Raimundo Llanio Navarro

Doctor of Sciences. Clinician and gastroenterologist. Full Professor and Professor Emeritus. President of the Interamerican Society of Digestive Endoscopy. President of the Interamerican Association of Gastroenterology. Vice President of the World Organization of Digestive Endoscopy. President of the Cuban Society of Gastroenterology.

Born in Artemisa, province of Havana, Cuba, on December 5, 1920. Distinguished figure in Cuban medicine, dedicated for more than forty years to gastroenterology services. He studied medicine at the University of Havana, obtaining second place in his class, serving as an internal physician for two years.

During his professional career he has held various teaching and management responsibilities, among which stand out: He won by competitive examination a position as resident physician of internal medicine at Calixto García Hospital, and received an appointment as instructor at the School of Medicine. Head of the Clinical Ward at Calixto García. Head of the Gastroenterology Service.

Scientific Contributions
The professor's scientific and pedagogical contributions are numerous, among which the following are mentioned:

He prepared the clinical propaedeutics textbook for the medical program which has had four revised and expanded editions.

He has published twelve books as principal author and fourteen as co-author.

He introduced laparoscopy in emergency medicine, advancing early diagnosis in acute abdomen and performing the procedure under local anesthesia.

He also introduced ambulatory laparoscopy.

He used diagnostic exploratory laparoscopy in children from newborns to eight or ten years of age.

Recognition
For his relevant and significant contributions to Cuban medicine, he was deserving of numerous recognitions and honors granted by Cuban and foreign institutions, entities, and organizations, and the medical teaching profession is grateful for his contributions.

Interview with Prof. Raimundo Llanio Navarro
MEMORIES OF CHILDHOOD AND YOUTH
I come from a middle-class family and I did not have wealth or great luxuries, but my childhood was happy. I played with the means I had, I gathered with the boys on the street where I lived. I was born and spent most of my adolescence in Artemisa.

All my siblings (some already deceased) were born in Artemisa, where my father practiced as a physician. Most of my life took place there.

My father, named Enrique Llanio del Castillo, a general physician, my mother was Carlota Navarro González, a descendant of Canarians, daughter of Spaniards directly, because most Cubans have Spanish ancestry but she had it directly. The surname Llanio is Andalusian. My mother was born in the Canary Islands and had a level of schooling that reached primary education, but she had extraordinary natural intelligence: she painted just as well as she upholstered a chair, embroidered, or cooked. Whatever she did, she did well, without ever having studied it.

The people who most influenced my adolescence during my secondary studies in Artemisa were two teachers whom I always remember: one was named Donatilo Cruz, who taught Grammar and Literature, a man somewhat discriminated against because he was mulatto, a great pedagogue, very eminent, who managed to motivate students greatly and always maintained everyone's interest in his classes; and Dr. María Teresa Ponzoa, a biologist, who taught Natural Sciences and Anatomy. I never forgot those teachers because I felt very good in their classes, I felt very motivated and they influenced me greatly.

When Instituto No. 1 of Havana opened during my adolescence (located on Zulueta Street), I studied the Baccalaureate in this city. There were no textbooks or lectures; I studied from class notes and in 21 months I graduated with honors in all subjects and 12 awards, being honored with the Gold Medal. Perhaps it's worth telling you that I had to come from Artemisa every day to study the preuniversity program at that Instituto.

VICISSITUDES OF STUDYING MEDICINE
Despite having obtained the top academic record of my class, and believing that because of this I would have free tuition at the School of Medicine, when I arrive at the University I request free tuition for the first year. I begin to study (there were three partial exams at that time). I take the first partial exams, and when the list comes out, among those who had obtained that tuition, mine had been denied.

It's worth noting that free tuition had been given to children of professors and to friends of all the delegates and to very rich people through influence, and I, who was someone in difficult economic circumstances—they said: No, because my father was a physician.

I couldn't pay the tuition. I continue studying and make a claim to the dean. I finish the second partial exams and continue obtaining excellent grades, but they deny me the tuition again.

