RESUMEN

BACKGROUND: Leprosy is a chronic infection that presents with varying dermal and neurological symptoms, and which can lead to extensive disability and morbidity, often with accompanying social stigma. AIM: To review the patients presenting to the Liverpool School of Tropical Medicine (LSTM) between 1946 and 2003, looking specifically at country of birth and of infection, details of clinical presentation, diagnosis, management and reactions. DESIGN: Retrospective record review. METHODS: We retrieved all available clinical records for patients seen between 1946 and 2003 (n = 50), consisting of letters, hospital and LSTM casenotes, and some radiographs and photographs. Any history of tuberculosis or diabetes was recorded. RESULTS: Most patients (64%) were born in the Indian subcontinent, and most were thought to have contracted the disease there (62%). Features at presentation included anaesthetic skin lesions in 19 (36%), hypopigmentation in 15 (30%), and peripheral nerve enlargement in 25 (50%). Diagnoses were made by a combination of clinical data and biopsy (60%), and slit skin smears were positive for acid-fast bacilli in 61% of multibacillary patients. Initial presentation was with a leprosy reaction in five cases (10%), and reactions were documented in 42% of all patients. Treatments were varied, progressing from traditional Eastern medicine to the WHO-approved multidrug therapy in use today, with prophylaxis for children and close contacts. DISCUSSION: Leprosy remains an important diagnosis to consider in patients with a history of work or travel in the tropics, and is a diagnosis with far-reaching medical, social and emotional consequences.

Asunto(s)

RESUMEN

Cuba's primary health care model is presented. Unlike ambulatory care services, which are but one component of primary care, Cuba's model is a comprehensive public health approach that meets the World Health Organization's definition of primary care. The history of the development of Cuba's model is presented, including an update on the innovative neighborhood/home clinics. Achievements in health outcomes as a result of Cuba's model and the consequences for women's health care are discussed. Examples are presented of the effects on health care delivery of the economic hardship that Cuba has experienced since 1991 as a result of the loss of 85% of its trade with the former Soviet Union and the intensified U.S. embargo. A critique of Cuba's model concludes the article.

PIP: Cuba has been able to achieve some things that few Western countries have been able to achieve: equal access to health services for the entire population and equity in health status. After the 1959 revolution, community organizations conducted a census to obtain baseline demographic and epidemiologic data about the population, a literacy campaign, and sanitary and immunization campaigns. Polyclinics provided various social, environmental, and community health services free of charge. They were geographically distributed. Cuba instituted its neighborhood/home clinic model in 1984, a holistic, family, and neighborhood approach to comprehensive health care of the community. The family physician and nurse live in the neighborhood. Health education and health promotion are central to this model. The physicians and nurses are expected to conduct research and to present their findings at congresses or in journals. Cuba's infant mortality rate is not much higher than that of the US (1993, 9.4 vs. 8.3). Major causes of death in Cuba match those in developed countries, mainly heart disease and cancer. More than 95% of pregnant women attend their first prenatal visit during the first trimester. They receive prenatal care monthly unless they have a high-risk pregnancy when they receive prenatal care once a week. Infants receive well-baby care once a month. Sex education is available to everyone. All primary care facilities provide contraception. Nevertheless, the induced abortion rate is high, which concerns the government and health providers. Key effects of the economic hardship Cuba faces caused by the fall of the Soviet Union include food rationing, emigration, increased use of traditional herbs, lack of exchange of professional literature between the US and Cuba, and lack of enough paper to continue publications of medical and nursing journals. Cuba has prioritized health and education over economic development.

Asunto(s)

RESUMEN

The authors present an overview of Cuba's response to HIV/AIDS including: (a) the development of comprehensive health care in Cuba; (b) the epidemiology of AIDS in Cuba; (c) the sanatoria approach to treatment and recent changes; (d) the idea of comprehensive HIV/AIDS care as a basic human right; (e) the effects of the special period on the HIV/AIDS program and containment of the epidemic; and (f) a critique of Cuba's HIV/AIDS program.

Asunto(s)