Dr. Mary Abernathy is one of the doctors who went to Cuba with the Kelley School Business of Medicine Physician MBA Program in 2017 as part of the Global Healthcare Immersion course. These are her reflections from the experience.
We started our journey at 3 this morning. I had booked a 6 AM flight a while back, and now I was beginning to wonder why I had chosen one this early. I had been excited to go to Cuba ever since I started the Business of Medicine Physician MBA Program! What an experience!
The first leg of the journey, we went to Newark, and from there we were flying to Havana. Our flight into Havana was uneventful. I noticed after we landed that the airstrip did not have any lights for night landings. We arrived a few minutes early and had to wait for a place to get to the gate — Only we never made it to a gate.
We ended up parking the plane on a large paved parking lot area. We got off the plane like the President by walking down a staircase! The only difference was — he usually is not carrying his luggage as he deplanes. The air felt hot, heavy and humid as we arrived about 2:30 PM.
Getting through customs in Cuba was the usual hurry-wait-stand-still-stern-face-don’t speak-unless-spoken-to session, but it was uneventful. We met up with our group outside the airport and surrounded the tour guide.
CET had arranged for us to be picked up at the airport in 1950’s style American-made cars. But because they were American cars, they could not pick us up right outside the airport. We had to walk about a quarter mile to get to our get-away cars. They were as brightly-colored as popsicles. Ours was bright orange, inside and out. The seats were vinyl and covered with clear plastic. It was the same clear plastic my grandmother used to put on her carpet to keep it clean when we visited as kids!
On the way from the airport we made two stops. The first was to fix something on the engine of the lead car. The driver merely got into his trunk pulled out some tools, made some adjustment under his hood and then we went on our way. The second time we stopped we picked up a fellow student, Will Berry. The brakes on his car were no longer working so the driver stopped the car by pulling into a hotel that had a steep incline. We merely put William into another car and went on our way.
Neither of these stops phased the other drivers. It was almost like it happened every day. Either one would have stopped me in my tracks and involved AAA in the US, but these people just kept going.
That was the first time I saw the Cuban spirit. The Cuban people make do with what they have, and they get the job done regardless of the hardships or issues that stand in their way. They are warm, loving, sincere and dependable, despite any hardship that comes their way.
Day Two: Sunday
We stayed at the Hotel Nacional in Havana. The hotel looks and feels like something out of the 1950s. It reminded me of the famous hotel in West Baden, Indiana before the big remodel. Everything seemed elegant yet really old and worn simultaneously. The north side of the hotel faced the Straits of Florida. The seawall called the malecon was the only thing between the sea and the hotel. The malecon is a popular gathering place for all Cubans. It is a source of entertainment and culture.
I woke up and didn’t remember ever sleeping so well! I had been so exhausted from the yesterday’s travel. I had slept nearly 10 hours! I rarely sleep over seven. Breakfast was a huge smorgasbord buffet in the basement that all the guests enjoyed. Cuban coffee is strong, hot and delicious.
After breakfast, we had two lectures about Cuban healthcare and culture. Dr. Marcelino Feal, surgeon and professor of general surgery, spoke about healthcare in general in Cuba.
Miguel Coyula, architect and urban planner, spoke to us about the history of Cuba from the time Christopher Columbus arrived in 1492 until present day.
I began to see Cuba and the Cuban people in a different light than before. I began to have empathy and understanding of the struggle (la lucha) that the Cuban people had survived through. I began to see the “la lucha” that the Cubans had been through and understood why Fidel Castro was such a loved and respected leader. I also began to see the far-reaching effects of the fall of the Soviet Union and ongoing snubbing from the US.
Interestingly I think the Cuban people are not bitter, but they mainly continue to do as they have always done- get the job done with what they have!
After the lectures, we took a walking tour of old Havana. We spent the afternoon visiting four plazas or central open areas: Plaza de Armas, Plaza de San Francisco de Asis, Plaza Vieja and Plaza de la Catedral. Each plaza had a specific history and were lovely open spaces for people to meet. Each plaza has a government building, a market and a post office for the people to gather.
