Cuba’s Healthcare Revolution

Cuba’s revolutionary vanguard: US medical students Keasha Guerrier, Kereese Gayle and Akua Brown

Three winters ago our Open Source trip to Cuba turned around on an astonishing moment of serendipity. At a bus stop in Havana my colleague Paul McCarthy heard a laugh he recognized from high school in California. “Only Akua Brown laughs like that,” he blurted. And Akua Brown it was, the friend he hadn’t seen for a decade, now finishing her fourth year at the Latin American Medical School in Havana.

Over the next few days, Akua Brown and her friends poured out their four-year immersion in Cuban life and language, Cuban magic and slang, the Cuban versions of sexism and racism, Cuban boyfriends and families, drums and faith, bureaucracy and student volleyball, and by the way, this strange Cuban thing about toilet seats and toilet paper: the revolution doesn’t seem to believe in either.

But the core of our long conversations is medicine, the Cuban way. This is aggressive, free, hands-on health care that makes house calls, and lingers for the feel of emotions and homelife. Doctors’ training like doctors’ care is free: the payback required of the students here from all over the hemisphere is only that they return to underserved areas of their home countries.

Michael Moore and our friend the Nobel Prize cardiologist Bernard Lown knew the results in Cuba all along. “I have been to Cuba 6 times,” Dr. Lown emailed me, “and learned much about doctoring in Cuba. Their thinking on social determinants of health, on the primacy of public health and the vital role of prevention strategies are unmatched in the world. With spending of less than $200 per person per year for health care, they have achieved health outcomes no different than in the USA where expenditures now exceed $7000 per person annually!”

Keasha Guerrier, a science major from the New York Institute of Technology, knew about Cuban medicine because “my father’s from Haiti, my mom is from Guyana.” But her brother teases her about “blackouts” in Cuba, and she has other relatives and friends who don’t know why she’s there, or ask her to “pick up a box of cigars on the way out.”

Keasha Guerrier

Am I just a pawn in a game the Cuban government is playing? I push back hard against that idea. There are a lot of things that the Cuban government has done that some people might not agree with. But medicine with a community base in training and practice — that is one the things they got right on the nose. They hit the nail on the head. The people who instituted this program saw how it works in Cuba… and they compared Cuba’s situation to countries in Central and South America or third world countries, Africa, Haiti. And they saw how they can make a difference. Here, you do a lot with a little bit… What they are trying to teach us is that you don’t have to be confined to working for a paycheck. But using all the things that you know, you can help a broad base of people. In that respect, I think that the intentions are pure.

Keasha Guerrier in conversation with Chris Lydon over roast chicken with rice and beans at the restaurant El Ajibe in Havana, December 19, 2008

Kereese Gayle grew up in Lousiana and Florida. She was a Spanish major at Georgetown who could see herself coming out of medical school in the US with crushing debts. “My family is Jamaican,” she says, “so we knew about the quality of the Cuban medical system. To this day I know I’m where Im supposed to be.”

Kereese Gayle

We’re here at a very important time in the history of the world. We’re getting the type of education that I think people are looking for. More and more people are thinking very seriously about the idea of universal health care, about the idea of rights for everyone to basic access to health care. I think we’re going to be a huge part of that…

We learn how to diagnose our patients with our hands, our ears, our eyes more so than with technology–X-Rays, CT scans– because you don’t end up doing those kind of really costly labs as often here. So we definitely have that as an advantage… We learn how to interview our patients thoroughly, and how to do a really thorough physical exam and do it well, and be comfortable with that… Doctors here not only do house visits but they go into homes: they have a form that you fill out to check off what risk factors the person has [in their home]. Is their water contained properly? Do they smoke? We get that kind of first hand view. In the United States, you can ask someone if they smoke or if they have a pet and they easily can lie to you. But here, as someone’s primary physician, you can see not only the physical medical aspects but the psychological medical aspects as well. Do you feel tension the minute you walk into the room? Are people in a mentally healthy environment, or do we need to get [them] to a psychologist. There are so many advantages to the system that we can take back and apply to the communities where we live.

Kereese Gayle in conversation with Chris Lydon sipping lemonade at El Ajibe in Havana, December 19, 2008

Akua Brown minored in Spanish at San Francisco State University, and spent most of her first two years in Havana learning the Cuban vernacular and testing her Bay Area ideal of the Revolution.

