Dr. Reymi Castillo González still maintains friendships with residents of Guamo Viejo, in the municipality of Río Cauto. Photo: Nuria Barbosa

Offering healthcare services in the country’s remote mountainous regions is a learning experience vital to the professional development of young Cuban doctors. After graduating they work for one year in offices in rural zones across the nation as part of their social service commitment.

Granma International spoke with a few of these doctors, all of whom highlighted the importance of their work based on principles of social justice and humanism. Their efforts have contributed to reducing infant and maternal mortality rates; raising average life expectancy, and reducing numbers of deaths due to chronic non-infectious diseases.

Dr. Gisel Acosta Fonseca worked in the community of San Lorenzo, located in the Sierra Maestra mountains, some 18 kilometers from the municipality of Bartolomé Masó in the western province of Granma.

The town has about 1,600 inhabitants, the majority of whom are coffee growers.
Acosta worked in a doctor’s office equipped to provide first aid and carry out health prevention and promotion measures.
There, she treated common conditions among the population including high blood pressure and diabetes. She also implemented national programs designed to reduce the levels of cancer, and respiratory, viral, and bacterial illnesses.

“Community-based social organizations support us in our efforts to implement a wide range of protocols. These include the Committees for the Defense of the Revolution (CRDs), The Federation of Cuban Women (FMC), and the National Association of Small Farmers (ANAP). At the same time we attend a primary and secondary school, as well as a boarding and semi-boarding institution, where we provide information on different issues, to teach children and young people correct food and hygiene habits to guarantee their health,” stated Dr. Acosta Fonseca.

Dr. Luis Rogelio Proenza Reyes learned about natural and traditional medicine while working in Montero. Photo: Nuria Barbosa

All pregnant women receive 12 scheduled consultations including their respective clinical exams and scans. The young doctor takes pains to stress the importance of infant care to expecting mothers, highlighting breastfeeding as the best way to feed newborns.

Meanwhile, those approaching their due date, or who presented preconception risk factors, are admitted to a municipal maternity home where they are monitored by ob-gyn specialists, she noted.
Dr. Acosta Fonseca went on to explain that children are also closely monitored during their first year of life with monthly check-ups and vaccinations against 13 diseases. When an emergency arises an ambulance is called and the Unitary Medical Emergency System activated.

“One of the main conditions I treated was an outbreak of severe diarrhea, with reports of seriously ill patients. Thanks to the support of the population and health authorities in the region we were able to eliminate the outbreak without it turning into an epidemic,” stated the young health professional.
Dr. Acosta Fonseca has also held public health talks, where she stressed the importance of hygiene and above all washing hands. “ The office received hydrating solutions and medicines to tackle the outbreak, and staff received immediate training regarding appropriate measures to take.”

Dr. Gisel Acosta Fonseca was supported in her work by community organizations. Photo: Nuria Barbosa

Dr. Luis Rogelio Proenza Reyes had a similar experience while working in Montero, a town near the municipality of Niquero, also in Granma province.

A largely sugar producing region, residents are known to be friendly but reserved.

“I lived at the office, in rooms next to the consultation area. The most common ailments I saw were intestinal parasites, respiratory infections, and allergies. We also had patients suffering from chronic non-infectious conditions such as, high blood pressure, diabetes and heart disease.”

Dr. Proenza Reyes was supported in his efforts by a group of pediatricians, obstetricians, cardiologists, surgeons, and oncologists, among other specialists, who visited the area every month. However, serious and or emergency cases were referred to the Gelasio Calañas General Municipal Hospital in the town of Niquero, or to the Celia Sánchez Manduley provincial hospital located in Manzanillo.

The young doctor noted that his office was equipped with the necessary medicines, tools, and devices to respond to almost all emergencies; and although he considers the training he received during his time as a medical student to have been highly beneficial to his work, he also sought help from an internal medicine specialist who often visited the surgery.

“Working in a rural area,” noted Proenza Reyes “I learned a lot about natural and traditional medicine, it taught me to be more sensitive to problems and find quick solutions despite a lack of material resources. I met humble and grateful people who are often scared to visit their local doctor's office, because they don’t know how to describe their condition. This experience gives us the opportunity to connect with people, different from those that live in urban areas, and who often teach us a different way of relating to one another.”

Meanwhile, Dr. Reymi Castillo González worked in the community of Guamo Viejo, in the municipality of Río Cauto, Granma province, with campesinos who dedicated their time either to growing rice or shrimp fishing. This was the first time she had visited the area, although she was born and lived only a few kilometers away.

Young doctor Yordán Reinier Merladet Montero described his time working in rural areas as a difficult but also valuable professional experience. Photo: Nuria Barbosa

The young doctor explained that she was warmly received by residents, and built and maintained friendships with some of her patients. “I had to address population aging because I was met with a group of people over 60 years of age. I believe that these residents were very concerned about healthcare at a social level; and wanted to know about good hygiene habits.”

Currently preparing to join Brazil’s “Mais Médicos” (More Doctors) program, set up by the government of former President Dilma Rousseff, Dr. Reymi Castillo González, who has already completed a short course in Portuguese and her training to become a Comprehensive Family Medicine specialist, described her time working in a rural area as gratifying and an important learning experience.
Meanwhile, her classmate Yordán Reinier Merladet Montero was stationed in a remote, mountainous area known as La Habanica, home to over 1,000 inhabitants. There, among the region’s lush vegetation, campesinos grow coffee, taro, and tubers. The town has electricity and telephone lines; and a well equipped office which included oxygen tanks, suture materials, and medicines to treat emergency cases, according to Dr. Merladet Montero. In addition to the consultation area, the facility was also fitted with a bathroom, kitchen, and two extra rooms, as well as household appliances and a radio station.

According to the health professional on the day of his arrival, at about 11pm, he received a patient with an injured leg.

“He was riding his horse when a big rock fell on him. It had cut his toe and his other foot was in pretty bad shape. That day there was no electricity, I had to use a lantern to do the stitches. The most difficult thing was finding the necessary materials to dress the wound. I don’t know how I did it, but I was able to treat the patient.”

Dr. Merladet Montero, who is also currently preparing to join the More Doctors program in Brazil, noted that he faced many fears during his time in La Habanica, all of which he was able to overcome with the help, respect, and support of residents. Regarding his time working in the country’s rural areas he categorically stated: “I fulfilled my duty to the Revolution and contributed my personal efforts to a common wellbeing.”