Day Three: Monday
I went for a short walk on the hotel grounds and stumbled across ammunition bunkers built into the hills surrounding the hotel. Hotel Nacional sits perched on a hill overlooking the Straits of Florida. During the Cuban missile crisis, they created underground bunkers into the hill for protection. They lead into the hotel somewhere. I felt I could imagine the standoff between the Cuban and US government during the Cuban missile crisis.
A few of the members from the IUSOM met with the Minister of Public Health in Cuba. We discussed the possibility of creating a formal collaboration between IUSM and Cuba. We also visited a local primary care office (policlinic). Each neighborhood has a physician and nurse assigned to take care of the approximately 800-1000 people that live in that neighborhood.
In the afternoon, we took a long bus ride in the country and toured the ELAM (Latin American School of Medicine). This school trains non-Cuban students sent from around the world to become doctors free! This includes tuition, books, room and board. The goal is to train primary care doctors to go back to their countries and serve disadvantaged patients in their home country. Once again, it is an example of the generosity of the Cuban people.
The first six months is basic language training. Each student must know Spanish well. If they already know Spanish then they must study English, because most medical terms are in English. The remaining 18 months are devoted to learning premedical studies to be sure all students start at the same level. We met with three American students studying at ELAM. One of the students (Joshua) was from Indianapolis! What a lovely surprise!
The U.S. students explained they chose to study at ELAM due to the focus on preventative care and treatment of the mind, body and spirit. We also toured the Cuban “Victoria de Giron” Medical School. It is on the same grounds as a former girls school run by the Society of the Sacred Heart before the 1959 revolution. Once the revolution started the girls school was abandoned. In the early 1960’s, the medical school moved from Habana to this location. This was the first medical school in Cuba. Now there are 13 total.
Cuban medical schools focus more on primary care and public health. Each physician must be able to keep record and analyze data to improve the health of their communities. In other words, they are trying to teach medical students “population health” from the start!
Day Four: Tuesday
I got up early as usual and went immediately to watch the sun rise over old Habana on the hill overlooking the Straits of Florida.
This day was devoted to learning about the advances that Cuban scientists had made in biotech and pharma. Dr. Manuel Raices Perez-Castañeda spoke to us about the amazing progress that had been made in the treatment of many chronic diseases.
American cancer patients have traveled to Cuba to obtain chemotherapy medicine that they cannot get in the U.S. They have a medication called Heberprot-P, which can heal diabetic ulcers and reduce the need for amputation. I am surprised that American drug companies have not figured out how to produce this medication. It seems like something that would be incredibly valuable to our diabetic patients back home.
They have another medication called Heberferon for the treatment of non-melanoma skin cancer that appeared to significantly improve the treatment and survival. I think it would be beneficial for patients in the US to have better access to these medications.
The remainder of the day we toured a large hospital called Hermanos Ameijeiras in Habana. It was named after three brothers that were war heroes. We began to realize that most of the time we met and listened to lectures but did not get to actually “tour” a health care area. We nonetheless got a good picture of the healthcare most Cubans receive.
We had lunch at Paladar San Cristobal. This was the same restaurant that President Obama had visited and we sat in the same room. The walls were covered with clocks and record albums and memorabilia. Most of our lunches started with a mojito and finished with a shot of rum!
In the evening my sister and I walked to Café Laurent and had dinner on a fifth floor balcony. We both chose Italian course. I had lasagna and she had seafood risotto. Most evenings we would finish the day drinking wine and mojitos on the hill overlooking the Straits of Florida.
I began and ended each day looking back toward America over the Straits of Florida.
Day Five: Wednesday
We made an impromptu visit to an artist’s studio and home across the street from our hotel.
Several of the physicians in my group actually made large purchases at the studio before we came back home. The artist was an art professor at the university. He told many stories, including that his wife was a former student and now a sculptor. His son was a photographer and his daughter “ran the business.” He was quite charming and entertaining. If you ever get to go to Cuba, you must visit. He lives on the 10th floor of the building across the street from Hotel Nacional.
