Forum 2009, No. 3: Site Visit to Ramón Pando Ferrer Cuban Institute of Ophthalmology (#GFHR09)

Posted by Jaspal | Posted in Global Health | Posted on 19-11-2009

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TITLE: Forum 2009, No. 3: Site Visit to Ramón Pando Ferrer Cuban Institute of Ophthalmology (#GFHR09)
The Global Forum for Health Research “Forum 2009: Innovating for the Health of All” takes place this week in Havana, Cuba from 16-20 November. This is the third of a series of posts from the conference.
The conference organized afternoon site visits to Cuban institutions on Monday, Wednesday, and Friday this week. The hot ticket was a visit to any of the institutions comprising the West Havana Biotechnology Park (“Polo Científico del Oeste de La Habana”), a cluster of 53 institutions such as the Finlay Institute, the Center of Molecular Immunology, and the Center of Genetics Engineering and Biotechnology.
Monday’s visits were cancelled and I leave Friday morning, so Wednesday was my only opportunity. I stress the word opportunity – it seems that international journalists, even though invited to the conference, are not allowed on the site visits. On Tuesday I ran into Thulsi – Thulasiraj Ravilla, Executive Director of Aravind Eye Care System – at the conference. [Aman, Mahad, and I worked closely with Thulsi when conducting organizational research with Aravind and Aurolab in 2004.] Thulsi mentioned that he’d like to visit an eye hospital, so with some help from the Ministry of Public Health and a few other Cubans, I was able to track down the Marcelino Rios, director of Cuba’s flagship eye hospital at the conference that afternoon. He invited us for a tour of the facility on Wednesday.
After a slight detour to the Pediatric Hospital, we made it to the three-building campus that is Pando Ferrer (Ramón Pando Ferrer Cuban Institute of Ophthalmology) early Wednesday afternoon. There we met with hospital leadership and were provided a comprehensive tour of the facilities. They were very open, allowing us to take any photos that we wanted, but I won’t be able to share the photos we took because of continuing Internet issues.
Observations from the visit:
-Assembly line surgery. Until 10 years ago, cataract surgery patients here were moved through an assembly line process where each surgeon was stationary and was responsible for a single component of the surgical process. Thulsi said that he had read about this system long ago, and that it was the development of an ophthalmologist named Federov (?). Our hosts confirmed that it was done this way in the Soviet Union and allied states. The motivation for changing the patient flow for cataract surgeries to a single surgeon / single patient model was the advent of an improved surgical procedure (phacoemulsification), which was incompatible with the assembly line method.
-Purchasing lenses. Included in Pando Ferrer’s historical product mix were Aurolab intraocular lenses (IOLs). Cuba does not currently produce IOLs and now many of their lenses are sourced from China. Commodity purchasing decisions lie with a national ophthalmology authority that primarily consults Pando Ferrer. Perceived quality was very important to them, and they spoke highly of the quality of the “Indian lenses”.
-Foreign doctors and patients. We met a Bolivian ophthalmologist training here and observed large groups of patients from both Belize and Barbados. The foreigners, physicians and patients alike, come here as a part of inter-governmental agreements. When we first walked into the microsurgery building, we were greeted in the hallway by a photograph of Hugo Chavez.
-Free for patients. Health services are free for patients – for Cubans and for the foreign patients like those we saw. This even includes LASIK surgery. There is an exception with outpatient medicines and eyeglasses, but the payment is largely “symbolic” in the words of one of our hosts. The payment in most cases is just a few pesos in the moneda nacional, the same price as a an ice cream cone at La Coppelia in Vedado.
-USSR+MS-DOS. The hospital has been using electronic information systems since the 1980s, when the USSR provided assistance in setting up MS-DOS based systems for tracking patient information. The system has undergone several revisions since then and now their internal informatics department is in the process of building a more comprehensive, system connected across departments for managing clinical records. For now, informatics technicians are responsible for inputting data from paper that comes from the ophthalmologi

The Global Forum for Health Research “Forum 2009: Innovating for the Health of All” takes place this week in Havana, Cuba from 16-20 November. This is the third of a series of posts from the conference.

The conference organized afternoon site visits to Cuban institutions on Monday, Wednesday, and Friday this week. The hot ticket was a visit to any of the institutions comprising the West Havana Biotechnology Park (“Polo Científico del Oeste de La Habana”), a cluster of 53 institutions such as the Finlay Institute, the Center of Molecular Immunology, and the Center of Genetics Engineering and Biotechnology.

Monday’s visits were cancelled and I leave Friday morning, so Wednesday was my only opportunity. I stress the word opportunity – it seems that international journalists, even though invited to the conference, are not allowed on the site visits. On Tuesday I ran into Thulsi – Thulasiraj Ravilla, Executive Director of Lions Aravind Institute for Community Ophthalmology – at the conference. [Aman, Mahad, and I worked closely with Thulsi when conducting organizational research with Aravind and Aurolab in 2004.] Thulsi mentioned that he’d like to visit an eye hospital, so with some essential help from the Ministry of Public Health and a few other Cubans, I tracked down the Marcelino Rios, director of Cuba’s flagship eye hospital at the conference that afternoon. He invited us for a tour of the facility on Wednesday.

After a slight detour to the Pediatric Hospital, we made it to the three-building campus that is Pando Ferrer (Ramón Pando Ferrer Cuban Institute of Ophthalmology) early Wednesday afternoon. There we met with hospital leadership and were provided a comprehensive tour of the facilities. They were very open, allowing us to take any photos that we wanted, but I won’t be able to share the photos we took because of continuing Internet issues.

Observations from the visit:

  1. Assembly line surgery. Until 10 years ago, cataract surgery patients here were moved through an assembly line process where each surgeon was stationary and was responsible for a single component of the surgical process. Thulsi said that he had read about this system long ago, and that it was the development of an ophthalmologist named Federov (?). Our hosts confirmed that it was done this way in the Soviet Union and allied states. The motivation for changing the patient flow for cataract surgeries to a single surgeon / single patient model was the advent of an improved surgical procedure (phacoemulsification), which was incompatible with the assembly line method.
  2. Purchasing lenses. Included in Pando Ferrer’s historical product mix were Aurolab intraocular lenses (IOLs). Cuba does not currently produce IOLs and now many of their lenses are sourced from China. Commodity purchasing decisions lie with a national ophthalmology authority that primarily consults Pando Ferrer. Perceived quality was very important to them, and they spoke highly of the quality of the “Indian lenses”.
  3. Foreign doctors and patients. We met a Bolivian ophthalmologist training here and observed large groups of patients from both Belize and Barbados. The foreigners, physicians and patients alike, come here as a part of inter-governmental agreements. When we first walked into the microsurgery building, we were greeted in the hallway by a photograph of Hugo Chavez.
  4. Free services for patients. Health services are free for patients – for Cubans and for the foreign patients like those we saw. This even includes LASIK surgery. There is an exception with outpatient medicines and eyeglasses, but the payment is largely “symbolic” in the words of one of our hosts. The payment in most cases is just a few pesos in the moneda nacional, the same price as a an ice cream cone at La Coppelia in Vedado.
  5. MS-DOS from the USSR. The hospital has been using electronic information systems since the 1980s, when the USSR provided assistance in setting up MS-DOS based systems for tracking patient information. The system has undergone several revisions since then and now their internal informatics department is in the process of building a more comprehensive, system connected across departments for managing clinical records. For now, informatics technicians are responsible for inputting data from paper that comes from the ophthalmologists.

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