US ISPO: Reaching Beyond Our Borders—Cuba 2015

The U.S. National Member Society of the International Society for Prosthetics and Orthotics (US ISPO) sponsored an educational, interactive conference and tour to Cuba, January 25-29. The tour was designed for O&P and other physical rehabilitation professionals, and offered opportunities to create bridges of understanding of professional, cultural, and human perspectives. [caption id="" align="alignright" width="257"] The oldest of the craftsman shoemakers had worked in the same job for 50 years. The youngest had just started learning and was making T-straps. Photograph by Dianne Farabi, courtesy of US ISPO.[/caption] Participants were given an inside view of Cuban rehabilitation services, had the chance to visit healthcare facilities and learn about Cuba's health system, tour iconic sites, and experience Cuba's culture. The following is a summary of the trip. Day One: The first day was taken up with a midmorning charter flight to Havana, Cuba, from Miami. After their arrival, attendees were treated to a bay-side lunch, a bus tour of Havana, and a welcome reception hosted by sponsors Becker Orthopedic, Cascade Orthopedic Supply, OPIE, Shore Prosthetics and Orthotics, and US ISPO Chairman Jon Batzdorff, CPO. Day Two: On Monday morning, Batzdorff welcomed the 42 participants and Cuban official representatives to US ISPO's first Cuba educational tour. The session took place at the Hotel Nacional, Havana, a block from the Hotel Capri, where most of the participants had accommodations. The first speaker was José Portilla Garcia, MD, professor of international health and representative of the Cuban Ministry of Health, with whom US ISPO representatives had met earlier this year. [caption id="" align="alignnone" width="439"] Photograph of a hip orthosis layout by Clint Snell, courtesy of US ISPO.[/caption] Takeaways from Portilla's talk about the Cuban health system included the following: Comprehensive general medicine (primary and family doctors) is the main focus for Cuban healthcare in order to make the best use of limited resources. Prevention and primary care form the basis of the system. More specialized care is provided through community-based polyclinics in each of the country's 15 regions. The polyclinics comprise the backbone of Cuba's health system. Population numbers are decreasing due to families having fewer children. 18.5 percent of the Cuban population is over 60 years of age. 10 percent of the national budget goes toward healthcare. Cuba has about 33,000 family physicians. Specialization in family medicine is required for more than 97 percent of medical graduates, who spend one internship year and two residency years in training after they receive their degrees. Later, they can apply for a residency in a second specialty. There are eight medical schools in Havana and 30 in the country. [caption id="" align="alignright" width="259"] Paul Prusakowski, CPO/L, FAAOP, examines a Cuban-made prosthesis. Prosthetic components from China, Brazil, Cuba, and from Ottobock, Duderstadt, Germany, were in stock. Photograph by Michelle Whitehead, courtesy of US ISPO.[/caption] The second speaker was the president of La Asociación Cubana de Limitados Físico (ACLFIM), a national support group with more than 74,000 members, whose mission is working for a future without barriers, and with total accessibility and full social integration for people with physical disabilities. He presented an overview of their activities, including employment and education opportunities, environmental and architectural barriers, family counseling, and sports and recreation. Day Three: Tuesday's agenda included a tour of Frank País Orthopedic Hospital, Havana, and a presentation led by Norberto García Mesa, MD, who gave an overview of the hospital, spoke about the hospital's special projects, and fielded questions from the group. Participants were interested to hear about a new biomedicine for treating diabetes-related foot ulcers that is getting strong attention. The treatment was developed by a young Cuban inventor at the Center for Genetic Engineering and Biotechnology and is currently undergoing clinical trials in several countries. The group also toured the various departments and visited the "gallery" of internationally noted Rodrigo Álvarez Cambras, MD, titular professor of academic merit and director of the Frank País Hospital Orthopedic Science Complex. Day Four: Zamarreño Hernandez, MD, welcomed the group at the Julio Díaz González National Rehabilitation Hospital, Havana's largest rehabilitation center, where he outlined the work being done there and his philosophy of rehabilitation, which he explained is based not only on scientific aspects, but also on considerations of the patient's total environment. He reported that they are making their own equipment for functional electrostimulation for neuromuscular treatment, and that they are working on a virtual reality program with the University of Havana that will involve avatars for dancing therapy; the free software is slated to be available in April. [caption id="" align="alignright" width="350"] The government-sponsored healthcare system does not cover prosthetic components. Individuals must purchase these devices. A transtibial prosthesis costs $90. The average monthly income in Cuba is $20-$30. Photograph by Clint Snell, courtesy of US ISPO[/caption] A highlight of the trip was a tour of the country's largest O&P facility, Julio Díaz González National Center of Orthopedic Technology. The building encompasses several city blocks. The first room toured was the prosthetics lab; attendees saw casts, laminations, and prostheses in various stages of finish. The U.S. group members and the Cuban workers began spontaneous and enthusiastic conversations, exchanging ideas and suggestions, and the language barriers seemed nonexistent. The next room was the shoe fabrication room, where custom, leather-welted shoes are handmade using custom lasts. Shoes of every size and shape were being made, from the first molding of the leather to the last eyelet. Here the conversation was equally engaging but completely different as the U.S. group realized that none of them possessed the skill to do what these shoemakers were doing. Other areas toured featured handmade corsets, metal and leather leg braces, and metal and leather back braces. One tour participant remarked that although the Cuban technology lags behind that of the United States, the workmanship is superior. US ISPO plans to continue communication with some of the Cuban representatives to discuss future activities, including twinning, participation in Cuban conferences, and other educational initiatives. "Cuba is a lesson about what is possible with few resources," said Dianne Farabi, US ISPO executive director. —Jon Batzdorff, CPO, US ISPO chairman, and Dianne Farabi, US ISPO executive director

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