Traditional Chinese Medicine in Today’s Cuban Health Care
By John Voigt
In Cuba, the legends abound about outstanding Chinese doctors of the nineteenth century who helped create a foundation for the use of Traditional Chinese Medicine (TCM) in twenty-first century Cuba. (See “Not Even the Chinese Doctor Can Save Him” in the May issue.) Nevertheless, TCM’s acceptance and use by the Cuban medical establishment did not happen overnight. Historically and during the beginnings of the Revolution, TCM along with most other Alternative Medicine was rejected by the Cuban government and by a majority of its western trained doctors. As in the past century, the Establishment considered such healing modalities “antiquated occult quackery.” Such things were an anathema to Marxist Communist beliefs.
Photo by Alexander Kunze on Unsplash
The Political and Economic Situation.
With the US Embargo beginning in 1960, and the withdrawal of USSR support in 1991, along with the internal problems of their socialist-communist economy, Cuba was and remains economically devastated. There were and still are massive shortages in pharmaceutical drugs and medical supplies for the doctors, clinics, and hospitals that service the Cuban people. (Things are much different for tourists. See Modern Health Care for Tourists below.) Today in 2018 hospitals and clinics for the common people of Cuba all too often have little or no drugs, soap, toothpaste, toilet paper, bed sheets or pillowcases—not even aspirin! Often there are no hypodermic needles, or used ones are washed in bleach and reused. Relatives living in Florida smuggle in prescription drugs.
Amazingly even with these horrid conditions, the World Health Organization’s latest report in 2016 has Cuba with an average healthcare expenditure of $2,475 per person; Cubans have approximately the same life expectancy (males 77/females 81) as Americans (males 76/females 81) who average a healthcare expenditure of $9,403 per person. Source: http://www.who.int/countries/cub/en/ and http://www.who.int/countries/usa/en/
Cubans even have a lower rate of infant mortality than that of the USA. Source: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html
These figures — $2,475 and $9,403 are not typos — they represent among other things Cuba’s extensive use of alternative medicines and Traditional Chinese Medicine (TCM); as well as governmental enforced implementations of beliefs and lifestyles somewhat similar to Chinese and Asian ways of life, such as the paradigm that preventing an illness is easier than curing one, or the importance of daily socially required group gymnastics such as taijiquan or qigong. Or of small teams of doctors and nurses going throughout the entire country rigorously enforcing mandated medical examinations, or actively having people reduce or end smoking. Both Cubans and traditional Chinese health practitioners believe health is not just the absence of illness, instead, health is a state of complete physical, mental and social well-being. For both Cuban leaders and Confucius, the health of the human body and mind is an integral necessity for the very important health of the society. In Cuba, revolutionary health practices are a part of a continuing revolución. For Cuban lawmakers, if for no other reason, healthy people are important because they make healthy workers, soldiers, and government officials. The political reality is clear: no health means no revolution. Admittedly Cuba is a totalitarian government, something that Americans understandably will not accept, but at least in a theoretical — yet highly practical sense — there is much for us in America to learn from Cuba.
Returning to past historical realities, since the 1960s until the present the enormous difficulties presented by the American Embargo, and especially the subsequent lack of medicines and supplies, the Cuban medical establishment was forced to search for new approaches. Health officials began to incorporate techniques outside the scope of what doctors had previously been taught in the universities. After all, for a century Chinese doctors in Cuba had shown that TCM affected cures for certain illnesses that western medicine had not. Some skeptical doctors even started planting medicinal herbs in their backyards; at least they would have something to give to their sick patients.
Photo by Bruno Martins on Unsplash
TCM Becomes Official.
Beginning in the late 1980s medical students in Cuban universities began to be trained in alternative techniques. An executive report, “The Analysis of The Health Sector in Cuba” issued in 1996 by the Ministry of Public Health (Ministerio de Salud Pública) outlined this new approach:
The strategic objective of the National Health System is to give priority to the development of natural and traditional medicine. The “Program of Development” initiated in 1991, includes the search for active medicinal principals of plants, their clinical testing, and the subsequent generalization of the results so that they can be progressively incorporated into the techniques and procedures of the East Asian medical tradition.
By 2009 the Ministry moved to a full acceptance and legally enforced implementation of these radical methodologies as befitting a revolutionary culture. These changes were made official in August 20, 2009, with the publication of Resolución Ministerial No 261/2009. Below are key excerpts from this document along with several annotations made by the author. TCM is only a part of the Resolution no. 261, nevertheless it is hoped the reader will find the document interesting. With it, Cuba is probably pursuing Alternative Medicine more than any other country in the world. The original text in Spanish may be found at “Resolución Ministerial No 261/2009” at http://legislacion.sld.cu/index.php?P=FullRecord&ID=210
Photo by MINISTERIAL RESOLUTION NO. 261/2009 Republic of Cuba
RESOLVE – FIRST: To approve for medical care, teaching, and scientific research in health services throughout the country national, [with] the following types of Natural Traditional Medicine.
