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PAHO

La fiscalización y el acoso al psiquiatra cubano Dr. Sergio Ramos por parte de Ministerio de Salud Pública (MINSAP).

En días recientes recibí por correo electrónico el texto de una carta abierta enviada al Presidente de la Asamblea Nacional del Poder Popular de Cuba por parte del Dr. Sergio A  Pérez, Psiquiatra cubano de reconocida trayectoria en el campo de la Suicidiologia. Buscando los antecedentes de esta información encuentro esta entrevista que aparece en el sitio web: Médicos y Pacientes. En ella el Dr. Sergio A Pérez Barrero trata temas tan controversiales como son la situación de indefensión de los médicos especialista cubanos en su trabajo diario y en sus desempeños  profesionales. También trata temas espinosos como son la participación de los médicos especialistas cubanos en eventos internacionales y los derechos humanos. El hostigamiento  laboral y profesional es notorio contra este especialista. Como parte de la búsqueda de información el nombre de este siquiatra cubano aparece en una polémica relativa a un plagio de unos de sus trabajos por parte de un académico puertorriqueño. 
Aquí incluimos el texto de la entrevista y esperamos que los lectores aporten informaciones y comentarios al respecto. El Editor


El Dr. Sergio Pérez es un psiquiatra cubano, fundador de la Red Mundial de Suicidiólogos, asesor de la Organización Mundial de la Salud en temas de suicidio y un reconocido autor en este tema. Aislado profesionalmente, controlado y fiscalizado por el Ministerio de Salud de su país, no puede salir libremente para sus compromisos y trabajos profesionales, necesitando siempre un permiso especial

