Health Care Professionals/Medical Meeting/Love of Travel

Lynn Black, MD and Karl Neumann, MD

Havana, Cuba.

For most of us in travel medicine a meeting located far from home, especially in a country that we have never visited, is generally more satisfying than one within driving distance. Even better if that country is controversial (but stable), constantly in the news, on most travelers’ wish list to visit, and has a unique health care system that we know little about but would like to get to know more. Still better if the meeting has no more than 20 participants and is hosted by warm, enthusiastic and knowledgeable faculty who present useful information (using Powerpoint!), and where we meet colleagues, local and international, with whom we form ongoing relationships for friendship and networking.

In fact, each issue of this newsletter has numerous listings of such meetings and courses, held in all parts of the world, with one tailor-made for you, fitting your professional and personal needs and desires, your level of adventure, and your time frame and budget. Please see the calendar and the educational course section. This issue, for example, contains information about meetings in Peru, Tanzania, Alaska, and, of course, our upcoming major ISTM-sponsored congresses in South Africa in February and in Portugal in May 2005. Our listings keep growing, with meetings and courses in ever more countries, as travel medicine continues to expand.

The recent 5-day International Travel and Tropical Medicine Course at the Tropical Medicine Institute Pedro Kouri (IPK) in Havana is a typical selection from our menu. IPK, founded in 1937, is located on a large campus on the outskirts of Havana. It has been through all the trials and tribulations of recent Cuban history, and faced some difficult times but has survived, recovered and is now thriving, if not yet prospering. Today IPK, with a professional staff of over 700, is a World Health Organization/Pan American Health Organization Collaborating Center for the study of numerous diseases including tuberculosis, dengue, and leptospirosis. IPK offers dozens of programs to train students and researchers from all parts of the world, operates a large infectious disease hospital, and has played a significant role in the development of numerous vaccines, including ones against hepatitis B, meningococcal meningitis serotype B, and leptospirosis, with some of these vaccines already in use, and others in the advanced phases of testing. IPK is also the Cuban national reference laboratory for AIDS and helps train thousands of Cuban physicians to serve in medical needy areas of Central and South America and Africa. The Institute maintains close ties with medical institutions in Europe, Latin America and the United States.

The recent 5-day travel and tropical medicine course, the second annual one, attracted participants from half a dozen countries. The 20 hours of lecture were in English, given mostly by local faculty who had a good command of the language. Among topics discussed were dengue fever, malaria, hanta virus hemorrhagic diseases, ebola virus, and immunizations for travelers, to mention just a few. There were also discussions of the local health care system, a system that struggles under difficult economic conditions, and deals with constant shortages. In addition, there were optional hands-on learning opportunities in laboratory bacteriology and parasitology, and opportunities to visits other laboratories, local hospitals, and other health care facilities.

Well-planned travel medicine courses, especially ones in remote locations, should provide a wide lens view into the local health care system. This in turn requires some understanding of the countries economic and social system and realities. In Cuba, the health care sector is clearly one of the few jewels in the country’s otherwise difficult economy. (The education system may be the other bright spot.) In part due to the work at IPK, "tropical diseases" no longer exist in Cuba. The incidence of hepatitis A is closer to the rate in developed countries than in the third world, and typhoid fever is a rarity. The infant mortality rate is under 7, on par with North America and Western Europe. All children are vaccinated against the more common childhood diseases. The life expectancy is a healthy 76 years.

Though the meeting was held on the outskirts of Havana, participants lived in hotels or with families in private homes/apartments in the center of the city, with the residence selected entirely dependent on participants’ preferences and wallet. Top hotels were quite good, virtually on a par with similar establishments elsewhere, and almost as expensive. Accommodations with local families, called "guest houses," were sparse but adequate, and provided visitors the opportunity to experience a Cuban home and local cooking. Such accommodations are licensed by the Cuban government. One such facility was across the street from the Hotel Nationale, the best hotel in Cuba, with a delightful family in a relatively small apartment. Guests had their own rooms and bathroom ($30/night including breakfast), with other meals extra. A Spanish/English dictionary came in handy for guests who spoke picito espanol.

A van picked up participants from their residences and transported them to the meetings, about a 25-minute ride from downtown. The ride back and forth turned out to be very interesting, a regular sightseeing tour, offering a view of the city and suburbs.

Living downtown allowed participants to explore Havana, absolutely and positively guaranteed to be a never-to-be forgotten experience. A must are walks through Vieja Habana, the huge old section of the city, and along the waterfront. Here are hundreds upon hundreds of architecturally majestic and beautiful houses, each one different from the next, but virtually all in terrible states of neglect and disrepair. In isolated cases only the walls remain, held up by leaning timbers. Others appear to be occupied but have broken windows and boarded up doors, with people living inside. Here and there you see a house being restored, allowing your imagination to picture the entire area as it used to be. But even amid these ruins, one cannot fail to sense the grandeur that once was Havana.

Especially memorable is walking the streets at night, when you see the facades of the houses lit by streetlights without seeing the disrepair that they are in. And as you walk along you almost always hear the exiting beat of Cuban music coming from small cafes or open windows. Also not to be forgotten are the cars on the streets, most of them Soviet built or thousands of over-sized America models, mostly from the 1950s, amazingly still running, and many of them in fairly good condition.

An informative travel and tropical conference plus the spirit of Havana is a mesmerizing blend. The warmth and friendliness of the Cuban people, the energy of the narrow, colorful streets of Old Havana, learning to salsa, seeing the Museum of the Revolution, drinking a mojito in Hemingway’s hangout… Is there a better way to experience the world than to be involved in travel medicine?

Lynn is an internist with experience in emergency medicine and medical care in developing countries. She lives in Concord, Massachusetts.

Karl is a pediatrician and the editor of NewsShare. He lives in New York City.