June 22, 2016
Kendra Kamp is doctoral student in the College of Nursing.
As our airplane made its final descent, I looked out the window at the lush green grass in disbelief that I was about to step foot in a land once forbidden to many Americans – Cuba. During the first two weeks of April, I traveled to Cuba with College of Osteopathic and College of Human Medicine students.
Dr. Barbara Smith, the associate dean for research, and I, a Ph.D. student, had the privilege of representing the College of Nursing. The purpose of our trip was to learn from the Cuban health care system by engaging in a hands-on experience in the clinics and hospitals. My research interests examine informed decisions regarding diet modification; therefore, I was specifically interested in learning about informed decisions in the Cuban context.
Cuba is a beautiful country. Classic cars line the streets; although, you do see newer, non-American, vehicles as well. The architecture visually displays the country’s history. Buildings with archways and ornate details are characteristics of Spanish colonization. On the other hand, large boxy-looking cement apartment buildings display the rigidity of the former Soviet Union.
We stayed in Old Havana which is filled with stunning buildings built in the Spanish style. Upon closer inspection, we realized that often the building façade was restored while the remainder of the building was crumbling. These buildings are an example of the dichotomies that exist within Cuba and its health care system.
The Cuban health care system is a three-tier system as follows:
Hospitals (general hospitals, maternity hospitals, and pediatric hospitals)
Specialized hospitals (such as The Institute of Cardiovascular Disease)
The foundation of the Cuban health system focuses on preventative health and primary care. In the city of Havana, every six to nine city blocks (approximately 1,500 people) has a primary care doctor and nurse responsible for the health of the community. These health care providers live in the community and examine patients in the clinic and during home visits.
Health care is viewed as a right of all individuals and is free to Cuban citizens and visitors. Although health care is free, there is a cost to the government to provide this service. In order to remind patients of the governmental cost, signs are hung around the clinics and hospitals that say: “health care is free but it costs”.
The providers are especially proud of the mother and infant program. Babies are very important in Cuba since its population is not growing. During pregnancy, women are closely monitored for risk factors such as gestational diabetes, hypertension, or poor nutrition. For the first six months of the baby’s life, the provider visits the child every two weeks. These visits alternate between trips to the general clinic, and providers travelling to the family’s home.
During the second week of the trip, I spent three days in Calixo Garcia, a general hospital, and two days in a maternity hospital. There were several differences between hospitals in the United States and Cuba. Resources are scarce in Cuba; one surgical ward we visited had two pieces of gauze and no bandages, tape, or other dressing supplies. This is common and often patients bring their own supplies to the hospital. The family members assist in bringing the patient to the bathroom, feeding and moving them from bed to chair. Hospitals lack technologies the United States views as standard. Therefore, clinicians become extremely skilled in obtaining health histories and physical exams.
Cuba, as a collectivist culture, has ways of addressing poor prognoses that are different than the United States. If a patient has six months to live, the patient would not be told this information. Rather, the provider shares this information with the family and the family decides whether or not to share with the patient.
There is much for us to learn from the Cuban health care system. The clinicians are extremely skilled in relying on history and physical results. Assessment data is often utilized since scanners and tests are often not available. The system of family practitioners living within the community enables the providers to monitor disease and seek to prevent complications.
Many times during our trip, Cubans thanked us for visiting their country and learning about the health care system. Although the purpose of the trip was for students to learn, the trip served a greater purpose: Michigan State University professors and students served as ambassadors for the United States. Our actions reflected both on Michigan State University and the United States. As relations between the United States and Cuba are normalized, I look forward to a continued exchange of health care practices and information.