Then, I'm left with only one alternative: to make an appeal to the rector of the University, not to the dean of the School of Medicine.

I make the appeal to the rector and they tell me it will be studied, because the appeals that arrived there were a small group. I continue studying. I have excellent grades in all subjects; I have only one exam left. And at that moment they call me from the rector's office, and I think: "now I have the tuition." But they called me to tell me that since I only have one exam left, they will give it to me, but don't ask for it again, because even if I had one exam left they won't give it to me anymore. So for the next year I couldn't continue studying.

The grades didn't matter, the medals I obtained, the honors, the awards. None of that mattered.
I finish my exam and say: now how do I continue my studies? My father couldn't pay the tuition and was in a very difficult situation with his children, my mother, and the house he had to maintain.

Then friends tell me: You like sports, you say that you play ball, that you like to run and swim. If you do sports they can give you a sports tuition, which is not for the school of medicine, but for athletes. They give it to you and you can study. Well, I'm going to register at the university stadium, at the head of which was Dr. Barriento as the chief of that place.

When I arrive there they tell me, it's not because you do sports that we give you the tuition, it's because you stand out and are part of the national team of the university and then we give you the sports tuition.

So I go to the famous Martí Park, which at that time was the Military one. One of the boys lent me swimming trunks. They put me to swim in the 25-meter pool with the swimmers who were training for competitions, and I with all my defects keep pace with the others.

He says, well you have many errors, many defects, but you can train because you have speed.
Why did I have speed? Leaving Artemisa toward Pinar del Río, two kilometers away is the Canoa Lagoon, an enormous lagoon where I would go with friends to swim. And the Gamboa River was 10 kilometers away; there was a small dam there and we swam in it. It was more of a pastime, I had never trained but it seems I had speed.

I start practicing and five weeks later were the novice competitions (there were novices, juniors, and seniors). When I arrive at the competition after five weeks, I place among the top three and win first place. But the top three passed to the junior category, and I moved up. However, only one person per year could pass to the senior category. Although three entered, only one would advance to seniors; the next year three more would enter, one would leave, and five would remain. And there were about 12 accumulated, and the swimmers were getting bored.

When I got to that competition there were nine waiting for four or five years to enter seniors and I had to compete with them and only one passed. With good luck I obtained first place, and in less than two months I went from novices to senior. And upon entering seniors I already represented the national team of the University and from then on they gave me the sports tuition.

But that forced me to practice all the following years and in addition to studying intensely to be among the top academic performers, I had to practice intensely throughout my entire degree until I graduated. In summary, I had to earn my medical degree by swimming.

Perhaps that's why I've always thought that when one has everything easy they don't appreciate it properly, they don't value it, they believe they deserve it. But at that time that was the situation of almost all students. In this way I was able to study the medical degree.

In the first years of my medical studies I thought it better to work in some hospital to learn practical elements and finally I managed to work in the treatment department of the children's hospital (Pedro Borras) and I'll tell you that there I felt influenced by a person, precisely a nurse named Adelina who was the head.

To that department came the poorest children. Adelina trained me for a few days and assigned me the task of injecting about 120 children each day whose state of malnutrition was lamentable. They were administered intravenous calcium 3 days a week and the other 3 days they received intramuscular lipoid injections to fix the calcium.

I did this in the morning and after the task, approximately two hours, I joined her in draining abscesses in the buttocks resulting from poorly placed injections, encysted due to lack of sterility in the needles.
These poor children, weak, almost starving, suffered greatly when opened with the scalpel to drain the pus, and finally a gauze was placed as a drain to prevent the wound from closing until the infection disappeared. These dressing changes were daily and you can imagine the suffering of the children and of us.

I can tell you two things: one is that Adelina with her dedication and commitment influenced me positively more than all the professors, and also in that place my sensitivity to the suffering of the little ones was deeply affected, despite my gentleness in treating them and my confidence that I was managing to diminish their suffering. This was another reason that also determined my decision and love for medicine.

