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The Cuban Pharmacopeia: Green Medicine

US + Cuba Medical Project


Advisory Board: Harry Belafonte, Angela Y. Davis,
Hon. Ronald V. Dellums, Alice Walker, et al.

The US+CUBA Medical Project was created in 1992 as a non- profit humanitarian and educational organization dedicated to sending licensed shipments of medical aid to the people of Cuba, facilitating dialogue and exchanges between the health communities of the U.S. and Cuba, and advancing the understanding of health care as a human right.Through education about how the U.S. embargo of Cuba limits the availability of essential medicines and medical supplies to the .Cuban people, we demonstrate the need for a more rational and just U.S. policy toward Cuba.We have sent $8 million worth of medical aid to Cuba to date.

US+CUBA Medical Project One Union Square West, Suite 21 1 NewYork, NY 10003

Board of Directors: Bob Guild, Trudy Orris, Guillermo Perez-Mesa, M.D, Karen Ranucci, Michael Ratner, Vivian Stromberg, Margaret Ratner

Advisory Board Harry Belafonte, Angela Y. Davis, Carmen Diana Deere, Ph.D., Hon. Ronald V. Dellums, Kathy Engel, Robert E. Greenberg, M.D., Bishop Thomas Gumbleton, Carlos Maldonado, Concha Mendoza, M.D., Jairo Pedraza, Helen Rodriguez-Trias, M.D, Helen I. Safa, Ph.D., Victor W. Sidel, M.D., Don Sloan, M.D., Benjamin M. Spock, M.D., Alice Walker

Staff Elena Schwolsky, RN, MPH

FROM THE DIRECTOR:

Dear Friends:

This Fall/Winter issue of Talking Cuba is filled with exciting reports and updates. Through our projects and shipments many people have come to learn about the inhumanity of the U.S. embargo against Cuba and oppose it on moral and legal grounds. Through licensed shipments we reach out to people in the U.S. who believe access to life-saving medicines is a human right.

Your generous support of the US+CUBA Medical Project makes it possible for us to increase the number and size of our health exchange delegations, follow through on our commitment to send life-prolonging medications to those with HIV/AIDS in Cuba, and continue shipping badly needed medications to the women and children of Cuba who are among the groups whose healthcare suffers most severely as a result of the U.S. embargo.

Sincerely, Margaret Ratner

************************************************ NEW STAFF!

Elena Schwolsky (RN, MPH) recently joined the staff of the US+CUBA Medical Project as Program Director. Sena is a public health nurse and community health educator with years of experience in program development for families in diverse urban communities. Elena's involvement with Cuba dates back to the early 70's when she participated in the Venceremos Brigade. She has wrok with the New Jersey Network on Cuba on local activity to end the embargo and, in 199 1, initiated an ongoing professional exchange between Cuba's AIDS Program and a pediatric AIDS program in Newark, New Jersey. From January to May of 1996, Elena worked in Havana with the Grupo de Prevenci6n SIDA (GPSIDA), setting up a "train the trainer, prevention education program for women and men living with HIV/AIDS in Cuba. Proyecto Memorias, the Cuban affiliate of the NAMES Project AIDS Memorial Quilt grew out of Elena's work with GPSIDA and in August of this year she coordinated the first International Display of the AIDS Memorial Quilt in Cuba.

LIFE WITHOUT BORDERS AIDS CONFERENCE The US+CUBA Medical Project's HIV/AIDS Program, Life Without TBorders, is proud to have co-sponsored a ground- breaking international conference in Havana, Cuba in August, 1997. The conference, "Building Bridges, Crossing Borders: HIV/AIDS and Sexuality in Cuba, the Caribbean, and Latin America" drew more than 300 delegates from the region and provided a unique opportunity for people living and working with HIV/AIDS to find common ground and develop strategies to work together on HIV/AIDS initiatives. Panels and workshops were coordinated by Dr. Jorge Perez of the Pedro Kouri Institute for Tropical Medicines.

