By David Wald and Juan Reardon, MD, MPH
This article originally appeared in the November 6, 1995 edition of Microtimes
It's hardly unusual when computer technology and medical technology are joined. In Cuba, computerized information technology is coming to the rescue of physicians and medical workers. Project InfoMed is the embodiment of this development.
Cuba's long-term involvement with health care was bolstered in the early `70s when President Fidel Castro proclaimed his objective that "Cuba will become a world medical power." To a considerable degree this has come to pass (with fifty-seven thousand physicians, Cuba has one doctor for each 192 inhabitants.) Based on a high level of general and specialized education Cuba has invested heavily in medical technology--biotechnology, pharmaceuticals, and medical instrumentation, as examples.
Maintaining the effectiveness of a sophisticated medical system requires the efficient dissemination of medical data, including the ability to search and locate specific information, as requested by physicians, researchers, and medical students. With the advantage of a highly educated population, and with the cooperation of key medical personnel, the Ministry of Public Health succeeded in creating a well-functioning National Center For Medical Sciences information (CNICM). That was established some thirty years ago.
Information specialists at CNICM were charged with the task of continually updating the medical system with respect to modern medical technology worldwide. To a large degree, they've been involved with subscribing to, cataloging and distributing medical journals, many from the United States. The weakening of the Cuban economy has had the effect of lowering the budget for medical journals and books; From a high of $1 million CNICM is currently down to $35,000. But Cuban medicine has also contributed to the store of world medical knowledge. CNICM handles the publication of twenty-five medical journals through the National Center's publishing facility, ECIMED (Editorial Ciencias Medicas.)
Almost two years ago CNICM initiated Project InfoMed, aimed at the creation of a wide area network to link outlying areas of the country to regional and provincial servers which, in turn, connected with a central database in Havana. Here was one way to circumvent the problem of insufficient copies of medical journals, with the added bonuses of computerized search capabilities and rapid data transmission.
The short-term goal? To allow any medical worker with access to a terminal to request medical information--journal articles, pharmaceutical data, medical alerts--at the tap of the keyboard, from the central computer; information that is vital to optimum diagnosis and treatment of their patients. The family doctor, say, in an outlying mountainous region may not know what herbs and conventional medications would be most appropriate to prescribe for a particular patient. They can ask the proper questions through the computer system and a central database repository will probably provide the answer within seconds.
InfoMed also makes it possible for medical scientists. academics, researchers, medical students, and professionals to communicate with one another. Through the system, Cuban professionals can easily obtain and submit important medical articles, bulletins, and even excerpts from books.
Contra Costa County epidemiologist Dr. Juan Reardon met with Dr. Jose Francisco Rodriguez Perez, a young physician who was assigned to the project less than a year ago. Dr. Rodriguez provides medical expertise for Lic. Pedro Urra, a computer professional originally trained in foreign services. Urra is responsible for the overall design of the InfoMed network and directs the development of software for the system. A major consideration, Dr. Rodriguez explained is the creation of user-friendly software for medical personnel who are not about to become hackers. The approach was to initiate a system structure that would be flexible enough to permit additional sophistication as soon at it was available--but able to get medical workers online as quickly as possible. It is apparent, from the present level of traffic, that they have done that.
The director and subdirector of the National Center, Dr. Jeremias Hernandez Ojito and Jehova Oramas Diaz, respectively, provided background information about the National Center and explained that a major portion of Project InfoMed was initially funded by the Pan American Health Organization (PAHO) with follow-on money from United Nations Special Projects.
At this stage of the project, the InfoMed network is a national grid. After only eighteen months of implementation following the six month planning period, the InfoMed network was already in place, with four servers currently functioning in the provinces (City of Havana, Villa Clara, Camaguey, and Santiago de Cuba) and with a list of subscribers in excess of two hundred, and growing fast. Those four will take on the additional role of regional servers as soon as the other ten provinces have their servers installed. Those ten are being prepared at CNICM and will be in place by November 1995. All servers are Intel-based 486 PCs (The city of Havana will house the core of the system.) The sites for the servers will generally be major technical hospitals and medical schools in each province. Staff physicians, medical students, and researchers will have access to terminals located in and around their respective institutions, general and special hospitals, medical schools and medical research institutes. At the present there are about one hundred terminals scattered across the country.
Two of Cuba's best known research centers are the Carlos Finlay Institute, where the first WHO-approved meningitis B vaccine was developed (currently being used by Argentina and Brazil and under evaluation in Chile and several other Latin American countries) and the Center for Genetic Engineering and Biotechnology, both in western Havana. Such institutes will have high priority for multiple terminals. At the other end of the medical hierarchy the goal is to locate more terminals in remote areas where family doctors may have access to the InfoMed Network.
