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Monday, January 29th, 2007 03:34 pm
My kid is actively pursuing medical school anyplace but here, by which I mean Europe, Canada, and Cuba.
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Wednesday, January 31st, 2007 11:10 pm (UTC)
I know there's some disagreement about the actual state of healthcare in Cuba. The people I've talked to who want there in person make it sound fairly dire (and mostly they're people who are *trying* to make it sound good). The doctor/patient ratio seems to be *excellent*, the basic preventive work very good, for whatever reason they seem to have less of an AIDS disaster (not sure that's a medical outcome though). The changes in infant mortality over time are troubling, and questions on how the policy on aborting high-risk pregnancies impacts those stats are interesting (my emotional reaction is that they should be, but I'm not I think up to overriding the parents' decision, but then who pays for care if it's really expensive?)

If you happen to know (or if you care enough to read it), do you feel the Wikipedia article http://en.wikipedia.org/wiki/Healthcare_in_Cuba is reasonably "neutral point of view"?

Correspondence in the New England Journal of Medicine seems to show considerable difference of opinion about the training system, too. There's also a long interesting article in the Washington Post largely about an American woman named Melissa who's studying there, which has little bad to say about the training as I read it (but lots about the living conditions of course). I'm guessing you (and he) have found these obvious things already, I'm just noodling about info sources and conflicting data sort-of in general.

Anyway, more good doctors are generally a good thing, and it mostly seems to be a pretty darned fulfilling career, if you survive the training sane.

Certainly emigrating to a different country is a *really* big deal. All of us have ancestors who did, of course (at least so long as Africa as the source of H. Sap. holds up).
Friday, February 2nd, 2007 07:44 am (UTC)
The changes in infant mortality over time are troubling
The CIA factbook gives Cuba's infant mortality rate in 2005 as 6.33 per thousand. The US has 6.50 per thousand in the same year (that is to say, a slightly worse rate, though not significantly).

If I try to find a country with a similar wealth, I run into difficulties, because the countries I can find with similar PPP (http://en.wikipedia.org/wiki/List_of_countries_by_GDP_%28PPP%29) (which appears to be a GDP adjusted to make it more comparable across countries) are pretty dire, except for Slovenia and Oman: war-torn Serbia, Cameroon, Turkmenistan, Nepal, Kenya . . . only Slovenia has a better infant mortality rate than Cuba. Serbia has the next best of this group after Cuba at 12.89, more than twice the rate. Oman, which Wikipedia refers to as "a major success story for economic growth," has a rate of 19.51, more than three times that of Cuba.

So what's the troubling change here? Are you troubled because it's been getting better, is much better than you could expect for the economic condition of the country, and compares quite well to the US?

The article was kind of a hash, I thought -- it repeated the same sentences about infant mortality and abortion several times, to the point where I thought I must be reading it badly. I'd rather have seen more facts about health care delivery: doctors per capita, doctors per capita by urban v. rural, well child visits and vaccinations, mortality rates for indicator conditions (perinatal maternal mortality, for example, or nosocomial infections). To quote somebody saying "This hospital is dirty" is mildly interesting, but I don't know what to make of it. "Dissident surgeon" covers a lot of ground, and I don't know whether the guy's a Semmelweiss or a nutcase or what.

There's no such thing as a neutral point of view. To be useful to me, an article doesn't have to be neutral, or to share my worldview (which for the record does not entail worshipping Cuba, which is as we all know a place with a sketchy government and not nearly enough democracy). But it does have to give me material I can chew on and decide its meaning for myself.

The high abortion rate is a good thing, I think. Damn straight it contributes to a low infant mortality. It's much, much better to elect to abort than it is to wait and let the child die a painful and ugly death outside the womb. Not to mention the wear and tear on the mother. Go Cuba.