Reconoce que es difícil que su contexto varíe y subraya que “mal puede andar un país cuando una prostituta goza de mayor libertad que un médico, porque ella no necesita autorización de funcionario alguno para salir del país y yo tengo que ser autorizado por el ministro”. Ante este escenario, el Dr. Sergio Pérez se muestra muy escéptico y no cree que la reciente visita del presidente estadounidense Barack Obama a Cuba vaya a ayudar a mejorar su situación, “puesto que a las autoridades de Salud les importa un bledo su visita de cara a estas situaciones domésticas. Están más interesados en los negocios que puedan hacer siempre que puedan ejercer como intermediarios”.
¿Desde cuándo atraviesa esta situación de aislamiento? 
En Cuba el aislamiento no es perceptible para un observador no entrenado. Desde hace varios años he tenido que enfrentarme a las máximas autoridades de la Psiquiatría en el país por mi dedicación a este tema. El Comandante Bernabé Ordaz, director de la Revista del Hospital Psiquiátrico de La Habana se negó a publicar mis artículos en la única revista en la que podíamos publicar los psiquiatras pues eran sobre el tema del suicidio. Tuve entonces que publicar en revistas extranjeras.
El Dr. Sergio A Pérez
en lo que parece ser su oficina de consulta como Psiquiatra.
Hace años le pedí que publicara uno de mis libros y que les donaba los derechos de autor a los pacientes de esa institución con la condición que le hiciera el prólogo. Y en el texto dice todo lo contrario a lo que afirmó en la carta que me envió en respuesta a la que hice a la Comisión Editora, pues se le exigían a mis artículos lo que no cumplían los publicados por los miembros de dicha comisión.
Fui llamado al Ministerio de Salud pues el Jefe del Grupo Nacional de Psiquiatría le hizo una carta al viceministro primero de entonces, el Dr. Abelardo Ramírez en el que le decía que yo “estaba dando datos sobre suicidio que atentaban contra la seguridad del país y que pretendía crear un sistema de salud paralelo en Cuba”.  No pudo probar esas mentiras que aducía y se consideró que yo no tenía problemas. Pero no le ocurrió nada a quien dijo esas mentiras que atentaban contra mi actividad profesional. 
Años después se me privó de asistir a un congreso en Uruguay, con todos los gastos cubiertos que es la única manera que puedo salir de Cuba, y me dijeron que no debía asistir pues "no era prudente" que lo hiciera. Pero nunca nadie me dijo quien fue quien considero tal cosa ni quien tomo tal decisión. 
Se me intentó despojar de un viaje a Costa Rica como asesor temporal de la OMS pues deseaban que fuera el Jefe del Grupo Nacional de Psiquiatría, a quien no habían cursado invitación alguna. Me defendí y fui citado por el viceministro de Asistencia Médica a una reunión en una oficina del Palacio de las Convenciones con el presidente de la Sociedad Cubana de Psiquiatría, el Dr. Ricardo González. Y fuimos los dos a Costa Rica. Pero deseaban dárselo a ese señor dadas las ventajas económicas que tales viajes patrocinados por la OMS ofrecían.
Hace meses no se me envían estudiantes ni residentes a mi consulta a pesar de ser el psiquiatra de mayor categoría docente de Granma, mi provincia y desde hace años no se me invita a evento científico alguno en el territorio. 
Recientemente me enteré que mi libro ‘Psicoterapia para aprender a vivir’ fue publicado en el sistema braille para ser presentado en la Feria Internacional del Libro 2016. Ya fue publicado y se me ha mantenido desinformado, no me han avisado, no me han pagado y en esta ocasión denuncié lo sucedido e hice público que había donado mis derechos de autor a la Asociación Nacional del Ciego y Débiles Visuales. 
¿Cómo es su día a día? 
Todos los días son similares. Trabajo en un programa de radio en Consejería, de donde se me ha querido expulsar, pero aún no lo han hecho porque “no han recibido la carta del organismo superior”. Cuando eso suceda, me tendré que ir del programa, lo cual he sabido por personas que trabajan en la radio y que siente admiración por lo que hago y han sido testigos de primera mano de esos comentarios. Trabajo en un centro de rehabilitación de adictos y realizo consultas en el barrio más humilde y con las peores condiciones socioeconómicas desde 1986. 
¿Cómo está siendo fiscalizado? 
Vuelvo a decirle que para un observador no entrenado, pudiera parecer que no estoy fiscalizado. Escribí una carta a Cubadice, programa televisivo en el que denunciaba la actitud de los periodistas ante los males de mi patria y después de esa carta, que fue discutida en las unidades militares y en las reuniones del partido comunista, me han enviado varios “lobos disfrazados de ovejas” como supuestos “disidentes” proponiéndome pegar carteles contra el gobierno, supuestos “periodistas independientes” para hacerme entrevistas, supuestos “pacientes” que me piden si puedo comunicarlos con alguna oficina de derechos humanos para denunciar un prolongado tramite de una vivienda u otra situación, pero no he caído en la trampa de hacerles el juego. Yo amo a mi patria no a quienes la administran que no han probado ser eficientes. 
¿Puede salir con libertad del país? 
En el 2012 no fui autorizado por el actual ministro de Salud a cumplir con dos invitaciones con todos los gastos cubiertos al congreso de Psiquiatría de Chile y al Foro de Prevención del Suicidio de la Asamblea Legislativa de Costa Rica. Con el dinero que me regaló un amigo psiquiatra chileno, el mismo que me había invitado, pude sacar el pasaporte personal y salir sin necesidad de pedir permiso a las autoridades de salud entre 2013 al 2015, asumiendo todos los gastos en Cuba y pidiéndoles a quienes me invitan recuperar lo invertido, lo cual he logrado y a veces he recibido más de lo que he invertido. 
Cuando les enseño los documentos de lo gastado, me dicen: “Doctor, rompa esos papeles. Las personas han pagado para escucharle a usted. Usted recuperara lo invertido y más, así que rompa esos papeles que aquí no le hacen falta”. En 2016 los médicos estamos “regulados” y no podemos salir del país sin autorización del Ministro de Salud. 
¿Necesita un permiso especial? 
Debo pedir permiso escrito del director de mi trabajo, que debe enviar esa carta al director de Salud del municipio, quien tiene que enviarla al director provincial de Salud que debe enviarla al Ministro de Salud quien debe autorizarme o no. Tiene 50 días para responder lo que conlleva que pierda alguna de las invitaciones pues si la cambian de fecha, ya ese trámite no sirve pues hay que empezar de nuevo.
¿Ha tenido que rechazar trabajo en otros países? 
No he estado en esa situación pues el único país donde trabajo es Cuba, atendiendo a mis compatriotas. Pero no voy a ningún país a trabajar enviado por el Ministerio de Salud puesto que según me han informado mis colegas, el ministerio se queda con la mayor parte del dinero.
¿Recibe ayuda de instituciones internacionales? 
En la década de los 90, traje a mi país un proyecto de Befrienders International, la mayor organización de voluntarios en la prevención del suicidio para invertir más de 800 000 libras esterlinas en crear centros de ayuda al suicida, pero aunque consideraron que el proyecto era muy bueno, no fue aprobada su introducción en Cuba. 
Tuve la oportunidad de realizar una investigación multinacional de la Neurobiología del suicidio con el Departamento de Psiquiatría de la Universidad de Minas Gerais y tampoco fue aprobado. Entonces ante tantas negativas reiteradas, desistí continuar haciendo lo mismo para recibir la misma respuesta. No se puede. En estos momentos continúo recibiendo ayuda internacional en literatura científica solamente.
¿Cómo se puede solucionar su situación? 
Divulgando la existencia en mi país de esa estúpida resolución que limita mi libertad y atenta contra mi dignidad, pues como he escrito, mal puede andar un país cuando la prostituta goza de mayor libertad que un médico. Ella no necesita autorización de funcionario alguno para salir del país y yo tengo que ser autorizado por el ministro. Mientras mayor sea la solidaridad más posibilidades hay que modifiquen esa absurda medida. 
¿Percibe la solidaridad de otros profesionales sanitarios? 
He recibido muchas muestras de solidaridad de los más eminentes suicidiólogos de Europa, Estados Unidos y América Latina.
¿La visita del presidente Obama puede ayudar a suavizar situaciones como la que está viviendo usted?
No creo que influya la visita de Obama, pues a las autoridades de Salud les importa un bledo para cuestiones domésticas. A ellos les interesa la visita de Obama en cuanto a los negocios que puedan hacer y siempre como intermediarios de esos negocios. Si alguno de mis colegas estadounidenses quisiera hacer un Centro de Prevención del suicidio poniendo el capital y que yo fuera su director, en el que se hicieran capacitaciones e ingresos de ciudadanos extranjeros pagando sus servicios y a ciudadanos cubanos sin costo alguno, no lo permitirían, pues el intermediario tiene que ser el Ministerio de Salud, con quien se tendría que hacer dicho negocio, no conmigo. Y es muy posible que ellos propongan hasta el director, aunque los inversionistas deseen que sea yo quien asuma dicha responsabilidad.  
El Prof. Dr. Sergio Pérez Barreto  es médico Psiquiatra y Profesor Titula de esta especialidad. Fundador de la Sección de Suicidiología de la Asociación Mundial de Psiquiatría y de la  Red Mundial de Suicidiólogos. Reside en la Provincia Granma en Cuba. E-mail: serper.grm@infomed.sld.cu
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When Nature Calls: Cuba’s Public Health Infrastructure Exposed.

