By Maribel Acosta Damas on April 4, 2022

In the 21 years of free and high-quality operation, the humanitarian program of Chernobyl children in Cuba gave – along the way – not only results in health but the possibility of medical and scientific systematization of its applications in all areas. The program adopted the name Cuban Program of Integral Medical Attention to the children related to the Chernobyl accident and its formal period is between March 29, 1990, and November 24, 2011. Its headquarters was established at the Tarara Pediatric Hospital in coordination with other hospital institutions of the Cuban health system, institutions and organizations of the country and 26,114 patients from Russia, Belarus and Ukraine were treated.

The report that closed the program expresses both the general data of the program and its most relevant results:

ORGANIZATION OF SERVICES:

Medical services were structured in the three levels of medical care:

Primary Level: Comprehensive medical care offered by family doctors and nurses in Tarará’s own homes where patients are housed.

Secondary Level: Provided at the Tarará Hospital and in different pediatric and clinical-surgical hospital services in the capital of the country.

Tertiary Level: Provided in Institutes and specialized centers with state-of-the-art technology.

MEDICAL ASSISTANCE PROGRAM:

Comprehensive Medical Examination to all patients upon arrival, preparation of Clinical History and dispensation in the first week.

General laboratory tests for all patients, are aimed at confirming and evaluating referred diseases; and are directed to the main organs of the shock of ionizing radiation.

Imaging studies.

Specialized examinations according to medical indication and in correspondence with the particularities of each patient.

Specialized interconsultation according to need.

Integral medical treatment and rehabilitation.

Psychological Rehabilitation includes consultation with specialists, group activities, and a wide Cultural Recreational Program that includes visits to Museums, Zoos, aquariums, etc.

Comprehensive Stomatological Care.

Dosimetric measurements and prognosis estimation.

Hygienic Epidemiological Surveillance.

STATISTICAL INFORMATION

Total patients received

Country Children Adults Total

Moldova 2 2 4

Armenia 9 2 11

Russia 2715 213 2928

Belarus 671 59 730

Ukraine 18477 3964 22441

Total 21874 4240 26114

86% of the patients received were from Ukraine, 11.2% from Russia and 2.8% from Belarus, Armenia, and Moldova.

Distribution of children by sex

57% of patients were female and 43% were male.

Age groups in children

Group

Under 5 years of age 2203

5 -9 4814

10 – 14 12480

15+ 2377

Total 21,874

By specialty and alphabetical order Total % Allergies 2717 12.4% Allergies

Allergic 2717 12.4% Cardiovascular

Cardiovascular 1561 7.1% Dermatological

Dermatological 9225 42.1% Endocrine

Endocrine 12822 59.6% Stomatology

Stomatological 7346 33.5% Physiatry 2209 10.0

Physiatry 2209 10.0% Gastroenterology

Gastroenterology 10634 48,6% Gastroenterology

Genetics 493 2.2 % Gynecology

Gynecology 714 3.2% Hematology

Hematology 389 1.7% Immunology

Immunology 1447 6.6% Pneumology 923 4.2

Pneumological 923 4.2% Neurological

Neurological 1114 5.0% Nephrological 1050 4.4

Nephrology 1050 4.8% Ophthalmology 2110 9.9

Ophthalmology 2110 9.6% Oncology 117 0.5

Oncology 117 0.5% Orthopedics

Orthopedic 6581 30 % Otorhinolaryngology

Otorhinolaryngologic 4758 21.7% 21.7% Psychologic 1259 5.7

Psychological 1259 5.7% Rheumatology

Rheumatologic 634 2.9% Rheumatologic 634 2.9% Rheumatologic 634 2.9%

It should be noted that most of the patients were carriers of more than one chronic disease.

Main diseases

Endocrine disorders:

59.6% of the patients present endocrine system affections within them stand out in order of frequency:

Thyroid hyperplasia IA 23.1%.

Thyroid hyperplasia IB 12.2%.

Thyroid hyperplasia grade II 4,3 % Thyroid hyperplasia grade II 4,3 %.

Thyroid hyperplasia grade III 1.1%.

Other Endocrinopathies 18.9%.

Many of these patients improve with only contact with a natural environment rich in iodine, were evaluated, treated and returned recovered with specific recommendations.

Within the group of other endocrinopathies, exogenous obesity, gynecomastia and short stature were highlighted.

Affections of the digestive system:

(48.6%) presented digestive affections such as:

Recurrent abdominal pain was the main reason for consultations.

Endoscopic studies were performed in 60% of those affected, as they met the criteria for the same.

The endoscopic findings were related to:

In the Esophagus, Hiatal Hernia 5.7%.

In the Stomach, chronic gastritis in 54.8%, lymphoid hyperplasia in 12.8%, acute gastritis in 1.7%,           gastric polyps in 1.7%.

