Cover Sheet
Defining Health, Providing Care: Lessons from the Healthcare System in
Karen Strickland, M.S., Lic. Mental
Health Counselor (LH00005787), Social and Human Services Instructor-Seattle
Central Community College
1701 Broadway, 2BE3212A,
206-587-6911
FAX:
206-344-4390
August 23, 2005
Title Page
Defining Health, Providing Care: Lessons from the Healthcare System in
Abstract
The socialized healthcare system in Cuba is organized in a
way that offers many doorways to care, beginning with the Family Doctor/Nurse
team in the neighborhood and including general healthcare clinics, mental
health clinics, hospitals with psychiatric units and Havana Psychiatric
Hospital. It is characterized by
universal access, community orientation, prevention, and integrated and
comprehensive services. Common measures
of the collective health of a community demonstrate that the system is
effective, with life expectancy and infant mortality rates comparable to those
in the United States. This analysis of
the strengths of the Cuban system can be instructive as the U.S. struggles to
address the healthcare needs of the population.
Key words: healthcare, Cuban, socialized, prevention, integrated
DEFINING HEALTH, PROVIDING CARE:
Lessons from the Healthcare System in
For many people in the U.S. Cuba conjures either romanticized
images of exotic island life or negative feelings and beliefs in reaction to
Communism. In either case, the response
reflects an oversimplification of the reality of life in Cuba. In this article I will examine the healthcare
system, with an emphasis on social work and mental healthcare, to illustrate
the more complex reality in Cuba while acknowledging some of the successes of
the revolution of 1959. I will explain
similarities and differences in the types of treatment but more importantly, I
will examine the socio-cultural context of social work and the structure of the
system that provides these services to Cubans.
It is useful to compare the system and the context in Cuba to that which
exists in the U.S.; however, it is necessary to also recognize the differences
between the two countries, including their levels of economic development and
their divergent global roles. If social
workers and other helping professionals can examine the strengths of the Cuban
system of care, there are many lessons to be learned that can support our
efforts to better meet the healthcare needs of the U.S. population.
My observations are based on two
two-week trips and a ten-week sabbatical to Cuba. My first visit occurred with a group of about
twenty women in March/April of 2002.
Prior to the trip we studied a range of topics together...democracy in
Cuba, sexism, racism and homophobia, the
impact of tourism on developing economies, the healthcare system, socialism and
capitalism (1). We traveled the island,
from Havana to Santiago de Cuba and back again, visiting a grandparents' home,
a school, a collective organic farm, a mental health clinic, and the Sierra
Maestra, where we hiked part of a trail in the mountains from where the
revolution was staged. We met with
leaders of the Youth Communist Organization, The Federation of Cuban Women
(FMC), The Trade Union Association and a Biotechnology Institute. Everywhere we went warmth and generosity
defined the climate with afternoon shots of rich, sweet coffee keeping many of
us energized throughout our long and intense days. Cubans make a clear distinction between the
government of the U.S. and the people, a distinction that allows for finding
common ground and shared visions of a better world.
During these two weeks I took in more
information than I thought possible. I
was inspired by what I heard and marveled at the commitment the government had
made to provide for the well-being of the people. The revolution had prioritized education and
healthcare and, in spite of a 40 year economic blockade, the fall of the Soviet
Union, assassination attempts by the U.S. on Fidel Castro and efforts by both
the U.S. and the anti-Castro contingent in the U.S. and elsewhere) to sabotage
progress (Franklin, 1988), healthcare
and education remained strong. I was
also skeptical, however, because I knew that our trip was structured so we
would see the strengths of the system and because of the anti-Cuba propaganda I
had grown up with here in the U.S.
Before the two weeks ended I had decided that I would return for a
longer time so that I could understand more thoroughly what was happening in
Cuba in the realm of social work and mental health care and what we might learn
from their experience.
My second trip occurred nearly two
years later, from January 2 to March 13, 2004.