Sherri L. Porcelain*

A disaster will not spontaneously trigger an outbreak of disease, unless, of course, a highly infectious disease such as Ebola is the reason for the emergency event. Countries are vulnerable to both newly emerging and remerging communicable diseases when collapsing infrastructure and continuing neglect threatens the health of residents and tourists visiting the country.

Cuba’s current challenges with cholera, dengue, and its viral relative, chikungunya, are good examples. Cholera and dengue continue to spread throughout the island, while the Cuban government claims that all the reported cases of chikungunya have been imported to the island from Haiti and the Dominican Republic. According to the Pan American Health Organization’s (PAHO) Update on Chikungunya Fever in the Americas (August 8, 2014), Cuba has officially reported 11 imported cases with no suspect or confirmed locally acquired cases since the start of the outbreak in the Americas. (1)

Chikungunya, a viral disease transmitted by an infected mosquito, has reached this hemisphere for the first time in history in December 2013 when it arrived on the Caribbean island of Saint Martin and spread throughout the region. Recent data shows local transmission of chikungunya has been identified in 29 countries and territories in the Caribbean, Central, South and North America, including the United States with a cumulative total of 508,122 suspected and 5,271 laboratory-confirmed cases, as of August 1, 2014. (2) Cuba rebuffs what independent journalists, rumors, and local health professionals describe on the island.