Continuing with the vicissitudes of the medical degree; at the end of the third year, before entering the fourth (the degree was five years), 20 first places were put up for competitive examination.

In each class around 1,200 to 1,300 students began their studies, but there were only 20 places. Those 20 places were through strict competition, evaluating honors and awards.

Upon winning the position of internal student for one year, my life changed completely: first I had a bed in a three-bunk cot in the upper levels of the guard corps at Calixto García. (It's good to remember that at those times I was living in my grandmother's house, very far away, I had to walk terribly because I didn't even have money for transportation); second, I had breakfast, lunch, and dinner at that Calixto García. Sometimes I hear people say the food is not good, imagine what it was like in 1944 when I entered. I'll remind you that the bread was bought from prisoners at the Príncipe prison, close to the hospital. Third, I earned 20 pesos monthly, which for me was a fortune, and I had the possibility of rotating through all the departments.

Once in the internship, I didn't do as many did—if they liked clinical medicine, they stayed in clinical; others in surgery, in gynecology. The professors didn't care if they rotated; they would sign off for all of them so they wouldn't go there. But I rotated through all the services: ophthalmology, otorhinolaryngology, orthopedics, gynecology and obstetrics, etc., and it has all served me in life.

All the knowledge I learned has helped me: I saved my daughter's life by knowing how to deliver a baby, because she was born dead and when the obstetricians gave up I saved her life.

What I learned in the rotations through those services helped me greatly, since there were a large number of patients: because all those poor folks came to Calixto García. This is how I completed the 4th year as an internal student.

The following year after obtaining 8 honors and 4 awards I obtained the position of internal student in the 5th year, ranking third on this occasion. It wasn't easy to advance at those times because the best were there and I started the fifth year.

I had to keep swimming. I swam to be a competitive, high-level athlete, in addition to studying early mornings and nights. I don't know if you know that at that time athletes were eternal students: they spent 10 or 12 years studying and all they did was practice. They didn't study.

I had to face the challenge of trying to be among the top academic performers and also be among the best swimmers to maintain the tuition on one hand and maintain the internal position on the other.

At the end of the 5th year and of course the Medical degree, again competing for the position of internal physician but for 2 years. In this way I obtained a position as internal physician for two years at Calixto García Hospital in Havana. That was the privileged group of 20.

At that time I had decided to be a Pediatrician and for circumstantial reasons when I graduated as a physician I couldn't be placed in the pediatrics ward of Calixto García and had to dedicate myself to clinical medicine in the Clinical Ward Altos of Calixto García Hospital. After those two years there was the possibility of going to a competitive examination for resident.

At that time there were two positions for resident in clinical medicine, one in surgery, one in obstetrics, and one in pediatrics, among those who had been interns of that class and the previous one. That is, among the best of two classes (a selection of 40 from about 3,000 students) and those 40 best would compete for those positions. If I was left out, I had nothing else. In the end, I got that position and had two more years as a clinical resident.

Later I obtained the position among all residents as Head of Internal Affairs, which was practically subdirector of the Hospital, and I was director by substitution at Calixto García in those years for six months because the director requested leave.

In summary I graduated as a physician in 1946, obtained the position of internal physician until 1948, in 1949 I went to resident competitive exams and stayed until 1950 and in 1950 I obtained the position of head of internal affairs and stayed one more year.

It's worth noting that when I graduated as a physician, with what I earned and my wife's salary, who was a nurse, we got married owing everything on payment plans, and when all these positions ended, having no salary, there were times when we couldn't even pay the installments, and we lived off some night shifts I did at private clinics, especially at the Sanguily Clinic (now the Institute of Neurology). The only fixed salary coming into our home was my wife's as a nurse, as you can understand, very low, especially if I tell you that we had a daughter and had to pay an employee who lived in the house to care for her, otherwise we couldn't work. They were very difficult years, and despite that I continued working in the Clinical Ward Altos of the Hospital without receiving any remuneration.

