical University Post-graduate students in Masters and Post-Masters training. Assist to train our Biomedical Technologist and others in health.
III. Medicines and medical supplies and technology. Cuba to assist PNG with medical drugs and vaccines for general medical diseases and non-communicable drugs in diabetes, cancer and hypertension. Assist PNG with medical supplies and diagnostic technologies.
IV. Information and communication technology. To assist PNG with Health Information and Technology.
V. Asset and Infrastructure. Assist PNG with asset and infrastructure development.
Prime Minister Peter O’Niell arrived in Cuba on the 21/11/16 from the APEC Meeting in Lima-Peru to officially visit Cuba at request of the President Castro. PM O’Niell and the PNG Team on the ground visited the Medical and Research Institution, Medical School and Hospital in Havana. In several of his speeches during these site visits, Prime Minister Peter O’Niell told the Cuban Government delegate on site after receiving collective advise from the visiting PNG Team and the situation back home that the PNG-Cuba Health Collaboration is an important one. Prime Minister O’Niell said, whilst the need to immediately recruit 20-30 Cuba Doctors to fill District Hospitals where there are no doctors, the medium to long term intervention will be to revitalize the proposed stand alone School of Medicine & Health Sciences as a University of its own by 2018. Once this is done, the immediate plan is to increase the under graduate intake to 100 and increase it to 300 intakes per year in the MBBS programme, and like wise to the other programmes offered. He requested that professors in Cuba to come teach at this new Medical University. He further stated that despite the difficulties that Cuba went through after the revolution, the people of Cuba have kept themselves together and he praised their robust health system. In the Primary Health, Cuba is number one in the world.
One of the National Doctor Association’s Petition in the need for the stand alone Medical University to the O’Neill-Dion Government has now been answered.
In the meantime, the 100 national doctors who are without jobs or employed outside of the public health system and wishing to join this health sector should immediately get in touch with either the Department of Health,  National Doctors Association or Medical Board Pre-registration Committee Chairman. Your name will then be forwarded to the Department of Health for employment.
Days in Cuba: 20-24/11/16
The PNG Health Diplomacy Team is comprised of the; 1. Prime Minister Peter O’Niell.

2. Madam Lynda Babao-O’Niell.

3. Hon. Rimbink Pato, Minister for Foreign Affairs.

4. Hon. Sasindran Muthuvel, Govenor for WNB.

5. Frank Aisi, Deputy Secretary (Policy), Department of Prime Minister.

6. Dilm, Foreign Affair Secreatary.

7. PNG Commissioner to United Nation.

8. Collin Punupo, staff of Office of Prime Minister.

9. Sakias Tameo, Deputy High Commissioner of PNG in Australia.

10. PM’s Media Consultant.

11. Health Secretary Pascoe Kase.

12. School of Medicine & Health Sciences Dean-Professor Nakapi Tefuarani (also, he is President of the PNG Medical Society and a paediatrician).

13. Medical Board Chairman-Dr. Osbourne Liko (also, he is the Chief Surgeon),

14. NDA Secretary – Dr. Sam Yockopua (also, he is Chief Emergency Physician)

15. NDA President-Dr. James Naipao (also, he is Chief Otolaryngology Head & Neck Surgeon)
<For Media Release>
Dr. James Naipao

National Doctor Association President.
Reporting from: Havana, Republic of Cuba.

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