Urra and Rodriguez explained that the UN grant covers the cost of only the servers and related expenses. The task of obtaining sufficient terminals is left up to the Cubans themselves (about eight hundred in all are needed. They pointed out that PC-XT and PC-AT computers, counterparts to the early Model A and Model T Fords are quite adequate as terminals. Fitted with 20MB or 40MB hard disk drives and 2400 baud modems, these older machines are allowing the users to tie into the national system. All of the terminals currently in place have been gathered from various sources, including eighteen from the Bay Area which arrived in July on a Pastors for Peace Friendshipment Caravan. The Bay Area support group for Project InfoMed is collecting and servicing PCs with the goal of sending two hundred units in January 1996. (N.B., These computers are part of the shipment that was violently seized by U.S. Customs on Jan. 31, 1996.)
Apart from the obvious hardware requirements of InfoMed, there is the matter of access to international medical databases--The US National Library of Medicine has compiled some very impressive databases. The most extensive and well-known being MEDLINE, used by thousands of medical personnel in our country. MEDLINE is available on-line as well as on CD-ROMs (which are updated quarterly). Rodriguez and Urra expressed great familiarity with MEDLINE, as well as with a few other databases such as Cancernet (which is already available to them via an Internet dial-up connection). The software to fully access the on-line version is available at nominal cost; the problem at this time is Cuba's lack of hard currency to pay for a high-level connection with the Internet (SLIP/PPP connection). But the CNICM is planning on such a connection some time in the not-so-distant future. Then InfoMed will be able to fully access medical data bases beyond their own national system.
At a medical school in Havana the Instituto de Ciencias Basicas, Victoria Playa Giron (ICBVPG), we interviewed Dr. Felix Fernandez, biochemistry professor and director of information. In a study hall/library, surrounded by forty or fifty medical students cramming for exams, Dr. Fernandez described the plan to locate terminals right there where those students would have access to the medical databases. With computer technology popular among the youth in Havana, medical students are taking to networking with easy familiarity. (There are numerous computer clubs and formal classes in beginning, intermediate, and advanced computer technology, some located in the old Sears building in Central Havana, a building which also houses the popular email network, Tinored.)
The National Institute Oncology and Radiobiology (INOR) is a leading cancer hospital where Maria Sol Lopez is director of the National Center for Oncology Information. She will be in charge of the node soon to be located within that institution and expressed great enthusiasm for the arrival of the equipment. Dr. Gilberto Fleites, chief of thoracic and abdominal surgery, is an energetic individual whose knowledge and interests include not only medicine but economics and computer technology. He spoke from the standpoint of an end-user of InfoMed and clearly saw how his work will become more effective with the advent of the node, particularly when he will have live access to Cancernet at the National Library of Medicine. Fleites explained his problem with obtaining and analyzing CAT scan images of patients from outlying districts who are awaiting surgery. The shortage of imaging film is being overcome by submitting those images on the net without the intermediate step of recording them on the scarce media.
Cuban medicine has, for many years, maintained extensive central registries of medical statistics, the cancer registry being among the most important. With the use of InfoMed, explained Fleites, the task of keeping accurate records is greatly simplified.
The nations largest hospital, the Hermanos Ameijeiras, is a twenty-three-story building near the Malecon, Havana's aging boulevard on the Caribbean Sea. Located on the twenty-second floor of the hospital, the managers and users of the Ameijeiras node enjoy a fine panorama of Havana. The Ameijeiras started out to be a bank building until the new Cuban government (post-1959) decided to convert it to a hospital. It contains some of the most advanced medical equipment in Cuba. There Ella Esposito, the soft-spoken computer engineer in charge or the new InfoMed node, patiently described how the advent of InfoMed had substantially changed their working lives for the better. As a de facto "National Hospital" the Ameijeiras often plays the role of hospital of last resort and is called upon to handle medical cases that are beyond the capabilities of general hospitals. In that role, the specialists at the Ameijeiras are obliged to maintain close communications with many other hospitals in Cuba, The InfoMed network is making that task far more manageable.
One of the tasks of the Ameijeiras is to generate and disseminate medical educational material for the general population throughout Cuba. A separate department is dedicated to the production of leaflets, videos, and audio tapes on good health practice: preventing obesity, hazards of smoking, proper nutrition, alcoholism, etc. Now the use of InfoMed has simplified the task of transmitting this material to outlying medical institutions. Even such mundane tasks of announcing medical seminars, conferences and lectures by visiting professors can be carried out with the use of InfoMed. The attendance of medical personnel at these functions is far higher than ever before (A recently visiting Canadian eye specialist was puzzled by the unexpectedly large attendance at his lecture at an institute in Havana until he learned that notice of his talk was disseminated via InfoMed.)