In these years and until the Revolution triumphed I had no more positions, nor salary. The Revolution surprises me working at Calixto García, but working for free, because as I told you from 1952 until 1959 I had no salary. I lived off the night shifts I did, especially where the Institute of Neurology is now (former Sanguily Clinic). And every holiday of the year I was the substitute, just as much during Holy Week, December 24, February 24, May 1st, December 31st, etc.

They paid me five pesos, ten pesos, and with that I lived and with the 90 pesos my wife earned as a nurse.

I've never been much concerned with money and I've never thought that I would die of hunger. I always took advantage of the night shifts to study constantly.

During the years I worked without remuneration in the Clinical Ward Altos of Calixto García Hospital I never accepted a political position at any House of Relief.

I remained that way for several years, until the Revolution came and appointed me professor and gave me a decent salary that has allowed me to live all these years without the past anguish.

Currently in the final review phase is the book Syndromes, precisely number 19, which I have dedicated to the Special Period because I started it and worked on it these ten years, to be consistent with a thought I internalized long ago that says:

The past is owner of memories,
The future is owner of illusions and hopes,
Only the present is ours,
Let us make proper use of it.

My greatest satisfaction is knowing that users, physicians and technicians have been nourished by its teachings and appreciate them, and in some cases treasure them, as they have told me, for the usefulness it represents for them.

"My greatest happiness throughout my professional existence has been able to contribute to sowing in those who accompanied me or were trained at my side, the seed of scientific curiosity, the desire for improvement and, fundamentally, dedication to the patient and human sensitivity in our daily work with the sick and suffering human beings."

A while ago I wrote this thought that summarizes what I have tried to be and do in my life. I have been fortunate to live long enough to verify that largely those around me and who had confidence in me for their training, today have stood out, and that fills me with satisfaction. Furthermore, I consider it the best reward for my dedication and commitment, because I am sure that those seeds multiply and will continue to bear fruit to their successors.

When I reflect on all these years, I consider that my life has been a constant challenge, as you have been able to verify.

On a personal level, I would feel more than satisfied and compensated if the triumph achieved over these challenges has managed to: benefit the sick, bring prestige to our institution and what is more important add this grain of sand to the successes of our country in the scientific world.

NATIONAL AND INTERNATIONAL TITLES AND POSITIONS:
1. Doctor of Medical Sciences
2. Professor Emeritus of the Superior Institute of Medical Sciences of Havana.
3. Principal Full Professor of Clinical Propaedeutics and Internal Medicine of the Superior Institute of Medical Sciences of Havana.
4. Full Member of the Academy of Sciences of Cuba.
5. Director of the National Institute of Gastroenterology.
6. Senior Researcher
7. Specialist of Second Degree in Gastroenterology.
8. President of the Cuban Society of Gastroenterology and Endoscopy.
9. President of the State Court of Gastroenterology.
10. Ex-President of the State Court of Internal Medicine.
11. Ex-President of the State Court of Pharmacology.

RELEVANT INTERNATIONAL POSITIONS:
1. Ex-President of the Interamerican Society of Digestive Endoscopy (SIED) 1991-1993.
2. Ex-President of the Interamerican Association of Gastroenterology (AIGE) 1993-1995.
3. Ex-Vice President of the World Organization of Digestive Endoscopy (OMED) 1994-1998.