Here we go again.

Most likely Cuba’s failure to report chikungunya is intentional and not due to poor data gathering capabilities. Cuba has an advanced epidemiologic surveillance system with highly skilled scientists and dedicated health professionals. However, the government’s failure to release timely outbreak data threatens health security today.

A brief discussion on the relationship of climate change, failing infrastructure, and the frequency and intensity of natural disasters is considered below to identify both the challenges and realities with such diseases as cholera, dengue, and chikungunya in Cuba.

Climate Change

Scientists project that climate change will impact both the frequency and intensity of extreme weather patterns. The Caribbean region, and islands like Cuba, could expect rise in sea levels, and this combined with more intense weather events will make flooding more common.

Cuba’s coastal regions will be impacted the most, however, Cuba could experience protracted seasons of both droughts and flooding, and reliable potable water could become scarce.

According to José Rubiera, top Cuban Meteorologist, the “seawater temperature is rising and the conditions in the upper atmosphere are favorable to rapid intensification. These cases are now somewhat more frequent; it means something is changing.”(3)

The vibrio cholera bacteria has been known to survive in brackish waters and estuarine environments, attaches to zooplankton and moves along the ocean currents as it is carried into new areas,(4) continuing the threat to Cuba and Hispaniola.

This danger is especially problematic in countries where fragile water, sanitation, sewage, and housing systems are further threaten by climate change and rising water temperatures where the multiplication of the cholera bacteria has been documented.(5)

Infrastructure

Even though Cuba’s official reporting on their health status indicators match developed world measures, I suggest that the earlier investment in the Cuban public health infrastructure is eroding quickly and without greater attention, the likelihood of infectious diseases spreading spatially and temporarily will continue.

As reported in New England Journal of Medicine article earlier this year, the reality is that, “Any visitor can see that Cuba remains far from a developed country in basic infrastructure such as roads, housing, plumbing, and sanitation.” (6)

According to Relief Web, PAHO warned Cuba a week before Hurricane Sandy (October 2012) struck that further damage to the sanitation system could be problematic in the areas previously affected by cholera and other illnesses related to water use and handling of food.

It is no surprise that “Drinking water is contaminated in most Cuban cities,” and neighborhoods have ongoing problems with sewage in the streets. (7)

Let’s not overlook the poor hygienic conditions in hospitals and clinics. Cuban independent journalists along with dissident physicians have described water and vector borne disease outbreaks associated with the government’s failure to meet basic sanitation standards. (8)

Current water treatment facilities seem to lack the chemicals, equipment, and appropriate filter units, along with the inconsistent availability of chlorine for safe water. (9)

Furthermore, a failure to maintain continuous water pressure will hinder the amount of water and contributes to the contamination of the water supply. (10)

Lastly, a valuable engineering report on Cuba’s infrastructure reminds us “more than 50% of the water pumped through the distribution system is lost due to leaks in deteriorated piping.” (11)

Natural disasters

Based upon what we know about climate change and infrastructure demands in Cuba, the vulnerability and hazard reduction strategies associated with natural disasters are especially important with high winds, surging seas, and flooding. Hurricane season begins June 1 through November with October and November recognized as the most active times for cyclones to strike in Cuba.

Fifteen hurricanes and two major storms have struck Cuba since the new millennium. The greatest risk for landslides is located in the eastern provinces where earthquakes also have a higher likelihood of threats.

While Cuba has a well-developed emergency evacuation and response plan, they show a poor performance in disaster reconstruction, recovery, and mitigation. (12) This is evident as the battering of their public health infrastructure continues to decline.

