HIV/AIDS: A Doctor's Declarations
By: Yuniet Escobar Ortega
11/30/2006
http://news.cubasi.cu/DesktopDefault.aspx?SPK=160&CLK=139228&LK=2&CK=72138&SPKA=35
The
first time I heard someone speak about Doctor Jorge Pérez Ávila was on Saturday
noon. I remember the day and time because it’s usually the moment in which I can
watch the television newsreel at ease that day they were reporting the
presentation of the book AIDS: Confessions to a Doctor, written by the
former-director of the Sanatorium of Santiago de las Vegas, the first one built
in Cuba to assist patients infected with HIV/AIDS. I was accidentally looking
for a story for a journalistic work on that issue, and I found it interesting to
speak with Jorge who has been since day one present in the battle our country
has faced against this disease.
After several calls and arrangements he welcomed us exactly one Saturday in his
office at IPK. In spite of being busy for a trip he had to the Vatican, he
granted me some of his time at 11:00 a.m.
- Excuse me, but I need to go out for a few minutes, can you wait for me?
- Yes doctor, it’s no problem.
- Have you read the book already?
- No, I haven’t been able to buy it.
- The fact is that it’s not for sale yet, first we are distributing it to people
infected of AIDS. I will leave you one so you start reading it, but it’s only
borrowed, he said and disappeared behind a door.
When I took the book in my hands I remember I noticed that his name was barely
visible in the cover. When I opened it and I began reading I realized the reason
why, and after talking for almost two hours I could verify that Jorge Pérez
Ávila belongs to those exceptional and simple men who love what they do without
caring about sacrifices.
- Doctor I beg your pardon, but I won’t return the book to you. I am fascinated
with it. Many of the questions I brought with me are answered in it, but anyway
I’d like to begin speaking about how our country got ready to face AIDS.
- The first AIDS diagnosis was made in our country because we got ready to do it
contrary to other countries which had heard about AIDS, but were not prepared to
receive it. We were lucky that in year 1983 and during a visit to the Institute
of Tropical Medicine Pedro Kourí (IPK) our Commandant in Chief alerted us of
this problem. I remember the director and professor, Gustavo Kourí, was
presenting to the Head of the Revolution the whole work developed by IPK in the
first years of its second stage, after the activities of the Institute were
reinforced in year 1980, in its provincial facilities of Siboney Neighbourhood,
in Havana City. After a long explanation on behalf of professor Kourí, Fidel
told him: "Gustavo and what will you and the IPK do to prevent AIDS from
entering Cuba? I have the opinion that it will be the epidemic of this century.
And I think it should be your responsibility as well as the institute’s to
detect the first cases, also to avoid that it becomes a health problem in
Cuba."
"Imagine, nobody knew what to answer precisely because data on the disease was
short. It had been described by North Americans in year 1981, but its etiology
was unknown. Then we understood that we should train our specialists and we send
two of our workmates abroad so they got trained in the clinical diagnosis, one
went to France and the other one to Brazil. By mid 1983 a meeting was held in
Washington sponsored by the Pan-American Organization of Health and the Center
for Disease Control (CDC) in Atlanta, Georgia, where it was informed that there
were data that evidenced the existence of an infectious disease and that it was
transmitted through blood and sexual contacts. From that moment, the Cuban
Ministry of Public Health created a national commission to face the illness. The
first thing that was done was to look for the existence of possible cases in our
country, hence it was established a report to the National Direction of Hygiene
and Epidemiology and to the offices of the Vice-minister Héctor Terry of any
suspicious case that presented clinical manifestations similar to those
described for AIDS: repeated pneumonias, possible Pneumocytis carinii or stains
in the skin, possible Kaposi sarcoma. The national commission also took several
measures, one of the most important was that related to the suspension of blood
by-products import since it was thought that they could be infected, for that
same reason its import was banned and twenty thousand existing flasks were
destroyed.
"All these measures have allowed Cuba today to have one of the lowest figures of
infected in the region, even when we are questioned if they are real. Everybody
wonders why there’s so little AIDS in Cuba. It is difficult to believe in a
place where sexual relationships are easy, where there’s tourism, there are no
prohibitions and women have as much rights as men to determine the kind of
sexual relations they want, besides we live in a country where sexual
relationships begin in early ages. However they don't keep in mind the complete
work of prevention deployed in Cuba.
Furthermore, the illness was not
mystified, politicized, neither were discriminated against the sanitary actions.
We treat AIDS like syphilis or gonorrhea. Through surveys and the search of
contacts we were able to detect 54% of the cases. Many of those people who had
VIH stopped having unprotected sex, because people must be educated and given
responsibility. At the same time since year 1987 pregnant women had tests
taken."
- Doctor, and when was the first case detected?
- Well no matter how prepared you are, you never imagine when the first case
will come up. It was in year 1985 that we ran into the first case. It was a man
who had returned from a mission in Mozambique. He had been treated in several
hospitals and was finally remitted to my office; Doctor Juan Carlos Millán who
had been trained abroad was in that day, a very qualified person. I remember we
were discussing the case and in the end we arrived to the conclusion that it was
better to run the analysis we had kept and which had been sent by the Cuban
colleague training in Holland, because we could not buy it due to the blockade.
The result was positive, then we decide to speak with the patient and admit him
at the medicine ward of IPK; of course we didn't speak to him about the
diagnosis, only of continuing some clinical studies and the analysis. We really
didn’t know how to react, what we did was to send for his wife whose result was
negative. The full story is in the book let’s not repeat it, but we saw that
there was transmission in one of his sexual contacts, we informed the director
of the center, the vice-minister of Hygiene and Epidemiology and Cuba began a
wide program of action. In that moment actions were much quicker, we began by
putting detectors in blood banks that eliminated the possibilities of blood
transmission as well as innocent victims.
- Doctor I’d like to go over a bit about a serious issue that is happening at
the social level on the fact that pregnant women should not have their son, up
to what extent should specialists intervene?
- The first thing is to know and not speak nonsenses, even in television it is
said that AIDS causes abnormalities and other things. We have experiences and
results that indicate that 26 HIV positive children have been born out of 300
women, a very low percentage. I very particularly think that’s a decision for
the family to make, the couple if she wants to have a son. We as specialists
talk to them about the risks and we prescribe a treatment they must follow
strictly. There are patients who follow their treatment and have no problems.
Medicine is like love neither always, nor never. The doctor is not a
fortune-teller and a 100% safety can not be given that the boy will be born
without HIV. That depends on the viral load and his immunologic state. In case a
patient has a high viral load and a deteriorated health condition it’s advisable
not to have it, but as I already told you, that depends on each pregnant women
and the family. There are also several techniques like artificial insemination
and the semen wash and others that help the boy birth without the HIV in case
his dad is the one infected with HIV.