OUTLINE
- PETITION
- SUMMARY
- INTRODUCTION
- OBJECTIVES
- PROGRESS ON THE ISSUE
- ARGUMENTS SUPPORTING OUR PETITION
- CONCLUSION
- ANNEXES
THE
PETITION
The
comprehensive final State Exam of Cuba held after the completion of medical
training in the last year before the award of the degree of Doctor in Medicine
(M.D) should be accepted as the final evaluation of Pakistani medical scholars
in Cuba, as is done by the respective authorities of more than 55 other
countries such as China, Venezuela, Argentina, South Africa, Yemen, Mexico etc.
whose students study and get training from the same institutions and faculties.
To
achieve this objective, the Medical Universities of Cuba where the Pakistani
students are currently studying on the government awarded scholarship program should
be recognized by the Pakistan Medical & Dental Council (PM&DC),
according to its rules and regulations, keeping in view the already set example
of recognition of seven Chinese Universities.
In this way, Pakistani
scholars would be exempted from appearing in the National Examination Board
(NEB) test and would receive equal treatment like the students who study in the
government institutions of Pakistan, in order to start their medical practice.
SUMMARY
In the
aftermath of the Kashmir Earthquake of 2005, Cuban head of state at the time,
Mr. Fidel Castro Ruz offered scholarship for 1000 brightest Pakistani students
in the field of medicine. As a result of a joint venture between the
governments of Pakistan and Cuba, under the project name “1000 Cuban
scholarships for studies in General Comprehensive Medicine”, these 1000
students were selected on merit from all over Pakistan & Azad Kashmir and
sent to Cuba in three batches. Here in Cuba we are receiving quality education
from leading Cuban universities. However after completing our studies, passing
all the examinations successfully, including a final Cuban State Exam before
being awarded our degree in medicine, we have to appear in the National
Examination Board (NEB) test in Pakistan, conducted by the Pakistan Medical
& Dental Council (PM&DC). The purpose of this report is to make a
petition that we should have the right to be treated in the same way as other
medical students in Pakistan studying in any government medical institutions,
who incorporate in the Pakistani health system without appearing in the
aforesaid NEB test. This test is specially designed for the Pakistani students
who travel to different countries in order to study medicine on their own
resources and responsibility without any merit based selection criteria. This
objective can be achieved by the recognition of the medical Institutions of
Cuba by the PM&DC, where the Pakistani students are getting quality
education. That is why an overview to our university is
being provided to show that the institutions where the Pakistani students are
getting their medical training are of international standards and they should
be recognized, according to the rules and regulations of the concerned
authority, facilitating the students of its own country. Some important aspects
of the Cuban Healthcare program are also being discussed, highlighting a need
on the reforms needed in our country and how the 1000 doctors of the future,
can be helpful in this regard.
OBJECTIVES
- To demonstrate a world-class standard
of the Cuban medical education.
- To demonstrate the aspects we need to
learn from Cuban healthcare program.
- To demonstrate that the NEB test is
not necessary in our case.
- To demonstrate how the Pakistani
students studying medicine in Cuba can bring positive changes to Pakistani
health system.
INTRODUCTION
Our
scholarship program was offered by the President and Commandant in Chief of
Cuba, Mr. Fidel Castro Ruz in the wake of the terrible earthquake that struck
Pakistan in October, 2005. Mr. Fidel not only sent a brigade of more than 2000
medical and paramedical staff to assist in the relief efforts after the
disaster, but also he was generous enough to offer 1000 fully-funded
scholarships in medicine for the Pakistani students. The purpose of these
scholarships was to help our nation in the true sense by helping us to cope
with the severe deficiency of doctors in our country.
We
are the 308 Pakistani scholars of the first batch that reached Cuba in 2007.
Presently, we are studying in the University of Medical Sciences, Santa Clara
in province of Villa Clara. There are other 630 more students who are getting
education at the respective Medical Universities in the provinces of Cienfuegos
and Sancti Spiritus.
We,
the first batch, have studied the 5 years of medicine here in Cuba with
brilliant professors and instructors after first doing the Spanish language and
the premedical course for one year. The 6th year which consists of
the internship (house job) will be the last one after which we have to appear
in a final State Exam of Cuba before finally being awarded the degree of Doctor
of Medicine (M.D). After one year of Spanish language and premedical course, 5
years of medical education, another year of house job and successfully passing
the final State Exam of Medicine, we have to appear and pass another exam in
the form of NEB organized by the PM&DC, in order to get the license to
practice medicine in Pakistan.
During
the course of our stay here, we have always tried to communicate with the authorities
of Cuba (Commandant in chief and the Health Ministry) and Pakistan (Senate, HEC
and PM&DC) on various occasions, and made efforts so that mutual agreements
may be signed between the governments of the two countries that makes the
passing of the Final Test which is arranged here by the Cuban administration
after the 6th year of house job, before the award of degree, serve
as a criterion for us to get the license of practicing medicine in Pakistan.
In
March 2010, a delegation headed by the
Senator Ms. Nilofar Bakhtiar comprising of HEC and PM&DC officials had
visited the Cuban Universities where the Pakistani students are studying, had
also recommended processing the proposed draft agreements between the two
countries with immediate effect to facilitate the Pakistani students in Cuba.