In the duodenum, chronic duodenitis in 39.5 %, lymphoid hyperplasia in 6.4 %.

In the duodenal parasitological smears, positivity for Giardiasis was 34.5%.

In Cuba, with the change in eating habits, diagnosis, treatment and reduction of stress, all returned cured or improved.

Dermatological affections:

Dermatological affections represented 42.1% of the affections.

Vitiligo with 22.2% of those affected and 90.3% of repigmentation.

Alopecia with 14.3 % of affected and hair growth in 86.4 %.

Psoriasis with 2.6 % who improved the inter-crisis time in 95.4 %.

Other affections 3%.

According to the experience accumulated in the center of placental Histotherapy of Tarará, the patients with these affections remained for 6 months or more with constancy in the treatment, obtaining a 90.3% of repigmentation in the case of vitiligo. In alopecia, 86.4% hair growth. In psoriasis, the inter-crisis time improved by 95.4%.

Stomatological conditions:

Stomatological affections represented 33.5%.

High caries rate 4.2%, mainly in the first decade of the program.

96.4% of the patients were examined and those affected underwent oral sanitation.

Orthopedic conditions:

Orthopedic diseases accounted for 30%.

Scoliosis 15.2%.

Flat feet 9.1%.

Other bone deformities 5.7%.

All were given rehabilitative treatment, and orthopedic devices and surgical corrections were performed when necessary.

Chernobyl children in Tarará. Photo: Archivo Equipo Médico.

Otorhinolaryngological affections:

21.7% of the otorhinolaryngological affections corresponded to:

Chronic Tonsillitis in the great majority 8.2%.

Chronic Pharyngitis (5.5%),

Hypoacusis (3.6%).

Deviations of the nasal septum (3.1%)

Epithiasis (1.3%).

Allergic and immunologic conditions:

Allergic affections accounted for 12.4% and immunologic affections accounted for 6.6%.

Recurrent infectious diseases

Seasonal allergy

Atopic dermatitis

They were treated with immunomodulating vaccines, which succeeded in spacing the crises.

Hematological diseases:

Of the total number of Ukrainian patients received in the center 1.7% presented hematological diseases, 122 with different types of Leukemia, 6 of them required bone marrow transplantation; the rest were treated with chemotherapy and radiotherapy according to the individual characteristics of the case.

Leukemias 122

ALL 107 87.7% AML

AML 5 4% CML

CML 9 7.3% MMMLT

MLML 1 0.8% OTHER HEMATOLOGIC DISORDERS 267

Other hematologic disorders 267

Aplastic anemia 6 2.2% Hemophilia

Hemophilia 4 1.4% Hemophilia

ITP 17 6.3% OTHER DISORDERS

Other disorders 240 89.8%

Oncological conditions:

117 patients with tumor processes were treated which corresponded to 0.5%, of which 90.5% were malignant tumors and only 9.5% corresponded to benign tumors.

To date, we have no reference for lethality in any of the cases.

Psychological alterations:

Psychological alterations were manifested mainly in the first decade as post-traumatic stress with anxiety, depression, estimation, overvaluation of the objective and subjective losses of the disaster, reaching inadequate tendencies in the formation of personality. In the second decade, they were characterized by social adaptation disorders.

Patients with disabilities, according to conditions

Patients rehabilitated for disability accounted for 10%.

Orthopedic: 1543 70 %.

Neurological: 461 21 %.

Neurosurgery: 18 0.8 %.

Reconstructive surgery: 68 3 %.

Visual Surgeries: 25 1,1 %.

Rheumatologic: 68 3

Complex surgeries: 26 1.1%.

Cardiovascular conditions

Cardiovascular conditions accounted for 7.1%, among which the following stand out:

Functional murmurs 3.3

Valvulopathies 1.4%.

Other conditions 2.4%.

In addition, 18 complex surgical procedures were performed

Ophthalmological conditions

9.6% corresponded to ophthalmologic affections, with refractive disorders standing out, which were corrected with glasses; and heterotropias, which were mostly surgically corrected.

Nephrological conditions

Although they did not contribute a large number of patients, 4.8%, it should be noted that within this %, 6 renal transplants were performed and the main affections were due to glomerulopathies.

Neurological affections

They represented 5.0% and the fundamental affectations were:

Migraine headaches

Recurrent vascular headache

Infantile cerebral palsy

In the case of infantile paralysis, most of them underwent surgical treatment to correct bone deformities and rehabilitation treatment.

