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By Steve Wilkinson.
After emergency treatment for a stroke, 54-year-old Alejandro Diaz
Rodriguez was sent to the Julio Diaz Hospital on the outskirts of
Havana for physiotherapy. A policeman from Havana, Alejandro was
admitted for eight weeks to see if Cuba's most advanced centre of
rehabilitation could recover the use of his left arm and leg.
I find him seated in what resembles a barber's chair with a pair of
electrical nodes attached to the back of his left knee. Every two
seconds his foot bends at the ankle with a jerk produced by an
electric charge from an apparatus being operated by his
physiotherapist.
This is called Functional Electrical Stimulation and it is used here
to treat all kinds of paralysis. Often, in cases such as Alejandro's,
it results in a complete recovery of the use of his limbs. In other,
more difficult cases, the hospital designs a portable apparatus which
the patient carries strapped to their waist. They operate this
manually to provide the artificial stimulus needed to produce walking
movements. In this way, with the aid of a pair of sticks, a
hemoplegic patient can get about without the need of a
wheelchair.
"This treatment is used in very few countries," says the hospital
director, Professor Eulogio Montoya, " But we have developed it to a
very advanced degree here."
Professor Montoya, 55, the black son of a sugar worker, has made his
life's work the development of this hospital, which is Cuba's centre
for all kinds of physio and rehabilitation therapies.
"Here we train all the physiotherapists in Cuba and all the doctors
who wish to make some field of rehabilitation their specialization.
We are also a teaching hospital for therapists from other countries
such as Argentina, Mexico and Chile."
The hospital, founded as a home for invalid children in 1958 was
converted into a rehabilitation hospital by the government of Fidel
Castro shorty after the revolution in 1959.
"The first patients were the wounded and disabled from the
revolutionary war." Says Professor Montoya. In the beginning it was
relatively small with 172 beds and only seven for children. But then
in 1986, after a visit from "Commander in Chief" Fidel Castro
himself, it was enlarged.
"Fidel saw that there was long waiting list of patients who needed
therapy, and immediately sat down with all of us here to discuss a
development plan. Because of his intervention we are now able to
accommodate many more patients and offer a much wider range of
therapies," adds the director.
Today the hospital has 410 beds for in-patients, 75 of which cater
for children suffering mainly from cerebral paralysis. As well as
this, it has the ability to treat up to 500 outpatients daily. People
are sent here from all over the country for any one or a combination
of some 17 different kinds of treatment.
The most advanced of these are magnetotherapy, in which magnetic
fields are used to alleviate muscular pains such as lumbago, and
laser therapy which the hospital has developed as a variation of
acupuncture.
The hospital is a centre for the training in acupuncture which was
introduced after the legendary Che Guevara came back from China in
60s with news of its efficacy. Therapists here also use what they
call "auricular therapy" from Vietnam whose charts resemble those of
reflexology except treatment is applied to the ear instead of the
foot.
A patient in the clinic I visited was having various different kinds
of seeds inserted in her ear as a treatment for vertigo.
"Does it help?", I ask incredulously,
"Yes, of course," comes the equally surprised reply, "The only thing
it doesn't do is make me slimmer!"
The hospital also provides hydrotherapy, mud therapy, massage,
ultrasound, infrared, psychotherapy, occupational therapy and
something they call "recreational therapy" in which they prescribe
recreational activities to help patients recover full fitness.
In the children's ward, therapists who originally trained in England
use the Bobath technique to help cases of cerebral paralysis.
Here, mothers are admitted with their children for courses of up to
eight weeks in which the mothers learn how to perform the technique
themselves so that they can continue the treatment when they return
home.
Dr. Nesfran Valdez, is the 42 year old woman vice-director of the
hospital who introduced me to a group of women and their children
undergoing training in the technique, explains:
"They receive training in all aspects of looking after the children
with this disability. This includes psychology, diet, exercises,
massage and training in how to help the children walk."
At any one time, 75 women from all regions of the country stay here
with their children and a further 50 local cases are brought in every
day by bus from Havana province. As with all else in Cuba, this
treatment is absolutely free, and the women are given paid time off
work if necessary to attend.
