A Letter from Cuba
I recently traveled to Cuba as part of a U.S. women's delegation, sponsored by the Women's International League for Peace and Freedom, Sojourner, and Hermanas, an organization dedicated to building solidarity between U.S. and Caribbean women. Away from our group, I was armed with the most rudimentary of Spanish skills and an Insight Map Cuba, which provided an interesting counterpoint to my observations.
There are also, of course, rather more somber images of Cuba: frustrated youths who dream of futures elsewhere; a communist system that has failed its citizens; political repression; anti-American slogans and statutes of Lenin; crumbling buildings, empty stores, and over-crowded buses. It is an island frozen in time. --Insight Map Cuba
"A Communist system that has failed its citizens" A large part of our time in Havana is spent at the Second World Meeting of Friendship and Solidarity, a conference that draws over 4,000 people from every continent to express their support for Cuba in the face of the U.S. embargo. There are numerous workshops and impassioned speeches on the embargo, solidarity, the plight of Cuba. Of the embargo: "This blockade is warfare . . . by the richest, mightiest power known to history. History knows nothing like this dirty war in peacetime, a war waged without the support of the United Nations." Of solidarity: "Neither has history known such solidarity. In the 1990s, solidarity groups more than tripled. 167 meetings in 40 countries, 9 continental meetings in all. . . . The flower of friendship has bloomed in the bitter blood of our struggle." But as the speakers go on, doubts begin to creep in, and even a five-hour speech by Fidel himself does not assuage them. Cheers rock the hall, Cuba si, bloqueo no!, Cuba yes, blockade no!, often for minutes at a time, and I start to feel uneasy--it's too much like a sports event. I know Cuba can't be perfect--what exactly are we saying si to? And what happens if the blockade ends? . . . I also notice that there are no Cubans here, except for the ones on the stage, or the press people. Here we are, a bunch of people from other countries, expressing solidarity . . . to whom? Although I am uncertain about the conference, I have no ambivalence about the embargo. In general, embargoes seem ineffective and intolerable, killing citizens while allowing the leader with whom the United States has a disagreement to point at the embargo as the source of the country's suffering. And what's worse is that even the embargoes against North Korea, South Africa, Vietnam, the Soviet Union, Chile, and Haiti allowed the passage of food and medicine, as did more recent ones against Yugoslavia and Iraq--but not the one on Cuba. But I do feel uncomfortable with the rhetoric surrounding the embargo. "When the embargo is lifted . . . " is the constant rallying cry, but I cannot think of the end of the embargo as a catch-all panacea to all of Cuba's problems. I keep these thoughts to myself, ashamed of my ambivalence in the face of such passionate activism against a situation I myself condemn. The conference ends with an outdoor demonstration, crowds of Cuban children waving flags, media filming the foreign protesters outside the U.S. Special Interests Section, where the protests to get Elian back took place. Over and over, I hear Cuba solidarity activists extol the virtues of Cuba as a model for their own countries. Over and over, I have heard anti-Cuban coverage from the U.S. media when I was in the United States. Is Cuba heaven or is it hell? I feel pulled in some ideological tug-of-war, just as much a relic of the Cold War as the U.S. embargo is. Two documentary filmmakers on the delegation later tell me about a meeting they had with a Cuban friend of their former professor. She hates the government, says that they took money out of the pockets of Cubans to pay for the delegates to come to the conference. "Those children do anything they're told, waving their flags, roasting in the sun. They are using the children, and you, you know." The conference holders would have us believe that Cuba is perfect, the only oppression is the embargo, but that isn't true, she says. I don't really know what to think, but am relieved to hear a dissenting point of view. I feel stuffed full of propaganda, flag-waving, just like I do on the Fourth of July back home. What is the real Cuba? I know I can't possibly form an educated opinion, but I feel completely stripped of my political filter here, the knowledge that allows me to assess political situations in the countries I've lived. I remember the anecdote about the group of blind men feeling different parts of the elephant, unable to at all figure out what creature it might be.
