American Society of Regional Anesthesia and Pain Medicine August 2016 - 14

"To Have and Have Not:" The Ultrasound Revolution Reaches
Cuban Shores
INTRODUCTION
On January 29, a small team of
anesthesiologists from the United
States conducted the 2016 Regional
Anesthesia and Acute Pain Workshop
for local physicians in Havana, Cuba.
The date marked not only the first acute
pain medical mission by American
anesthesiologists since the Cuban
Revolution but also the rebirth of a
friendship with our close neighbors
and medical colleagues. This is a
recount of the preparation, execution,
and analysis of the mission and its
accomplishments.

Andres Missair, MD, EDRA
Associate Professor
Associate Director Fellowship
Program in Acute Pain Medicine

Alexandru Visan, MD, MBA
CEO, Executive Cortex Consulting, LLC
Assistant Professor

Oscar De Leon-Casasola, MD
Professor and Vice-Chair for Clinic
Affairs
Chief, Pain Medicine
Department of Anesthesiology
Jacobs School of Medicine and
Biomedical Sciences
State University of New York at
Buffalo

Department of Anesthesiology
BACKGROUND
University
of Miami, Miller School of
Cuba is an island nation in the Caribbean
Medicine
with a population of approximately
Miami,
Florida
11.4 million. It boasts one of the most
comprehensive and accessible health care
Section Editor: Melanie Donnelly, MD
infrastructures in the world, with 70,594
physicians and 99.4% primary care
coverage of the population.1 In total, 249 hospitals, 470 primary
PREPARATION
care clinics, and 54,857 beds comprise the nation's health system.1 While the concept of an acute pain workshop is simple enough,
its ultimate success lies in the sustainability of its program
Thanks to this infrastructure, Cuba can lay claim to various
once the faculty has returned home. The academic exercise of
significant health achievements, including the first country to
teaching and learning is subordinate to the application of the
eliminate polio (1962), the first country to eliminate measles (1996), educational material in daily clinical practice. For this reason,
and the lowest AIDS rate in the Americas.2 It would seem highly
the program curriculum was designed to teach not only nerve
unlikely, therefore, that a country with such medical development
block techniques but also how to establish and manage an acute
would benefit from an
pain service. Once the
international educational
framework was established,
mission on acute pain medicine
session topics defined, and
for its own anesthesia
volunteer faculty identified,
specialists. Yet, while Cuba
the work (paperwork)
was the first country in Latin
began.
America to have radio and
color TV, it was also the
One month prior to the
last to have Internet. Five
design of the program, a
decades of economic embargo
meeting was held with the
and the disappearance of
Cuban Ministry of Health
Soviet economic support
in Havana to determine
have left the Cuban medical
the feasibility of the
infrastructure with limited access to expensive medical technology, mission. Three days of meetings with a veritable alphabet soup
in particular perioperative ultrasonography. Ultrasound guidance
of supervisory departments from the Cuban government would
for venous access or neural blockade is nonexistent. Most Cuban
dishearten even the most naïve or obstinately resolute. The
anesthesiologists rely on paresthesia technique, and only a handful
Ministry of Health (MINSAP), Ministry of Commerce, Ministry
have access to neurostimulation. Despite these obstacles, many
of Foreign Affairs, Cuban Association of Anesthesiology, and
have a working knowledge of anatomic landmarks for neural
United Nations Emergency Children's Fund (UNICEF) were all
blockade, and some even use surgical nerve blocks in their daily
seated at the proverbial table. The timeline was very tight, by
clinical practice.
any bureaucratic standard, but miraculously all parties agreed

"Five decades of economic embargo and
the disappearance of Soviet economic
support have left the Cuban medical
infrastructure with limited access
to expensive medical technology, in
particular perioperative ultrasonography."

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American Society of Regional Anesthesia and Pain Medicine
2016



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