As
we have been selected on merit basis by the government of Pakistan, we request
an equal treatment as that of students studying in government institutions in
Pakistan. In this regard, we would need your help and kind consideration so
that the future of 1000 bright students should be secured which would not only
be a relief for their families but also for our nation who has a dire need of
qualified doctors.
A
comparison of the programme among others in the following table.
PROGRESS ON THE ISSUE
PROGRESS ON THE ISSUE
The Cuban Deputy
Minister of Health issued a certificate vide their official letter no. 190
(5/3/10) on 4th of March, 2010 on the request of the Higher
Education Commission (HEC) of Pakistan, enumerating 9 points relating to the
scholarship program, the kind of universities in Cuba, the title of degree, the
training and method of teaching in WHO recognized institutes.
Some of the points
are as follows;
1) That
the universities of Medical Sciences of the Republic of Cuba, including ELAM,
are recognized in the directory of World Health Organization for the
universities and the faculties of medical sciences all over the world.
2) That
the universities of Medical Sciences graduate a General Doctor with a solid
training which allows him/her to diagnose, treat diseases and rehabilitate
patients, being the fundamental basis of the training program health promotion
and disease prevention with ethics, knowledge and skills on natural disaster
situations or others of different nature.
3) That
the title issued by the Universities of Medical Sciences at the end of the
studies is Doctor in Medicine.
(The copy of the letter is attached with this report as
Annex 1)
A PM&DC/HEC
delegation visited Cuba in March, 2010 which was led by the Senator Nilofar Bakhtiar,
representing the Senate Standing Committee for Education. PM&DC was
represented by council member Prof Dr Abdul Rasheed and HEC was represented by
Prof Dr Riaz Hussein Qureshi, Adviser (HRD) HEC. This delegation held several
meeting with the Cuban Health Ministry on the subject of scholarship program
and afterwards the Cuban Deputy Minister of Health issued a certificate vide
their official letter no. 190 (5/3/10) on 4th of March, 2010 (letter
attached as Annex 1) relating to the scholarship program, the kind of
universities in Cuba, the title of degree, the training and teaching in WHO
recognized institutes.
The aforementioned
letter signed by the Cuban Deputy Minister of Health was accepted by the
PM&DC in a letter signed by Prof Dr Abdul Rasheed, verified and counter
signed by Prof Dr Riaz Hussein Qureshi, representing the HEC, in the presence
of Ambassador of Pakistan in Cuba at the time, Mr. Najm us Saqib, dated 7th
March, 2010.
In this letter it was
declared categorically by the PM&DC that “any medical student who graduates
from the aforesaid WHO recognized institutions would become a qualified medical
doctor”.
(This letter is attached with this report as Annex 2).
The delegation
submitted its report to the Chairman Senate Standing Committee on Education,
also containing 13 recommendations for the HEC & PM&DC to initiate
appropriate measures to streamline the scholarship program.
(The recommendations are attached with the report as
Annex 3).
Some of the
recommendations are mentioned as under:
1) In
order to streamline the scholarship program, two proposed draft agreements
regarding the program and qualification of degrees between Government of Cuba
and Government of Pakistan should be processed with immediate effect.
2) 6
monthly monitoring of the project as well as the facilities may be conducted by
the HEC and the PM&DC.
3) Student
demands, related to PM&DC may be taken up promptly including the facility
of house job in Pakistan and policy decision about NEB examination.
Unfortunately, no
further advancement could be made on the recommendations highlighted by the
delegation until January 2012. No other delegation could be sent till now. Due
to the efforts of the students and our parents at various levels, a meeting was
held on the 23rd of January, 2012 with subject to our scholarship
program, house job and NEB examination between the Senate, HEC and the
PM&DC.
In this meeting it
was decided that the Pakistani students in Cuba will do their house job in Cuba
and their house job in Pakistan is exempted on the condition that the Cuban
authorities incorporate the additional requirement of subjects, identified by
the PM&DC, in the house job.
Regarding the test,
it was declared that all students shall appear in the NEB examination conducted
by the PM&DC after the award of the degree from Cuba. The PM&DC was of
the view that all the foreign medical graduates have to pass the NEB
examination in order to get the license for practicing medicine in Pakistan, so
an exception of exempting the test can’t be made for the Pakistani medical
students in Cuba. After the meeting a letter was issued where the above
mentioned decisions were shared with the students.
(The copy of the letter is attached with this report as
Annex 4)
The Rector of our
medical university has issued a letter on
9th of July 2012, in which he has praised the excellent
results shown by the Pakistani students not only in the academics but also all
other co-curricular activities. The letter sheds light on following points…
1) The
exam held here in Cuba is a comprehensive (practical & theoretical) and
profound evaluation of the students which is obligatory to pass before the
award of degree; doctor in medicine.
2) The
rigorous Cuban State Exam held before the award of degree, which is recognized
by the authorities of 55 other nationalities, like China, Mexico, Argentina,
South Africa, Panama, Venezuela etc, whose students study along with us and
they don’t have to appear in any further exam in their own countries to
validate their degree.
3) There
is no need for a re-evaluation before their incorporation into the health
sector. If it would happen, then they would delay on joining to the Pakistani
population for giving them services they need.
4) The
university would be ready for any kind of exchange or cooperation necessary in
relation to this subject.