Akua Brown

The education system here is excellent; there is very little homelessness. Everyone has a right to free health care… up to the most specialized needs. Neurosurgery, open heart surgery, cost nothing to the people. And the fact that a government with so little financial resources is able to do this says that the United States can do so much more… And without the debt that most medical students graduate with, we won’t be afraid to start our own projects and programs without necessarily needing the money to pay back the loans and the things hanging over our heads. Living here for six years, I think we have learned to live a simpler life with bare necessities. I ride the bus, I hitchhike, I buy from the community market. I’m not complaining–home is comfortable, but this is livable.

Akua Brown in conversation with Chris Lydon savoring the coffee at El Ajibe in Havana, December 19, 2008

The practical visions of these blessedly gifted women brought to mind Ralph Waldo Emerson‘s indomitable “world spirit.” Entering the second half-century of both the black freedom movement in the US and the Socialist revolution in Cuba, each with its ups and downs, these very American young women would remind you that grand ideals, the best we have, can prevail. “Things seem to tend downward, to justify despondency, to promote rogues, to defeat the just,” as Emerson wrote at the end of his essay on Montaigne; or the Skeptic. “Although knaves win in every political struggle, although society seems to be delivered over from the hands of one set of criminals into the hands of another set of criminals, as fast as the government is changed, and the march of civilization is a train of felonies,- yet, general ends are somehow answered. We see, now, events forced on which seem to retard or retrograde the civility of ages. But the world-spirit is a good swimmer, and storms and waves cannot drown him…”

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    Chris, I’ve been listening to your show since the time when you did an interview with Edward Said (actually, I found your site searching for Said material) and used quite a few of your shows as my audio/listening comprehension aids in quite a few of my college English/ESL classes. So this is what I want to contribute to your Cuba exploration project: you should organize all your Cuba shows into one series, just like you did with Global Warming, Race & Class and others, so that it’s easier for educators around the world to make their classes more captivating, … more “cognitively efficient”, and so we – in our hyper-instant-gratification era can “spread the word”, one powerful word at that, by just one-clicking the “Send Link” button.

    Many upon many thanks for your devoutness to your vocation, your exemplary professionalism, your ingenuity in carving out stories and themes for journalistic research. Elias, Russia.

  • hurley

    Bravo ladies, bravo Cuba, bravo Chris.

  • babalu

    While it’s great that these three Americans were afforded a medical “education” in Cuba they could otherwise not have paid for in the States, for the average Cuban student, the medical education is, by far, the most expensive in the world. they pay for said education with their right to think freely, with their right to express those thoughts freely, with their right to choose where they live, where they work, what they eat, who they can associate with, with their right to live as individuals, their right to do just about anything like all free human beings. Not to mention years of indentured servitude after graduating, where the Cuban government sends them abroad as slaves, using their new education as either propaganda or an outright business, charging said governments for imported healthcare.

    And these three ladies’ education hasnt been free either, their propaganda value for the Cuban government is priceless, especially with “reports” like these that absolutely whitewash the true realities of Cuba and Cuban life.

    Perhpas, Chris, had you truly wanted to learn about a real Cuban doctor, one borne of the system, you would have tried to interview Dr. Oscar Elias Biscet, a true graduate of this vaunted healthcare education system. I suppose, however, the cuban government wouldnt have allowed you to interview the good doctor at his prison cell.

  • john-gunther

    It’s hard to see an outcome that doesn’t involve Cuba being bought up by international business interests. Cuba’s current quaintness and equality (and I’m not qualified to say how authentic they are) are just two aspects of an artificially imposed isolation that has many other very negative effects. But there’s no good transition to modern life. Once Cuba is opened up to outsiders, everything of value will be controlled or even owned by them as a condition of the flood of money and resources they provide. In the course of this, the investors will demand low taxation and unfettered profit-making potential. The Cubans will spend generations as cogs in the labor machine while simultaneously craving the tidal wave of plastic that modern marketing does such a good job at promoting. The old Cuba will disappear, for better or worse, and it will become another Miami or Kingston or Aruba — the poor locals serving the rich foreigners and small cadre of rich Cubans who originally enable the process. At least since 1989, there’s been a financial vacuum in Cuba and once punctured, it’s very unlikely to be filled by benevolent, humanitarian investors. What’s unusual about Cuba, as distinct from most other authoritarian regimes, is that the leadership seems (again, I’m no authority) not to have enriched themselves on the backs of the citizens. If true, this is extraordinary — indeed unique — and it’s beyond belief that a new regime will show that same restraint in the face of being able to sell the whole nation for personal gain.

