José Jordán Rodríguez

Dr. José Jordan was a distinguished pediatrician and renowned world expert in the areas of nutrition, growth and development. He successfully directed the National Study of Child Growth in Cuba, for which he received an award in the seventies.

Dr. Jordan was founder of the gastroenteritis and acute respiratory infection wards for specialized care of small children with such conditions in hospitals in Cuba. He likewise developed intravenous hydration protocols for the treatment of gastroenteritis. He was a promoter of the use of flame photometry in monitoring electrolyte replacement, a solution with a chemical composition very similar to the one he recommended and which was adopted by the United Nations Children's Fund (UNICEF) for the treatment of similar cases.

He was an author of books, and contributed more than 20 chapters to textbooks published throughout the world. He wrote more than 150 nutrition articles that have appeared in important international scientific and medical journals. He was the recipient of numerous awards and honors throughout the world.

In 1998 Dr. Jordan Rodríguez received the distinction of Academic in Merit from the Academy of Sciences of Cuba. He practiced pediatric medicine from 1944 until his final years of life, during which he continued to teach and practice pediatrics.

Jordán wrote in his autobiography: This brief account of my experiences in the field of public health will begin with my birth in Pinar del Río, about 180 kilometers from La Habana, Cuba's capital.

My father, who graduated as a physician in 1913 and was the first pediatrician to practice in the city and province, knew how to care for my health and prepare me well for life. When I turned 9 years old, he had me take English lessons with the best teacher in that city, and at 11 years old I learned typing and shorthand, skills that later proved very useful in all my studies. I always wanted to be a doctor. At 18 years old I began my medical degree, which I later devoted to pediatrics.

My good grades allowed me to obtain in 1941 a position as an intern at the Calixto García University Hospital, in La Habana, a position that only the 12 medical students with the best records could aspire to. At the same time, I began to attend the Municipal Children's Hospital of La Habana, barely one hundred meters away from the University Hospital.

Around that time, during World War II, some sulfas already existed and soon penicillin, streptomycin and other antibiotics appeared. I then had the opportunity, together with other colleagues, to save the lives of many small children who previously died from meningoencephalitis and other previously incurable infectious diseases.

At the end of 1944 I graduated as a physician and immediately entered the Department of Pediatrics, along with three colleagues, as an unpaid auxiliary physician. The Chief Professor indicated to us that one of us should take care of the classes on nutrition and infant feeding, particularly of the infant, a task that I assumed voluntarily. From then on I was in charge of teaching classes in that subject during my clinical internships in the Children's Hospital wards.

I performed those duties for three years, after which I published my first book, Lessons in Nutrition and Dietetics in Childhood, which was later adopted as the official textbook for the pediatric nutrition department. Meanwhile, I continued providing clinical care to children in one of the infant wards of the Children's Hospital.

From that point on, I began to worry about the main causes of mortality within the hospital. The wards were divided according to the age of the children and in the infant wards there were cubicles with two cribs. I noticed that in one cubicle they would place a child with acute gastroenteritis and in the adjacent crib a newborn who was only under observation, without having any contagious disease. The same person cared for both children without any hygiene precautions, with the result that the healthy infant contracted gastroenteritis and died dehydrated and with electrolyte imbalance. This led me to found, in the mid-fifties, the so-called Gastroenteritis Wards, where there was a sink between the two little beds. Soon in-hospital mortality dropped markedly and this good experience also led me to found the Acute Respiratory Infection Wards, also with excellent results.

For cases of gastroenteritis I established the use of intravenous hydration together with the flame photometer for the diagnosis and appropriate management of parenteral hydration, paying attention to the proper amount of sodium, chlorine and potassium. These works were presented at the Ross Pediatric Conference that took place in La Habana around that time. The electrolyte solution that I created was very similar to the one later recommended by the United Nations Children's Fund (UNICEF).

My first contact with the Pan American Health Organization (PAHO) took place in 1947, when, after the end of World War II, I visited its Headquarters in Washington, D.C., to attend a meeting. I was then passing through New York to participate in the Fifth International Congress of Pediatrics held in mid-July at the Waldorf Astoria Hotel, where I met Professor L. E. Holt.

In October 1957 I joined the American Academy of Pediatrics. In Cuba, infant mortality at that time was recorded in statistics as 60 per 1,000 live births, but there is no doubt that in reality it was much higher. In the sixties, when I visited the rural areas of the country, I saw the graves of children in the countryside and I was particularly impressed by those on the south coast of the province of Oriente. Due to lack of communication with the nearest city, which was about 80 kilometers away and which had no road access, the sick were taken to the south coast in the hope that from there some vessel would take them to the city of Santiago, which was the only one nearby. There is no doubt that under those circumstances there was a great underreporting of infant mortality.

Before the political changes that took place in Cuba in 1959, infant mortality and health care were not government priorities. The situation changed later.

Before 1962, the only School of Medicine in the country was located in La Habana, but that year another was founded in the province of Oriente, precisely in Santiago de Cuba. I attended the inauguration and toured the south coast of the province on that occasion via a road that connected four newly built rural hospitals. When I went to visit them, I noticed the presence of graves on the south coast of that province.

In 1965 the first course in Pediatrics took place at the new School of Medicine and I was the professor selected to teach it for a period of six months. In 1966 I performed the same task at the Finlay Hospital of La Habana, and in 1968 I returned to the province of Oriente to teach another pediatrics course in the north, in the city of Holguín. Everywhere I fought to establish measures to reduce the main causes of mortality in children, and my ideas were always taken into consideration.

The year 1966 marked the beginning of my concern about the mortality, morbidity and sequelae produced by the so-called "accidents" in children. I conducted and published several research works on their causes. Subsequently I was appointed Member of the Panel of Experts in Accident Prevention of the WHO and the International Association of Pediatrics.