According to researchers the most “troublesome is the lack of meaningful official programs to attempt to minimize or mitigate the damage that is caused by the severe vulnerability of the built environment to the hazard agents of hurricanes and earthquakes,” (13)

Hurricanes Michelle (November 2001), Isadore (September 2002) followed by Lily (late September 2002) presented national challenges.

However, it was Hurricanes such as Charley (August 2004) which became the most destructive to strike Cuba’s western Havana region since 1914 followed by Ivan (September 2004), the first Category 5 hurricane to hit Cuba in 80 years. This battered Pinar del Rio, Cuba’s most western region, which has been more regularly impacted by hurricanes.

The 2005 hurricane season was very active with Dennis (July), Rita (September), and then Wilma (October) reporting the worst death toll in Cuba in more than 40 years.

After some quiet hurricane seasons, Gustav (August 2008) a Category 4, and weeks after tropic storm Fay hit, became the strongest storm in 60 years with an estimated $5 billion to damage to medical facilities, schools, infrastructure, crops and livelihood. (14)

Hurricane Ike (September 2008) reported hundreds of water wells in rural areas damaged, dams overflowing, and more than 1 million without potable water.

U.S. engineers report that the “water supply system is unstable because pumps are in need of repair and because of frequent interruptions in the electrical supply needed to run the pumps,” (15) which is especially challenging during hurricane seasons.

Hurricane Sandy (October 2012) hit the eastern region leaving devastation in Santiago de Cuba and Holguin while threatening highly populated communities and destroying critical public health infrastructure.

In 2013, Ricardo Mena, a United Nations official responsible for disaster risk reduction in the Americas announced that “Cuba has enormous amount of deteriorated buildings that can't withstand natural disasters." (16)

While Cuba has a well-developed disaster response system, the foundation to protect its people continues to crumble and expose the fragility of the water, sanitation, sewerage, housing and road systems. Rising sea levels, flooding, warming temperature, and the number and frequency of emergency events are expected to create both water-borne and vector-borne diseases threats in the 21st century. So if we want to blame Cuba’s recent problems on climate change, natural disasters, or other reasons it doesn’t matter. What matters is protecting the health of the country’s residents and visitors. This must begin by reminding the international community that Cuba's silence on disease outbreaks (17) -along with their deteriorating infrastructure- could wreak havoc when nature calls.

Notes

(1) PAHO Epidemiology Week Report on Chikungunya to Date (Week 32), August 8, 2014.

(2) Center for Disease Control and Prevention (CDC), Chikungunya in the Americas http://www.cdc.gov/chikungunya/geo/americas.html, accessed August 8, 2014.

(3) Patricia Grogg. Hurricanes Getting Stronger in the Caribbean, InterPress Service, Interview with José Rubiera July 10, 2013, http://www.ipsnews.net/2013/07/qa-hurricanes-are-getting-stronger-in-the-caribbean/

(4) RR Colwell Global Climate Change and Infectious Disease The Cholera Paradigm (1996) Science, 274 2025-2031.

(5) Joan L Aron & Johnathan Patz Ecosystem Change and Public Health: A Global Perspective (2001).

(6) Edward D Campion, and Stephen Morrissey, A Different Model-Medical Care in Cuba New England Journal of Medicine Perspective, January 24, 2014.

(7) Katherine Hirschfeld, Book Review, Linda Whiteford and Laurence Branch’s Primary Health Care in Cuba: The Other Revolution (Rowman and Littlefield, 2008), in Soc (2009) 46:293–296 Published online: 27 March 2009 p. 294.

(8) Katherine Hirshfeld (2009).

(9) Eds. Manuel Cereijo and Helena Solo-Gabriele, Infrastructure Assessment for a Transition in Cuba (March11, 2011), Endowment for Cuban American Studies p. 11.

(10) Ibid.

(11) Cerijo and SoloGabriel (2011), p.12.