(The copy of the letter is attached with this report as
Annex 5)
On 23 July 2012, the file “The Petition
of Pakistani Medical Scholars in Cuba” was presented to the Ambassador of
Pakistan to Cuba Khalilullah Qazi, who made a recommendation of making all
possible concessions to these Pakistani students in this issue:
“More than 900 Pakistani students
studying medicine in Cuba form a group which is unique in terms of its size and
the nature of the scholarship programme offered by the Government of Cuba, with
the consent of the Government of Pakistan. Our students have put their hearts
into their studies and earned appreciation from Cuban authorities. All Cuban
dignitaries including the Minister of Public Health I have met, since my
arrival here in May 2012, profusely praised performance of Pakistani students
during my meeting with them. They, therefore, deserve to be favorably
considered for all possible concessions.”
The
letter was sent to the President of PM&DC on July 25, 2012 which included the file prepared by the
students and forwarded to Special
Secretary/ Additional Secretary (Americas) Ministry of Foreign Affairs,
Islamabad and Prof. Dr. Riaz Hussain Qureshi Advisor (HRD) HEC, Islamabad.
(The copy of the letter is attached with this report as
Annex 5.1)
WHY AN EXCEPTION CAN BE MADE?
During meetings of PM&DC with the
parents committee and HEC, the stance taken by PM&DC was that an exception
of the exemption of NEB exam cannot be made for the Pakistani medical students
in Cuba.
An exception can be made in our case if
we consider the following:
1. REQUIREMENT
OF THE PM&DC TEST:
The NEB test conducted by the PM&DC
is specially designed for the Pakistani students who travel to different
countries in order to study medicine on self-finance basis, without any
specific selection criteria, on their own means and responsibility. However, we
are the 1000 students selected on merit basis by our own government. This is
first of any kind of government scholarship in the history of Pakistan, which
makes it an exception in itself that students in such a large number were sent
in an overseas scholarship program. Our selection was made by HEC on the basis
of the aggregate marks of the Matric and F.Sc examination. The majority of the students
here have an aggregate of more than 80%; also there are students who had gained
top positions in their respective board examinations. This makes us different
from the students who go to study in China, Russia or to states of Central
Asia, who don’t follow any kind of merit criteria. Some of them even don’t have
the minimum requirement (60%marks in f.sc) for admission in any medical school
in Pakistan, but they get admission in different countries. They choose the
medical schools on their own, which may not have the necessary facilities or
the environment to become a qualified medical doctor. For such students, the
NEB exam is a need to filter the worthy professionals but in our case, our
project has been under the scrutiny of our own government through HEC, which is
involved right from the beginning from our coming to Cuba, in the selection of
medical institutions here, till to date, in every decision making process. So
we shouldn't be compared and treated like those foreign medical students
mentioned above.
2.
TIME
DURATION
The deed of agreement signed between the HEC & the
students said that the total duration of course would be of six years; 1 year
Spanish language and 5 years of medical education. But after coming here, we
learnt that the actual duration of the medical training is of six years
according to the Cuban Curriculum, so making the total duration of study period
of seven years. Now after the completion of 7 years of studies here, passing
the final State Exam of Cuba for getting the degree, if we have to undergo
another exam, conducted by PM&DC in order to validate our degree attained
in Cuba, it will further delay in our incorporation into the society as medical
practitioners.
It should be taken into account that the test itself
consists of three steps plus an English language test, which takes
approximately a year to go through it, considering that one passes all the
steps in their first attempts. Keeping in view the pattern of the test, this
test requires preparation of at least a year to be capable of passing it. So
after summing all this, it can be seen easily that it would be taking us no
less than 8-9 years to finally be able to practice medicine in our country.
It should be noted with concern that a graduation degree
is taking that long, one which is being supervised by our own government. The average age of students here at the time of our
graduation will be 27 years and considering the environment in our
country, it is must to get a post-graduate degree to finally be able to support
ones family where the majority of the students here belong to families of low
economic background, and that the families would be dependent completely on
them in a matter of few years for financial support.
Apart from the difficulties that will be faced by the
students on their arrival in Pakistan, we all are also aware of the fact that
there is a severe deficiency of doctors in Pakistan (1 doctor for 1234
persons).
The only solution which addresses all of these issues
lies in the recognition of the Cuban universities by the PM&DC, following
its rules and regulations, which exempts the students of the burden of the NEB
exam and saves precious time of a 1000 students. A high-level delegation
comprising members of the National Assembly and/or the Senators along with
officials of the PM&DC and the HEC can visit Cuba for this purpose.
(The copy of the confirmation of award of scholarship by
HEC is attached with this report as Annex 5.2)
3.
EVALUATION OF THE PROGRAM BY HEC AND PM&DC
In 2008, a delegation comprising of HEC
and PM&DC visited the university campus and revised thoroughly the
curriculum and the academic facilities provided and stated their satisfaction.
As mentioned earlier, in 2010, a
Pakistani delegation comprising of Senator Nilofer Bakhtiar, Prof. Dr. Riaz
Hussein Qureshi (Adviser HEC), and Prof. Dr. Abdur Rasheed (Council Member
PMDC) visited the university campuses where the Pakistani students are getting
the medical education.
