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Volume 1, Issue 2
Summer 2005:

Two Years in Zimbabwe

Angelino Ramón Garcia Hernandez

Cell 2 Soul. 2005 Summer; 1(2):a4

Editor's Note: Dr. Angelino Ramón Garcia Hernandez (Figure 1) was a Cuban misionero physician in Zimbabwe from 2002 to 2004.

Figure 1: Dr. Angelino Ramón Garcia Hernandez

I had the opportunity to serve as a primary care physician for two years in Zimbabwe under the auspices of El Programa Integral de Salud. This program, founded by the Cuban government in 1998, began as a humanitarian response to the devastation caused by hurricanes George and Mitch in the Caribbean. Over 30,000 people died in these two storms alone. At the request of those countries affected by the tropical storms, Cuba agreed to send both medical and auxillary personnel to serve the needs of local populations, as well as solicit advanced technical equipment and medicines from industrialized nations for their use.

Today El Programa Integral de Salud (PIS) operates under the following principles.

  • Provide gratis, as long as they are needed, professional and technical medical personnel, especially in the area of primary care.
  • Medical teams provide services primarily in underserved rural areas.
  • Physicians provide medical care without regard to race, creed, or ideology, taking care to avoid internal political disputes, at all times respecting local laws and customs.

To date, PIS is active in 18 countries, providing 2,995 healthcare workers, 1,883 of whom are physicians. These workers serve over 8,132,165 inhabitants in 6,893 rural communities. Thus far they have attended over 5,177,837 patients, 1,135,431 of which are children, with 173,997 of those under a year of age. PIS has built 572 primary care clinics, 92 community housing units, 4 social centers, and one geriatric care facility. Sixteen hospitals are currently under construction.

Prior to our departure from Cuba, we were required to interview with a group of Zimbabwean medical examiners. I was anxious during this process, as this was my first experience interacting with a group of foreign doctors who spoke only English. In the end I was one of those selected to serve abroad.

Shortly after our arrival in Zimbabwe on February 28, 2002, my colleagues and I were escorted to the Zimbabwe Electricity Supply Authority (ZESA) Training Center in Harare. For the next eighteen days we were briefed on Zimbabwean customs and culture, and given an overview of the health care system in addition to a short course on the most prevalent health problems in the country.

National elections were underway at this time; for security reasons my colleagues and I were discouraged from traveling about in the city. This was a new experience for me; in my country elections occur peacefully, with no friction in the electoral process.

After our indoctrination, my colleagues and I were assigned to different regions in the country. They sent me for additional training to the lovely province of Bulawayo. It was very clean and so beautiful there that, after viewing the photographs I sent home, my family in Cuba thought that I had been to Europe. They couldn't imagine that such a modern city could be found in Africa, so accustomed had they become to the rural African scenes aired on television.

In the city of Bulawayo I got to know a good number of people, most of whom turned out to be very amiable and supportive. At this juncture I had the good fortune to establish several lasting friendships with the faculty and parents of students at of a local private school. Although I had it pegged as an institution catering to the wealthy, I was pleased to find that the majority of the students had their feet on the ground. These families welcomed the top-quality education for their children, but they also provided assistance so children with limited resources could attend as well. I will be forever indebted to a number of individuals here who extended much kindness and generosity to me during my sojourn in Zimbabwe.

It was in Bulawayo that I started my three-month training period. Here we learned to perform various surgical procedures, all of which were new and innovative to us. Family doctors in Cuba practice primary care; we don't attend patients in the hospital. In Zimbabwe it was different. We were taught to perform Cesarean sections and D&C's (dilatation and curettage) by those Cuban physicians who preceded us — a stoke of good luck, because they instructed us in Spanish.

I must admit that I was uncomfortable with my new responsibilities at first, but after rolling up my sleeves and scrubbing in on several procedures, I found them to be relatively easy to perform. What was required was patience and practice, and it was to this end that I dedicated myself. After an intense period of six weeks, I found that I could perform these procedures competently.

After this training, my next step was to serve the local population at the Gwanda Provincial Hospital (Figure 2). This is located in Gwanda, a city of around 20,000 people, in the Matabeleland South Province. During my sojourn there I worked closely with the nursing staff on the adult medical, pediatric and maternity wards (Figure 3). The hospital provided a small apartment for my living quarters and a monthly stipend of $50 for incidental expenses.

Figure 2: Gwanda Provincial Hospital

Figure 3: Nursing staff on the adult medical, pediatric and maternity wards

Although provincial, Gwanda boasted a large shopping mall that included a supermarket, a cafeteria, a phone store, an Internet café, as well as other small shops. The local people were always ready to assist me in whatever way they could, because they knew that I had come to serve as a resident doctor.

During my time in Zimbabwe I saw many interesting patients — interesting not only from a medical standpoint, but also from a personal perspective.

One day while working in the outpatient department, I attended a South African man who had come seeking care from "the Cuban doctor". He had voluntarily maintained celibacy for the previous fourteen years after learning that he was HIV positive. Several weeks before this visit he had developed a painless genital lesion, which distressed him greatly.

I prescribed medical treatment, and asked him to schedule a return visit. To my chagrin, the lesion showed no improvement. We discussed initiating antiretroviral therapy, but my patient could not afford the cost of the medicines. Although I had asked him to come back, he did not return for further care.

My encounter with this patient set me to thinking about the healthcare system in Cuba, where all HIV positive patients receive antiretroviral therapy gratis, as well as all other medications needed to treat opportunistic infections associated with AIDS.

Another interesting case happened in this way. During one of my nights on call, a nurse telephoned me at home, pleading with me to come in to evaluate a patient with an abscessed molar. He had traveled some distance to seek medical care, and the nurse had no idea what to do for him. I could scarcely believe my eyes when I saw his face (Figure 4).

Figure 4: Abscess patient

He told me that he had been stung by an insect six days ago. He subsequently developed facial inflammation, but he had to wait until he was able to scrape together enough money for bus fare to the hospital for medical treatment. We administered IV antibiotics and arranged for a dental consultation. The next day we transported him to the National Hospital for further care.

The saddest thing here was to witness the deterioration of this patient's condition, all for lack of adequate funds for transportation and treatment. I can hardly imagine the pain that this poor man had to endure just because he had no money to pay for his care.

For me the most difficult thing was to see first-hand the extent of the ravages of poverty on the people of Zimbabwe. Every time I saw a child begging in the street, I thought of my own child back in Cuba, and I gave whatever I could to help. There were times that I worked on the pediatric ward when we had no milk for the children. I would go to the market to buy two or three cartons of milk for the severely malnourished ones. It hurt me deeply to see how patients had to wait sometimes days for care due to a lack of funds for transportation or payment for medical services. Many times this resulted in unnecessary suffering that could have been easily avoided had the patient received timely care.

The two years I spent in Zimbabwe were unforgettable. The more I write of these things, the more I remember. And as I transcribe these words, I know that even now Cuban doctors continue to serve the people of Zimbabwe, colleagues of mine who have stepped forward to take my place. In many ways this experience served to make me a better doctor and a more caring human being. At the same time, I am happy to be home in Cuba with my family (Figure 5).

Figure 5: Dr. Hernandez and his daughter

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