Tuesday, 13 June 2017
In April this year, on a self-funded tour, I had the occasion to visit Cuba. Amongst meetings I had with the Vice President and the minister associated with mines and energy and foreign affairs, I had the privilege of meeting the Director of the Centre for Genetic Engineering and Biotechnology, Dr Manuel Perez-Castaneda. This evening I wish to present some of the information that Dr Perez-Castaneda gave me not in relation to Cuba so much but indeed to Australia. I want to speak briefly about non-melanoma skin cancers and particularly about the work undertaken in Cuba on diabetes, foot ulcers and the terrible sequels that do occur from there.
Cuba of course has been isolated for many years, not the least from the United States of America. Their whole focus has been on health care within their communities, including their rural communities. I will give you some interesting statistics of how successful they have been. In 1960 in that country there were 37 infant deaths per 1,000 births and a life expectancy of 62 years. By 2014 the 37 deaths per 1,000 had reduced to four and the life expectancy had increased from 62 years to 79 years. There is a very heavy emphasis on public health, including in rural areas.
They have had enormous success out of that institute, with some 30,000 personnel working in 31 collaborating enterprises on that campus just outside Havana. They have been working, for example, on a nasal vaccine against hepatitis B, a disease that is now practically eliminated in Cuba. They have international patents for a prostate cancer vaccine. There were 22,000 cases in 1992 and that was down to 16 in 2012. This resonates for us. Also I mentioned issues associated with non-melanoma skin cancers, and I will come back to that in a moment.
What was humbling for me was that Dr Perez-Castaneda delivered to me statistics about the instance of these conditions in Australia, state by state and major city by major city. I checked of course with our Assistant Minister for Health whether those figures were accurate, and indeed they were.
He presented to me, for example, the most common causes of death in Australia and the 16 most lethal cancers here in our country—not in Cuba, but here in Australia. He presented data to me from work they are undertaking in Cuba associated with nonmelanoma skin cancers. Of course, Australia is the world leader in skin cancers generally. The statistics he showed me were that currently we have about half a million—about 577,000—cases a year of nonmelanoma skin cancer in our country. They are achieving enormous success with nonsurgical intervention using pharmaceuticals for which they have international patents. Indeed, the institute has 1,816 international patents approved and another 2,336 pending.
But I want to go to the whole question associated with amputations as a result of foot ulcers caused by diabetes—not in Cuba but in our country. These are the figures that Dr David Gillespie, in the other place, confirmed when I got off a plane from the United States the other day. We have 4,400 amputations a year in our country as a result of diabetes—12 a day, seven days a week. There are 10,000 hospital admissions for diabetes related foot ulcers: a third of those who are diagnosed end up in hospital and a third of those who end up in hospital end up with a limb being amputated. That is the level of this issue.
What does it cost us? It costs the Australian economy, apart from the emotional cost to the 4,400 families every year—the 12 families every day—about US$3½ billion annually. The average person spends 24 days in hospital and we have 1.4 million Australians affected by this particular scourge. And, as I said earlier, a third of those 1.4 million will end up with ulcers and in hospital, with a third of them having amputations.
As he presented these statistics to me, he also showed photographs of a Victorian truck driver, Mr Alan Tillotson, who was forced to retire from his job as a truck driver in Melbourne because of ongoing foot complications caused by the fact that he had had an amputation.
When I came out of Cuba and went back to Panama I spoke to our ambassador. I rang him to give him an overview of my trip to Cuba, and I do not think he will mind me saying this. He said to me: 'Chris, this is personal to me. My father lost a limb to amputation from diabetes—a foot ulcer. He then lost the other limb and he lost his life. My abiding memory as a kid was of my mother carrying my legless father around. He had lost both legs as a result of this scourge.'
What is interesting is that in Cuba they have started a nonsurgical treatment using an injection around the abscess. For those of you who have not yet had your dinner I will not go into the pathology of it! There is a treatment every second day for 18 days around the abscess causing the foot ulcer, and the Cubans are enjoying a 95 per cent success rate with nonsurgical intervention in this particular treatment—a 95 per cent success rate.
What Dr Perez-Castaneda did for me was to go back and say, 'Well, here are your statistics on a state-by-state and on a city-by city approach in your country.' His estimate is that we could reduce that level of 4,400 amputations to far less than 1,000 a year, with the emotional saving to those families and the incredible financial saving to our health system. But what is interesting in that country is that because of their public-health circumstance and a hierarchy right down into the rural and regional areas of Cuba, now at the very earliest stages when somebody sees that they have a blister which may become an ulcer then rather than sit back and do nothing they immediately go to a local health service. That service may or may not be able to provide treatment, but they can immediately move it up the hierarchical tree so they can start the treatment process. It was humbling to learn that the United States, having embargoed most activities in Cuba, have very graciously lifted the embargo on surgical, non-surgical and pharmaceutical treatments. He also told me that they had reached out to many countries to have an international symposium in 2015 or 2016 to which we were invited but, unfortunately, we were unable to or did not attend.
The incidence of diabetes is going up dramatically in most countries of the world and we are no exception. It is a factor of our modern lifestyle. Cubans, of course, are very, very focused on this because sugar is a major part of their economy and it has been a major part of their diet. The head of Diabetes Australia says that there have been 100,000 Australians diagnosed with diabetes in the last year alone. At this moment, we have no formal reporting system in place and, yet, hospitals are reporting increases in amputations. Lest you think that it is only a condition of older people, we know very well that different forms of diabetes attack people at different ages including from the very youngest. I make these comments this evening because I have engaged with the health minister, the Aboriginal affairs minister, the international relations minister, my friend Ken Wyatt, who has responsibility for Indigenous health, and, of course, Judi Moylan who—as you and I both know—was the member for Pearce and is the President of Diabetes Australia. It is something that I want to see continued beyond my time in the Senate because here is a country reaching out to us, offering their service and offering their expertise. In my view, it is for us to pick up the phone, thank them and accept the invitation to come to Australia to talk about the work they are doing in those particular disease treatments.