Mr. Rasheed,
representing PM&DC, on the conclusion of the visit accepted and issued a
certificate which stated that there is no doubt that any medical student who
graduates from the WHO recognized institutions of Cuba would become a qualified
medical doctor.
This
is a categorical declaration by the organization and there is a need of
bilateral cooperation on part of both countries which solidifies in possible
draft agreements focusing on the recognition of the medical universities of
Cuba and other mutual agreements of reciprocity between the two countries, as it
had been recommended by the same delegation on the culmination of the visit,
but unfortunately no steps were taken to fulfil the recommendations. It wouldn’t only facilitate the 1000
Pakistani scholars but will also pave the way for future collaborations.
(Refer Annex 2)
4.
SUPERVISION BY EMBASSY OF PAKISTAN IN HAVANA AND HEC
Our project has been constantly
monitored by the HEC and the Embassy of Pakistan in Cuba receiving our study
and discipline reports frequently. The result and the overall progress have not
only been satisfactory but a matter of pride in many ways as well, especially
when compared with the results of students of other about 80 nationalities
studying along with us. The direct supervision of the government authorities of
the Cuba and Pakistan enhances the credibility of this scholarship program.
Our embassy in Cuba has always provided
help and support in any kind of problems faced by the Pakistani students.
Regarding the recognition of the universities, we are hopeful that it would also
play an important role in facilitating our government to take all the necessary
steps for the success of this scholarship program.
5.
OUR UNIVERSITY
The university where we are currently
studying is University of Medical Sciences, Villa Clara, has a special status
in the country, making it distinctive among all other universities of Cuba.
It is recognized in the directory of
medical schools of WHO (World Health Organization) and the Pan-American Health
Organization (OPS).
It is geographically located in the city
of Santa Clara in the province of Villa Clara which has a territorial extension
of 7942km2. It has 43 health sectors with 43 policlinics and 10
teaching hospitals. It has 39 different teaching scenarios in 13 municipalities
of the province.
The university founded in 1966, has 7
faculties in total with 3 faculties of Medicine and 1 faculty each of
Dentistry, Nursing, Health Technology and Psychology.
The
university offers undergraduate programs such as a standard six-year program
offering the Doctor of Medicine degree, 5-year program offering the degree of
Doctor of Dentistry, a five-year program offering the Bachelor of Health
Psychology, a five-year program offering the graduate degree in Infirmary & Nursing, a five-year program offering the Bachelor in Health Technology and a
two-year program for a health technician, apart from the post-graduate Masters
and Doctorate programs.
The University has 54 academic
departments in total having 4 departments of Basic Sciences, 6 departments of
Biomedical Sciences, 21 departments of Clinical specialties, 11 departments of
Surgical specialties, 4 departments of Diagnostic & Laboratory studies, 2
departments of Public Health, 5 departments of Dentistry and 1 department of
Psychology. Each of these departments offer specialized studies and
post-graduate degrees in their respective discipline.
The University of Medical Sciences,
Villa Clara has 10 attached teaching hospitals with teaching facilities which
include seven provincial and three municipal hospitals:
- 1) “Arnaldo Milián Castro” Clinical & Surgical Hospital
- 2) “Celestino Hernández Robau” Clinical & Surgical Hospital
- 3) “Comandante Manuel Fajardo” Military Hospital
- 4) “Dr. Luis San Juan Pérez” Psychiatric Hospital
- 5) “Mariana Grajales” Gyne-obstretics Hospital
- 6) “José Luis Miranda” Pediatric Hospital
- 7) “Ernesto Che Guevara” Provincial Cardiology Centre
- 8) “Mártires del 9 de Abril” General Hospital of Sagua la Grande
- 9) “26 de Diciembre” Municipal Hospital of Remedios
- 10) “General de Placetas” Municipal Hospital of Placetas
Apart from these hospitals there are 24
attached teaching policlinics which have all the necessary facilities and
infra-structure including laboratories and Imaging equipment for diagnosis and
treatment of the health problems at primary level and for the academic
activities. The names are listed in the annex attached to the report.
There is total faculty of 1134
Professors teaching in the different academic departments of the medical
university. There are 24 Senior Professors, 228 Associate professors, 286
Assistant Professors and 596 Instructors. Of these 21 have Doctorates in
particular sciences and 279 are 2nd grade specialists which makes a
total of 300 faculty members as equal to Doctorate, according to the Cuban
system of designation. A total of 38
faculty members have achieved national
distinctions and 21 have been honored at international level with different
awards.
Alongside the Cuban students, there are
1645 foreign scholars from 60 different nationalities including countries like
South Africa, Canada, Argentina, Brazil, Venezuela, Panama, Mexico and many
others who are studying medicine. At this time, it has 30 agreements of mutual
collaboration and students exchange programs with countries such as Spain,
Portugal, Italy, Columbia, Ecuador, Bolivia, Chile, Brazil, Argentina, Mexico
and Nicaragua.
The university has a specialized Center of Scientific Research and Investigation having 21 laboratories in different
specialties. It has fully equipped infra-structure having libraries, museums
and halls for different curricular and co-curricular activities relating to
sports, arts, music etc.
The university graduates a General
Doctor with a solid training which allows him/her to diagnose, treat diseases
and rehabilitate patients, being the fundamental basis of the training program
health promotion and disease prevention with ethics, knowledge and skills on
natural disaster situations or others of different nature.
