Professor Olga Esther Infante, from the University of Medical Sciences of Havana, explained that the term ‘pandemic exhaustion’ is perceived by the Cuban family, a concept coined by the World Health Organization in reference to a state of fatigue, lack of motivation and apathy. Infante specified in a televised conference that this lack of motivation leads to a relaxation of personal self-care and increases the risk of contagion, as well as affectations among group members such as irritability and manifestations of anxiety that can generate conflicts.

The also secretary of the National Group of Psychology of the Ministry of Public Health commented that authors speak of ‘family fatigue’ associated with the overload of assuming new roles such as work spaces, study and, in the case of women, it is more evident because they share various activities within the home.

She identified denial, evasion and a certain uncritical familiarity as the psychological mechanisms present themselves in the face of the prolongation of the health crisis ‘because people have become accustomed to receiving so much information and the time comes when they do not respond to this situation.’

She warned about the role of the family as the maximum responsible for the care of children and adolescents, given the confirmed cases with the disease in the group of children under 20 years of age, amounting to 21 thousand 59 since the beginning of the pandemic.

On the other hand, she pointed out as strengths within the family nucleus communication, cohesion, adequate housing spaces, socioeconomic conditions and systemic relationships that influence the behavior of its members.

‘For young people and adolescents in Cuba, the most valued social group is the family. We are confined, but we are with people with whom we have important emotional ties and that mitigates having to be at home. The Cuban family is given to solidarity, to receive and to offer support and that constitutes a strength ‘, she emphasized.

In her opinion, without underestimating what the confrontation with Covid-19 has represented, Cubans have social guarantees such as free public health, salary protection for the sick, among others.

To avoid negative situations at this stage, the expert recommended seeking professional help in the presence of psychological exhaustion, doing physical exercises, respecting life schedules and individual space, as well as communication within and outside the family environment.

(Taken from Prensa Latina)

Like any institution, the family is a social grouping that requires special attention from government in terms of its needs, including balancing work and home responsibilities and reducing domestic violence, among others.

Families vary, in terms of their composition, structure, and functioning. As our Constitution states, all different types are of interest to society as a whole, as is guaranteeing their rights and welfare. Policies and programs in many areas have an impact on families, often in unnoticed ways and perhaps not all families in the same way.

In the context of the current pandemic, the role of protecting family members becomes more important and requires more time and dedication. Taking care of our health, staying home, not going out unnecessarily, reporting any symptoms, being disciplined and responsible are priorities for our society now, to which families are fundamental.

There are those who think that the value of this institution is only apparent in happy moments, peaceful times, or that its function is to serve as an emotional refuge and solve daily problems. The value of families is evident and increases when each member assumes a responsible role within the unit, for the welfare, development and happiness of all members. It is essential that everyone participates in activities and tasks that support the family, that they share not only tastes and interests, but also responsibilities, and are concerned for each other.

The traditional division of productive and reproductive functions in households, based on sex, does not reflect our current reality. Increasingly, women around the world are engaged in productive work outside the home. In the case of Cuba, women participate in all sectors of the economy, and the economic function of many families has become more complex in recent years, as more and new forms of non-state work have emerged, in which several of members participate. These families have gone from being consumers to being producers of goods and services, and have established new forms of economic and personal relations among themselves.

Nevertheless, women continue to bear the greatest responsibility for reproductive functions, family care and household chores. A fundamental challenge around the world is ensuring that men and women share equal rights and duties in society. Gender equality in the home, the sharing of family responsibilities between men and women, and women’s participation in employment are basic elements of this challenge.

The family also plays an important role in education – in schools and beyond – and functions as an active mediator in transmitting human values, cultural identity and preserving intergenerational ties. In these times of pandemic, families have been key to ensuring that our children, adolescents and youth continue their studies through television classes, develop new study skills, and have access to enriching cultural products.

Good family communication is also essential, taking advantage of opportunities to talk with our children, since time is often short and everyone busy. It is a matter of encouraging frank, open and, above all, constructive communication, aimed at solving problems together – not arguing or fighting, much less using violence.