(12) B. E. Aguirre and Joseph E Trainor, Emergency Management in Cuba: Disasters Experienced, Lessons Learned, and Recommendations for the Future, in ed. David A. McEntire Comparative Emergency Management: Understanding Disaster Policies, Organizations, and Initiatives from Around the World, http://training.fema.gov/EMIWeb/edu/CompEmMgmtBookProject.

(13) Aguirre and Trainor, p.5.

(14) Canadian Red Cross, Cuba Hurricanes 2008, accessed August 7, 2014

(15) Helena M. Solo-Gabriele and Armando I. Perez Water and Waste Sector: Environmental Literature, Institutional and Economic Issues and Future Work, 378-389, in Infrastructure Assessment for a Transition in Cuba (2008) http://ctp.iccas.miami.edu/InfrastructureAssessment.asp p. 387.

(16) Jean Friedman-Rudovsky. Hurricane Tips From Cuba, New York Times, 30 July 2013: D.6

(17) Luis Rosas Suarez, El silencio epidemiológico y la ética de la salud pública cubana, Revista Cuban de Salud Pública 39(3) (2013), 524-539 and Sherri L. Porcelain Cuba’s Silence is Dangerous to Your Health, ICCAS Focus in Cuba Issue 197, August 5, 2013 http://ctp.iccas.miami.edu/FOCUS_Web/Issue197.htm.

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*Sherri L. Porcelain teaches global public health in world affairs at the University of Miami Departments of International Studies and Public Health Sciences and Senior Research Associate, Institute for Cuban and Cuban-American Studies.

_________________________________________________

The CTP can be contacted at P.O. Box 248174, Coral Gables, Florida 33124-3010, Tel: 305-284-CUBA (2822), Fax: 305-284-4875, and by email at ctp.iccas@miami.edu. The CTP Website is accessible at http://ctp.iccas.miami.edu.


Nota del Editor: Articulo recibido por correo electrónico desde la fuente. 

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Cuba: Chikungunya reported in several provinces.

This past Friday, the Pan American Health Organization (PAHO) reported for the first time, two imported chikungunya cases on the island country; however, it appears that it may be worse than the PAHO reports. Hablemos Press report reported Friday (computer translated), doctors at the Vladimir Ilich Lenin University General Hospital, in the eastern province of Holguín, are reporting cases of chikungunya fever in several provinces including  Guantánamo, Granma, Las Tunas, Santiago de Cuba, and in Havana.
Nota del Editor: Esta informacion toma como referencia el despacho que aparece publicado en Hablemos Press de la prensa independiente cubana. 
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Cuba’s Silence is Dangerous to Your Health

Sherri L. Porcelain*

After a century hiatus, cholera, malaria and dengue have returned to Cuba. This is no surprise since Cuba’s deteriorated water, sewage, sanitation and housing systems all create the ideal environment for rapid disease spread. Dengue, a mosquito borne viral disease, and cholera, a bacterial infection contracted by drinking water or eating food contaminated with a strain of cholera, present threats to both the local population and tourists visiting the island.

Luis Suarez Rosas, a physician with Cuba’s National School of Medicine, accurately captures the paradox of Cuban health care today in using the term epidemiologic silence to describe Cuba’s official position on disease outbreak information. Cuba is a unique case study because of its long history of highly trained infectious disease specialists as seen in the yellow fever response in the early 1900s, and the prominence of the Pedro Kouri Tropical Medicine Institute founded in 1937. Yet, today, the policy to call dengue euphemistically as a febrile illness or cholera as a gastrointestinal illness represents an unethical national public health policy affecting individuals beyond their national borders. This choice to withhold information derails global public health goals to inform and protect travelers; it also encourages rumors and creates confusion. Suarez Rosas, using dengue as a recent example, explains how this artificial epidemiologic silence does not help patients, nor does it address the risk or the perception of the severity of the disease. Additionally, it does not respond to the culprit, the aedes aegypti mosquito, which also carries the yellow fever virus.
While both the Center for Disease Control and Prevention (CDC) and the Pan American Health Organization (PAHO) provide health alerts and identify health problems, their information often relies upon the official reporting of information. However, the Program for Monitoring Emerging Diseases (ProMED), operating under the International Society for Infectious Disease, is an internet-based information system created in 1994 with the purpose of sharing emerging and re-emerging infectious disease information. ProMED mail welcomes all sources of information, including independent journalists who have reported outbreaks long before the Cuban government forced to make an official statement. ProMED continues to share information about the re-emergence of cholera in Cuba’s Manzanillo (Granma) Province in 2012 that spread through eastern provinces, and reached the western capital of Havana.