70 North American Delegates Attend

In addition to US+CUBA Medical Project, conference cosponsors included the Global Network of People living with HIV/AIDS (North America), UNAIDS, the Pan American Health Organization, the Cuban Ministry of Public Health (MINSAP), the Pedro Kouri Institute, and the Sanatorium Santiago de las Vegas. Seventy delegates from the U.S and representatives from 21 countries participated. The U.S. delegation included a New York City council-man, representa- tives of advocacy organizations such as Immigrants Fighting AIDS, physicians, researchers, and activists from community organizations such as IRIS House in NewYork and Detroit's Latino AIDS Network.

Daily visits to the sanatorium in Havana provided conference participants with a first hand view of this aspect of Cuba's AIDS program. Delegates also attended,the opening ceremonies of the First International Display of the AIDS Memorial Quilt in Cuba.This event was sponsored by Proyecto Memorias, the Cuban affiliate of the Names Project AIDS Memorial Quilt.

A skills-building workshop for people living with HIV/AIDS was sponsored by the Pan American Association of People living with HIV/AIDS. It brought together more than 60 people, under the leadership of facilitators from PAHO and the International HIV/AIDS Alliance, in an empowering three day meeting designed to build a regional PWA advocacy network.

$300,000 Donation in Medicines

The US+CUBA Medical Project's Life Without Borders World AIDS Day Shipment was launched by a donation of $300,000 worth of medications and educational materials, presented by the U.S. delegation.

The theme of the conference was building bridges and crossing borders, and indeed delegates left with a sense of renewed commitment to the fight against AIDS in the Americas, and to ending the inhuman U.S. embargo against Cuba which threatens the health and well-being of Cubans living with HIV/AIDS.

World AIDS Day Shipment

In Cuba,World AIDS Day will be commemorated with a "Caravana de Prevencion"-a caravan that will bring AIDS prevention activities to communities throughout the island. The caravan will arrive in Santiago de Cuba on December I st to participate in a national ceremony dedicated to people living with HIV/AIDS. The US+CUBA Medical Project will send a vital shipment of advanced AIDS-related medications to join in this commemoration, as part of our ongoing HIV/AIDS program Life Without Borders.

We've all heard the good news in the fight against AIDS-the new life-saving medications like protease inhibitors that are bringing hope to thousands.The bad news is that these drugs- are expensive and, due to very real inequities in global resources, they are unavailable to most people living with AIDS. Within this global context, Cubans living with HIV/AIDS face a particularly difficult access problem. Not only are resources scarce and drugs costly, but the 37year old U.S. embargo prohibits Cuba from purchasing needed Al DS medications from pharmaceutical companies in the U.S. In 1992, the Cuban Democracy Act tightened the noose even fu rther by forbidding foreign subsidiaries of U.S. companies from doing business with Cuba. No other country is faced with such restrictions!

As a result of the embargo Cuba has shortages in all HIV/AIDS related medicines, essential equipment and supplies for testing and diagnosis, and materials for HIV prevention Cuba's supply of new AIDS medications (protease inhibitors and antiretrovirals) must depend entirely on international donations.

The US+CUBA Medical Project's THIV/AIDS Program, Life without Borders is committed to the goal of providing an 18- month supply of advanced AIDS-related medications to every person with AIDS in Cuba through an ongoing program of medical aid. In August, the U.S. delegation to the International Conference on HIV/AIDS in Cuba delivered the first part of that shipment-over $300,000 worth of medication and prevention materials. Last month, we sent a shipment of 3TC, one of the newer antiviral medications, sufficient to provide an 18-month supply for IO people. We are calling upon our supporters to help us make access to medication a universal human right by making the most generous contribution possible to this shipment.