I took sabbatical from my teaching position, initially hoping to spend
six months in Cuba. Because of our
government's economic blockade, travel to Cuba is much restricted and my
children weren't allowed to accompany me; I chose to shorten my trip rather
than spend more time away from them than desirable. The trip provoked a great deal of
self-reflection and personal growth, leading to a deeper analysis of concepts
such as locus of control, which I will discuss briefly in this paper, and
unearned privilege (2).
This trip was much more informal than
my first. I focused my site visits on
social work and mental health care agencies, learning as I went that human services
were not easily categorized. In Cuba,
the healthcare system is holistic and fully integrates a wide array of helping
professionals, including social workers, psychologists, nurses, education
specialists, physical education teachers, psychiatrists, physicians, yoga
practitioners and nutritionists. In
addition to my interviews with professionals, I found my conversations with
ordinary Cubans instructive. The
knowledge that people have about the healthcare system, the services available,
and the various professionals from whom they might receive help demonstrates
the effect and benefit of one cohesive system with continuity from one
neighborhood to another, between municipalities and from one province to the
next. The users of the system know what
is available and how to access it. The
fact that healthcare is free is also a critical factor in facilitating easy
usage.
My third trip took place in
September, 2004 with the intention to complete follow up interviews after
having had time to synthesize the information I had gathered up to that
point. The threat of hurricane Ivan
limited my original plans but provided me the opportunity to see prevention
activities in action. It was remarkable
to follow the course of the hurricane and observe the preparations people
made. This is clearly a population that
is highly educated, aware of the need for taking individual responsibility
while expecting the government to fulfill its role in dealing with a potential
crisis. By highly educated I don't mean
solely in the formal sense, although it's also true that the population has a
high rate and level of formal education.
(In fact, the average number of years of education in 1992 was, eight,
well above other Latin American countries such as Brazil and Mexico (Azicri,
2000). I'm referring to popular
education, information made available through the use of media and
organizations such as the FMC and the Committees for the Defense of the
Revolution.
Every researcher, interviewer or
traveler brings her/his own world view into whatever situation he/she
enters. In the social sciences this
dynamic is reflected in the method used to gather information, the choice of
whom to interview, the initial questions asked and the follow-up questions as
well, and the final interpretation of information. I think it's important to be clear about my
world view as it pertains to the path my research has taken. I came to this project identifying more with
socialism than capitalism, believing that U.S. capitalism and its associated
values interfere with achieving social and economic justice. I see the U.S. policy toward Cuba as an
ineffective way of attempting to achieve the imperialist goals of the U.S. (Chomsky, 2000). In this regard, the distinction Cubans make
between the people and the government of the U.S. is perhaps overly
generous. Many people in the U.S.
believe it's fine, even right, for this country to assert its will on
others. We are an egocentric lot here in
the U.S. and seem to have little regard for the self-determination of others;
Americans wouldn't stand for a moment others doing to them what U.S. foreign
policy has done to countries around the world.
I spoke to people in Cuba who defined the problems they face as
primarily the result of the blockade, or the result of isolation following the
fall of the Soviet Union, or as the result of mistakes of the Cuban
government. Other explanations were
given as well, with ideas about what might improve the situation. Never did I hear anyone say that the solution
is for the U.S. to play a larger role in Cuban politics, policy, or any other
aspect of society. And yet, U.S. policy
attempts to do just that.
So read on with an awareness of my
perspective along with an awareness of your perspective, an openness to
challenging assumptions and preconceived notions you may have and a willingness
to pursue the questions that arise as you read.
Ultimately, to loosely quote Noam Chomsky, “don’t take my word for it…go
and check it out for yourself.”
Socio-cultural
characteristics and their influence on the healthcare system
Healthcare in Cuba exists within the
larger socio-cultural context, as it does in the U.S. I will examine four socio-cultural
characteristics critical to the efficacy of the system: socialism, community orientation, emphasis on
prevention and an integrated system.
Socialism The Cuban Revolution
is a Socialist revolution. This is at
the core of the structure of the healthcare system. Services are both funded and provided by the
government.
