Monthly Archives: February 2016

Why we should look to Cuba to improve our Healthcare System…

Cuba’s healthcare system has been in revolution ever since the 1950s when the infant mortality rate was more than 80 per 1000 births, whereas now it has been reduced to only 5. This is lower than the USA itself and Cuba’s life expectancy is nearly identical to the USA with the average being 78 years; one of the highest in the world. Yet Cuba only spends $431 per head per year in contrast to the USA which spends $8,553. How do they do it? The answer is simple; prevention instead of a cure.

Various graphs comparing the success of Cuba's healthcare system compared to the USA and Latin America
Various graphs comparing the success of Cuba’s healthcare system compared to the USA and Latin America

With its small population of 11 million, Cuba has a multitude of 90,000 doctors to support it. With more than 8 for every 1000 people, this is significantly more than the UK which has 2.7 per 1000. This volume of doctors is the key to the prevention model which ensures that every patient is visited at home annually, and those with chronic conditions have more frequent visits. Data from home visits is combined to put patients into categories according to their “risk”; measured on a scale of 1 to 4.This allows the doctor to assess whether an annual visit is sufficient, or if more regular visits are required. So there is a clear aim to stop the public getting ill in the first place which is completely logical. All house calls result in addressing problems with follow-up appointments; this applies even for the failure of preventing an unwanted pregnancy.

Vaccination rates are the highest in the world, their literacy rate is 99% and health education is compulsory in all schools. However, there are disadvantages to this system; the public have no choice and no alternative with private health care. Physicians do receive benefits such as housing and food subsides, but their pay is low- $20 per month. Although they get free education and their role is respected, personal wealth is unattainable. Cuba still remains an extremely poor country in other aspects with very basic infrastructure and sanitation. Nevertheless, the advantages of their healthcare system should be an example to countries around the world.

Cuban healthcare
Cuban healthcare

Due to the success of their healthcare and the extension of the Cuban life, the country now has an ageing population equivalent to the UK. Hence, new problems such as obesity, heart disease and cancer are rising. Ironically the “Cubans live like the poor, and die like the rich,” in that their lifestyle is within a poor nation yet they die from the same diseases as many from a rich nation such as the UK. Indeed, the Cuban government is tackling this with new investments for education on the importance of diet and exercise and the effects of smoking and alcohol.

Should we look to Cuba to solve the NHS problem?
Should we look to Cuba to solve the NHS problem?

In conclusion, Cuba would be one of the most successful countries if it was not a less economically developed country. This presents how prosperous the UK, US or any other more economically developed country could become if the same measures were applied. Everyone could have an increased quality of life in health and wealth. To start we need to train more doctors and ensure that everyone is vaccinated to prevent conditions and people getting ill in the first place. With the NHS system being close to failure, maybe we need to consider Cuba before it’s too late?

Trigeminal Neuralgia

Earlier this year I wrote a post about Temporomandibular Disorder (TMD); jaw joint dysfunction, which my mother suffers from. She has recently visited a specialist who has recognized that this condition is a consequence of trigeminal neuralgia. By looking into my mother’s medical history, the disorder is likely to have been caused after she had surgery to remove her wisdom tooth, in which her jaw was opened too far.

What is Trigeminal Neuralgia?

It is described to be a sharp, shooting facial pain which can last from a few seconds to around 2 minutes. Commonly it only affects one side of the face, in my mother’s case it is her left side. These attacks can happen up to hundreds of times a day, although most people experience it daily or weekly. This pain can improve or disappear, however with my mother the condition has developed into a more continuous throbbing ache, along with random sharp attacks. My mother is normally triggered when she over exerts herself, is exposed to cold wind or harsh weather. In other people a simple movement of the face or head can sometimes activate the pain.

The Trigeminal Nerve
Figure 1: The Trigeminal Nerve

What is the Trigeminal nerve?

The compression of this nerve which is the largest inside the skull is the main cause of Trigeminal Neuralgia. There are actually two sets of the nerve in both the left and right side of the face. Figure 1 shows how extensive the Trigeminal nerve is; it lengthens into smaller branches such as the Mandibular branch which sends sensory information from the skin to the lower jaw, teeth and gums. Typically either the Mandibular branch or the Maxillary branch (upper jaw) is affected. The exact cause of the condition remains unknown; however 95% of cases seem to be caused when pressure is caused by an artery or vein compressing the Trigeminal nerve. In this way the pressure causes the myelin sheath which protects the outer layer of a neuron to wear away which causes the uncontrollable pain signals to occur. However, accepting this as a cause in contradictory as it does not explain why sufferers experience pain periodically with times when there are no symptoms.

The various parts of the face that can be affected if the Trigeminal nerve is disturbed
Figure 2: The various parts of the face that can be affected if the Trigeminal nerve is disturbed

How is the condition treated?

Painkillers such as paracetamol are ineffective at treating this condition therefore anticonvulsant medication is usually prescribed. The only current type of this medication licensed for such treatment is called Carbamazepain. Unfortunately although the initial effect of this medication is effective, in the long-term it becomes more ineffective. In addition it has various side effects such as double vision, memory problems and allergic skin reactions. Hence, patients are normally referred for further treatment. In serious cases when medication is inadequate surgery may be necessary. Procedures may involve injection, for example glycerol injections into the Gasserian ganglion (where the 3 branches of the trigeminal nerve come together); this works by intentionally injuring the nerve so that it disrupts the pain signals travelling along it. This type of surgery has various complications such as numbness to part of or the entire side of the face. Indeed, the treatment will only cause the pain to be relieved for up to a few years so the consequences have to be considered before such treatment.

My mother has been referred to a specialist who will hopefully be able to assign an appropriate treatment for her condition. Living with the pain can be extremely difficult for her and sometimes her quality of life is affected considerably. In the meantime she tries to avoid doing activities that trigger her symptoms as it is important to live a normal life. If you experience persistent facial pain and find that normal painkillers do not suffice, you may want to consult your GP to see if Trigeminal Neuralgia is a potential cause. For more information on the condition visit: http://www.tna.org.uk/; the Trigeminal Neuralgia Association for the UK.