LICENSING UPDATE In July the U.S.+CUBA Medical Project was granted a license by the Department of the Treasury to send $18,105 to Cuba to cover the costs for 34 Cubans from through-out Cuba to attend a conference in Havana on "Sexuality, and HIV/AIDS in Cuba, the Caribbean, and Latin America:' (See cover article on conference.) This was the "first license to be granted under the Cuban Assets Control Regulations which provide for certain licensed transactions in "support of the Cuban people" Obtaining a license for the transfer of funds, as opposed to material aid, was a landmark achievement for USCUMED which we hope will set a precedent for other licenses permitting the transfer of funds.

LEGISLATIVE UPDATE The Cuban-Humanitarian Trade Act (H , 1951), which would exempt food and medicine from the U.S. embargo against Cuba, was introduced in the U.S. House of Pepresentatives on June 18, 1997. This bill, which already has bipartisan sponsorship, would exempt food, medicines, medical supplies and equipment from the embargo against Cuba. Supporters of the bill view it as an opportunity to broaden congressional debate on the issue of Cuba. The bill currendy has 61 co-sponsors in the House and is awaiting introduction in the Senate. Supporters are targeting moderate Republicans and legislators who have not taken a position on this issue befor-e.The broadest possible co-sponsor ship will ensure that the bill will get hearings in key committees, and eventually be approved.

Although the State and Treasury Departments insist that large donations of food and medicine are reaching Cuba, the report of the American Association for World Health (see article in this issue of "Talking Cuba") makes it clear that the licensing requirements have had a profound chilling effect on virtually all sales and most donations from the U.S. to Cuba. The report also explains that a national medical system cannot be run only on donations; Cubans must be free to buy the specific medicines they need.

A campaign is underway to convince key members of Congress to co-sponsor this bill. For more information about HR-1951, please contact:

LATIN AMERICANWORKING GROUP 11O MARYLAND AVE., NE, Box 15 WASHINGTON, D.C., 20002 PHONE: 202-546-70 1 0 FAX: 202-S43-7647

IFCO/ PASTORS FOR PEACE 402 W 145TH ST. NEW YORK, NY 10031 PHONE: 212-926-S7S7 FAX: 212-926-5842

*************************************************

A Medical Student's Experience in Cuba: More Than Just Salsa and Cigars:

by Adrienne Phillips, Brown University School of Medicine, MD '00

When I first mentioned to my medical school advisor that I was interested in studying HIV/AIDS in Cuba, her response was, "Cuba? But they're communist, why on earth would you want to go there?" I was almost deterred, but I thought.. does that mean Cubans are immune to an international pandemic? Or that Cubans should not receive up to date treatment for a virus that has no cure? Or that Cuban health authorities can not offer some insight into an epidemic that has everyone puzzled? Furthermore, I admitted to myself that I was equally ignorant about Cuba. I did my senior thesis on AIDS in Cuba and Brazil so I knew more than the average person, but other than our government's frequent criticism of Fidel Castro and his socialist policy, the rh)rthmic beats of Cuban saisa and Afro-Cuban jazz, and the popularity of Cuban cigars, Cuba remains a mystery to the majority of Americans. This is especially true with regard to their health care system and HIV/AIDS policy. Leaving my advisor's office, I was even more motivated to make my summer elective happen, and I'm glad I did because although it might sound clich6,1 had the best summer of my life. Before going to Cuba, I spent a month interning at the US+CUBA Medical Project. Having traveled to Cuba with the Project in January 1997 to deliver medical supplies, I was aware of its efforts to encourage dialogue between US and Cuban health care providers.The Project was instrumental in getting my license to travel approved, and in arranging my six week program at the Tropical Medicine Institute, Instituto Pedro Kouri (IPK), and at the AIDS Sanatorium, Sanatorio Santiago de lasvegas (SSV) with Dr. Perez, the director of Cuba's AIDS program.