1- Phytotherapy. [Medical treatment based on the use of plants and plant substances.]
2- Apiterapia. [Therapeutic use of bee venom, and other bee products such as honey, pollen, and royal jelly.]
3- Traditional Asian Medicine:
- a) Acupuncture. b) Catgut sutures sewn into acupoints.
- c) Stimulation of acupuncture points: [by use of]
- Drugs
- Light
- Temperature
- Mechanical [devices].
- Ultrasonic [devices].
- Electricity
- Magnetism
- Microsystems of the Asian Traditional Medicine [such as ear acupuncture].
4- Ozone therapy.
5- Homeopathy.
6- Flower Therapy:
- a) Bach Flower Remedies, [solutions of brandy and weak dilutions of flower material in water.]
7- Hydrotherapy: mineral springs, mineral baths, Peloids [clay or mud baths], thermal baths.
- Helium Therapy – (Heliotalasoterapia). [Heliox is a breathing gas composed of a mixture of helium (He) and oxygen (O2). It is a medical treatment for patients who have difficulty breathing, For example, croup, asthma and chronic obstructive pulmonary disease.]
- Traditional Therapeutic Exercises: [The Pan American Health Organization spelled out these exercises as: Taijiquan (usually Yang Style). Lian Gong Shi Ba Fa (created by Dr. Zhuang Yuan Ming; see Lian Gong Shi Ba Fa 18 Terapias Anterior on YouTube). Wushu (commonly called “Kung Fu.”) Qi Gong, and Hatha Yoga.] “Each movement is to be chosen with a modifiable therapeutic purpose according to the traditional medical diagnosis of the subject or patient.”] Ejercicios Terapéuticos Tradicionales.
- Naturist Nutritional counseling. [“In addition to meeting established nutritional requirements. Can include a vegetarian or macrobiotic diet, and traditional practices as used in Traditional Asian diagnosis. You should be aware of existing products in Cuba.”] Ministerio de Salud Pública, 2011. http://files.sld.cu/mednat/files/2014/08/prog-nac-mtn-2012.pdf ].
THIRD: The Deputy Minister attending Medical Assistance is authorized to issue the instructions considered necessary for the implementation and enforcement of this resolution.
Starting in 2016 all medical graduates in Cuba, including nurses and dentists, are required to learn Medicina Tradicional y Natural (MTN) which includes various Cuban versions of TCM. Almost all local clinics and hospitals of Cuba now offer Traditional Chinese Medicine, where acupuncture, reflexology, massage, heat treatments and liniments are the order of the day. Also, 30% of Cuban legally approved medicines are herbal. [Source: author interview with a Cuban physician in Havana, June 2016.]
TRADITIONAL CHINESE MEDICINE IN THE CUBAN STYLE.
[Note: If you have any medical problem see a health professional. This article uses information derived from Cuban sources and is to be used only for educational purposes.]
Acupuncture and Acupressure are used in a majority of hospitals and health clinics, however often with variations such as Auriculoterapia or Ear Acupuncture which is based on the theory that the auricle, the outer portion of the ear, is a microsystem which reflects the entire body. Auriculoterapia is said to cure many conditions such as headaches, sciatica, lumbago, joint pain, depression, melancholy, insomnia, liver and digestive problems. In Cuba, it is also used to control obesity, addiction to cigars and cigarettes, and as an anesthetic in surgery.
Cubans have extended this concept to using acupoints on the face, palms of the hands, and soles of the feet to function as mirror images of the acupoints throughout the entire body. Patients may be prescribed a do-it-yourself continuous treatment where a tiny seed is taped to the body part and the patient is instructed to press the seed during the day.
Taping a seed to an auriculotherapy point.
An aspect of Herbal medicine is added to this by using the seeds of the Mexican Thisel, also called the Mexican poppy, which the Spanish found the natives in Mexico used for healing. This plant can be poisonous; nevertheless the colonial Spanish added this plant to their pharmacopeia and called it cardosanto. It was used to relieve kidney pain, to help expel a torn placenta, and in general to help cleanse the body after childbirth. It has also been used to treat malaria [see Argemone Mexicana, Wikipedia.]
Electro-acupuncture – (Electropuntura) combines the use of needles with electrical stimulation by sending a small electrical current through the needle after insertion into an acupuncture point. Instruments used usually consist of two parts: a needle and an electric current stimulator. There are different types of stimulators, some use AC or DC electricity, high or low frequency, continual or intermittent electrical pulsations. It is primarily used as an analgesic for all types of pain. It is also applied to alleviate the pain during childbirth, as well as anesthetic for some operations, including caesarean sections.
Source: Wikipedia Commons
Diet Therapy is used in relation to healing a specific illness; often it is used with pharmaceutical drugs if they are available.