It is important to recognize that families are not passive agents of development, but that their special role and contributions to positive initiatives for development must be considered and made visible. In no way does this mean delegating all responsibilities to families. We are living in times of pandemic, an experience in co-responsibility for health care, with the state, the non-state economic sector, communities, families and the people themselves, all playing their part – a good practice to consider and implement in addressing other problems. In this context, Cuban families have demonstrated their strength in dealing with difficult conditions, based on the guarantees provided by the revolutionary government’s policies and programs, implemented for their protection and development, such as free universal education and health care, social security, and respect for and protection of the rights of children, women and all persons, as established in our Constitution.

Families are not only units of co-habitation, but also networks of support that are essential in confronting situations like the one we are facing right now, in which Cuban women have demonstrated an enormous capacity for resistance and creativity.

It is worth noting that, in the context of limitations on social interaction imposed by COVID-19, families have not lost their role in the education of younger generations, seen, for example, in support of school activities and the development of solidarity and internationalist values among children and youth. Families also contribute to preserving national and cultural identity, of critical importance given the cultural onslaught of globalized consumerism and individualism.

Concern for and attention to families as the basic units of society have always been priorities for the Revolution, at the forefront of which is the transformative work of the Federation of Cuban Women, in close collaboration with state institutions such as the Ministry of Education and the Ministry of Labor and Social Security.

If there is one thing the organization has emphasized, it is that all initiatives to contribute to the well-being and development of Cuban families can be improved. Reflecting on new ways to better serve families, to help them more, participating with them in the solution of problems and learning from their experiences, is an everyday, pending task.

(Source: Granma)

Although the Cuban National Public Health System was created in 1968, to implement a set of measures to deal with infectious and contagious diseases, malnutrition, parasitism, anemia, and others, the family medicine model emerged in 1984, as part of the necessary transformations in a society facing new challenges.

The emergence of family medicine sought to eliminate the fragmentation and super specialization of medical care; combat depersonalization and indiscriminate use of technology; coordinate care within the community; channel the dissatisfaction of the population with services; respond to the demographic transformations that lead to changes in morbidity and mortality; establish the emergence of medical thought based on a clinical, epidemiological, and social approach; and achieve a qualitative increase in the population’s health.

Dr. Sandra Galano Urgellés, head of the Centro Habana Medical Care Department, and speaker on the subject of family medicine at the 2018 Cuba-Health International Convention in Havana, explained that the family doctor and nurse program, also known as the “Physician for 120 Families Plan,” began as a pilot program on January 4, 1984, at a polyclinic in Lawton neighborhood, in the Havana municipality of 10 de Octubre, with ten pairs of doctors and nurses, who formed basic teams to provide care to 600-700 people.

They worked to improve the health of the population through comprehensive actions aimed at individuals and their families, the community and the local environment. Due to the results achieved, the program was extended throughout the country and before the end of 1984, there were already 237 family doctors enrolled in a new medical specialty: Comprehensive General Medicine.

The family medicine program provides healthcare for all age groups. Photo: Alberto Borrego
In the first six years, the number of doctors rose to 12,000, to serve a population of more than seven million people, covering rural and difficult to access areas, and insisting on prevention and awareness measures to prevent the emergence of diseases, with a coherent connection between the neighborhood and medical institutions, including research institutes.

“Family doctors stand as the guardians of public health. They are the first point of contact the population has with healthcare services. Our main task is to prevent people from getting sick,” the specialist in Comprehensive General Medicine explained.

Toward this end, doctors continuously assess patients’ risk factors, based on family genetics and social factors, taking into account the initial evaluation to classify them into four groups: healthy patients; those at risk; those who suffer from a chronic disease; and the disabled.

“For each of these groups, consultations are planned according to a schedule based on the condition and the frequency of its evaluation. If the patient is unable to come to the clinic, they are visited at home, in what we call field consultations. We even undertake medical admissions at home to treat some viral, bacterial, or other conditions,” explained the doctor.