The objective of providing an overview
to the university is to show that the institutions where the Pakistani students
are getting their medical training are of international standards and they
should be recognized, according to the rules and regulations of the concerned
authority, facilitating the students of its own country.
(Details
of the mentioned information is attached in Annex 6)
6.
CURRICULUM
The salient features of the curriculum
taught here in Cuba are discussed as follows:
The first six months of the curriculum
are devoted to pre-medical subjects with courses in general chemistry, biology,
physics, mathematics and history. The premedical courses are an important
element of the program in that they ensure that all of the students begin on
the same basic academic level. Non-Spanish speaking students are also required
to take an intensive Spanish course before starting the pre-medical courses.
The actual medical training takes six
years and consists of two years of basic medical sciences, three years of
clinical rotations and a one-year internship in different teaching hospitals
attached with the university.
The curriculum is based on the bio-psycho-social
model of practicing medicine and places special emphasis on the most common
health problems of the developing world. Primary care in the form of family practice
is considered very important in the development of a good physician.
The third year is spent entirely in the
internal medicine wards in the hospital where students dedicate most of the
first semester to learning the art of clinical diagnosis. The second semester
of the third year is devoted to learning individual disease processes and
treatments. Students are taught how to make a differential diagnosis based on
the interview and physical examination. Students are encouraged to be creative
in their thinking and their use of medical supplies. A question is asked very
frequently by the Cuban professors, ¨ what would you do and how would you make
the diagnosis if you were working in the middle of a desert and didn’t have
access to any diagnostic tests? ¨ This type of problem- based learning stems
not only from having to practice medicine in a developing country where certain
diagnostic workups are not always readily available, but also from the
understanding that a majority of the graduates will be returning to their home
countries to work in the most under-equipped of settings.
The fourth year includes rotations of
surgery, gynecology-obstetrics, pediatrics and a two-week disaster medicine
course. The fifth year focuses on the out-patient care in clinical
subspecialties of ophthalmology, otolaryngology, orthopedics, urology,
dermatology and psychiatry. The other rotations in the 5th year
consist of second part of disaster medicine and public health. In disaster
medicine, students learn everything from patient triage and treatment to the
organization of medical personnel and supplies in an event of a disaster.
English being one of the most spoken
languages is taught as compulsory subject comprising of basic language learning
and technical medical English, throughout the course of study, comprising up to
640 credit hours, thus preparing the students if need be to work in such a
community.
During the sixth and final year students
are enrolled in an internship in each of the core rotations which include internal
medicine, surgery, gynecology-obstetrics, pediatrics and family practice.
Interns from countries where Cuban medical teams are already in place complete
part of their internship year in their home countries under supervision of
Cuban doctors.
The Curriculum and teaching methodology
is designed in such a way that students learn the fundamentals of epidemiology,
disease prevention and control in a community whose health determinants are
multi-faceted. Students are taught that as they would work as primary,
secondary and tertiary care physicians, they must play a dynamic role in
leading their communities towards health, not just be stationary fixtures to
come to at times of illness.
Apart from this, special courses and
teaching classes are arranged for the students of different nationalities
keeping in view the epidemiology of their countries. As in our case, the Cuban administration
being aware of the fact that there are many diseases that are eradicated
completely in Cuba but still prevail in Pakistan, have arranged special courses
for the Pakistani students during which we are trained in these particular
diseases.
One can conclude here by saying that the
curriculum and training here is of international standards and the students are
prepared in a way that they can work in any kind of environment and play a key
role in the healthcare program of any community.
(Details
of the all the mentioned information is attached in Annex 7)
7.
DISTINCTION OF PAKISTANI STUDENTS
Taking
advantage of the opportunity to receive world class education, we have always
demonstrated the best academic results. In the academic year 2009-2010 and
again in the 2010-2011, our result was of 100% while in the 1st
semester 2011-2012, it is 97.4%, the best among the other nationalities.
Pakistani students are top position holders in many different exams. Moreover,
Pakistani students participate in all curricular and extracurricular activities
arranged by the university administration along with students from Cuba and
from other countries. Examples of such activities are the Competition
Examinations, Scientific Research Forums, Scientific Investigation
Competitions, Cultural galas etc. We are an active part of the Solidarity
Brigade with Cuba. Moreover, there are many Pakistani students who have been
given the distinction of working as Assistants (Alumnos Ayudantes) with
different Professors who are working in different specialties like Pediatrics,
Internal Medicine, ENT, and Anesthesia etc.
(The academic results are
attached as Annex 8)
The
Rector of our medical university has issued a letter in which he has praised
the excellent results shown by the Pakistani students not only in the academics
but also all other co-curricular activities.
(The copy of the letter is attached with this report as
Annex 5)
8. THE
CUBAN STATE EXAM
After
completion of the 6th year of medicine, we have to appear in a Final
Cuban State Exam (La Prueba Estatal) before the award of the degree (M.D). This
is a comprehensive test consisting of practical and written exams, designed to
evaluate the knowledge and all the necessary skills acquired during the
six-year course period, required for a doctor to prevent and cure any kind of
disease in any kind of condition. Any student whether Cuban or foreign who
studies medicine in Cuba has to pass this rigorous exam with minimum 70% marks
before being awarded the degree. The quality of the exam and degree can be
judged by the fact that 55 countries, whose students study in the same
university along with us, do not evaluate their students on their return back
home, once they have passed the Cuban State Exam. These countries include
China, Mexico, Venezuela, Argentina, South Africa, Panama and many others.
