Intensive care medicine in the world has been characterized, since its inception, by the ability to identify and dynamically address clinical situations involving patients in serious and critical condition, in which physiological instability predominates, and small changes can lead to rapid, serious deterioration, with irreversible damage to organs or death. This field of medicine requires a number of strict controls and the use of specially designed emergency treatments.
To better understand this work in Cuba, in times of pandemic, Granma spoke with Dr. Ricardo Pereda González, a member of the Intensive Care and Emergency Medicine National Advisory Group, who conceptualizes the specialty as focused on a group of special, integrated procedures to achieve the survival of patients in serious or critical condition that lead to recovery or cure of their disease.
In the practice of this specialized field, work is conducted on the basis of protocols which establish medical treatments and biosecurity measures to be taken; the system of collaborative work used to ensure high quality medical assistance and better results from the attention provided these patients.
“All medical activity is guided by protocols, followed on the basis of the patient’s illness. These are like action guides for each Intensive Care Unit (ICU), and respond to the evolution of the patient. There is no single national protocol for ICUs, rather they are adjusted to the case management situation of each specialized unit,” the specialist in Intensive Care and Emergency Medicine stated.
He added that, over the months of work battling the new coronavirus in Cuba, protocols have been successfully adjusted for patients with specific pathologies, to avoid contradictions with added incorporated medication.
-Could you tell us about Cuban protocols for the treatment of COVID-19?
-We designed our protocols based on international experiences, and have incorporated the valid contributions obtained in these months of the pandemic. The accumulated experience gives us security and peace of mind with the use of adequate and included medicines according to the situations presented.
-Is there a development plan for the country’s intensive care units?
-Based on our experience in addressing COVID-19, and the guidance of the country’s leadership, we have established a plan for the development of our intensive care units in three stages, starting from the experience gained with the introduction and development of this type of service in Cuba.
The principal goal is to increase the number of beds for the care of patients in serious condition, to be in a position to respond to this pandemic and future epidemiological situations, with the introduction of new medical technologies and personnel specialized in intensive care practices, taking into account that nursing is decisive to the recovery of a patient.
The first stage should be completed in 2021, and involves the repair and modernization of units currently in operation, and the incorporation of a significant number of beds, depending on the country’s economic situation.
The second is conceived through 2023 and the third until 2026.
Our intention is to add everything we need to complete services available in all intensive care units, and to have better, newer technological resources: including everything from ventilators to the engineering systems, among others, thinking about the physical structure of the premises, which must respond to the pathologies to be treated. COVID-19 led us to expand isolation cubicles. Our commitment and challenge is to save lives.
In Cuba, we prepared for the worse in an adverse scenario, facing an extremely complex situation to assist COVID-19 patients, and foreseen capacity was never exceeded and our hospitals never experienced a collapse.
-How do you explain the fact that our intensive care units did not collapse during peak periods with the highest numbers of cases?
-We have a well organized health system, with systematic, daily leadership, and direct participation of the country’s top authorities. This ensured that tasks were carried out as planned at each stage, under the leadership of the Ministry of Public Health (Minsap).
None of our units exceeded their capacity; even in very tense moments, we were able to refer patients to institutions that had been prepared and planned for an increase in the number of patients. This was contemplated in the national strategic plan to respond to the epidemic. We still have this design and it allows us to make decisions, at this time, about adjusting the plan to the current circumstances.
- Could you explain how infections and deaths among personnel in the red zone were avoided?
-This is due to the training and education that the selected professionals who work in the red zone receive. They strictly respected all the biosecurity measures, without ever violating protocols. A principle of caring for each other was generated as part of the discipline within hospitals and, especially, in intensive care units.
I include in this group those who guarantee the hygiene of the premises, the utensils and the distribution of food.
I think respect for and adherence to the biosafety protocol established for these places exists. Everything is written down. Our practice has shown us that adherence to the biosafety protocol has been successful in dealing with COVID-19 in Cuba.
-What Intensive Care experiences can Cuba offer the world at this stage of the pandemic?
-One of our experiences is in the effectiveness of the protocols, following them with discipline and respect.
Another is having a health system organized on several levels, with universal coverage and free of charge for the entire society, under the leadership of the Ministry and the government. Our protocol for attending COVID-19 patients begins and ends in the community.
The family doctor program has the responsibility for prevention, care and epidemiological surveillance of all territories. This is where action to prevent illness takes place and where patients are provided follow-up through all necessary levels of care, as the seriousness of a disease increases. Prevention involves the active search for individuals who have been, or may be, infected. For this effort, we have recruited students from all universities, with an emphasis on those in Medical Sciences, to conduct thorough community surveys. In addition, supervision by the country’s highest leadership has been decisive, making timely decisions on a daily basis.
These experiences are unique, given the nation’s political will to address a global health problem. To this can added the response of the population, which has maintained discipline in accordance with calls made by authorities. It would be an injustice not to highlight the response of the Cuban biotechnology industry and its scientists, who have worked together in a unified fashion.
-How does the U.S. blockade impact intensive care?
-The blockade has been omnipresent for many years, and the country’s economic possibilities have been reduced by the actions and coercive measures of the U.S. government. This limits and delays the introduction of technologies.
The blockade is criminal, not only for Cubans, but also for the U.S. citizens themselves, since it prevents the exchange of knowledge between the two countries”.
In figures
122 municipal intensive care units
152 intensive care units including:
47 neonatal
32 pediatric
73 for adults
1,203 beds for specialized care and treatment
10.7 intensive care beds per 100,000 inhabitants
15 beds per 100,000 inhabitants is the goal established in development plans through 2026.
(Taken from Granma)