A land caught in between: Cuba

In the summer of 2001, between my first and second years of medical school, I visited Cuba with a group called MEDICC (Medical Education Cooperation with Cuba), a group that sends U.S. medical students to Cuba to observe and learn about the health care system there. We stayed in the dorms at CENAPEM (School of Public Health in Havana) and at the Che Guevara Medical School in Pinar del Rio.

I had been to Cuba once previously in college (in 1992), when I studied abroad in the Dominican Republic, but this trip was different. The '90s were an extraordinarily difficult time for Cuba's economy after the USSR fell (see review of economy), and they had to make many drastic changes to survive.

I found it amazingly eye-opening, in terms of seeing how people live in such different circumstances from both the developed western countries and also from their poverty-stricken Latin American and Caribbean neighbors. This is truly a land caught "in between" two realities. It is also a land caught in time. You walk down the street and see cars from the '50s, buildings that have not been renovated for decades, and people wearing long-outdated clothes. Even the shops carry old products. And in this same land, you see tourist-centered services and accommodations that rival the best of the modern world. In this world, dollars are accepted as local currency, and the tourist can access the best of everything, even steaks and hamburgers; this in a country where beef is not available, not even rationed, and saved only for those with medical necessity. What an amazingly strange land.

I know that their leader, their beloved (by most) Fidel, will not live forever, and who knows what type of regime will follow him. For now, I feel blessed to have been able to observe and capture a snap shot into the reality that was and still is post-revolution Cuba.

Quick Tips:

We stayed in both Havana and Pinar del Rio on this trip. I would recommend Havana for all the touristy stuff but if you'd like to visit cigar factories and get a little off the beaten track, try Pinar del Rio.

Try to talk to the locals but be aware that it is not easy for them to talk to you: when we talked to locals, every now and then the authorities would pull them away and give them a hard time about it. Some say it’s because the locals are not allowed to talk to foreigners (for political reasons) and others say it’s so they won’t harass the tourists. They have a lot to say, and for many, it's almost a sort of catharsis to talk to someone from the outside world.

Best Way To Get Around:

Buses are very cheap.

This is a nightly ceremony at Castillo de la Real Fuerza, est 1558 (oldest fortress in Americas), in which men dress in the typical dress of the 16th century. They march on the top of the fort wall, and at exactly 9pm, they fire a cannon, signifying the closing of the gates to Havana, which was necessitated by the presence of the pirates during that time. It is an interesting historical reenactment, but know that it is geared only toward tourists. In this vein, you can take photos with the cannon, there is a band playing local music after the event, and you can buy foods and souvenirs from the fort gift shop. It makes one wonder, did they have mojitos in the 16th century?

The arts have always been very important to Cubans, and the ballet is no exception. This ballet troupe has been in existence since 1948 and has toured around the world! We were lucky enough to see a performance of "Coppelia" (no relation to the famous Cuban ice cream, I assume!), which was originally presented for the first time in 1948 but is still beautiful today. Costumes were lovely, and the set designs and colors used were simple but artful. Director Alicia Alonso is inspired.

A truly magnificent performance--I recommend it highly, and it will certainly broaden your experience of Cuba. Incidentally, we could see a movie for 10 cents, which seemed unbelieveable to us! In New York, it costs about $10!! Cuba puts a lot of emphasis on the arts, and they try to keep the prices low for nationals (I got the low price because I used my student ID card).

This is one of the most popular plazas in Habana Vieja (Old Havana) and has the famous and lovely Cathedral de San Cristobal (established 1748). The cathedral is open most days to visitors, and there is a huge, somewhat tacky tourist market in the open-air plaza. There is also an outdoor café and musicians playing on the patio, which is very popular among tourists. Although mostly for tourists, this is a very relaxed place to spend an afternoon, as there is outdoor seating and lovely open spaces to sit and people-watch or just unwind.

