Lessons from the global south

Does America have the greatest health care system in the world?

If you get a serious illness like cancer, have terrific health insurance and access to the top-notch physician specialists in your community, then there’s little doubt the American medical system is capable of performing miracles.

But a health system that doesn’t guarantee primary or preventive medicine as a basic human right – can it really be called “the best?”

That question was at the root of a talk in Milwaukee last week by Dr. Luther Castillo, a Honduras-born physician who is part of an international movement of health professionals who believe access to health care is a basic human right.

Dr. Castillo also has been leading an international team of doctors in Haiti who are volunteering their services to the 300,000 Haitians injured in the catastrophic earthquake last January. Castillo supervises hundreds of doctors who’ve traveled from two dozen countries, including the United States.

One of the first doctors to come from the Afro-indigenous Garifuna population in Honduras, Castillo was featured in the 2006 documentary film Salud! (Spanish for “health”), which examined how the cash-strapped, Communist island of Cuba achieved universal health care despite the country’s lack of resources. Once described by the BBC as “one of the world’s best,” the Cuban health system operates on the premise that preventive medical care is a birthright of all citizens. Castillo is a graduate of the Latin American School of Medicine in Havana, Cuba, which provides free medical education to low-income students from communities lacking in health care services. To get a free medical degree, students must promise to return to their home countries to work as doctors after graduation.

After earning his degree, Dr. Castillo went home to Honduras, where he opened the first independent, non-profit hospital to provide free health care to the impoverished Garifuna people. Although the hospital has helped thousands of local patients, it’s not unusual in developing countries for political and business leaders to consider such humanitarian work as a threat to their power. Consequently, Castillo — an outspoken critic of the military coup that overthrew the Honduran president in June 2009 —is now a target of that country’s new military government.

On a break from his work in Haiti, Dr. Castillo told the story of his life and work to about 75 people at Central United Methodist Church in downtown Milwaukee. He believes strongly that everyone deserves access to health care, no matter his or her status in society. To him, being a physician means living a life of public service, a philosophy taught by Cuban medical schools and one that differs from the view in the United States, where health care is a for-profit industry.

Dr. Castillo’s presentation in Milwaukee was sponsored by the Latin America Solidarity Committee, the Wisconsin Coalition to Normalize Relations with Cuba and other political and labor groups trying to advance discussion of health care as a basic human right in the United States. Also speaking that night was Dr. Paul Brodwin, an associate professor of medical anthropology at the University of Wisconsin-Milwaukee, who has extensively researched health care delivery systems in Haiti and other parts of the global south.

As it improves its own health care system, America can learn a lot from Dr. Castillo’s work and health care delivery in the global south, Brodwin said. One idea involves expanding the use of “community health workers” — the U.S. equivalent of case managers and public health nurses — to improve access to preventive medicine and primary care in low-income, underserved communities.

“The time is long past when the United States should tell other countries how to run their medical systems,” Brodwin said. “We should celebrate and take advantage of new flows of knowledge and expertise from other corners of the world.”

From Dr. Castillo’s talk, Brodwin said he took away two key lessons. The first is that high quality health care always and only comes through a political struggle.

The second focuses on differences in physician training in Cuba versus the United States. The medical school Dr. Castillo attended in Havana seeks talented students from poor and underserved communities and educates them for free with the idea that they’ll return home to serve. By contrast, Brodwin said, U.S. medical education has evolved in a direction where students not only need academic talent to get into medical school, they also need social privilege. And once in school, many U.S. medical students gravitate toward lucrative medical specialties and sub-specialties rather than primary care and areas with the greatest health needs.

“The Cuban model of medical education is an inspiring counter-example,” Brodwin said. Although it’s not a model that America can copy, Brodwin suggested “we should look carefully at how our system of medical education colludes in the maldistribution of medical resources and talent.”

It’s definitely a discussion worth having.

More information about Dr. Castillo, the Cuban health care system and the quest for global health can be found on the Salud! website.