My ambivalence continues as we move from Havana to Cienfuegos, a beautiful region to the east of Havana. On our first morning in Cienfuegos, we pay a visit to a maternity clinic--a clinic designed for women who have multiple or at-risk pregnancies, due to their age, mental, or physical health. If the community doctor determines that the woman has a high-risk pregnancy, she is required to stay in the maternity center until she comes to full term. The clinics have been an instrumental part of lowering Cuba's infant mortality rate, which fell to 7.9 per 1,000 births in 1996-a number that puts Cuba in the top twenty worldwide for lowest infant mortality rate, a ranking better than that of the United States. In Cienfuegos, the infant mortality rate is 5.8 percent, the lowest in Cuba. A psychologist visits the women once a week, and also does counseling with their families. The women are offered a highly nutritious diet by their clinic nutritionist; they can partake in yoga and meditation sessions every day; and women who volunteer for the task teach women in their communities what they have learned at the clinic. As we walk through the facility, past the women of various ages resting and chatting, one member of our delegation tells the staff that she never received such good care at one of the best hospitals in the United States. We stop at a community health clinic next. In Cienfuegos, there are 573 community doctor offices or health clinics, or 1 doctor to 600-700 people. The family doctor and nurse team at the clinic does home visits in addition to their regular office hours. Psychiatrists, OB/GYN, pediatricians, internal medicine specialists are all available after a family doctor has given a patient a referral. They have a mobile mammogram program, and do counseling and preventative work for both men and women around domestic violence and women's reproductive rights. The community doctors and nurses often live in the communities they serve, they explain, and so they know their neighbors, can counsel them more adequately. The quality of care in Cienfuegos is found all over the country. In Cuba, there is an average of 1 doctor for every 123 people. The Center for Sexual Education does extensive work on sex education, eradication of homophobia, raising awareness of HIV/AIDS and other STDs, and promoting women's reproductive and sexual rights. The average life expectancy of a Cuban man is 73; Cuban women live to an average age of 76. The current national healthcare system was nationalized in 1968, when the government established the Ministry of Public Health (MINSAP), with branches in each of the fourteen provinces. Each MINSAP branch then built hospitals and large regional clinics. In total, the government developed four central research and specialty training facilities, 21 medical schools, four dentistry schools, and a new pharmaceutical industry, according an article by Susan Howe entitled "Cuba's Family Doctor System." Spurred on by the success of the nationwide inoculation, health education, and literacy campaigns led by volunteers and members of the Federation of Cuban Women (FMC) after the revolution, the government implemented a similar focus on volunteer "health activism" in its healthcare system. The basic foundation of the Cuban healthcare system is the Family Doctor Team (FDT), the doctor and nurse who live within a community, and are responsible for the health of that area. The FDT is supported by "health activists" from the FMC and other neighborhood organizations. In addition to providing primary care for about 600 individuals, the FDT is on call for emergencies 24 hours a day. They also compile medical histories for each individual in their region, assess the overall health trends in their communities, and along with volunteer health activists, implement health education, immunization, and sanitation campaigns. The FDT records form the backbone of the nation's medical statistics, facilitating the treatment of any widespread medical problems, and the matching of organ transplant donors and recipients. Perhaps what is most remarkable about the healthcare system is the prevailing attitude that health encompasses psychological and social factors, in addition to physical ones. As Barbara Jaime Gonzales, a family doctor in Havana, told Howes:
Here, we know not just the sickness, but we see the house and the family conditions. Medicine is biopsychological, and a physical complaint may be a family problem. . . . I believe prevention is very important. When you live and work in a community like this you can prevent.
This is an attitude that transcends the local. I remember the interviews I sat in on of the parents of students at Cuba's Latin American School of Medical Sciences. The school pays for more than 3,000 students from 23 countries to study medicine in Cuba, then return to their home countries to practice medicine in their communities. (I recently learned that they have extended an invitation to take 250 African American students to participate in the course.) In particular, I remembered Adelina de la Rosa, from the Dominican Republic:
There are . . . hardly any hospitals at all [in our country]. There is so much contamination. There is one pediatric hospital in the Dominican Republic, for 8 or 9 million. At the maternity hospital, sometimes there are two or three women in one bed, all in labor. If you do not bring your own syringes, you cannot have an injection. We are so grateful that our child is doing this. Doctors don't work outside the capital, they are much needed where we live. Cuban-trained doctors will fill the rural spots
So when I step forward to give the clinic the medical supplies that we have brought from the United States, I feel unsure of my voice. How can a country with a struggling economy provide such a level of care for its citizens, and how can my country, the richest in the world, not do the same? Even worse, how can the United States deliberately try to destroy Cuba's healthcare system by denying them the medical supplies and equipment they need? As the 1997 American Association for World Health Report noted,
it is our expert medical opinion that the U.S. embargo has caused a significant rise in suffering--and even deaths--in Cuba. . . . The declining availability of food stuffs, medicines and . . . basic medical supplies . . . is taking a tragic human toll. . . . [I]n some instances Cuban physicians have found it impossible to obtain life-saving medicines from any source, under any circumstances. Patients have died. In general, a relatively sophisticated and comprehensive public health system is being systematically stripped of essential resources.
As we leave the clinic, a member of our delegation spots some children and takes a few Polaroids of them. Their faces are bright and healthy, laughing as they see their own images emerge from the pictures. As the children wave goodbye, their Polaroids flapping, I think, "Is this who the United States is fighting against?"