It is mostly a historical museum that chronicles the entire Cuban Revolution. It is also a sort of bastion of the Imperialist opulence and extravagance that was pre-Revolution Cuba, now presented to the people to be hated in all its forms. It is really a good place to visit if you are interested in Cuban history and the Revolution, so give yourself plenty of time. Note that almost everything is in Spanish. Admission is about $3.

In the small town of Las Terrazas in eastern Pinar del Rio province we visited Cafetal Buena Vista, a coffee plantation built in 1802 by French refuges from Haiti. But coffee isn't grown here commercially anymore. You can tour the former facility and see the various instruments used in coffee production, such as the huge grindstone (tajona) used to extract coffee beans from their shells. You can also see the eerie remains of the former slave quarters. The master’s house is now a restaurant. Although a reminder of the painful slave/plantation history of Cuba, it's a lovely place to visit, and today you can swim in the surrounding waters.

There are many cigar factories in the eastern province of Pinar del Rio. This industry is the most famous of the country and the one people think of when anyone says "Cuba". Tobacco was grown commercially in Cuba after 1580, and by 1700, it was the largest export. We were able to visit several factories where rooms full of people sit patiently, hand-rolling the delicate and lucrative product. The result can't be bought--well, not in the U.S., at least!

There are really interesting slogans and pictures of Che and Jose Marti everywhere. Some of them are “Venceremos!” (We will win!), “Siempre Rebelde” (Always revolutionary), “Hasta la Victoria” (Towards Victory), “La Revolucion Vive” (The Revolution Lives), “Socialism Hoy y Siempre” (Socialism today and always), and things like that. It’s like they are still back in 1959, when the Revolution first started and they were fighting imperialism. These slogans areeverywhere are a constant reminder that for them, everyday is the revolution. I felt like asking, who are they trying to convince? And what are they trying to win? My favorite slogan is “Hay 2,000 ninos viviendo en la calle en America Latina and ni uno en Cuba” (There are 2,000 kids living in the street in Latin America and not one in Cuba). I don’t know if it’s 100% true; I never saw any homeless people in Havana, but I have heard there are some people in the rural areas who don’t have homes. I have traveled extensively all over Latin America, and there were always slums and homeless people and beggars. I simply did not see that here. Of course, their lives are not without other types of problems.

I wanted to briefly talk about Cuba’s economy and some of the changes made in the last ten years or so. One of the first things I noticed when I visited Cuba, was how many more cars there are than I remember from my visit in 1991. At that time there was no gas, so people used bikes sent from China. Now, ten years after the USSR dissolved, Cuba has been slowly pulling itself out of the economic mire it was in in the '90s, largely due to tourism and a dual peso-dollar economy. Prior to the '90s, Cubans were not allowed to own dollars and I think you could get into big trouble for having them. Then, with the fall of the USSR, about 85% of the trade that Cuba depended on just disappeared, and Cuba had to think fast about a quick form of revenue, and they decided on tourism. It seems to have helped a great deal. There are many many old U.S. cars here, and I mean OLD--from the '30s, '40s, and '50s! I don’t know how they even get parts to keep them operational, but they must be resourceful because they do run, and many are used as 50-cent taxis to most parts of Havana.

In terms of jobs, education is paid for by the government, and there is supposedly no illiteracy in the country. School is actually mandatory until 9th grade, and all educational supplies are free, including books, pens, etc. Also, you are supposedly guaranteed a job after college, but the catch is that you can't study something that isn't "needed". (I assume the government decides what is needed.)

During my short stay, I was amazed at their tremendous strength of spirit, to see people on TV and meet people like us and other tourists who have things they wish they could have and cannot and know that it'll never change. One of our friends told us he makes $10 a month and can’t afford to buy anything with it; for instance, his shorts cost $14! Most people told us they get by in two ways – family abroad or a side (secret) business, like raising pigs, making wine, or, if they live in the rural areas, selling products from the capital at a higher price. People are not officially allowed to work more than one job, so there is no way to "get ahead" as we know it.

It’s amazing to me because, in spite of having so little and seeing all that we as tourists have, the Cubans are so hospitable and giving of whatever little they have. And if some try to hustle us (not that it happened too often), I feel like, who wouldn’t if put in their position?