These students serve in different parts of the world showing excellent
performance.
That
is why it wouldn’t be wrong if the Pakistani students be considered the same
way as there remains no need for re-evaluation, which causes loss of very
precious time, energies and resources.
(The names of the countries
which accept the Cuban State Exam as final evaluation of students and do not
re-evaluate their students on their return as enlisted in Annex 9 which refer
Annex 5)
9. ELAM
DEGREE
The
Republic of Cuba has established that for all the foreign students who graduate
in Cuba as Doctor in Medicine, the degree is issued by the Latin American
School of Medicine (ELAM), regardless of the place where the university campus
is placed. The degree issued by ELAM is recognized by WHO (World Health
Organization) and the Pan-American Heath Organization (OPS). Moreover, the
degree is recognized by the 55 countries whose students study in the same
university as the Pakistani students. ELAM has an international presence with
campuses outside Cuba. There are established campuses of ELAM in Venezuela, Bolivia etc.
(Refer Annex 5
and Annex 9)
10. CHINESE
UNIVERSITIES EXEMPTED
It
is important to note here that there already have been examples of the
exemption of the aforesaid NEB test, conducted by the PM&DC. In 2009, seven
Chinese universities were recognized by the PM&DC, thus exempting the
Pakistani students who study in these universities from appearing in that test
on their arrival to Pakistan. So, the question arises that why the Cuban
medical universities can’t be recognized in the same manner, even when there
are 1000 Pakistani students studying on a government scholarship program?
(A document
showing the list of Chinese universities recognized by PM&DC as per the official
website of the same organization is attached in annex 10).
It should also be noted here that China herself has agreed and
signed a project with Cuba by which 10,000 Chinese students would train as
medical doctors in Cuba so that their incorporation into their country can
improve their own healthcare program. The standard of the
exam and degree can be judged by the fact that Chinese students study in the
same program along with us without being evaluated on their return to China,
once they have passed the Cuban State Exam.
(Refer Annex 5)
This
point also make credible our petition that PM&DC has given exemption for a
specific period of time to Pakistani students who are studying
medicine on their own resources and responsibility without any merit based
selection criteria in Chinese universities and moreover, the Chinese students
studying in Cuba are exempted by their government for the appearance in any
further State Exam to validate their degree in their country in order to
practice medicine.
11.
VALUE OF OUR
PROJECT
One also needs to consider the value of
a project such as ours scholarship program. Cuba generously offered a
fully-funded scholarship program where she spent and utilized precious
resources ranging from the human resource to the material resources, with a
great objective that the doctors eventually formed from the program will be
able to serve their own people.
A lot has been spent by our own country
covering expenses such as our monthly stipend, traveling arrangements, the
visits made by different Pakistani officials to Cuba etc. with the objective of
development of human resource in Pakistan.
In short, a project was conceived with
an objective that once complete, would be of great help to the country which
has a considerable deficiency of medical doctors. A delay in our incorporation
as doctors into our country will not be helpful considering the need; and our
families who have been waiting for the time when we all would be taking care of
them would also remain in the suffering.
12.
CUBAN HEALTH
SYSTEM
The health of the world’s population is
divided into two groups, those who have access to healthcare services and those
who do not. The effect of this divide can be seen on the international level
where life expectancy in Norway averages 81 years as opposed to 38 years in Zambia.
Infant mortality rates are often used as a general indicator of health and
socio-economic conditions since the rates are affected by factors such as
access to perinatal healthcare.
Cuban health indicators are comparable
to that of any of the developed countries. The improvement in health indicators
achieved by Cuba in such a short period of time, with limited resources and in
the presence of trade embargo placed by USA, is unprecedented and appraisable.
Through their progress in preventive medicine, Cubans have achieved difficult
goals and have set a great example to follow for other countries of the world.
A comparison of the health indicators of
Pakistan and Cuba using WHO as source are shown in the table below:
Pakistan
|
Cuba
|
||||
Mortality and Life
expectancy
|
Life expectancy at birth (years)
|
Male
|
62
|
Male
|
76
|
Female
|
64
|
Female
|
80
|
||
Under
Five mortality rate (per 1000 live births)
|
87
|
6
|
|||
Adult mortality rate (probability of dying
between 15 and 60 years per 1000 population)
|
208
|
99
|
|||
Maternal mortality rate (per 100 000 live
births)
|
260
|
40.6
|
|||
No. of Doctors per 10,000 people
|
8.1
(1 for each 1234)
|
64
(1 for each 156)
|
|||
Source: National
Office of Statistics and Information; Anuarios Demográficos de Cuba.
