ACR Bulletin

Covering topics relevant to the practice of radiology

Healthcare in Havana: Excursion Explores Radiology Resources

A trip to Cuba leaves a delegation of U.S. physicians with a new appreciation for the work of their colleagues in the Caribbean nation.
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The week provided our delegation with a unique and intriguing population health experience.

—Howard B. Fleishon, MD, MMM, FACR
January 01, 2024

A group of radiology delegates and guests visited Cuba last fall for a professional exchange. Our goals were to gain a better understanding of the state of radiology and its challenges there and to reach out to our Cuban colleagues. The delegation of 23 physicians and 10 guests was organized by Citizen Ambassadors, a company expert at professional international visits. All delegates and guests paid for their own expenses. 

Cuban medicine is centered on a system of family medicine and primary care. Local offices are supported by regional clinics, with a number of larger hospitals and specialty centers located mostly in Havana. The focus on primary care is not surprising, given the limited resources and intention to reach as much of the population as possible. Healthcare is largely public with little privatization.

Our six-day itinerary, which began Oct. 1, 2023, included a local “polyclinic” or multi-specialty center and one of its neighborhood offices; the National School of Public Health (ENSAP); the National Institute of Oncology and Radiobiology of Cuba (INOR); the Ministry of Public Health to discuss breast cancer and screening; the Cuban Institute of Friendship with Peoples (ICAP); and a visit with the president of the Cuban Radiological Society.

Public health was presented as a priority for the Cuban government. The physicians we met were open, transparent and accommodating. Although highly regarded in the Caribbean and select South American countries, Cuban medicine is relatively isolated from the larger international healthcare community. 

Comparisons to American medicine are difficult if not inappropriate. For instance, infant mortality is reported to be very low. Yet, during the COVID-19 pandemic and due to its political isolation, Cuba was left to develop its own vaccine. More than 90% of the population was inoculated because of government mandates. In another example, incidence and mortality of breast cancer are high, complicated by the prohibitive costs for screening mammography.

Public health was presented as a priority for the Cuban government. The physicians we met were open, transparent and accommodating.

—Howard B. Fleishon, MD, MMM, FACR

Access to radiology resources is a problem and is not evenly distributed. Ultrasound in community offices, especially for pregnancy, is available. At the specialty hospital, there was a respectable array of advanced technology along with a PACS system. Yet the regional polyclinic we visited did not have functioning imaging equipment. 

The Cuban people are proud of their culture and very friendly. We experienced many memorable professional and personal interactions. Although English is not widely spoken, we had the good fortune of having expert guides who translated and helped us appreciate the culture.

Travel to Cuba is complicated. Visas are required with specifically approved conditions, especially for U.S. visitors. The only hotels permitted for Americans by the U.S. government must be privately operated, with no ownership by the Cuban government. The Cuban government specified the sites we were to visit after examining our CVs. 

We centered our experience in Havana. In its heyday, Havana certainly must have been an incredible city. Our hotel facilities were consistent with American standards. Unfortunately, much of the metropolitan area is in disrepair. Food choices can be limited. Public services can be sparse. Interestingly, the value of the U.S. dollar is established by the government but can be “flexible” depending on the merchant.

The guests accompanying our delegation were treated to an itinerary of art, culture and visits to historical landmarks. Some highlights for everyone included touring old town Havana, transport in local rickshaw-like “coco taxis,” a demonstration in wushu martial arts and a tasting at a local rum factory.

The week provided our delegation with a unique and intriguing population health experience. This was a rich mix of professionals and personalities. We had a diversity of participants with Gen-Zers all the way to “seasoned” citizens. Everyone was engaged, enthusiastic and eager to participate in the opportunities, conversations and, at times, frank discussions. We continue to stay in touch via WhatsApp.

Each member of our delegation expressed appreciation for the importance of international cooperation in radiology. Although U.S. radiology has its challenges, we are fortunate to practice with relatively limitless resources. By contrast, our colleagues in a country only 90 miles from our coastline struggle with difficult daily compromises because of the realities of their practice. 

Our delegation came away with the commitment that despite barriers due to longstanding political polarities, professional societies in our countries can come together to share education and expertise with the joint vision to improve patient care.

Author Howard B. Fleishon,  MD, MMM, FACR, professor at the Emory University Department of Radiology and Imaging Services, immediate past president of the ACR and former chair of the ACR BOC