Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices.1 On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand. The public health trip was led by Dr. Maisha Amen, founder of the Maat Center in Newark, N.J.2 Two other acupuncturists, as well as several physicians, nurses, educators, and psychologists participated in the visit.
Highlights of the trip included a visit to a polyclinic (analogous to a community health center here in the U.S.) and presentations on the spiritual practices embraced by many Cubans. Spirituality often reflects the trans-cultural synthesis of African practices, such as Yoruba, with Roman Catholic rituals and saints. Many Cubans pride themselves on this blending of cultures – syncretism – and this sentiment is reflected in health care and related practices as well.
The Cuban health system consists of three levels. All services are provided at no cost to individuals. At the first level, a physician and nurse work in a small community clinic. Care here is focused on prevention, teaching, and health promotion. Diagnosis and treatment are also available here. At the second level, the polyclinic, many health care professionals from a variety of specialties are employed. Polyclinics are open 24/7 in order to be available for their communities. More advanced treatment, such as minor surgeries can be performed at this level. The third level consists of institutes focused on specialties such as neurology or cardio-vascular rehabilitation.
Traditional medicine, including acupuncture, herbal remedies, massage, homeopathy, apitherapy (the medical use of honey bee products), ozone treatment, and exercise such as tai qi and qi gong, has been formally incorporated into Cuban healthcare practices for more than 40 years. Medical students study acupuncture in China and nurses are also highly trained to perform acupuncture, moxibustion, and cupping. Physicians receive specialty training in acupuncture in Shanghai. None of these forms of treatment are considered "alternative;" they are all completely incorporated into the fabric of the Cuban healthcare system. Patients and their providers determine which forms of healthcare are preferable and most appropriate for them. Treatment becomes a seamless blend of whatever approaches are selected.
With its emphasis on health of women, babies and children, the Cuban system is rated as one of the top countries in the world in terms of maternal and child health. Cuba's accomplishments are far better than those of the highly technologized U.S., which ranks near the bottom of industrialized countries in these same health indicators.
The spirit of openness and sharing is evident throughout the medical system. Cubans are proud to "share what we have." Our group visited a polyclinic in Matanzas, in the center of the island. The highlight for us was seeing the acupuncture clinic and having an enthusiastic dialogue with the staff. Two of the nurses had practiced acupuncture for more than 22 years and we traded our stories about successful treatment practices.
In addition to one of the authors, two acupuncturists participated in the trip. Loocie Brown, MEd, MAc, LicAc3 practices in Lexington Mass., and Brian Nicholas, MSAc, LicAc4 is licensed to practice in New York and New Jersey. We interviewed them in order to learn more about their interest and responses to how acupuncture is integrated into Cuban health care.
AT: What is your interest in Cuba?
Nicholas: As a person of African ancestry, my interest comes from the strong support Cuba gave to fight against apartheid and colonialism in Africa. Cuba trains doctors from various countries throughout the world to support the goal of making health care accessible to impoverished communities. I am also impressed about their impressive outcomes in education and health care. I also wanted to know more about whether they used traditional healing systems like acupuncture and more about their health care system structure.
Brown: I'm interested in the culture and politics of Cuba. I visited 15 years ago and wanted to see if any changes had occurred since then. The Cuban healthcare system is highly efficient and I wanted to learn more about their integrative approach to care.
AT: What did you learn about the structure of Cuba's health system?
Nicholas: First, health care in Cuba is free! Health care in Cuba is seen as a human right! We were informed that medications are kept as affordable as possible in the first level, and are free when used in procedures done at the second level (e.g. surgeries).
Brown: We learned about the three levels of care and how community level care is based on prevention. Self-care is encouraged and health promotion is a key element of a healthy lifestyle.
AT: What did you learn about Cuba's use of traditional health systems?
Nicholas: We were very excited to meet fellow acupuncture practitioners. They used acupuncture as general practitioners and used e-stim as well as bamboo cups. Traditional medicine has been part of a national health care system in Cuba since 1995 (though its presence long preceded that date). We were informed that the infant mortality rate in Cuba is very low, and that the life expectancy for women is 78 years, and for men it's 72 years. These accomplishments speak to the importance of strong public investment in their health care system. I also observed a noticeable absence of dialysis centers (which appear to be growing in my community) and lack of obesity amongst the general population, as is seen so commonly in my community.
AT: What would you say are the implications of those observations for communities without a national health care system?
Nicholas: I would say that Cuba's free health care system shows the importance of a strong commitment to community health care; which includes access to traditional modalities like acupuncture; and the importance of seeing health care as a human right, and not a profit driven system - especially given the obvious income and wealth disparities present in the U.S. In Cuba, life expectancy outcomes speak for themselves and validate their approach to health care. I believe that as a practitioners of traditional medicine, we can do more to make acupuncture an affordable medicine that works for the people.
Brown: We can learn a lot from the Cuban system. Their approach to therapeutics takes a broad perspective and they get impressive results. Economics of care demonstrate the importance and effectiveness of prioritizing people's needs. For a more modest investment in healthcare than the U.S. model, the Cubans can claim far better health outcomes.
With the normalization of relations between the U.S. and Cuba, we hope to increase our cross-cultural interchange and promote global health and wellbeing. The resulting syncretism of our mutual desire for a healthy population with both countries' dedication to advances in healthcare can influence the entire world to make integrative care a right, not a privilege.
- The New Shorter Oxford English Dictionary, 1993.