In June 2013, an independent journalist from Hablemos Press reported approximately 30 cases of malaria in Cuba. The Cuban government claimed these cases are imported by tourists or from returning residents that traveled to an endemic area. Imported cases of malaria are not new; however, the history of Cuba’s denials of other re-emerging diseases compels one to question the veracity of the government’s official report.
Malaria expert John Beier, Professor of Public Health Sciences at the University of Miami Miller School of Medicine, states that Cuba is receptive to malaria since the mosquito has not been eliminated. It is also important to acknowledge that local pocket of transmissions can exist through imported cases from other areas in the region, such as Hispaniola where malaria is known to exist. During rainy season, and when vector population increases, the risk of transmission increases as well. Still no official government report exists.

Sharing good epidemiologic evidence in a timely fashion is a reasonable expectation for global public health cooperation to be maintained. Promoting global health security begins with greater transparency on potential health threats. These are not state secrets as proposed during the 1980s and 1990s denial of Cuba’s dengue re-emergence, along with the incarceration of health professionals who released such data.

Cuba’s policy to withhold information on infectious disease threats for the purpose of protecting their health image, or their tourism industry is unacceptable in an era where rapid and frequent transport across borders occurs. International travelers and concerned citizens everywhere must realize that mosquitoes and microbes do not require their own passport stamp for entry into the United States, and the intrepid stowaways may arrive with their presence undetected.

Based upon what we know and don’t know-

We need to:
1.      Promote greater awareness about mosquito avoidance and cholera, dengue and malaria prevention for travelers to Cuba. While other countries may have higher reported cases, their risk is documented through transparency in their reporting. On June 27, 2013 the U.S. Interests Section in Havana, Cuba posted an alert message for U.S. citizens regarding road safety and traffic related deaths and injuries. This is an important health and safety message, so why not extend this to other public health issues such as dengue, malaria, and cholera?

2.      Become more proactive and use Rapid Diagnostic Kits (RDK) for early identification of diseases such as dengue and malaria. This could be especially important to Travel Medicine Clinics where licensed and trained health professionals have the ability to do accurate testing and patient histories. Dr. Kunjana Mavunda, Medical Director and Tropical Disease Specialist at International Travel Clinic in South Miami, Florida supports this approach. “I’ve been looking at these rapid diagnostic kits as part of the patient care and it is important that you get a good history of the patient and identify potential exposure risks.” She indicated that Cuba’s neglected infrastructure makes it ripe for potential disease spread.

3.      Generate a wider dialogue concerning Cuba’s epidemiologic silence. Notwithstanding the issues surrounding dengue, malaria and cholera, a bird flu spread remains a possibility. The 2003 Severe Acute Respiratory Syndrome (SARS) coronavirus scare originated in South China and today the Middle East Respiratory Syndrome (MERS), another coronavirus, lurks nearby. Will anyone hold Cuba accountable for failure to report early outbreaks? What about possible impact in South Florida?

Global health security depends upon the rigor of good science, the willingness of nations to uphold policies to protect both their citizens and visitors, and the timely reporting of potential health threats. A world that is forced to rely on rumors puts everyone at risk. Consequently, silence is dangerous to your health.

*Sherri Porcelain is Senior Lecturer in Global Public Health in World Affairs and a Senior Research Associate at the Institute for Cuban and Cuban-American Studies, University of Miami.
The CTP can be contacted at P.O. Box 248174, Coral Gables, Florida 33124-3010, Tel: 305-284-CUBA (2822), Fax: 305-284-4875, and by email at ctp.iccas@miami.edu. The CTP Website is accessible at http://ctp.iccas.miami.edu.

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