As the name of this journal implies, the Cuban "joie de vivre" overcomes it all--all the many hardships they face--and they continue to sing, dance, and make the best of their situation. In fact, while we were there, the popular song was Celia Cruz's "La Vida es un Carnival", and the words of the refrain, "Ay, no hay que llorar, que la vida es un carnaval y las penas se van cantando!", seem to be a way of life for them. (Rough translation: Ay, no need to cry because life is a carnival/party, and our worries will go away as we sing).

We decided to take a weekend trip to Trinidad, a famous old colonial town a few hours east and south of Havana. We stayed in "Casas Particulares", which are homes that are rented to tourists for about $5 per night. They’ll even cook your dinner for $5 and breakfast for $2, and it’s quite delicious! The views were spectacular! There is a cute "Plaza Mayor" with some old churches and a colonial plaza. One girl in our group met a local drummer and took a bongo and conga drum lesson one day!

Each night, we went to hear local bands play all the salsa favorites, and then we’d walk back to the home. It was a very small, quaint town of about 50,000 people. On the weekend, we decided to visit a nearby famous waterfall called Cascada Collantes (Salto del Caburni); it was quite a hike--2.5 km (2 hours) each way--and on the return, it was all uphill. My whole body ached! The next day, before returning to Havana, we hit the beach (Playa Ancon), which is also nearby, for a few hours of R&R. It was a terrific weekend trip.

It makes a world of difference that we visited Cuba as medical students. I think I noticed an inherent respect afforded to students of the "healing professions" here, in a country which takes it so seriously.

Cuba’s primary causes of death are similar to those of developed countries – heart disease, cancer, and stroke. This is amazing given that for the rest of Latin America and the developing world it is still infectious diseases! There are 23 medical schools in Cuba! Medicine is a popular profession and there is a doc in every neighborhood, not even one is unemployed! The doctor that I was able to visit on occasion lived in a modest house provided to her by the government, from which she took care of the 1000 patients who lived in her area. She told us that none of them had AIDS and it happened to be that there was no doctor in the neighboring town because they had gone on mission. Mission means that the doctor will spend about 2 years traveling to another country to offer medical services, but you can ask to opt out if you had small children at home. The doctor would also make house calls for any patients who could not come to her house for an appointment. This doctor is on call 24 hours a day! Doctors only make about $25 a month, which is the highest salary except for some people who work in the tourist industry. Some doctors even get other jobs to help with finances, like waitressing! Although it is difficult for anyone Cuban to leave the country, there are some ways, if you are invited by someone you can be on a waiting list for a few years and go, or you can enter a lottery to go. But doctors and some other health professionals are not allowed to go because in the '60s (right after the revolution) almost half the doctors in Cuba left.

"Natural and Traditional Medicine" as they call it has really flourished in this country, due to necessity, after the crisis time of the 90s. Since medications and resources (even things as simple as latex gloves must be washed and reused!) were becoming scarce, they sent doctors to China and other parts of the East to learn acupuncture, acupressure, floral and herbal treatments, among others. Now these modalities are also taught to Cuban medical students in their 5th and 6th year (theirs is a 6 year program) and is used extensively around the country, and it seems to be working well. We visited two centers which used Natural Medicine in their practice and it seemed to be quite successful. One was a pain clinic and we observed a woman with a back problem that caused her to walk hunched over go in for treatment with acupuncture and come out ten minutes later without pain and walking normally! We also observed acupressure treatment for Carpal Tunnel Syndrome.

They have places called "Cases de Abuelos" (Grandparents houses) in every neighborhood. This is a place for older folks to go when their families are at work or school and they get free meals, medical care, exercise, games and they seem so happy. They get to meet other folks their age to hang out with, dance, talk, go on trips, they told us some even meet and get married! We heard from one 82 year old women about how much better things are for them after 1959 because of Fidel, they now have somewhere to go instead of deteriorating alone at home, they get food, and in general the society has more racial and gender equality.