Ever since Fidel Castro's revolutionary regime assumed power in 1959, the United States has sustained poor diplomatic relations with Cuba. Over four decades later, the Embargo Act still forbids Americans from performing any economic transactions with Cuba, except for a few select groups of individuals, including government officials, journalists, health care professionals, students, academicians, and athletes, who may be able to obtain permission from the U.S. Department of Treasury to go to Cuba for specific purposes. Being a medical student, I have been fortunate to obtain a license to travel with my classmates to Cuba on a service-learning mission to deliver medicine/supplies and learn about health care practices in one of the last surviving communist regimes of the world.

    Along with 21 students and two physicians from U-M Medical School, I visited medical institutions (urgent care center, pediatric hospital, surgical tertiary care hospital, traditional healing clinic), public health facilities (maternity house, geriatric center, AIDS sanatorium, AIDS support groups), and development projects (housing/community projects, churches, Down's Syndrome school). After numerous conversations with sick patients, discussions with health care professionals, and observations of the medical practices in Cuba, it is evident that the progress of Cuba's health care system is being severely constrained by the world's most politically powerful nation, that holds the key to the door of technology, medications, and knowledge that saves people's lives. Private and public institutions in the U.S. hold patents to numerous medications, medical technology, and research that improve quality of life and save people from dying of fatal illnesses; however, under the current Embargo Act, Cuba is the only nation restricted from access to these resources. Cuba must instead rely on the limited wealth of information and technology generated by other industrialized nations to seek best treatments and medical practices available today.

    Given our nation's pride in being the world leader in biomedical technologies, pharmaceutical breakthroughs, and medical knowledge, it is unimaginable that Cubans are unable to take advantage of these means to save lives. It was disheartening to hear Cuban physicians complain about their inability to provide their patients with the best care possible that exists, as they cannot take advantage of the latest advents in treatment and procedures. It was also depressing to see Cuban patients realizing that "magic bullets" that can save life are beyond the reach of their physicians, or that they may die because the drugs that can cure/treat them by fighting their multidrug- resistant germs are unavailable to them. However, it was inspirational to see that, in the face of political, economic, and diplomatic adversity, Cuba's statistics and health care practices still reflect an incredible ability to maintain positive health outcomes through a strong focus on public health services, community medicine, and prevention. The Cuban government has maximized its resources to train physicians fit for treating their population ailments, create health care institutions that meet their cultural needs, and focus on preventive medicine to allow their health care system to be cost effective. A more positive relationship between the U.S. and Cuba would be mutually beneficial in providing Cubans with access to the best medical treatments and revealing to the U.S. the secrets of a successful health care system that maximizes its restricted resources and stretches its limits to provide cost effective health care, despite the numerous obstacles.

    Priya Saigal is a student at the U-M Medical School.