Q&A: We speak to Cuban specialist doctor Hernan Zaldivar Ricardo about his work in SA
Independent Media Group Foreign Editor Shannon Ebrahim spoke to newly-arrived Cuban specialist Doctor Hernan Zaldivar Ricardo on Cuba’s success in fighting Covid-19, and what expertise Cuban doctors are bringing to South Africa.
Q1. South Africa is very grateful that Cuban doctors have come here to assist with Covid-19. We understand that the Cuban doctors are particularly specialized in infectious diseases, and preventing and treating Covid-19. Please can you share with us your own medical specialization and whether you will be working on the front lines in South Africa fighting the pandemic?
A: It is a real pleasure to be here in the fight against Covid-19. I have specialised in General Comprehensive Physical Medicine, and prior to coming to South Africa we underwent intensive training at the Tropical Medicine Institute in Havana on effective methods to fight Covid-19. We spent a lot of time preparing for this mission.
My work in Cuba is providing internal medical care to members of the community, particularly in the area of transmissible diseases.We have been dealing primarily with the fight against the Zika, Dengue, and Chikungunya viruses which are transmitted by mosquitoes, as well as preventing and treating Cholera.
We will soon be briefed on where we will be deployed in South Africa, and we will likely go house to house looking for suspected cases, and providing education on how to prevent contracting the Covid-19 virus. We may treat positive patients as well.
Q2. Have you previously worked in countries outside of Cuba dealing with infectious diseases? If yes, please share with us where and your experiences.
A: I worked in Venezuela for three years from 2013-2015, and was on the frontlines addressing the outbreak of the Zika and Dengue viruses. We were involved in efforts at prevention as well as treatment and the provision of integral medical care. We worked in difficult conditions in the rural areas, and found that many people were not receiving any medical care until we got there. We were given a minimal stipend for living expenses and transport. But money is not a motivation for us. Even if doctors are well paid elsewhere, we work from the heart and our main concern is to provide medical care to patients and save lives. Fidel Castro said, “If you are not able to help others, then you are not able to help yourself.” Life is priceless, and we are here because we want to be here.
Additional revenue that goes to Cuba is not going to the Cuban government, but to the Cuban people to buy insulin, equipment for our hospitals, and food. We need these things as we are struggling under a suffocating economic blockade by the United States.
Q3. Is this the first time you have worked as a doctor in South Africa? What do you foresee as some of the particular challenges our country is facing in the battle against the pandemic?
A: This is the first time that I have been to South Africa, and I have left my wife and two young children at home in Cuba. My children are 3 years and 7 years old, and I missed my daughter’s 7th birthday last week as we were in South Africa under quarantine in our hotel. We do not know how long our mission in South Africa will be as it depends on the situation in the country.
One of the challenges that I foresee in South Africa is that you have 11 official languages, unlike in Cuba where everyone speaks Spanish. This makes it difficult to provide information in all the official languages on Covid-19, and communicate effectively to people how they can protect themselves, and explain in detail about the virus.
Q4. Do you feel South Africa should remain on a strict lockdown for as long as possible given the sharp rise in the number of infections currently taking place in the country?
A: Epidemiologically, lockdown is the right approach as Covid-19 spreads very easily. The numbers of infections in South Africa is high, and many people walking around are asymptomatic. There is the risk of a second wave of the pandemic which will be much worse. The best thing to avoid propagation of the virus is to avoid person to person contact, and we believe the South African government is taking good measures. Different provinces in South Africa have more severe infections like the Western Cape, and this province may need to move back to level 5 of the lockdown. It is difficult for people to be confined to their homes when they need to work, but the government needs to provide food support. In Cuba our government provides food support to the people under lockdown, despite its financial constraints.
Q5. We understand that Cuba's health system is very effective as it focuses on prevention and primary healthcare in communities. What can South Africa do in terms of prevention so it can more effectively flatten the curve?
A: South Africa should send nurses, social workers, and medical students out into communities to communicate prevention strategies to the people. They need to teach people how to use masks and gloves correctly, promote the use of hand sanitizer, and tell people to avoid physical contact. People need to be given information on the characteristics of the virus and how it spreads. These workers need to screen communities for suspected cases, and if a case is confirmed they must be isolated immediately. South Africa also needs to ensure it has enough PPE for those working on the frontlines.