We then took a bus tour to Revolution Square. This was a huge parking lot surrounded by monuments to revolutionary heroes including Jose Marti, Che Guevara and Fidel Castro. All had played major roles in Cuba’s history. We were there for 20 hot humid minutes midday. I can’t imagine staying there for a seven hour speech!
We met several younger Cuban physicians for lunch. Each Cuban physician sat at a different table. We enjoyed meeting with Dr. Babyle Medina Vega. She is a 33-year-old trauma surgeon that is probably the most beautiful trauma surgeon in the world. She as short but muscular and looked like she could hold her own in a room full of men.
We asked questions about gender pay equity and the working conditions. We asked her about her extra job (la lucha). She explained that her boyfriend was her “la lucha” as he paid for her apartment. She did not have to work an extra job to pay for amenities that others have. We welcomed a break in the activities and rested poolside for the remainder of the afternoon.
Day Six: Thursday
I started the day again watching the sunrise over old Habana.
There were usually cool breezes in the morning coming up the hillside overlooking the ocean, so you did not know whether to wear a jacket or not. I imagine summer is dreadful in Habana since this is winter and the average temperature is 75 during the day. Far cry from Indiana!
As the sun begins to rise it highlights that shapes of the clouds before it actually crowns over the buildings. It reminded me of a baby’s head crowning during a vaginal delivery.
Gail Reed from MEDICC, Medical Education Cooperation with Cuba, spoke to us about their efforts to expand cooperation between the Cuban and U.S. governments. She is an American, but has lived, married, divorced and raised children in Cuba for the past 30 years.
She was delightful and spoke about the Cuban culture. MEDICC serves to create bridges between Cuba and the US in many forms. She was trained as a journalist and now serves as the executive director.
We visited CENESEX (National Center for Sex Education) today and mostly heard about transgender patients in Cuba. We sat in a hot room with 2 circulating fans which did little to make us more comfortable. We discussed LGBTQ, transgender and contraception in Cuba.
I learned that despite Cuba being a country where Catholicism is practiced, abortion is legal and widely used in Cuba until 12 weeks. Fetal anomalies can be terminated by a medical procedure after 12 weeks, but they do not refer to it as an abortion. Likely, this has helped to decrease their infant mortality to levels well below the US in a very short period.
In the afternoon, we visited an elderly care rehab center. The highlight was a musical serenade by 8-10 elderly ladies. They sang three songs in Spanish. The oldest was a 92-year-old woman dressed like Carmen Miranda. She just needed the fruit on her hat. She had kissed several members of our group when we arrived.
After their musical performance they gave each doctor a souvenir. It was a small pin shaped liked a hat to wear on our coats. It was probably one of the most beautiful gifts I have ever received!
Day Seven: Friday
My favorite part of our last day was our visit to the Institute of Tropical Medicine or Institute Pedro Kouri (IPK).
It was a fairly far distance form Habana by bus. It is comparable to the NIH or CDC. In fact, we were told that Dr. Anthony Fauci had just visited IPK last fall.
The head of the institute was charming and spoke Spanish, French and English fluently. He reminded me of Cary Grant. He gave the presentation in Spanish though, because it had been a long time since he had studied in the U.S.
Many of the professors and older physicians that had studied abroad were interested in creating collaborative studies. Christopher, our tour guide, reported knew two people that had developed Dengue fever in the past and had been hospitalized there a long time ago.
When we asked questions the professor would sometimes answer in English. I enjoyed his warmth and candor and waiting around for us to arrive at 4:30 PM on a Friday! He again expressed interest in collaboration.
Our farewell dinner was wonderful. We sat under a roof in an open area. We never had to worry about insects as Cuba sprays. Rarely ever did I see even a fly out in the open. Each meal usually lasts two hours in Cuba and opens with a Mojito and ends with a shot or Havana Club rum and cigar. Meals are served family style at most restaurants. Each meal has black beans and rice as a staple. I probably gained five pounds during the week.
We leave in the morning. I have loved spending time in Cuba, and I look forward to working with Cuban doctors in the future.