The funding part of the equation
needs little explanation. Regardless of
where one lives, employment status or income level, one need not concern
oneself with whether or not healthcare is affordable…the government pays the
bill. Contrast this with the system in
the United States, which is made up of funding from individuals, employers,
charitable donations, foundations and the public coffers in the form of such
programs as Medicare, Medicaid, Children's Health Insurance Program, etc.
In the U.S., whether or not people
have healthcare insurance depends on whether they fall into one of the
categories of people typically covered:
those living below or at some percentage of the poverty line, those with
jobs providing insurance as a benefit, older adults, people with certain documented
disabilities, working people below a certain income level if their state offers
a program like Washington State's Basic Health Plan, children, if their
parents' income is below a certain level and above another, people sick enough
that their life is in danger...at this point you might be experiencing the
confusion accompanying the maze some folks must navigate in their effort to
obtain healthcare. In the U.S a human
services professional advocating on behalf of clients who need services, must
be aware of the many different programs targeting various client groups and
consisting of different eligibility criteria.
In Cuba, all citizens have access to the healthcare system and its
structure is replicated throughout the country.
In Cuba, the provision side of the
equation begins with the family doctor/nurse team which has the greatest
proximity to the people and evolves toward greater intensity and
specialization, with the hospital as the final level. All healthcare professionals are government
employees and the programs are government-run as opposed to our mixture of
for-profit, non-profit, and government-run services. Social workers are often government employees
but may also be affiliated with the Federation of Cuban Women (FMC), a
non-governmental organization.
Family Doctor/Nurse
Team
The family doctor/nurse team resides in the neighborhood
where they work, seeing patients in either the doctor’s office or the patient’s
home. This team is responsible for
150-250 families in the neighborhood and they pay particular attention to
pregnant women, chronically ill folks, children, older adults and anyone
recently released from the hospital living within their catchment area. These healthcare providers see patients at
their offices or in the patient’s home.
They also may work at the policlinic.
The Policlinic
The policlinic is a
multiservice center located within the municipality. There are approximately fifteen in Havana and
they are designed to make a wide range of medical services available close to
where people live. I visited the
policlinic in Lawton, a bustling maze of rooms and halls full of people. Services included emergency treatment for
injuries or illness, physical therapy, prenatal care and psychiatric care, just
to name a few. Patients may stay for up
to three days at the policlinic, and
can be transferred to a hospital if necessary or discharged.
The policlinic I visited in Lawton is the point of contact for older
adults who attend classes organized by the social worker, Rosa. She is one of a team of healthcare
professionals providing prevention services as well as treatment. These adults may take an exercise class down
the street with Juan, who also conducts classes for people with hypertension,
pregnant women, and children ages 3-5 years.
As part of the healthcare system, these are all free of charge.
Mental Health
Centers
There are also approximately fifteen mental health centers in
Havana, one in each of the municipalities.
These centers provide prevention and treatment services for various
mental health issues. I visited two
centers, one in the municipality of Arroyo Naranjo and the other in Regla. Clients seen at the Arroyo Naranjo center
have access to psychiatric medication, counseling, psychological testing, group
counseling, psychosocial rehabilitation, acupuncture, yoga and community
education. One of the expressed goals of
the staff is to reduce the stigma associated with mental health issues through
active involvement in the community; this occurs through social, recreational
and educational activities (personal
communication, L. Roque, Licensed Counselor, and S. Salazar Amador, Licensed
Counselor, Mental Health Community Center, Arroyo Naranjo, 2/10/04).
The mental health center in Regla is also
community oriented with an emphasis on prevention. The center provides community work and health
promotion activities such as developmental and parenting classes, relaxation
training, violence prevention and use of medicinal plants. Recreational activities in the community are
also recognized as a way of preventing emotional and mental health issues. The center is also well known for its work
with people with Down’s Syndrome and they provide the full range of psychiatric
services (personal communication, R. Gil
Sánchez, Director, Mental Health Community Center, Regla, 9/21/04).