Project InfoMed demonstrates the unique functions that a computer network can perform in the scientific community, particularly medicine. The Cuban experience, born out of dire necessity rather than mere option, is demonstrating to the world community the great potential of computer networks to enhance the well-being of people, even beyond its value to the business community.
Copyright (c) 1995 by David Wald. All rights reserved.
WE ENCOURAGE YOU TO DISTRIBUTE THIS MATERIAL TO OTHERS !!!!
When doing so, please include due credit to the authors.
We the undersigned, representatives of various Cuban institutions, Health Care workers and Christians state that:
Access to information is an essential necessity for health care workers. The difficult economic situation facing Cuba after the fall of the Socialist Bloc, particularly the Soviet Union, added to the brutal tightening of the US government blockade has had an extremely negative impact on the country's ability to provide the necessary information to support the efforts being made to maintain and improve the public health standards of the Cuban people.
The right information in the right hands at the right time SAVES LIFE'S, even more effectively than any medicine or new techniques.
The National Center for Medical Sciences Information is coordinating a national network which encompasses libraries and other kinds of information centers serving of the health system. The economic difficulties the country is experiencing have obliged us to seek out alternative information sources to make it possible to provide the level of information necessary to support the work of doctors and other health professionals.
InfoMed has been one of these alternative methods. The medical science electronic information network is the most developed alternative. It's development is due to the support given by the Ministry of Public Health, aided by international organizations such as the Pan American Health Organization (PAHO), the United Nations Development program, and the Caribbean and Latin American Medical Science Information Center.
The Network has been extending it's coverage over the last few years and today is in every province of Cuba. It has 24 hour service seven days a week and offers a growing number of information services which make up for the lack of information received through traditional channels.
These computers which represent a humanitarian gesture of solidarity are today held up at the US border. They were coming to support our efforts to allow specialist who provide primary care, workers in intensive care wards where children's lives are saved and specialists in general medicine to begin to take advantage of the new possibilities opened up by information and communication. In a world where all recognize the importance of information as a resource essential for improving the living standards of our peoples, especially their health standards, any attempt to hamper efforts to achieve this objective infringes the rights of states and of humankind. From the basis of our Christian faith moreover, we have continuously and commitedly opted for life and for each and every way which helps to improve and extend the quality of life. The way shown by Jesus Christ in his relations with disease and the sick lights our way and gives us courage in this undertaking.
Cuban Council of Churches Martin Luther King Jr. Memorial Center Cuban Worker-Student Baptist Congress Christian Student Movement Brotherhood of Cuban Baptist Churches Oscar Arnulfo Romero Reflection and Solidarity Group Kairos Christian Center for Arts and Liturgy The "El Fuerte" Reflection and Discussion Center The Latin American Union of Ecumenical Youth The christian Medical Commission Dr. Noemi Gorrin- Pediatrician and President of the Christian Medical Commission Dr. Flina Ceballos- Neuro-Pediatrician Angel Lorenzo Gonzalez- Intensive Care Nurse Dr. Marianela de la Paz- Family Doctor Dr. Loida Sardinas- Family Doctor Yamila Laura Lee - Nurse Dr. Roberto Ohoa- Family Doctor Dr. Amaryllis Castro- Family Doctor
February 1, 1996
Havana, February 6(RHC)-- Cuban Foreign Minister Roberto Robaina met on Monday with the 39 members of the 6th Pastors for Peace caravan currently visiting Cuba. The group is in Havana for one week and will visit hospitals, schools and other places of interest. Among the stops for the group yesterday was InfoMed, a project of the Cuban Health Ministry, which was to have received donated computers, seized last week by U.S. authorities. The Pastors for Peace caravan was stopped in San Diego, California, as the group attempted to cross the border into Mexico and, ultimately, bring the computers to InfoMed here in Cuba.
While some of their number are in Havana, others from the 6th Pastors for Peace caravan remain behind on the U.S.-Mexico border in San Diego to continue the struggle for the release of the confiscated computers. A nation-wide campaign has been launched to raise even more computers to replace those seized by U.S. authorities. And, more importantly, a campaign is underway to raise consciousness about the illegal U.S. blockade against Cuba. One way in which education is being carried out is by referring to the links between U.S. domestic and foreign policies. Radio Havana Cuba spoke with Richard Becker, a representative of the International Peace for Cuba Appeal and Pastors for Peace.
"It is very ironic that at this time when both the Congress, the `Contract on America' authored by the Republicans, but also the Democrats and Clinton, are all determined to reduce services of all kinds and particularly medical services to all sectors of the population. When in the United States, 50 million people have no health care, it's ironic that the government should use a huge amount of its resources to stop the caravan. This is a multi- million dollar operation that's been launched against the caravan, to deny the sending of computers to Cuba, to strengthen this health care system in Cuba.
