`Salud!' to gain fame with `Sicko'

Akron Beacon Journal

Posted on Mon, Jul. 02, 2007

Retired Akron health commissioner says U.S. could learn from Cuba

By Tracy Wheeler
Beacon Journal medical writer

It's a documentary film with a shocking premise: the U.S. health-care system could learn a thing or two by looking at how the small, poor, Communist country of Cuba delivers universal health care to all of its 11 million residents -- who are just as healthy as Americans.

The story line might sound an awful lot like Michael Moore's ultra-hyped Sicko, which opened in theaters this weekend. But Moore wasn't the first to draw this comparison.

That distinction belongs to the film-makers behind, Salud!, which includes Akron's retired health commissioner, Dr. C. William Keck, who served as one of three executive directors.

It's odd to think of Keck (a calm, cordial, soft-spoken man) having anything in common with Moore (an in-your-face, hey-look-at-me filmmaker), but here they are tied together by the idea that an American health-care system that spends $6,000 per person per year can learn something from a Cuban system that spends about $250 per person per year.

Look at the numbers, Keck said. Both countries produce essentially the same life expectancy -- 77.7 years for the United States, 77.6 years for Cuba. In terms of deaths of children younger than 5, both countries have a mortality rate of 8 per 1,000, yet, when it comes to infant mortality, Cuba loses fewer babies in child birth (5.3 per 1,000 births) than the United States (7 per 1,000 births).

Keck is not claiming that the Cuban system is perfect. Though Cuban doctors have been performing heart transplants for many years, they performed their first liver transplant just last year. High-tech equipment is scarce. And if you've been diagnosed with a rare or complex disease, Keck said, there's no better place to be treated than the United States -- if you have insurance coverage. Unfortunately, 43.6 million Americans are uninsured.

In Cuba, however, everyone has access to health care, paid for by the government.

The idea for Salud! began in 1992, when Keck -- the then-out-going president of the American Public Health Association -- visited Cuba. As a former Peace Corps volunteer in Bolivia, Keck carried certain biases into Cuba with him. He came out impressed with what he saw.

``I thought, `That was cool, but that's the end of it. There's no reason to go back,' '' he said.

But in the next 20 years, he returned 15 times.

In 1997, he helped prepare a report on the harmful effects the U.S. embargo on Cuba was having on the Cuban people and their health.

The report by the American Association for World Health found that ``a humanitarian catastrophe has been averted only because the Cuban government has maintained a high level of budgetary support for a health-care system designed to deliver primary and preventive health care to all of its citizens.''

Keck followed the report by speaking before Congress, but the embargo stayed in place. The restrictions have only grown tighter in an effort to starve the Castro regime.

``That's obviously worked very well,'' Keck said sarcastically.

Despite the lack of resources, he said, ``somehow they've managed to pull through.''

They've done it by providing true universal access to health care, with a focus on up-front prevention, rather than the disease treatment focus of the U.S. system.

Cuban doctors make much less money than their American counterparts. But a sense of community service spurs Cubans to continue to join the ranks. Cuba has many more doctors per capita than the United States (627 per 100,000 versus 264 per 100,000).

The Cuban system is ``completely socialized. Everyone works for the government,'' Keck said. And the government has strict rules of what it expects from its doctors. All doctors are required to serve two years as family doctors before they can apply for medical specialities. Family doctors are assigned a case load of about 150 families and are required to see every patient at least twice a year, with one of those visits held in the patient's home.

It's not likely that such a set-up would ever work here, Keck admits. But, he asked, ``Shouldn't we be open to lessons we can learn? Shouldn't we understand how they do that? There just well may be a lesson or two in it for us.''

Salud! has played to packed rooms at the American Medical Student Association, to a room of 600 medical students at Harvard, at Johns Hopkins University at the American College of Preventive Medicine in Miami, and won the audience choice award at the Pan African Film Festival in Los Angeles, where one viewer stood up and said, ``Thank you for making this film and thank you for keeping it apolitical.''

That sentiment won't last long, though.

Any mention of Cuba won't be seen as apolitical, especially after Moore tackles the issue.

Critics see this discussion as a not-so-subtle way to steer America toward government-run health care, a single-payer system that they say will elbow out private insurers and stymie medical innovation.

So far, the feedback to Salud! has been positive, Keck said, but probably because it's been shown to those who tend to agree with the premise. But as Sicko gains steam and Salud! earns a spot on the national stage, Keck is expecting ``push-back that's more sophisticated.''

``We almost would have had to kill for this kind of attention. But we're not sure if it's a be-careful-what-you-wish-for situation,'' he said. ``There's an opportunity that a little awareness will be raised by this.''

Tracy Wheeler can be reached at 330-996-3721 or tawheeler@thebeaconjournal.com.