Hospitals with
psychiatric services
Another location for the provision of mental health and
social work services are general hospitals with psychiatric services. I visited The Salvador Allende Hospital in
Cerro and met with the social worker and drug counselor. While mental health treatment programs are
separate from drug treatment and treatment for alcoholism, all services reside
within the psychiatric unit. The
prevalence of schizophrenia is about the same as in the U.S., 1% of the
population. Rates of alcoholism and drug
addiction were not available, although both were acknowledged with alcoholism
being a greater problem than drug addiction.
Interestingly, on several occasions when I asked about drug problems,
people identified the problem of abuse of prescription drugs, as if this were a
larger issue than abuse of illicit drugs.
Finally, the Havana Psychiatric Hospital (HPH) is a facility
spread out over a large campus with activity rooms, work areas and a sports
stadium. I visited the hospital with a
group of conference attendees from many countries throughout Latin America,
including Brazil, Argentina, Spain, Ecuador and Chile and we were informed that
this is the largest psychiatric hospital in Latin America. They have a wide range of activities,
including track and field, ballet, drama, crafts, music, etc. Patients with serious psychiatric illness are
typically treated with psychotropic medication, similar as in the U.S. Some medications are limited in supply and
the more recent selective serotonin reuptake inhibitors are not available (personal communication, A. Guzmán Sabó,
Dr., Mental Health Community Center, Arroyo Naranjo, 3/11/04).
Cuba’s socialist healthcare system,
with services both funded and provided by the government, is characterized by
continuity of care and easy access to services.
Because the system consists of the same components in every
neighborhood, municipality, and province, the Cuban people know what services
are available and where they are located.
Additionally, because the family doctor/nurse team is responsible for a
relatively small number of people, they are aware of the health issues or
family problems their patients face and can readily refer them to the
appropriate services as well as communicate with the healthcare/social work
professionals involved.
Community orientation
A strong community orientation with little emphasis on individualism is
a second socio-cultural characteristic that differs from the culture in the
U.S. and impacts the world of social work and mental health care in Cuba. One example of this is in the record-keeping
of the members of any given community.
In conversation with Rosa Mazón Cánovas, the social worker for older
adults at the Lawton Policlinic, I asked if she had any idea how many older
adults lived in her catchment area. She
didn’t have just an idea of the number, she knew exactly how many lived in the
area. Similarly, when I spoke with the
mental health counselor in the psychiatric department of the Salvador Allende
Hospital, she pulled out a list of all the clients with schizophrenia, all the
children with developmental disabilities, everyone with depression, etc. Dr. Gil Sánchez, director of the mental
health center in Regla, knew exactly how many residents of Regla were in the
hospital on the day I visited the clinic.
What these details indicate is that there is very little opportunity for
people to fall through the cracks of the system; communities are relatively
small -remember that the family doctor/nurse team is responsible for 150-250
families, and the mental health center serves a community of about 43,000
residents. The system is designed to be
proactive.
This community orientation and
detailed record keeping have implications for privacy, conceptualized
differently in the U.S. compared with Cuba.
One example in the U.S. of this is in the enforcement of our involuntary
commitment laws. Current laws, specifying
that an individual must be a danger to self, danger to others due to a mental
disorder or gravely disabled if they are to be involuntarily committed, have
helped to address the historical violation of civil rights as evidenced by
involuntary commitments based on little objective evidence. Yet, one can argue that we have swung too far
in the opposite direction, failing to provide mental health services to people
whose judgment and thinking processes are so impaired as to put them in danger,
but not quite enough danger to warrant forced treatment. We can see this same dynamic as it pertains
to chronic inebriates whose health deteriorates day by day, slowly approaching
the eventuality of their death, while we proclaim allegiance to the
individual’s right to refuse treatment.
I was unable to ascertain the involuntary commitment laws in Cuba,
although my impression, based on the fluidity of the system and the de-emphasis
on individualism, is that they are less stringent than in the U.S.