PUBLICATIONS IN NATIONAL AND INTERNATIONAL BOOKS
Author of the following National Books:
1. Clinical Propaedeutics. First Edition, Two Volumes. National Press of Cuba. Havana, Cuba 1962.
2. Clinical Propaedeutics. Second Edition, Two Volumes. Consolidated Company of Graphic Arts. Havana, Cuba 1963.
3. Laparoscopy in Emergencies. Scientific-Technical Publishing. Havana, Cuba 1977.
4. Clinical Propaedeutics and Pathophysiology First and Second Edition. Editorial Pueblo y Educación. Havana, Cuba 1981 and 1988.
5. Clinical History. Editorial Pueblo y Educación. Havana, Cuba 1987.
6. Intestinal Parasitosis. Editorial Pueblo y Educación. Havana, Cuba 1989.
7. Gastroenterology. Manual of Diagnostic and Treatment Procedures. Editorial Pueblo y Educación. Havana, Cuba 1989.
8. Gastroenterology (Basic Principles and Diagnostic Tests). Editorial Pueblo y Educación. Havana, Cuba 1992.
9. Color Atlas of Laparoscopy. Editorial of Medical Sciences. Havana, Cuba (1992).
10. Laparoscopy in Emergencies (Second Edition) Editorial Pueblo y Educación. Havana, Cuba 1998.
11. Syndromes. (In Final Review Stage). Editorial of Medical Sciences. Havana, Cuba 2002.
12. Introduction to Clinical Medicine. (In final review stage). Editorial Pueblo y Educación. Havana, Cuba 2002.
13. Clinical Propaedeutics and Medical Semiology. (In final review stage). Editorial Pueblo y Educación. Havana, Cuba 2002.

Co-Author of the following National Books:
1. Standards of Medicine. First and Second Edition. Editorial Medical Sciences. Havana, Cuba 1976.
2. Standards of Surgery. First and Second Edition. Editorial Science and Technique. Havana, Cuba 1983.
3. Standards of Gynecology. First and Second Edition. Institute of the Book. Havana, Cuba 1969.
4. Manual of Internal Medicine Procedures. Institute of the Book. Havana 1970.
5. Comprehensive General Medicine. Editorial Medical Sciences. Havana 2000.

Co-Author International Books:
1. Medical Emergencies. Third and Fourth Edition. Editorial Alfa y Omega. Dominican Republic 1981 and 1987.
2. Major Digestive Syndromes. Editorial Jarpyo. Madrid Spain 1988.
3. Farbatlas of Laparoscopy. Editorial Schatahuer-Verlag-Stuttgart-New York. Germany 1980.
4. Diseases of the Digestive System. Editorial Interamericana-McGraw Hill. Madrid, Spain 1989.
5. Digestive Diseases. Editorial CEA, S.A. Barcelona Spain 1990.
6. Topics in Gastroenterology. Brazil. Scientific Medical Editorial MEDCI LTDA. Rio De Janeiro Brazil 1992.
7. Video-Endoscopic Surgery. Editorial Revinter. Rio de Janeiro. Brazil 1993.
8. Digestive Endoscopy. Editorial Revinter. Rio de Janeiro Brazil 1997.
9. Laparoscopic Surgery. Editorial McGraw-Hill Mexico. Second Edition 1997.

2.- WHY PHYSICIAN AND HOW A PHYSICIAN SHOULD BE.
I have said this many times, and sometimes I explain it better than others.

More than 40 years ago I read Aesculapius's Advice to his son who wanted to be a physician and I understood that in them my thinking was contemplated, and not because I knew them, because I had been a physician for years when I learned those criteria. That was not what guided me, but I found an ancient version of what I thought.

In my preuniversity studies, I felt attracted to biological sciences and when I saw friends or family members who were ill or injured I felt moved. Furthermore, my father was a physician in Artemisa. I think this influenced my decision to study medicine.

I believe that a physician must have many qualities. First, he must be someone who has ethics in his way of working, acting, and behaving before society, because society expects everything from him, even putting life in his hands.

He must realize that he has the responsibility to study and keep himself as updated as he can, although of course nowadays it's practically impossible to read all that is published.

He must have a fundamental characteristic, which is human quality. If the physician doesn't have that quality I think he should leave Medicine, because with sensitivity and tenderness one often helps a patient much more than with all the knowledge.

I think physicians should understand that the physician has the greatest authority in society. When I often ask this question to students and colleagues no one answers because perhaps they think some authority of the country might have it. I ask them the second question: can any leader or any authority ask a person to undress, show their genitals and allow a physical exam without forcing them?... Well, this means that the physician is recognized to have more authority than anyone.