While in the office over the summer, I had a first hand glimpse of the complexity of planning anything that has to do with Cuba. For example, the bureaucracy involved in processing the applications for participants to an international conference. We were constantly on the phone with Washington explaining the importance of everyone receiving their license in a timely manner.

When I arrived in Cuba in July, I was received warmly by everyone. I was a little nervous about how people would respond to me as an American because I thought they would associate me with the U.S. government's foreign policy that has imposed such economic hardship. On the contrary, my Cuban host family, my friends, and the hospital staff at both the IPK and SSV welcomed me with open arms and took special care to make sure I had a wonderful experience. Each day I woke up at 6:30am in order to catch the guagua that passed through my neighborhood around 7:15am. My mornings were spent attending 4 conference where the doctor on call from the previous night reported the status of all the patients and new admissions. Rounds followed, usually on the AIDS floor with my two preceptors. My preceptors explained the disease process and treatment plan for each patient and also taught me a few physical diagnosis techniques (something that will prepare me as I start my second year of medical school here in the States). I saw patients with various infectious diseases, but the two that stand out in my mind are a patient with malaria and a patient with schistosomiasis. Having completed a microbiology course this past spring, it was timely to see these diseases in a clinical setting. Now I have faces and personalities to match the diseases, making themunforgettable. After lunch I went to the hospital's microbiology lab to learn diagnostic techniques and to view slides. I finished the day shadowing my preceptors in the outpatient consultation. The majority of the patients seen were HIV+. They were generally quite receptive to me. Many explained what it was like living with HIV and how they were treated by health care providers, their family, and their communities.

My agenda while in Cuba was to assess the Cuban response to HIV/AIDS and how their program is adapting to face Cuba's challenges of the 90s, particularly a changing economy and a tightening of the U.S. Embargo. For this reason, it was particularly rewarding that my experience working in IPK and SSV culminated with participation in the international HIV/AIDS conference. This was the first international conference that I have attended, and it was an extraordinary experience. Not only did I attend informative lectures and seminars, but I was also able to network with key international AIDS specialists from around the world.

As an American, the theme of the conference gave me the opportunity to reflect on the importance of sharing ideas and learning from others. Unfortunately, our government's foreign policy with Cuba has jaded the average American's vision of Cuba. Cuba is not the brutal, corrupt, politically repressive nation some would like us to believe. Of course there are valid criticisms of Castro and the revolution that have caused over one million Cubans to flee their homeland, but the brotherhood and pride felt by Cubans remaining on the island is remarkable.As an African-American, I was especially impressed by this nationalism as many of the people remaining in Cuba are of African descent.

It's an absolute disgrace that politics influence health care, but I as a future physician will not let this deter me from my goal to improve the health of my patients. Health care everywhere should be a human right, and despite the political problems between the U.S. and Cuba, the controversy should be left between our two governments. The U.S. Embargo has been in place for nearly 40 years, and is not making Castro and his government noticeably weaker. Instead, it is having a devastating impact on the health and nutrition of the general Cuban population. It is also allowing U.S. citizens to become ignorant to the true beauty of Cuban culture. In the 1950s, Cuba was considered an elite tourist spot with such notables as Nat King Cole and Ernest Hemingway making routine visits.

Today in 1997 it remains equally enticing, but unfortunately Americans are not legally allowed to enjoy the island without going through a highly bureaucratic license application process. It's easy to be critical of Cuban Society and of their strict HIV/AIDS program, but the revolution has survived for over 30 years and Cuba reports the lowest HIV/AIDS rates in the world. Thus, its policies must have some worth, and the only way to observe positive aspects of Cuban society is to spend time there. My pursuit of this experience was based on my desire to discover more about Cuba not necessarily more about communism, not necessarily to dance in the popular salsa discotecas (although it was fun), and definitely not to smoke Cuban cigars. It's easy to believe the media and all the antiCastro propaganda, but nothing is ever as it seems and I am glad that I had the opportunity to build bridges and cross borders with my Cuban hermanos.


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