This likely difference is not solely
the result of emphasizing civil rights; we clearly have not prioritized
healthcare in general, nor mental healthcare in particular in this
country. Nevertheless, this phenomenon
highlights our emphasis on individualism, which has certain costs and benefits,
as does an emphasis on a community perspective.
In Cuba, the latter position ensures that health professionals know
which individuals and families in their community are having difficulties or health
issues so they can receive care; at the same time, Cubans, for good or ill,
don’t experience the same degree of privacy as we do in the
According to Dictionary.com, one
definition of individualism is “belief in the primary importance of the
individual and in the virtues of self-reliance and personal independence.” In the U.S. this includes a belief that the
individual holds primary responsibility for difficulties or failure. The opposite view prevails in Cuba. Cubans seemed to have a more balanced sense
of what an individual has control over and what they do not. While specific people in particular
situations might be seen as responsible for their problems, the general view is
that, when given the necessary resources, people will thrive.
In the U.S., conversely, the general
view is one of blaming the victim. When
the circumstances of an individual situation are understood, however, the view
may change to incorporate external forces.
For example, the character of people with chemical dependency is often
thought of in very negative terms…they are weak-willed, selfish, irresponsible,
deviant, etc. A person may think,
generally, that an addict ought to be thrown in jail rather than “coddled” and
given second chances in treatment and so on.
When that same person knows the addict and her/his family, though, the
familiarity allows her/him to see the complexity of the situation, the result
being less victim-blaming and more compassion.
Emphasis on Prevention
A third prominent
socio-cultural difference in Cuba is the emphasis on prevention. Enhancing the quality of life and promoting
well-being were integral parts of the healthcare system, in contrast to the
U.S. focus on treatment. Dr. Gil
Sánchez, Director of the mental health center in Regla, pointed out that the
mental health of the population is the collective responsibility of sports
programs, cultural programs, the population, the government and the mental
health professionals. He spoke of the
importance of parenting classes in the community as a way of preventing mental
health problems and he pointed out that people are more likely to take
advantage of prevention activities if they are free. The policlinic in Lawton provided exercise
classes for older adults, preschool aged children, and pregnant women. All residents have access to these programs
and services and need not be covered by a particular plan in order to
participate, an advantage of a socialized system of care.
The emphasis on promoting well-being
was apparent in several different situations, remarkable in the way it was
institutionalized. During my first trip
to Cuba in 2002 the group was hosted by the Federation of Cuban Women. They work to enhance the quality of life with
social work programs similar to those we have here in the U.S., for example
providing training for various career opportunities; the tone of the discussion
differed, however, characterized more by what could be accomplished and what
gains could be made as opposed to what problems would go away. The spirit of the conversation was devoid of
victim blaming, the underlying assumption reflecting the humanistic perspective
that if people are provided with the skills or resources they need, they will
succeed.
An integrated system Social work and
mental health treatment are integrated into the healthcare system in Cuba,
resulting in a relatively seamless continuum of care. There are many entry points into the system
and all components of the system are available to all residents. Imagine a hypothetical client, Julia, who
begins experiencing overwhelming emotions and heightened stress. She’s having troubling taking care of her
children and her aging parents, she’s working but doesn’t have adequate food
day to day and spends a great deal of time traveling to work each day. Julia has easy access to her doctor who lives
and works a few blocks away and knows Julia’s family as well as her
circumstances. The doctor and Julia both
know the FMC social worker who also lives in the neighborhood and can be
consulted with, and the doctor may also refer Julia to see a therapist, social
worker or psychiatrist at the policlinic.
If more appropriate to her needs, Julia can receive help at the mental
health center. Except for the FMC social
worker, who is technically outside the healthcare system and works for a
nongovernmental organization, these resources are all part of one big system,
avoiding bureaucratic boundaries that can complicate the treatment process.