Q6. We understand that Cuba has been developing a number of treatments relating to Covid-19 which are highly effective, some of which are also being used in China. Can you share with us what type of antivirals Cuba has found effective?
A: Cuba has been developing a number of treatments, and in South Africa we will work according to South African protocols. One of the antivirals that we have been using in the context of Covid-19 is Interferon Alpha 2b. This is being produced in two centres in both Cuba and China, and is proven to be highly effective. Cuba and China have been producing Interferon for 20 years already, and it is being used in the context of other illnesses like Multiple Sclerosis, Cancer, HIV, Leukemia, and Hepatitis B and C.
There are different ways to apply it, and we are using it as a form of prevention and administering oral drops to our general population in order to increase the Interferon in the body. It is like a wake up to the Interferon in the body so that the body’s memory continues producing it for itself. Interferon helps the body to respond more effectively to the virus, but there are no guarantees, and it is not a vaccine.
We are also giving nose drops called Nasalferon to our doctors and nurses working on the frontlines, and for Covid-19 positive patients we are administering intramuscular injections of 0.3ml three times a week for two weeks. More than half of the positive cases have recovered.
We have also had success in the use of other antivirals such as Kaletra, which is also used in the treatment of HIV.
The US is trying to discredit Cuba as part of its efforts at the strangulation of our country, and spreads disinformation that the medicine in Cuba doesn’t work, and that our doctors don’t have knowledge. But Cuba is getting results.
Q7. We have seen Cuban medical brigades being deployed in many countries around the world to assist in the fight against Covid-19. We watched as Cuban doctors went into the epicentre of the pandemic in Italy. Cuban doctors are known as brave, selfless, revolutionary doctors. But do you ever feel afraid of going onto the frontlines and putting yourself at risk?
A: It is normal to be a little afraid, but we don’t care if we have to put our lives at risk, as we are here to save lives. So far no Cuban doctors have died addressing infectious diseases in other countries, not even in West Africa during the Ebola outbreak.
Q8. What would you say are some of the lessons that South Africa can learn from Cuba in terms of fighting such an epidemic, and what would your advice to our government be?
A: The South African government is doing a great job. What should be an important priority in South Africa is strengthening primary health care, as that will enable the country to more effectively deal with pandemics like Covid-19. In Cuba we ensure that our primary health care reaches the most far flung communities. We are a population of 11 million people, and at the start of the Covid-19 outbreak, in one day we were able to make contact with 8 million people as part of our Covid-19 prevention efforts.
Q9. The world was so impressed by the efforts Cuban doctors made in West Africa to curb the spread of Ebola, and did so very effectively. Were you involved in that work at all?
A: I would have liked to have worked treating Ebola patients in West Africa but I was working in Venezuela at the time. I became a doctor for that - to treat people. A few of my friends went to West Africa to treat Ebola patients and it was very difficult for them as they had to use the same PPE for a long time, and they had to wash it over and over with hypochlorite. But the work was very rewarding and they saved many lives.
Q10. It seems that the world may be facing an increasing number of outbreaks of infectious diseases in the future. How can we better prepare ourselves to fight them, and what should we focus on?
A: What is of great concern is that a potential second wave of Covid-19 infections will be even more dangerous. If you look at the Spanish flu in 1920, the second wave of infections was far worse. If you think you are winning and you allow people to go out, that is when it can become problematic. You must never let you guard down and you must keep checking. It is like in boxing, when you think you are winning and you let your guard down, that is when your opponent scores a knock-out punch. The US wants to reopen some states, but if they open too early when there are still Covid-19 cases, the situation will become much worse.
In Epidemiology it is all about numbers, the numbers will determine when it is safe enough to reopen. If you re-open too soon, then you may have to lockdown again for a longer time.
Cuba has a strong people and a strong country, and we have endured an economic embargo for over 60 years. Our government is taking care of its people during this pandemic and we will survive and win this battle. Life is priceless.