La Biblioteca Médica Nacional: The National Medical Library of Cuba.

U.S. citizens can legally travel to Cuba provided they are enrolled in an educational institution, conducting research, or participating in a professional conference. The authors individually responded to the call for participation at the Fifth Regional Congress on Health Sciences Information (CRICS V) held in Havana, April 25 to 27, 2001, due to our work as health sciences librarians in states along the U.S.-Mexican border. Prior to our arrival, Cuban health information professionals invited us to visit the Biblioteca Medica Nacional (BMN) during the conference. As we were the first U.S. medical librarians to visit the library, we wish to share our experiences through this brief communication. Cuba, known widely for its excellent health care system, still functions under poor economic circumstances. The annual per capita gross national product in 1995 for Cuba was $1,522, compared to $26,980 for the United States. Yet, the World Health Organization's (WHO's) healthy life expectancy rankings place Cuba as thirty-third worldwide, not far behind the United States' ranking as twenty-fourth. Furthermore, Cuba is fifth in the western hemisphere behind Canada, the United States, Dominica, and Chile in the WHO disability adjusted life expectancy (DALE) rankings, which summarize expected number of years to be lived in what may be termed the equivalent of “full health.” According to these rankings, Cubans have the highest basic life expectancy among all Latin Americans [1–3]. BMN pursues the ambitious mission of serving the information needs of health sciences professionals, faculty members, and students throughout Cuba. BMN supports fourteen provincial health sciences libraries, libraries serving large hospitals, and various other libraries serving academic programs that train health professionals. The library itself occupies what looks like a storefront at the corner of the busy Calle 23 and Avenida N in the Vedado section of Havana. The School of Public Health is a block away. One of Havana's six medical schools can be found within two kilometers. Resources are modest by U.S. standards. A sign in both Spanish and English on a cordoned-off XT computer near the entrance to the library reads: “Honoring Gives Honor: First computer delivered from the USA/Infomed Group's solidaric help that allowed the National Library of Medicine to set up its electronic network.” BMN does have leading medical journals such as JAMA, the New England Journal of Medicine, and the American Journal of Public Health. Its online catalog functions like any online catalog in U.S. medical libraries. Books and journals are housed on the lower level of the BMN in closed stacks. When users request a desired item, one of six runners quickly delivers it to the main reference area. BMN is open twelve hours per day, Monday through Saturday. Members of the Reference Brigade at BMN work twelve-hour shifts for a total of about thirty-six hours per week. They rely on a small collection of reference resources, several desktop computers, and eight public workstations. We observed them to be busy, exhibiting a sincere willingness to help users, just as can be found in U.S. health sciences libraries. One reference librarian told us that she has worked there for twenty years, and she still loves her job, because she learns something new every day. The main public area adjacent to the reference area consists of approximately sixty seats at tables and carrels. The public area, only moderately busy on a Tuesday afternoon, was full the following Saturday. Fifty staff members work at BMN including ten clerical staff, thirty library technicians, and ten professional librarians. Library technicians receive two years of training at Cuban technical schools. Professional librarians participate in a five-year general master's degree program at the university, which they follow with training in their areas of specialization in librarianship such as the health sciences. All educational programs in Cuba are free. BMN provides interlibrary loan and reference services, disseminates journal tables of contents, and maintains the CUMED database. CUMED indexes approximately thirty Cuban health sciences journals. BMN offers some courses for health sciences students in the Havana area, as well as continuing medical education courses for practitioners. Medical students in Cuba typically receive formal library training from the library at their institutions during their first three months of medical school, but they still tend to ask for librarians' assistance even after this training. Gomez and Urbina have described the Cuban medical education system in detail [4]. How BMN supports interlibrary and reference services illustrates some of the similarities and differences between U.S. and Cuban health sciences libraries. Physicians or other health care practitioners at rural sites in Cuba who need information typically seek assistance from the nearest of fourteen provincial health sciences libraries. In some cases, practitioners may contact the libraries at large hospitals, if nearby. These libraries all have book and journal collections. If the reference question cannot be answered at the local or provincial medical library, it is referred to the Reference Brigade at BMN. If practitioners need books or journals not owned by the provincial or hospital library, local libraries send interlibrary loan requests to BMN. These requests may be emailed to BMN, depending upon the local library's access to email. Cuban health sciences libraries do not use facsimile technology. When BMN owns requested books, they are sent via the postal service. When BMN owns journals, images of articles will be transmitted as scanned attachments to email. If local libraries do not have the capacity to receive scanned documents, they may be sent to provincial government offices instead. Otherwise, photocopied versions of articles will be sent by postal service. BMN serves as the ultimate referral point for books or journal articles in Cuba, so it does not request interlibrary loans from libraries in other countries. Like their U.S. counterparts, Cuban health sciences libraries have trouble securing adequate budgets for building collections. Budgets are stable from year to year, however. Fixing or replacing an air conditioner, the current need at BMN, requires special funding requests. We were told there had been plans for a new library building. Because of the “Special Period”—the economic austerity program begun in 1990 by the Cuban government to counter the loss of extensive trade and financial aid from a collapsed Soviet Union, along with the effects of the ongoing U.S. trade embargo—those plans had to be set aside. Cuba does not have an equivalent to the Medical Library Association (MLA). BMN instead performs many of the same kinds of continuing-education functions as MLA does for health sciences librarians. This continuing-education role involves structured courses and specific expert advice to individual librarians. The librarians at BMN told us that both their library systems and practices have been heavily influenced by health sciences libraries in the United States. For example, an editorial [5] in a recent issue of the journal for Cuban health sciences librarians, Acimed,† discusses an article in the October 2000 issue of Bulletin of the Medical Library Association. Also, BMN uses the Spanish version of Medical Subject Headings (MeSH) and the U.S. National Library of Medicine's classification system. When we visited BMN, we brought with us a complete run of the 1993 to 2000 issues of Bulletin of the Medical Library Association, which were much appreciated. We were largely ignorant of the Cuban library system before this trip. Our Cuban colleagues welcomed us warmly at BMN. They answered all of our questions completely. This welcome resembled the hospitable reception for previous delegations of academic and public librarians from the United States at other libraries in Cuba [6–8]. During our tour of the BMN facility on April 24, 2001, our hosts informed us that we were the first U.S. medical librarians to visit BMN. We thank all of our Cuban hosts for their hospitality, especially Jehova Oramas, M. D., vice director of BMN's parent agency, Centro Nacional de Informacion de Ciencias Medicas, who made the initial arrangements for our visit. We also are particularly grateful to BMN Director Barbara Lazo and her colleagues, Ileana Armenteros, chief specialist for technical services, and Margarita Pobea, chief specialist for information services, for facilitating our visit. We hope this article will encourage U.S. librarians to seek out opportunities to meet with their Cuban counterparts to share ideas and experiences. Interested readers may want to visit the BMN Website‡ or Cuba's Virtual Health Library.§ The authors intend to return to Cuba to understand how health sciences libraries, particularly those in the provinces, contribute to such an impressive health care achievement in spite of poor economic conditions. Countries with few resources such as Cuba may offer creative, low-cost solutions for the financial challenges currently facing U.S. health sciences libraries.

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