Tuina or therapeutic massage is used to promote a more harmonious balanced flow of qi (bio-electrical energy) to cure diseases and promote health. In Cuba, as elsewhere, the practitioner’s hands are used to massage muscles and tendons. Acupressure techniques to affect the qi flow, and manipulation techniques to restructure musculoskeletal and ligament relationships may be added. Liniments, poultices and herbal balms, often from plants native to Cuba, may be used to increase the benefits of the treatment.
Moxibustion – (Moxibustión) is a method that treats and prevents diseases and corrects energy imbalances by applying heat through cones or moxa cigars burning on certain points of the human body. The raw material most commonly used for this technique is the dried leaves of the mugwort plant ground to a fine powder. In Cuba incense, and the wicks of oil lamps also are used.
Indirect Moxibustion – (Moxibustión Indirecta) is a method Cubans use that combines acupuncture with moxibustion. It is indicated for the treatment of joint pain due to cold and moisture. A little burning moxa is carefully applied to the handle of the inserted needle.
Another technique also called indirect moxibustion has an insulating ingredient placed between the slowly burning moxa cone and the skin of the client. The healing properties of the substance are considered added to the healing properties of the moxibustion. For example, one slice of ginger approximately 0.2 cm thick is recommended for a weak spleen and stomach, joint or abdominal pain and other symptoms of yang deficiency.
Garlic is used in the same manner as ginger. It is indicated for scrofula, skin infections and poisonous insect bites in their early stages.
Salt: the navel is filled with salt and a large moxa cone is placed over it. This is indicated for cases of cold limbs, weak and imperceptible pulse, vomiting, and diarrhea.
Phytotherapy (Fitoterapia – or “Plant Therapy”). This refers to the use of medicinal plants and vegetables and their derivatives to prevent, alleviate or cure diseases. Given Cuban history there is a heavy influence of Afro-Cuban practices. Currently various governmental health agencies are investigating methods and techniques to streamline and modernize Phytotherapy in line with the basic requirements of “safety, quality and efficacy.” American and African techniques are being actively studied and used along with traditional Chinese and native Cuban methodologies.
[The species most frequently used in Phytotherapy are Cocos nucifera L. (Arecaceae), Bidens pilosa L. (Asteraceae), Cissus sicyoides L. (Vitaceae), Erythroxylum havanense Jacq. (Erythroxylaceae) and Stachytarpheta jamaicensis (L.) Vahl. (Verbenaceae).] Source: http://www.ncbi.nlm.nih.gov/pubmed/15013195].
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Modern Health Care for Tourists. Today hospitals for tourists are in much better condition than those for native Cubans. These hospitals can be world-class 21st century facilities, and they are expensive. Generally speaking they are closed to regular Cubans, who have their own Government controlled free healthcare. The turismo de salud [“Health Tourism”] programs are understood to be a method to raise money for the impoverished country. Tourists and foreign diplomats combine vacations with state of the art health care which often includes Traditional Chinese Medicine and other more exotic health care alternatives.
Hydrotherapy at a turismo de salud [“Tourism of Health”] clinic.
Source: https://cubanosporelmundo.com/2015/09/28/turismo-de-salud/
Children Learn Plant Medicine
Children begin studying the multiple uses of medicinal plants in primary school, learning to grow and tend their own plots of faloe, chamomile, and mint, and later they conduct scientific studies about their uses. Radio and Television programs instruct people on how to relieve common stomach upset and headaches by pressing key points. Acupuncture is offered at all three levels of health care [primary care physician, clinic, hospital]. Cuban biochemists have produced a number of new alternative medicines, including PPG (policosanol), a natural product derived from sugarcane wax that is effective at reducing total cholesterol and LDL levels, and Vimang, a natural product derived from the bark of mango trees. [source: Healthcare in Cuba. Wikipedia.]
In Cuba since 2006 no cases of acute hepatitis B reported in children under 15 years of age.
Source: http://www.radio26.cu/2016/05/11/cuba-sin-hepatitis-b-aguda-en-menores-de-cinco-anos/
A short coda as a conclusion. ¡A Ese No lo Salva, Ni el Medico Chino! —“Not Even The Chinese Doctor Can Save Him!” is a popular slang expression that first appeared in mid-19th century Cuba. This article ends with the thought that in 2018 whoever that “Chinese Doctor” was, he or she might now actually be able to “Save Him!” and bring “Him,” (their patient), back to a state of health. Or better yet, with the use of TCM and other alternative medicine preventative techniques, the patient never would have gotten sick in the first place.
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This article originally appeared as part of “Traditional Chinese Medicine in Cuba” in Qi Journal, vol. 26/3; autumn 2016. It is used with the permission of the author, who may be contacted at john.voigt@comcast.net
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**Beautiful featured image photo by Ellen Carlson Hanse on Unsplash