Therefore, the physician must understand this as a total commitment in which there can be no lewdness, no malicious looks, nor try to take advantage of that situation (neither with men nor with women) and feel completely obligated to that person who is capable of giving him all her bodily riches and her thoughts, telling him intimacies that she wouldn't confide in anyone, and even puts her life in his hands.

The physician must reciprocate that commitment and to achieve it it is necessary to have great human sensitivity and dedicate the time that each patient requires, treat him in a friendly manner, empathize with him and achieve that he confides his concerns (which sometimes they don't say in the first interviews), study and make his greatest effort and call on anyone who can help him in diagnosis and/or treatment.

In my view if it's not that way, he cannot be a good physician because he should never forget that "he represents the breath and hope for that weak human being who sees his health broken and the least he expects is solidarity and humanism."
This phrase is from a patient and cherished friend who passed away a few years ago, who sent it to me in a congratulatory letter on the occasion of Physician's Day.

3- WHY PROFESSOR?
Since I started the first year of medicine I had the need to teach classes to other students for a few pesos because my economic situation was very deficient and in this way, although I was paid little, it helped me cover my expenses. This went on during my years of study.

After graduating (1946) and having obtained by competitive examination the position of internal physician at Calixto García hospital, I went to work in the Clinical Ward Altos of that hospital and classes in General Pathology were taught there, so the official professors of the School of Medicine assigned me numerous classes to teach to students in the 4th year of medicine. Two years later (1948) they appointed me Associate Professor (with honorary status) and 2 years later (1950) I presented a thesis and advanced to Professor Instructor, also honorary, and I continued that way until the triumph of the revolution in 1959.

A year later and due to the exodus of almost all professors I was appointed full professor and assigned a salary by the university. The first thing I did was change the name of the subject which from then on is called Clinical Propaedeutics, which is the correct name, and I wrote the first textbooks that didn't exist.

In summary I believe I am one of the oldest professors of our Faculty of Medicine and practically since my graduation in 1946 until today I have performed the dual role of care and teaching. During these years I have written more than 24 books, many of them for students of medicine, dentistry, and nursing.

Currently I continue to have great passion for education and I believe I have contributed to the teaching of all physicians, dentists, and nursing graduates of our country.

4- WHY YOU ARE PART OF THE GROUP THAT STAYED
During my childhood, adolescence, and adulthood I was never affiliated with any group or political party.

When the revolution triumphed and I heard the ideas that were defended and being developed by the comrades who had managed to overthrow and defeat the political-military regime that had reigned all those years, I understood the justice of the stated positions and decided to collaborate with my knowledge and unconditional support to make the dreams of those brave fighters come true.

That's why I linked my life to the Cuban Revolution because its postulates and principles have always seemed to me the most honest in trying to guarantee to this people and especially to the dispossessed all the opportunities they never had in their lives.

I have defended these principles in many countries because even though we may have committed errors in the way of implementing them on some occasions, they have never been errors in the principles. On different occasions in honest and sincere debates with people and professionals from other countries I have told them:

What rights are supposed to be guaranteed to a child at birth, whether born in a poor or rich cradle?

In my opinion:
The right to life, the right to food, the right to development, the right to education, the right to work, the right to sports, the right to culture in its various manifestations, the right to happiness, the right to form a home and have descendants guaranteeing them also these rights, and some others.

Notice that I have not said at any moment the right to wealth and spurious pleasures, nor to large residences, cars, yachts, airplanes, drugs, vices of all kinds, etc.

I firmly believe that no one who considers themselves honest can deny these truths which are only guaranteed in a society like ours here or in any part of the world where it exists, each with its cultural, racial, or historical characteristics.

We know that in all social systems there will always be differences related to vocation, the will for improvement and natural or acquired conditions of each individual, but: all absolutely all must have at least those rights guaranteed.

For these reasons I have dedicated most of my existence to working to contribute in some way to the consolidation of this system and I don't regret it, especially when I look back at my life and contemplate the development and crystallization of these rights in these years.

Source: https://www.jornada.sld.cu/llanio.html