World Heart Day is a global event that occurs on 29 September. It is the world's leading heart awareness platform, hosted by the World Heart Federation. 26 is bringing to its readers an outstanding professional with a passion for cardiology.

A few outstretched hands guide me to the H-4 ward of Dr. Ernesto Guevara de la Serna General Teaching Hospital. The references I have of my interviewee are valuable: "He is brilliant, the best of his year, demanding, he has a very low timbre in his voice...", but nothing that distinguishes him among the doctors who pass me at a rapid pace and, to top it all, with almost all their faces covered.

Half an hour later, after stumbling backward corridors, I began to perceive the successes of Dr. Maikel Santos Medina, the head of the Cardiology service, with indicators that make him notorious at a national level. Talking further inside, I hear the doctor's insistence on delving into the chest, an organ that is often accompanied by metaphors but which, in green attire, tends to be implacable.

...
The biology teacher at the Luis Urquiza Jorge Vocational Pre-university Institute of Exact Sciences (IPVCE by its acronym in Spanish), the first time she saw him cross the threshold of her door, interested in doing tests in the subject, gave him a good scolding: "What do you mean, medicine?! And for Maikel, a physics competitor, with results in national competitions, the horizon loomed on the cusp of technical careers.

He confesses that the lack of motivation for engineering, despite his passion for the exact sciences, dressed him in the white coat, and for good, because he cannot imagine himself in other scenarios, or doing anything other than at the right hand of a patient, looking for answers in his anatomy, when gravity chooses to pave the way.

It is not surprising that he was the best graduate of 2004 at the local University of Medical Sciences, nor that for his exceptional performance, he received as a prize the "ticket" to work for a year in Maisí, Guantánamo, and then another year outside Cuba.

"Having just graduated, any responsibility becomes even greater, especially when the lives of human beings are at stake. I remember that La Asunción, the place where I arrived, was the second major settlement in Maisí. As I imagined, the referral point was several kilometers away, so the Family Doctor and Nurse Practitioner's offices had to deal with more than 80 percent of the community's health problems."
"I lived there, in a typical doctor's office, so there were no weekends off or holidays. You were the doctor from the moment you opened your eyes until you went to bed. That rigorous school tested not only academic knowledge but also the real willingness to dedicate one's entire existence to serving others."

Despite the intricacies of the place, the hospitality of the people bridged the gap and it was a fruitful stage that felt like a reward in the end.

"Later, as part of the Exceptional Performance Program, I traveled to Guatemala with a group of colleagues. The experience gained in Guantánamo weighed heavily, but we were also going without all the 'resources', and about to face situations that would demand much more than what we had in our backpacks."

"In the blink of an eye, we were in Nebaj, a mountainous area where more than 95 percent of the population was indigenous and where many dialects, diverse lifestyles, and beliefs converged, in short, an ethnocultural mishmash that from a health point of view constituted a gigantic challenge."

"From here, sometimes people don't know how the doctor on mission works and lives. One tells, but always omits details to the family to avoid worries. In Guatemala, we did it under very difficult conditions. We had weekly schedules in different villages, at the same time we were on medical duty, and there were many emergencies."

"At that time it was compulsory for me to specialize in General Comprehensive Medicine (MGI). I remember that most of the complications I had to deal with were gynecological, due to mishandling by the midwives or the non-viability of the fetus' position. I lost count of the number of deliveries I attended."

"And leaving the ward, you had to take your backpack, a week's worth of food, and your papers and wait for the facilitator to take you in his motor to some village, walk through the jungle, give consultations there until nightfall, sleep there and the next day at dawn go on to another village and then to yet another..."

THE PATHS OF CARDIOLOGY

Maikel returned to Las Tunas as a specialist in MGI but was ready to look for another discipline that was more in line with his expectations. He says that, at first, due to family health issues, he was inclined towards Nephrology; however, he soon learned that he would become a cardiologist.

"What I liked most about this branch of medicine is that it provides comprehensive management of the patient; you have to correlate the physiognomy with the heart. We receive those who are seriously ill and we can see their complete evolution, we accompany them throughout the process."

"My training, I have to tell you, was pleasant. Until then, cardiology residents in the province were trained in Holguín or Havana, but together with a colleague with whom I shared part of my academic training and who is personally a great friend, we did the specialty here and we were the first graduates in our homeland, in 2010."