By 1969, with a good national registry already established, the infant mortality rate had dropped to 46.7 per 1,000 live births. The Minister of Public Health of Cuba convened a meeting at the end of 1969 to set the goal of reducing that rate by an additional 50% during the following decade (1970-1980), which was achieved before the end of the period, in 1977, with a reduction in the rate to 22.9 per 1,000 live births. During the meeting I pointed out that once the goal was achieved, the lives of many children would be saved, for whose health, growth and development we would have to care, which implied carrying out as soon as possible a national study aimed at exploring the situation of child health. That is why from January to May 1970 I was sent to London, England, to design the study, which was carried out between 1972 and 1974 with the help of professor James M. Tanner.

In the study, which in total had a random sample of 52,000 children and adolescents from 0 to 20 years of age from throughout the country, 18 anthropometric measurements were taken and the sexual development of the participants was examined. 10% of the sample members had a hand X-ray taken to determine their bone development. The results were presented in several scientific papers published in two books, one of them edited in Cuba and the other in Spain, as well as in national and international scientific journals.

In 1978 the Scientific Council of the Ministry of Public Health of Cuba awarded him a prize for best research. This work, as pointed out by professor Frank Falkner and professor Tanner himself, was considered the most complete to that date, which also led to his receiving the Paterson prize in Vancouver, British Columbia, Canada, in 1978 and the WHO World Health Prize in Geneva, Switzerland, in 1987.

I have been a Consultant in Growth and Development for PAHO for many years and Member of Committee II/5 of the International Union of Nutritional Sciences. I have presented 154 scientific papers at national events and 156 at international events.

In 2001 I participated in the National Congress of Pediatrics, where I presented a paper on the history of that discipline in Cuba. I have been the author of three books known worldwide and two of national distribution, as well as 15 chapters in foreign books (WHO, PAHO, UNICEF, etc.). I have also published 79 papers in international journals and 76 in national journals.

I have been invited to participate actively and to teach courses and lectures in 72 cities and 34 countries in North America (Canada, United States and Mexico), Central America (Costa Rica, Guatemala and Panama), South America (Argentina, Brazil, Bolivia, Colombia, Ecuador, Paraguay, Peru, Dominican Republic, Uruguay and Venezuela), Europe (Germany, Austria, Belgium, Bulgaria, Czechoslovakia, Spain, France, Hungary, Italy, Poland, United Kingdom, Switzerland, USSR), Asia (Philippines and Japan) and Africa (Egypt and Ethiopia). Most of the time I have attended as a Temporary Advisor or Consultant for PAHO or UNICEF.

In 1995 I received in Cairo, Egypt, the World Prize of the International Association of Pediatrics, and in 1993 I was awarded the Christopherson Prize of the American Academy of Pediatrics, in Washington, D.C.

I have been named Honorary Member of many pediatric societies in Latin America: Brazil, Mexico, Paraguay and Peru and Professor Honoris Causa of the Autonomous University of Santo Domingo, Dominican Republic. In my country I have received 22 national honors, including the National Order Carlos J. Finlay, another on the occasion of the 250th anniversary of the University of La Habana, the Medal of 50 Years of Service to Health and many others.

At the end of 2001, the American Academy of Pediatrics made the video Watch them grow: A retrospective of a Cuban pediatrician in recognition of my dedication to this specialty.

Of all the gifts, none better to date than having achieved that infant mortality in Cuba dropped in 2001 to 6.2 per 1,000 live births, a rate similar to that of Canada and slightly lower than that of the United States. Cuba continues to rank among the countries in the world with the lowest infant mortality rate.

Currently Cuban children receive vaccines against the following childhood infectious diseases: tuberculosis, poliomyelitis, typhoid fever, diphtheria, tetanus, whooping cough, mumps, measles, rubella, meningococcal infections, Haemophilus influenzae type b infection and hepatitis B. These conditions have been eradicated, thereby saving 18,500 lives of children under one year old and preventing 2,000 cases of childhood blindness, 2,000 of deafness, 1,800 of serious heart disease, 10,000 of paralysis from poliomyelitis and a total of 650,000 of communicable diseases.

Thanks to this, it is estimated that two and a half million children have not missed school due to illness.

Cuba continues to fight against accidents with the motto indicated by me in the work designed for UNICEF in For Life (Facts for Life), where it is stated that "Care begins with C," since accidents in children can occur in the City, the Countryside and the Coast. In the city they can occur in the House, the Street, the School and the Children's Circle (daycare). In the house there is danger in the Room, where the Crib is, the parents' Bed, the Vanity, the Dresser. From there the child exits through the Corridor and can go to the Kitchen (very dangerous) or to the Dining room. In the yard of the house there is danger in the Cistern if it doesn't have a cover. Then the child can go out to the Street, where the Bicycles, the Cars, the Trucks, the "Camels" (double-space buses) and the "Quarentiñas" (buses with forty cent fare) are dangerous.

At School there will be other dangers, as well as at the Children's Circle (daycare), but responsibility is no longer that of the family, but of trained personnel to prevent accidents. From the City we move to the Countryside using the Road. In the countryside you have to be careful with the Horses and the Carts. From the countryside we can reach the Coast and there the danger is in the Canoes and Falls into the water.

At times I have noted that we pediatricians are "doctors for children, psychologists for parents and [...] psychiatrists for grandparents." In short, in memory of my father I am deeply satisfied with the results that our country has achieved in the health field during the twentieth century. My father practiced his profession from 1913 to 1956, when he retired (43 years in total), and I have practiced it from 1945 to the present (60 years).