In the Cardio-vascular treatment room I am shown two cardiograph
machines. One called Cardiocid and the other Herocid. Both are highly
advanced computerized diagnosis machines designed and manufactured in
Cuba and which have recently been sold to other countries in Latin
America. In the voice-training department speech therapists use a
machine called Videovoz, also designed and manufactured in Cuba,
which gives a visual display of voice patterns so that hearing
impaired patients can imitate the correct sounds of speech inputted
by the therapists.
Such advanced machines are an indication of the kind of development
that this poor, Third World country has undergone in the past
thirty-six years. Professor Montoya says: "Before the revolution
there were no more than 40 beds for rehabilitation patients in the
whole of the country. Now we have enough provision to cover the whole
population's needs."
Finally, I am shown the building operation which will soon see the
hospital enlarge so that it can provide even more facilities and
training. The work on the new wing, which will house a sauna,
swimming pool and other aquatic based treatments was suspended in
1990 after the collapse of the former Soviet Union caused a severe
economic crisis. But this year it was restarted and the hospital
hopes that it will be concluded by 1997.
The hospital will then be able to offer training and treatment to
foreigners who will pay in the hard currency necessary to keep this
centre of excellence open.
Like many other enterprises in Cuba, Julio Diaz is short of hard
currency to buy necessary equipment and spare parts. This is due to
the collapse of their original suppliers in the former Eastern Bloc
and an economic embargo from the United States which has made it
increasingly difficult to obtain certain things.
In the prosthesis workshop, for instance, they lack the right kind of
aluminium to make leg supports. The workshop provides prostheses for
paraplegics throughout the country.
Here I find Andres Paciencia, himself a former patient who works at a
bench making shoes, although he himself will never walk again. For 33
years he has been bound to his wheelchair, amputated from the waist
down after an accident.
Part of his rehabilitation at the hospital was to learn how to work
with his hands and this resulted in him turning his therapy into his
actual work.
" I live nearby and come to work in my chair every day," he says,
"Apart from aluminium and leather for the shoes, I'd only ask for one
thing from England. That's some new wheelchairs. Look! Mine has
nearly had it and if I don't get a new one. How will I get to
work?"
Similar stories are heard everywhere these days but spirits remain
high. Despite the lure of more lucrative work in the tourist industry
which has been reported in the press as causing a "brain drain" from
the medical system, not one nurse or doctor has left Julio Diaz for
that reason. "This is a specialist centre of learning where people
come to improve and work for love," says Dr. Nesfran. "I can honestly
say that no-one has gone from here for a job in the tourist boom."
* To arrange a visit to the hospital or obtain information on training etc. fax: Prof. Dr. Eulogio Montoya Guibert 00-53-7- 33-5750.
*Donations of equipment can be sent via the Cuba Solidarity Campaign in London: Tel: 0171-263-6452.
List of equipment which the hospital needs:
1. Sheets of hard aluminium D16AT 5mm thick.
2. Sheets of hard aluminium D16AT 4mm thick.
3. Sheets of hard aluminium D16AT 3mm thick.
4. Iron rivets 3x20 mm with a flat head.
5. Copper rivets 3x20mm with a flat head.
6. Aluminium rivets 3x20mm with a flat head.
7. One pin buckles 16mm wide.
8. One pin buckles 18mm wide.
9. Leather or vinyl for orthopeadic shoes.
10. leathet or vinyl to line shoes.
11. Shets of acrylic.
12. Sheets of Desilene.
13. Endless saw blades for cutting aluminium 0.6 mm with 16 teeth per
inch.
14. Foley catheters Nos. 16, 18, 14.
15. Urine bags.
16. Antibiotics: (Cedax, Visant).
17. Ibuprofen (cream, suppositories or tablets)
18. Volteren (cream, suppositories or tablets).
19. Piroxican (cream or tablets).
20. Naproxen (cream, suppositories or tablets).
21. Analgesics (paracetamol).
22. Anti-inflamatories.
23. Anti-rheumatics.
24. Akatinol (tablets or viales).
25. Wheelchairs for aduts and children.
26. Physioballs and any kinds of Bobath equipment.
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