"Here in Cuba, there is universal health care -- in a much poorer country than the United States. Every single person is guaranteed the right to health here in Cuba. And the purpose of these computers was to strengthen this already excellent health care system. So we have the spectacle of the United States government, on the one hand cutting back medical services -- already inadequate medical services for its own citizens -- and then using its resources to try to deny better health care for the people of Cuba. This is outrageous! And we need to bring this to the attention of everyone in the United States and fight against both the domestic and international policies of the U.S. government at this time."
/* Written 4:36 PM Mar 9, 1995 by jreardon in igc:reg.cuba */
/* ---------- "More on InfoMed: Cuba" ---------- */
InfoMed is the computer net of the National System of Health Information of the Ministry of Health in Cuba. It has been operational since 1992.
Goals: To facilitate the exchange of electronic information in the field of medicine, biomedicine and health in general. Intends to facilitate linkages between professionals, academicians, researchers, functionaries and Public Health workers in general in Cuba and abroad.
Linkages: InfoMed is linked to the key nodules of the Cuban E-Mail Net and with the X.25 Net of the Cuban Academy of Sciences. For international e- mail it is connected to PeaceNet, allowing e-mail exchange with the world nets, including INTERNET and Satellife. With the exception of these international e-mail services, we lack direct connection with INTERNET.
Users: Currently InfoMed provides services to users throughout the country with great possibilities of growth, only limited by the lack of equipment in the health institutions, given that the interest in the service health care workers is enormous.
Up to now there are approximately 500 open accounts, 80% of which are of collective use in health institutions of Cuba. This makes the estimates of users harder to make. The amount of information traveling through the net is continuously increasing and currently the daily average is 14 MB.
Electronic Mail: InfoMed allows users to send e-mail nationally and internationally.
Discussion Groups: Lists of discussion groups are available, both with and without moderators.
File Retrievals: Files available at the Net servers in public and private directories may be accessed and downloaded.
Database Searches: Through e-mail bibliographical and reference searches can be requested from the National System of Health Information. Additionally, on-line consultation is available.
Information : Users may subscribe to specific information services generated by the National Center of Medical Sciences Information (CNICM), such as health news, table of contents, electronic bulletins, and others.
. Consultation on development of computer net projects
. Consultation on the installation of local and wide nets (Novell, Unix, etc.)
. Consultation on the acquisition of computer hardware, modems, and other communication hardware and software.
. Consultation on the development and use of information services for electronic nets.
. Consultation on the analysis and development of new information systems
Goals for the near future:
. Distribution of new bulletins
. Widen the discussion groups
. Teaching courses through e-mail
Examples of resources available through InfoMed:
. MMWR (CDC's Morbidity and Mortality Weekly Report)
. CANCER (Articles from ONCODISK CD)
. BIPK (Epidemiological Bulletin from the Institute of Tropical Medicine)
. DIARIA (Information Service on news relevant to medical/health field)
. ANUARIO (ASCII files on Cuban Health Stats- 1993)
. ACIMED (Publication on the National System of Medical Sciences Information)
. CATCOL (Current Databases on the Catalog of Publications by CNICM)
. FITOMED (Database on medicinal plants evaluated by the ministry of health)
. NEURITIS (List for the dissemination of information on Neuritis)
. LF (Books and brochures at the National Medical Library: 5,500 entries)
. LILACS (Cuban medical literature database published in local journals/books; 6,000 entries. 50 new entries each month)
. TE (Thesis of medical students and residents; 16,000 entries)
UN Project: United Nations Development Program
InfoMed is implementing a strengthening project with the support of the United Nations Development Program. The goals are to make the services of InfoMed more available to institutions and health professionals with the establishment of nodules in 13 medical schools in the country. With this effort the country wide net will be strengthen with 13 UNIX servers for e-mail and other services.
This groups of dedicated servers will constitute the backbone of InfoMed are will permit the decentralization and expanded availability of the service. Any health institution with a terminal, a phone line and a modem will be able to communicate with the closest nodule and participate of the benefits of the national net.
This project must be completed by the end of 1995 and it involves the equipment and the training of the staff. Currently there is only one InfoMed nodule, which is for the whole country, is located in La Habana and serves mostly users in this city and periphery. Once the project is completed we intend to extend to the provinces the experience accumulated in more than two years of services.
Once the project is finished there will be a great capability at the national level to offer e-mail services and other services which will be under-utilized if the number of users is not increased. Terminals and modems are needed for institutions and clinics.
For more information: contact-C N I C M:Centro Nacional de Informacion de Ciencias Medicas 27 # 110 e/ M y N. Vedado. CP 10400. Ciudad de La Habana., Cuba Telf:(537) 321991 Fax:(537) 333063 E-Mail: email@example.com
Cuba Solidarity Homepage
USA-Cuba InfoMed Project