Cuba & Zika

Author: David Kotok, Post Date: October 16, 2016
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I’m in Cuba and have been meeting with doctors and others to learn what the situation is here with regard to Zika. I’ve visited a daycare center and a rural community and been briefed on mosquito control.

What I’m learning is eye-opening.

Cuba has 3.5 times the population of Puerto Rico. While Puerto Rico has 25,955 confirmed Zika cases, Cuba has only 14, 13 of which were contracted off the island.

(Note: Keep in mind that all Cuban statistics reported here are official government numbers. That is the only data we have. People here are very cautious about contradicting the government, and the government knows every person I met with.)

But on the face of it, Cuba is doing a better job with Zika defense and related health issues than we are doing in America and certainly better than we are doing in the nearby American territory. Cuba and Puerto Rico have the same climate. The same rainfall. The same species of mosquito. Yet the outcome in one place is so vastly different than in the other. How is Cuba doing it?

The Cubans learned some hard, valuable lessons from epidemics of dengue fever that hit them in 1977, 1981, and 1997. These outbreaks killed hundreds of people, and hundreds of thousands were infected. In the wake of the 1997 epidemic, an epidemiological alert system was established; and mosquito control was reinforced in the entire country.

What that means on the ground is that mosquito control teams visit every house in the country at least weekly, and schools and other community facilities receive daily visits. They fumigate weekly. Standing water elimination is a constant. People attribute the lack of Zika cases to this preventative effort that they learned from combatting dengue. I’m getting this story from villagers, teachers, and others – it’s not just a government propaganda story; it’s real.

Cuba has a national healthcare system with about 80,000 physicians and 80,000 nurses. The doctor-nurse teams cover the entire country and attempt to fully know every household. The healthcare system is very community-focused, so there is a lot of personal visiting by the doctors and nurses, hence a strong emphasis on prevention. Medical care in Cuba is a constitutional right and a national cultural tradition. Say what you want about communism and universal healthcare – and there is plenty to criticize – but when it comes to Zika prevention efforts, Cuba is hugely ahead of the US.

In sad contrast – and you may not have seen this reported in the news – the number of locally acquired cases of Zika in Florida can no longer be counted on one hand. In fact, they now number 164 and have spread beyond Miami to at least five Florida counties. (See http://www.miamiherald.com/news/health-care/article66790817.html.)

The total number of confirmed Zika cases in the 50 US states is now 3,936, and Alaska is the only state where Zika has not appeared (http://www.cdc.gov/zika/intheus/maps-zika-us.html). Is this vast difference in the management of Zika between the US and Cuba due to lack of Zika defense funding by our government? Are there other reasons for the difference?

I still have many unanswered questions as I continue on this trip.

I asked if there were any Zika birth-defect cases. The official answer is that there Is none. (There have now been at least 28 in the US and Puerto Rico, and 2,684 pregnant women have Zika.)

I asked about the treatment of cases where the fetus shows abnormal indicators. Answer: Abortion is fully legal in Cuba. There is no debate about that. Also, the medical system allows doctors to advise couples of possible risks or indicators of deformed or abnormal babies. The final decision on an abortion is up to the parents.

I asked for abortion statistics. I Could not obtain them. Births yes, but abortions no. I asked who had those statistics. Answer: the health ministry. I asked how to get a meeting to discuss Zika details and infant mortality and abortion. Answer: It takes an official inquiry that must be presented in writing and must receive advance approval by the health ministry. I asked if the abortion policy contributed to the low infant mortality rate. Answer: You have to ask the health ministry.

But I am impressed by how good a job the nation of Cuba seems to have done with Zika – and depressed by how poorly we have done in my own country. It is about time we woke up to the growing reality of Zika damage to our families and economy. For our other reports about Zika and US policy failure see www.cumber.com.

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