In addition to the system components
being integrated, the lens through which clients are perceived reflects the
ecological model, or looking at individuals as part of a number of systems, all
of which interact with the individual and each other. For example, when Julia talks to the doctor,
the social worker or a therapist, the whole of her life is assessed and
attention paid to the social and economic factors that are contributing to her
difficulties. The very real impact of
limited resources such as food and transportation are acknowledged, validated
and appreciated as a major cause of her emotional state. There may not be easy solutions to these
conditions but locating the source of the difficulty outside of the individual
is therapeutic in that it prevents a loss of self-esteem and the negative
consequences of a self-fulfilling prophecy resulting from taking too much
responsibility for one’s situation.
Also, it leads to finding solutions that are outside of the
individual-increasing access to resources, for example.
In Cuba there are also various
treatments for health issues that are typically referred to as “alternative
therapies” in the U.S. In all three of
my visits to Cuba people spoke of treatments that are not common here. Acupuncture, yoga and water therapy are used
in the treatment of schizophrenia.
During my first visit in 2002, our group met with the president of the
Finlay Biotechnology Institute and learned about their research in the areas of
immunizations and macrobiotic diet. When
the president of the institute learned that one of our group was a yoga teacher
she immediately engaged her in a discussion of the benefits of yoga for overall
health. The group was impressed with the
obvious importance of yoga as a part of health from this doctor’s
perspective. We ended up sharing a
delicious vegetarian lunch with our hosts and not once did we hear mention of
genetically modified foods, which was my first association with the term
biotechnology.
The inclusion of “alternative”
therapies was also evident at a mental health conference I attended. Dr. Guzmán Sabó from the Arroyo Naranjo clinic
began his workshops with music, singing and dancing. At another of his presentations, the music,
singing and dancing were accompanied by the smell of incense permeating the
air. This isn’t something I’ve observed
at conferences in the U.S. and it reflects a holistic view of health and
well-being.
Impact of the
healthcare system
Now that I’ve described the structure of the system and some
of the sociocultural influences on it, the reader may find her/himself asking,
“how effective is it?” Although prevalence
data on mental health and substance abuse problems was unavailable, there are
some general health indicators that speak to this question. Oxfam America, an organization affiliated
with Oxfam International, published “CUBA-Social Policy at the Crossroads: Maintaining Priorities, Transforming
Practice,” (Uriarte, 2002), which
examines social policy in Cuba since the revolution of 1959. Dr. Uriarte provides compelling data
indicating the success of the healthcare system.
Common measures of the health of a
population include infant mortality and life expectancy. The rate of infant mortality in Cuba is
7/1000, the same as the U.S. rate and slightly higher than Canada’s
6/1000. A comparison with countries that
are economically similar is meaningful and we might use the Dominican Republic
for comparison. Their rate is 44. Even Costa Rica, with a well-developed system
of social services is much higher at 12/1000.
To further compare the infant mortality rates in developed countries,
consider the rates in Sweden, which is 2.77 and in Germany, 4.2 (CIA World Factbook).
The Oxfam report does not address
within country differences, but a Centers for Disease Control report provides
comparison data within the U.S. In 2001,
this report found rates of 5.7/1000 for Whites, 13.3 for Blacks, 9.7 for
American Indians and 4.7 for Asian Americans (Matthews, et.al, 2003). It
is clear that prenatal access to healthcare is key to lower infant mortality
rates, a service emphasized in Cuba but limited in the U.S., particularly for
those with lower incomes.
Life expectancy is 75.7 in Cuba, 79
in Canada and 76.7 in the U.S. according to the Oxfam report. In the Dominican Republic life expectancy is
70.6 and in Costa Rica, 76 (Uriarte,
2002).
One more interesting statistic is the
number of doctors per capita in each country.
Cuba’s rate of 5.18/1000 people is double the U.S.’s rate of 2.6/1000
and more than double the rate in Canada, which is 2.1/1000. Costa Rica weighs in with 1.5/1000 and the
Dominican Republic with .85 (Uriarte,
2002). The fact that medical school
in Cuba is entirely free certainly accounts for the high rate of doctors. In addition to those in Cuba, Cuban doctors
and nurses are working in many Latin American and African countries. Students from those countries as well as the
United States are attending medical school in Cuba free of charge, with the
agreement that they’ll return to their communities where healthcare is limited
after completion. I met students from
Venezuela studying social work in Cuba.