Although work is ongoing to digitalize medical records, for the moment the majority consist of patient record cards, including the necessary classification, and the schedule and results of all appointments and consultations, to ensure visibility and control over health measures.

Family doctors follow a treatment protocol applied at a national level, according to the conditions they are dealing with, and therefore are part of medical research through the introduction of new drugs, and the implementation of 16 specific health programs, such as the maternal and child health, oncology, communicable and non-communicable chronic diseases, and HIV-AIDS care programs.

To undertake these efforts, they receive guidance and support in basic working groups which include specialists in pediatrics, gynecology, social workers, sociologists, and vector control workers, and are integrated with the more than 450 polyclinics in the country.

“It is up to doctor’s offices to plan consultations in all other specialties, and through these, more widespread services are offered at the community level. In our offices, adults, children, pregnant women, and the elderly are all treated free of charge and with a comprehensive approach by various specialists. The main aim is to tackle health issues or impact on those that could pose risks with the potential to trigger disease,” the specialist added.

This means coordinating hospital appointments with the arrival of specialists working in second level institutions to the community. These specialized doctors are referred to the patients they will attend. “For example, if a person needs to be evaluated by an angiologist, we communicate with the polyclinic, request the appointment and the patient leaves with the day and time that the specialist will receive them. This facilitates specialized consultations,” explained Dr. Galano.

She noted that this type of experience could be of valid use in other countries. In fact, similar programs have already been implemented in Venezuela with the Barrio Adentro (Inside the Neighborhood) mission; and Brazil, with the Mais Médicos (More Doctors) program. Dr. Galano also highlighted that it would be much easier to implement such a program in developed countries, with greater economic resources, although it must always be adapted to the social context in which it is put into practice.

Despite its three decades of existence, this is a model that continues to be developed, perfectible and open to change, according to the specific health issues of each community. The main challenge is to constantly innovate, while at the same time maintaining its founding principles.

Family doctor and nurse’s offices are found even in the most remote areas of Cuba. Photo: Germán Veloz Placencia
“Thanks to this type of community program, our country has obtained tangible results in lowering the infant and maternal mortality rates, low birth weight, and other social achievements,” the specialist added, who stated she was a loyal advocate of family medicine, an area that is little explored worldwide.

Results obtained in Cuba with the family medicine model

- Organization of health promotion and disease prevention measures, focused on changing lifestyles and avoiding risk factors

- Health services brought closer to the community

- Immunization coverage of 98.7% of all children under one year of age, against nine diseases. Since 2016, the Cuban child population has been protected from 13 preventable conditions with vaccines

- Early identification of more than 95% of pregnant women before the first trimester

- Increase in the number of mothers exclusively breastfeeding infants up to six months

- Greater access to physiotherapy and rehabilitation

- Consolidation of natural and traditional medicine practices

- Decrease in hospital stays from 6.4 days in 1990, to 4.7 in 2016

- Increase in family planning and sex education efforts

- Increase in life expectancy at birth to 78.45 years in 2017

Measures taken in Cuba to strengthen the Program

- Introduction of new technologies

- Strengthening of clinical methods

- Increased response capacity

- Sustainability of health coverage and greater accessibility to medical services

- Guaranteeing continuity of care with an appropriate referral system

- Creation of a network that facilitates access and management of information among health institutions

- Systematization of research and the introduction of results in medical practice

- Innovation of the family medicine model without renouncing its foundational concepts

- Adaptation of health services to respond to population aging

- Development of intersectoriality and community participation in combating non-communicable diseases as the first cause of illness and death among the Cuban population

Services offered in polyclinics

- Comprehensive rehabilitation

- Emergency and elective electrocardiography

- X-rays

- Ultrasound

- Optometry and optics

- Life support

- Clinical laboratory

- Family planning

- Sterilization

- Stomatology

- Comprehensive care for women, children and the elderly

- Comprehensive diabetic care

- Immunization

- Endoscopy

- Colonoscopy

- Menstrual regulation

- Minor and major surgery

- Allergy laboratory

- Infertility consultations

(Source: Revista Panamericana de Salud Pública, Vol 42, April 2018)