Cuba has always had a reputation for its strong medical education. I even talked about it some last year. They export doctors around the world. They import students to train as doctors who return home to grow national health systems across the developing world. As we saw at ELAM, medical internationalism is a big deal in Cuba, and they are proud of their accomplishments. But the largest medical achievement is providing free health care for the citizens of Cuba. I had heard rumors that the average person may not have the greatest access and that there were rural/urban quality disparities in the health system. I cannot speak to the quality of care for the average Cuban. I do know that healthcare costs make up a significant portion of their economy and specialized care does exist. Access issues are unsurprising. But this year we had two incidents in which our group came into contact with the Cuban health care system. So I know more than I used to.
The first accident involved a knee sprain. The girl, a graduate student, was in good spirits, but her knee was very painful after she tripped and fell, and the Cubans around her insisted she get it examined. Next thing she knew someone was driving her to the hospital. Luckily, she is a native Spanish speaker, so she was treating it like a big adventure. If it had been me, I might have been a little freaked out. But she got it evaluated, and they said it was not really damaged. She was back with the group a few hours later. She paid a minimal fee in the tourist currency (CUC). We all gave her over-the-counter pain medication and topical analgesics. A cane appeared from somewhere. She hobbled around for a few days and kept her foot propped, but it didn’t slow her down in the least. The service seemed to be pretty great for an emergency clinic visit in a foreign country.
The next accident involved our group leader. He just missed a step and went down. He joked that the Cubans laughed at him first, then took a picture of him on the ground, and then rushed to help him up once they realized he was actually injured. Tanya and I were pulled aside after a meeting, and he was sitting there, post-hospital visit, with his leg up and a cup of tea in hand. He had actually made it to the international department of the local hospital. It just so happened to be affiliated with one of the more important medical faculties outside of Havana, so he got very high quality care. His doctor spoke English, and they posed for pictures. He had actually torn something in his ankle and was all wrapped up for immobilization. The doctor realized he would want to see someone back home, so he did not give him a full cast. He did get a digital copy of his x-rays, though. Since most of the group members were his students, it was less awkward for Tanya and I to help him get around. At first he was on crutches, but Tanya got him a wheelchair. And, of course, we all helped with the drinks.
His medical costs were a little bit more expensive (100 CUC) than the student’s fees since he was more injured. But can you imagine an emergency room visit costing $100 in the U.S.? And he was still back in a few hours. I ran into our group leader recently at the national NAFSA conference, and he said that his American doctor was impressed with the Cuban imaging, which was better than his own at showing the break. But there was also a torn ligament that was not visible in the x-rays, so the Cuban doctor was right to prepare everything for additional consultation and imaging back home in the U.S.
But, after the second incident our Cuban hosts began to worry about cycles of three and bad luck and jinxes. So everyone was wearing red, a color known in Cuba to ward off bad spirits. And everyone else remained safe for the last few days of the trip. But we learned a little about how hard it is for someone on crutches or in a wheelchair in Cuba. Sidewalks are discontinuous. Curbs are a foot high without curb cuts. He needed constant assistance with carrying things or getting out of the chair to overcome an obstacle. At one point our Cuban host, an older gentleman, was pushing the wheelchair in the middle of the street, facing traffic. It was easier than the up and down we had been going through on the side, but it was inherently unsafe. Our small little taste of the challenges facing Cubans with disabilities made me aware that Cuba may have a robust and respected medical system, but it does not have the structural support this population needs. The health and educational systems try to make accommodations and services available at home, but disability rights and visibility have a long way to go in larger society. I have the utmost respect for the Cuban families who live and deal with disability.
Heading up the street, both in red. This random lady is getting in on the cosmic mojo correction.
The wheelchair actually came from the resort nurse (above), who Tanya conjured out of the evening. The hotel staff, everywhere we went, made sure to take good care of their guests. Tourism is critical to growing their economy.
Martha Van Devender is a Senior Evaluator and has been with ECE since 2005. She specializes in education from Anglophone Africa and Latin America. She is also interested in online research and verification tools. Martha is serving as the TAICEP representative for the AACRAO Cuba project and enjoys writing and presenting on this topic.