WHO website
(A comprehensive comparison of the health
indicators of Cuba with Pakistan and other developed nations is attached in
annex 11)
13. CUBAN MISSIONS WORLDWIDE
A
major influence in access to services is the availability of trained healthcare
workers. The WHO estimates that the world will need at least 4,250,000
additional health workers to address the health disparities. In the face of
this work crisis we are left wondering how to fill in the gaps left by the mass
exodus of health workers from developing nations to industrialized ones. Cuba
has tried to address these problems by sending thousands of healthcare
professionals to work in some of the most impoverished and medically
underserved regions in the world. Since 1969, it has been part of Cuba’s
international policy to provide social and medical relief to the third world
countries. There are many examples of missions completed by the Cuban doctors
in different countries where the services provided by these professionals have
been hailed by the respective countries. Some of the examples are Bolivia,
Venezuela, Ecuador, East Timor, Haiti, and many other African and Arab states
showing the world the quality of Cuban medicine and doctors. Even our neighbouring
country China is collaborating with Cuba with the objective to improve her healthcare
system.
Cuba
is also one of the few countries who volunteers in the health services whenever
and wherever a disaster strikes. In our own country, after the terrible
earthquake of 2005, the Cuban medical and paramedical team consisting of about
2500 professionals did an excellent job, acknowledged by the government,
general public and media of Pakistan. Over the years, this attempt to send the
doctors to the needed areas has evolved to include training professionals from
these areas to provide enduring healthcare for their populations. Our scholarship program is one of the
examples. The Cubans have recognized that solutions to what has become a global
health crisis depend not only on the number of physicians produced but also on
how they are trained as providers of care.
To that end, our training is oriented toward primary care, public health
and hands-on clinical experience. So we have been taught and trained by
experienced teachers in a healthy, dynamic and interactive environment. The
work done in different parts of the world by the earlier foreign students, who
have studied medicine in Cuba, is widely renowned.
(The list of countries which
have collaborations with Cuba in Health sector are enlisted in the Annex 12)
During the course of our study here, we have
learnt many of the different ways by which this small country has become a
leader in healthcare in the world. That is why, we, the students, think that
there is a dire need of health reforms in our country and we would want to play
a key role and present ourselves as volunteers, in any case where our
government need us while taking important steps for the improvement of the
healthcare system of our country.
CONCLUSION
In this report, by comparing the health
indicators of Cuba as compared to other developed countries, it has been tried
to demonstrate that we have a lot to learn from this industrious nation
especially the reforms they have made in the Health sector which have made them
a potential power in healthcare in the whole world. It should be acknowledged
that healthcare is a right, not a privilege.
It is high time that we take significant steps enabling us to provide
complete healthcare to the people of our beloved country.
In
the end, we conclude by once again presenting our petition that the
comprehensive final State Exam of Cuba held after the completion of medical
training in the last year before the award of the degree of Doctor in Medicine
(M.D) should be accepted as the final evaluation of Pakistani medical scholars
in Cuba, as is done by the respective authorities of the 55 other countries,
whose students study and get training from the same institution and
faculty. To achieve this objective, the
Medical Universities of Cuba where the Pakistani students are currently
studying on the government scholarship program should be recognized by the
Pakistan Medical & Dental Council (PM&DC), according to its rules and
regulations, keeping in view the already set example of recognition of seven
Chinese Universities. For this purpose, the proposed delegations can visit Cuba
and hold talks with the concerned Cuban authorities. By taking such a step,
Pakistani scholars would be exempted from appearing in the National Examination
Board (NEB) test and would receive equal treatment like the students who study
in the government institutions of Pakistan, in order to start their medical
practice. In this way by incorporating into the healthcare system of Pakistan
as soon as possible, not only the precious time of a 1000 students would be
saved and the hopes of their families realized, but also they would be able to
play a beneficial role in the healthcare system of Pakistan. We
have also tried to present the possible benefits that can be achieved from
taking such a step. The relations between Cuba and Pakistan are growing very
fast, these steps of recognition of the medical universities and agreements of
reciprocity will strengthen the ties.
|
|
|
|
|
.jpg)
|
|
|
Annex 7 Cuban Medicine Curriculum in comparison with the Pakistani curriculum
along with credit hours
.jpg)
.jpg)
Annex 8:
Annex 9:
Annex 10: Chinese Universities recognized by
the PM&DC,
(Page from the official website)
Announcements /
Notifications / Results - Recognized Chinese Universities - Relevance: 3007
http://www.pmdc.org.pk/Home/tabid/36/ItemId/17/Default.aspx - 8/27/2009 12:00:00 AM
http://www.pmdc.org.pk/Home/tabid/36/ItemId/17/Default.aspx - 8/27/2009 12:00:00 AM
 |
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Annex 11. A Comprehensive comparison of the health indicators of Cuba with Pakistan and other developed nations.
|
Pakistan
|
Cuba
|
|||
General
|
Total
population
|
180,808,000
|
11
244 543
|
||
Population
growth rate
|
1.8%
|
0.6/1000
habitants
|
|||
Population
under 5 year
|
22064000
|
231 909
|
|||
Total estimated
expenditure on health as per capita
|
63.0 US $
|
438.36 Cuban Pesos *
|
|||
Live births
|
4764000
|
133 067
|
|||
Surviving infants
|
4444000
|
132962
|
|||
Source: National
Office of Statistics and Information; Anuarios Demográficos de Cuba.