Conclusion
One’s worldview influences her/his interpretation of
observations, choice of questions and choice of focus. You have probably noticed this as you’ve read
this analysis, especially if you’ve been exposed to books, articles and films
that portray Cuba in a predominantly negative light, such as the documentary
“Fidel Castro” by Adriana Bosch. It is
stunning in its nearly complete omission of any of the accomplishments of the
Cuban revolution, especially the education and healthcare systems. Prior to
traveling to Cuba I wasn’t aware of how much negative propaganda I had been
exposed to and internalized. Upon
examination of Cuba’s healthcare system, the lessons we can learn became clear. Cuba is not an ideal society; people have
trouble obtaining sufficient food, even with the subsidies provided by the
government to everyone. The
transportation system is inadequate and unable to move people as quickly or
reliably as is desirable and, while homelessness is minimal (in the course of
my ten weeks in Havana, a city of two million people, I saw less than ten
homeless people), much of the housing is in need of repair and resources are
limited. And yet, there are food
subsidies so that everyone is assured a minimum amount and meals are provided at
no charge at workplaces and schools.
Buses run frequently and there exists a system of hitchhiking
(government cars are required to pick up hitchhikers and other drivers
routinely pick up people on the corners).
Over 90% of people own their homes; those renting pay at most 10% of
their income (Uriarte, 2002). Renovation of housing is an ongoing
project.
In my time in Cuba I received a
lesson in resourcefulness and hope. I
saw the pain in my friend’s face when she shared how much more difficult daily
life was that day, compared with my trip six months prior. I felt a knot in my gut when I saw her hope
challenged, her spirit deflated by the daily struggle. And then, after walking with other parents a
couple of miles to meet their teenagers coming home from school for the
weekend, I saw the joy of families reunited, as everyone grabbed a suitcase
here, a backpack there, a pillow, a bucket full odds and ends, and headed back
toward home. It was boiling hot that day,
and humid like it is in the summertime in Havana, and we were all dripping with
sweat and shifting our parcels attempting to lighten the load, to get more
comfortable in impossibly uncomfortable circumstances. The energy and the love couldn’t have been
more palpable. I looked around at the
faces of the boys and the girls and the moms and the dads, and saw the strength
and resilience and spirit of these people I had come to know a little bit. Of these people who had allowed me into their
world, shared with me their joys and their sorrows, opened their homes and
their hearts.
My experience in Cuba has had a
profound effect on me. I am opposed to
our government’s policies preventing citizens of the U.S. from traveling
legally to Cuba and I oppose the destructive trade barriers that create some of
the problems Cubans face and exacerbate others.
While the U.S. blockade is not
the sole cause of the economic problems in Cuba, its detrimental impact in the
lives of the people I met was clear. I
became acutely aware of the tendency toward oversimplification here in the
U.S. We know so little yet think that we
know so much. As helping professionals,
we can positively impact our work here as well as people in other places
through personal and professional exchange, sharing our ideas, drawing on the
strengths of each other and maybe most importantly, understanding the
complexity of other people’s lives rather than settling for the sound bite
version we are accustomed to hearing on the news.
At the present time, it is illegal for
citizens of the U.S. to travel to Cuba except under certain circumstances. The rights of academics to travel for
conferences and educational exchanges have been eliminated or limited. Clearly, these limits lessen our opportunity
to enrich our lives and our work through collegial exchange. You can learn more about taking action to
challenge these laws by going to the Latin America Working Group website, www.lawg.org.
References
Azicri, Max. Cuba Today and Tomorrow. University Press of Florida, 2000.
Bosch, Adriana, writer, producer and
director. “Fidel Castro,” film. WGBH Educational Foundation, 2004.
Chomsky, Noam. Rogue States: The Rule of Force in World Affairs. South End Press, 2000.
CIA Fact Book. http://www.cia.gov/cia/publications/factbook/
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