Surgical interventions

SPECIALTY INTERVENTIONS % INTERVENTIONS

Angiological 21 1.24 % Angiological 21 1.24 % Cardiovascular 18 1.06

Cardiovascular 18 1.06 % Cardiovascular

General surgery 780 46.23 % Reconstructive surgery 68 4.03

Reconstructive surgery 68 4.03

Neurosurgery 10 0.59

Ophthalmology 65 3.85 % Ophthalmology

Oncology 99 5.86% O.R.L.

O.R.L. 167 9.89 % ORTHOPEDIC SURGERY

Orthopedics 343 20.33 % Orthopedics 343 20.33 % Transplants 8 0.47 % Transplantation

Transplants 8 0.47

Urological 108 6.40

Total number of procedures 1687 7.7 % Other surgical procedures

Other surgical procedures 5466 24 %.

7.7% of the total number of patients received were operated, some of them with more than one surgical time and with the participation of more than one specialty in the Hospitals, William Soler and Cardiocentro, Juan Manuel Márquez, Pediatric of Centro Habana, Pedro Borras, Frank País, CIREN, among others.

Those operated on thyroid gland contributed the largest number of cases of General Surgery, chronic tonsillitis, and deviated septum to ORL. There were 18 complex cardiovascular operations, 99 malignant tumors, 6 bone marrow transplants and 2 renal transplants. In ophthalmology, strabismus contributed the most cases, in urology, malformations and varicocele, in orthopedics, scoliosis and limb deformities, burn sequelae and reconstructive surgery.

The 24% was contributed by other surgical procedures, mainly biopsies, endoscopies, laparoscopies, medulograms, cryosurgery and others.

Types of biopsies

Skin 115 2.1% Thyroid

Thyroid 412 7.5%.

Skin and thyroid biopsies were the ones that contributed the most patients, although other organs were performed, but to a lesser extent, endoscopy and digestive laparoscopy also contributed significant cases.

Laparoscopic studies

Digestive 102 1.8 %.

undamental complementary investigations

INVESTIGATIONS PERFORMED

Clinical laboratory 174992

Microbiological studies 15937

Imaging 50788

Other 5937

Clinical laboratory studies were routinely performed on all patients, including: complete blood count, hormonal study of TSH, T3, T4, Transaminansas and others. Within the routine were also included imaging studies such as simple ultrasound of the abdomen and thyroid gland as well as others needed by the patient.

In hospitals and institutes of the capital numerous and complex investigations were carried out, indicated by their own specialists.

Dosimetric studies

The results obtained in about 8000 children indicated that:

External irradiation was the most important contributor to the total dose, which was estimated at <1-170 mSv for 70 years.

Twenty-seven percent of the children came from clean areas, 25% from areas with different levels of contamination, 23% from evacuated areas and 25% from areas with no known ground contamination by Cs-137.

Some level of internal contamination is detected in slightly more than 60% of the children.

The levels of internal Cs-137 contamination are between 1.5 and 565 Bq/kg.

The internal dose generated by such contamination ranges between <1-9 mSv for 70 years.

The frequency of thyroid hyperplasia tends to increase with increasing internal contamination and surface contamination by Cs-137.

The other medical and biological indicators show no alterations when analyzed in terms of internal contamination and surface contamination by Cs-137.

Attention to Ukrainian adults

Regardless of the fact that the program was created for the attention of children affected by the Chernobyl catastrophe, medical coverage was also given to a group of adults who traveled as companions and many of them were carriers of chronic diseases that worsened during their stay in our country as well as others who requested to be attended to corroborate diagnoses by Cuban doctors.

Total cases seen: 2226 52,5 %.

Total interconsultations: 5478

Total investigations: 9130

52.5% of the adults received were attended and interconsultations were made with more than one specialty, the most demanded corresponding to the specialties of Endocrinology, Medicine, Dermatology, Ophthalmology and Gynecology.

The average number of complementary tests performed was (4) per patient.

Medical care in Ukraine (1998-2011)

Since 1998 in the City of Evpatoria, Crimea Province, a brigade of Cuban doctors worked with a Pediatrician, a General Comprehensive Physician, a Hematologist, an Endocrinologist, a Psychologist, and a Russian language translator.

Between 5,000 and 6,000 people passed through this program every year, which was advised by our specialists.

In the capital of Kiev, from the beginning of the Program, a Cuban doctor specialized in Pediatrics was present, who worked in the selection and classification of the patients together with the Chernobyl Youth Fund and later with the Ministry of Health of Ukraine.

Chernobyl in Cuba had a different look: compassion, solidarity, common learning, and sharing of everything we had in the hard times of the 90s for Cubans. Chernobyl became a medical and scientific challenge. It brought to light intelligence and humanism; it collected stories of love and uprootedness; it served as a shoulder for many people who lived through the horrors of loss and disease; it gave back hopes and saved lives. It showed the best of human beings; that is why those children of Chernobyl always return to Cuba, their other place in the world.

Source: Cuba en Resumen