WHO website
Table 2: MORTALITY AND BURDEN DISEASE
Pakistan
|
Cuba
|
||||
Mortality and
burden of disease
|
Life
expectancy at birth (years)
|
Male
|
62
|
Male
|
76.00 (2009)
|
Female
|
64
|
Female
|
80.02
(2009)
|
||
Under Five
mortality rate (per 1000 live births)
|
87
|
6.0
|
|||
Adult
mortality rate (probability of dying between 15 and 60 years per 1000
population)
|
208
|
99
|
|||
Maternal
mortality rate (per 100 000 live births)
|
260
|
40.6
|
|||
Prevalence
of HIV ()
|
.1%
|
1%
|
|||
Contraceptive
prevalence (per 10000)
|
27%
|
77.8%
|
|||
Source: National
Office of Statistics and Information; Anuarios Demográficos de Cuba.
WHO website
Source: National Office of Statistics
and Information; Anuarios Demográficos de Cuba.
Table 3: PROPORTIONAL MORTALITY AT ALL AGES
Pakistan
|
Cuba
|
||
Proportional
mortality (%of total deaths at all ages)
|
Communicable
disease
|
46 %
|
0.04%
|
Cardiovascular
disease
|
25%
|
21%
|
|
Injuries
|
8%
|
0.04%
|
|
Cancer
|
7%
|
20%
|
|
Respiratory
disease
|
5%
|
0.02%
|
|
Diabetes mellitus
|
1%
|
0.02%
|
|
Source: National
Office of Statistics and Information; Anuarios Demográficos de Cuba.
WHO website
Source: National
Office of Statistics and Information; AnuariosDemográficos de Cuba
WHO website
Table 4: HEALTH WORK FORCE
Pakistan
|
Cuba
|
||
per 10 000 population
|
Physician
|
8.1
|
70.0
|
Nurses & midwives
|
5.6
|
85.8
|
|
Habitants per
doctor
|
1234
|
143
|
|
Source: National
Office of Statistics and Information; Anuarios Demográficos de Cuba.
WHO website
Table 5: IMMUNIZATION PROFILE
Vaccines
|
2011
|
||
Pakistan
|
Cuba
|
||
Percentage
|
BCG
|
95
|
98
|
Pol3
|
79
|
99.9
|
|
DTP1
|
94
|
100
|
|
DTP3
|
89
|
100
|
|
Hib3
|
89
|
100
|
|
HepB_BD
|
NA
|
98.7
|
|
HepB3
|
89
|
98.7
|
|
AM-BC
|
NA
|
100
|
|
MCV
|
86
|
NA
|
|
Anti
typhoid (AT)
|
NA
|
100
|
|
Source: National
Office of Statistics and Information; Anuarios Demográficos de Cuba.
WHO website
Source: National
Office of Statistics and Information; Anuarios Demográficos de Cuba.
TABLE 6: Maternal, newborn and child health and determinants
Maternal, newborn
and child health determinants
|
||
Pakistan
|
Cuba
|
|
Antenatal
care(4+visits) per 10000
|
28%
|
100%
|
Births attended by
skilled health personnel per 10000 population
|
45%
|
|
Maternal mortality
ratio
100 000 live births
|
260
|
40.6
|
Neonatal mortality
rate 1000
|
60.72
|
0.1
|
Infant mortality
rate 1000
|
70
|
5.8
|
Under 5 mortality
rate 1000
|
87
|
6
|
Source: National
Office of Statistics and Information; Anuarios Demográficos de Cuba.
WHO website
Source: National
Office of Statistics and Information; Anuarios Demográficos de Cuba.
WHO website
Annex 12 Countries Which have Collaborations with Cuba in Health sector. (As of December 2011)
AMERICAS
|
|
Antigua and Barbuda
Argentine
Aruba
Belice
Bolivia
Bonaire
Dominican Republic
Ecuador
Granada
Guatemala
Guyana
Haiti
|
Honduras
Jamaica
Nicaragua
Paraguay
Peru
Venezuela
St.
Kitts and Nevis
St.
Vicente
St.
Lucia
Surinam
Trinidad
&Tobago
Uruguay
|
AFRICA
TO THE SOUTH OF SAHARA
|
|
South Africa
Angola
Botswana
Burkina
Faso
Burundi
Cape
Verde
Congo
Djibouti
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Equatorial
Guinea
Guinea
Bissau
|
Guinea Conakry
Lesotho
Mali
Mozambique
Namibia
Niger
RASD
Sao
Tomé and Príncipe
Seychelles Islands
Sierra
Leone
Swaziland
Tanzania
Uganda
Zimbabwe
|
Middle
East and Africa
|
|
Argelia
Qatar
|
Yemen
|
East
Asia and the Pacific
|
|
Laos
Kiribati
China
Solomon
Islands
|
Vanuatu
Islands
Tuvalu
Islands
East
Timor
Nauru
|
EASTREN
AND CENTRAL EUROPE
|
|
Ukraine
|
Portugal
|
Source:
Statistical Registries of Central Unit of Medical Cooperation.
Ministry
of Public Health (MINSAP) Cuba.
Acknowledgement:
We are extremely thankful to our
University Rector, Dr. Frank Quintana Gomez for taking personal interest and
giving us extraordinary help and support in making of this report. We extend
our gratitude to his staff for the help in this regard.
This report was only possible due to the
dedication and hard work of the Pakistani students studying medicine in Cuba.
We expect a kind response by the concerning
authorities to our request.