"Of course, our training included the practice in the cardio centers of the country, but in Las Tunas we were welcomed by a group with experience in healthcare and teaching. I remember a period with great affection. Sometimes it was after midnight and I was on duty with an old ultrasound machine to learn how to make echoes. I hardly slept, I had to study and study..."

"The first pacemaker I placed without another experienced figure nearby is something that I will never forget, I always took on the role with the responsibility that I had someone's heart in my hands and that did not make it any easier; however, it helped me to accept the profession with its exact dimensions."

WELL-EARNED REFERENCES

Ward H-4 also tells its own story. The 18 beds of the Coronary Intensive Care Unit (ICU) welcome him early in the morning every day, and not a leaf moves without Dr. Maikel knowing why.

He has been head of Cardiology for two terms, and since 2010 he has been familiar with the local universe, which is characterized by ischemic heart disease, arrhythmias, valvular conditions, and other pathologies, a challenge that is increasing due to the shortage of drugs and medical equipment.

Despite these objective issues, the service today shows a mortality rate for infarction in the hospital environment below 12 percent, a reference index for Public Health in Cuba and the world.
Survival is above 94 percent, with emphasis on people with acute myocardial infarction, which is the main cause of death.

To the institution's satisfaction, in the last five years, a number of indicators have decreased, including readmission rates and increased care, thanks to the incorporation of techniques such as echocardiography, ambulatory pressure monitoring, and ergometric tests.

Another positive issue is the closed cycle in hospitalization as part of the care of patients who are admitted with an acute or serious condition and then discharged with follow-up through specialized consultations, depending on the pathology. It is not lost track of.

Since 2007, the Cardiology service in the territory started teaching and in 2019 the National Accreditation Board decreed it as a certified specialty.

Among the few of its kind on the island, the Tunisian body guarantees that professionals have recognition beyond borders and has already trained cardiologists from countries such as Nigeria and Mali.

In 2023, the center will be 20 years old, two decades that have marked Maikel's fortune. As an authority there, he comments that his hierarchy is aimed at bringing the collective together, molding doctors, nurses, and residents, to achieve excellent care, emphasizing the particularities of each person. He assures that the best way to make demands is to lead by example, which has been his key to success.

Meanwhile, demand is growing. About 60 patients come to "H-4" every month, about 240 come annually with acute myocardial infarction and another 200 with unstable angina and other acute cardiovascular conditions.

TREE WITH DEEP ROOTS

It is impossible to limit my interviewee's curriculum vitae to just a few pages. So much remains to be said... he is the only doctor in Medical Sciences in the province; he is a member, together with a "handful" of Cubans, of the American College of Cardiology, the most prestigious society in the world in his field...

He is currently competing for the Annual Health Prize in Las Tunas with his research to create and validate a predictive scale for hospital death in patients with acute myocardial infarction. To do so, he uses seven variables that can modify the indicators with differentiated treatment for high-risk patients.

He also defended this study at the 30th Inter-American Congress of Cardiology held in Panama this year.
Since 2017, the service he heads has been the initiator of the Cuban Registry of Acute Myocardial Infarction (Recuima in Spanish), to create a database to define how patients evolve; it already has more than three thousand cases in its study universe.

Santos Medina was in charge of the Cuban mission in Laos between 2013 and 2015, from where he also keeps memories that encouraged his steps. Although he makes it clear that the biggest challenge he has faced is in the present, in his day-to-day work, dealing with a specialty that today works with the minimum essential staff because, as in other fields, absences are felt due to migration and "it hurts when we are dealing with brilliant people and we have to start again to train doctors.

"Cardiology has very expensive demands. A pacemaker, for example, costs around two thousand dollars. And we get about a hundred of them every year in the province, but there are not enough to go around. Another issue that affects us is the lack of drugs. Cardiopaths require constant medication and sometimes we have to adjust treatments and lower doses because we can't guarantee full coverage."

He speaks with all sincerity from the left side of his chest. She also says that she teaches her colleagues that they must put themselves in the patient's shoes, give explanations, and accompany them with affection but, above all, that they must study to save lives.

He shares her life with a colleague and dreams that one day they will expand their family. He repeats the term inexorably several times and coins it on each occasion. It is clear to me what she demands and what transcends the white coat. When I ask him about his future, he is blunt. Fortunately for people from Las Tunas, he only says: "I still see myself here."