Tuesday, 20 July 2010

Cuban doctors saving life of ‘dissident’ hunger striker Guillermo Fariñas.

Source: Granma Newspaper, 3 July 2010
Translation: Maria, RATB.

Interview with Dr Armando Caballero, head of intensive therapy at the Arnaldo Milan Castro Hospital, in Santa Clara, Cuba.

Science, humanism, professionalism and the most advanced and expensive treatments are being used to save patient Guillermo Fariñas’ life. Science, because of the use of the latest and most modern treatments in this patient’s treatment; humanism and professionalism, because he is receiving the most prestigious services from specialists who think that the fight for life is the best and most they can do; and the most advanced and expensive treatments because the Cuban state has not restricted efforts to get the latest generation of medicines to this person, medicines that are being used in the most prestigious hospitals, many of which have to be acquired from abroad.

Fariñas was taken to the intensive care unit (ICU) at University Hospital Arnaldo Milan Castro on 11 March 2010 in the city of Santa Clara. He had started a voluntary abstention from food which today has put his life in serious danger.

As we were interested in his health, we went to the hospital, located in the Cuban central province and we spoke to the doctor Caballero, boss of ICU in that hospital.

The first question we asked the doctor, the founder of this special unit, was to explain from his experience, how it is possible that this person is alive after four months of abstinence.
‘That is what everybody is wondering’ he said, ‘a person who doesn’t eat cannot survive for so long, but this is not Fariñas’ case.’

The doctor explained that this person refuses to eat through his mouth, and he has been in this situation for 125 days, and he was at home in this situation for two weeks in which he says he did not eat at all before he was admitted into hospital, where he has now been for 110 days. ‘We admitted him with a certain physical deterioration, a reason for which he had to stay in hospital. Being conscious, he accepted nutrients and food which is delivered parenterally.’

‘The patient is receiving amino acids, [building blocks] for the proteins that the body needs, we also give him lipids, vitamins and minerals. Everyone on a balanced diet requires these to survive. Fariñas arrived at the hospital weighing 63 kg and now he is between 67 to 69 kg. There has been an increase in his weight and it is because of the parenteral feeding he is receiving.’

‘Dissident’ hunger striker Guillermo Fariñas at his home in Santa Clara. He is demanding the release of US-backed counter-revolutionaries gaoled in Cuba. Cuba has refused to be 'blackmailed'.

How bad is the patient’s health at this moment?
‘Feeding through the veins requires that some nutrients that have a high osmolarity (molecular weight) go through the major veins in the body. This means you have to use catheters in the most important veins in the upper body, such as the subclavian and interior jugular veins, which has its dangers and complications, mainly when food substances such as amino acids and hypertonic dextrose [solutions] go through these catheters.
‘In these cases, the risk of blood infection is very high. Patients who are being fed through the veins for a long time are prone to contamination of the catheters with bacteria and fungi, and they can also have other complications like the one this patient is suffering now.’

Do those complications have to do with treatment or with the attention he is receiving?
‘No these complications are common in patients that are fed in this way.

‘For example, in the last 110 days that Fariñas has been with us, we have had to change the catheter ten times. When he was last on hunger strike in 2006 for 251 days, we had to change the catheter 37 times. In the 37 years, I have been working in the ICU, I’ve never had a patient that this procedure has been applied to so many times.

‘In this patient we have cured infections that were detected on time, and we used the adequate antibiotics when we found Staphylococcus aureus in his blood. The bacteria in the blood were isolated immediately and cured with efficiency taking special measures and given the right antibiotics.

‘Since last weekend, the patient has developed another complication that is not an infection - it is much more serious. He developed thrombophlebitis [blood clot related vein inflammation] in the jugular vein in the neck. The clot is a big danger because it could fall and go straight to the heart and from there to the lungs and create pulmonary embolisms that can kill a person.

‘That complication is seen in hospitals very often and is the cause of sudden death, when clots are big, but it can also fall and dissolve with the treatments we are applying, based on antibiotics and anticoagulants. This time we have also isolated the causes that triggered the phlebitis in the central veins - in this case it is a clot in the jugular in the neck.

‘Since last Sunday we have seen an improvement, although we can not confirm that he will not have a much more serious complication. Nobody knows what will happen, neither here, nor anywhere else in the world - if that clot will fall or not.

‘For that we have all necessary medicines. When we discovered the situation last Saturday, we discussed the diagnosis and confirmed the pathology with the best technology.’

Are those the limits of medicine in the fight for the patients life?
‘We are at the limit, especially now. This is something we have been talking to him about quite a lot; we have good doctor-patient relationships, we want him to quit his voluntary abstention and to start eating to get the necessary energy. He needs it because he has developed a temperature because of his infection.

‘It is almost impossible to feed him through another catheter because there will be other complications, when we already have one. To eat is very important for him to save his life.’