    With regard to the medical students you interviewed, I sincerely hope they “pay forward” their low cost, quality education by never trading their expertise for a high standard of living but rather devoting themselves fully to providing health care in parts of the world that are in desperate need of it.

  • Eloquent, stylish, mature, fun, profound, playful, outspoken: Keasha Guerrier, Kereese Gayle, and Akua Brown representing something deep.

    Of course, a lot of this isn’t specific to Cuba. Some of the things discussed had more to do with distinctions to US specificity or even with Anglo-American neoliberalism. Some of the experiences these women are describing happen all around the world, including in some communities in the US. And much of their discussion had to do with a truly Global attitude, which doesn’t rely on government politics but does have a lot to do with social politics.

    I hope we’ll hear from these three women in the future. As long as their voices are heard, there is hope for cultural awareness.

  • What a trio of well-spoken young women. I just hope they don’t come back to the U.S. and lose their idealism on the shoals of the American health care disaster …

  • Our friend the cardiologist Bernard Lown listened and commented by email:

    Your broadcast happily confirmed what I had observed more than a decade ago in Havana. These young articulate women got the essence. If impoverished Cuba can provide first class health care for its people so can other developing countries. Perhaps it is even possible for rich USA, if only it ceases viewing medicine as a marketable commodity.

    Your broadcast impressed me how much hidden talent and bursting idealism exists in this country. It was a mere accident that Keesha Guerrier, Kereese Gayle and Akua Brown discovered the possibility of gaining a medical education without burdensome expense.

    For me very striking was the difference between fourth year American med students and the black women you interviewed. By the time students here reach the end of med school, their idealism is largely tarnished. This is shown in a concrete way. Nearly none wish to enter primary care. The preferred choices are dermatology, ophthalmology, orthopedic surgery and cardiology. These are astronomic money making specialties. For example in cardiology the starting salary is about $400,000 annually.

    It would be interesting to repeat the interview after these young doctors return to the USA. How do they uphold their intense idealism against the tsunami force buffeting of market medicine?

    Ever thanks for the inside view of Cuban medicine.

  • homunq

    Babalu, it would be nice if things were always so black and white. It is absolutely true that freedom of expression is far more limited in Cuba than in most of the world; but by telling these women that they have foregone all right to free thought, in response to their own considered (though admittedly conditioned) self-expression, you are helping to silence them, not helping to free them.

    As for the “slave” system of Cuban doctor’s first assignments, I fail to see how it is one iota more oppressive than the all-night internships and crushing debt that US-trained doctors are subjected to. And living in Guatemala, I have seen first-hand how often Cuban doctors are, by far, the best medical care available for people who really need it.

    So before you talk about propaganda, take a look in the mirror. If helping people who need it is propaganda, then the Peace Corps is an arm of the CIA. Me, I’d rather believe in the possibility for good, even in overall evil systems like the Cuban government or the US State Department.

  • homunq

    John-gunther, about whether the authoritarian elite has “enriched” itself: I’ve been to Cuba. I don’t know the country deeply at all, and am no expert, but I can share what I’ve seen. I’ve seen cushy conferences, where the lifestyle was a funny amalgalm of luxury and scarcity that, on average, would barely scrape the lower echelons of the American upper-class lifestyle – say, an equivalent to $150K/year family income at best. And I’ve seen rural lifestyles which, though truly austere, don’t approach the level of degradation of US homelessness; say, an equivalent of $12K/year family income at worst, with little of the social ills that make it much worse in the US. Of course, I haven’t seen the prisons, but then I don’t think that the US has much to brag about in that regard. Overall, there is no question that there is a class in Cuba that lives well off the revolution (and on the backs of their fellow-citizens), so don’t idealize them. But the inequality in the US is at least several times steeper, so you must also acknowledge that Cuba has made a real accomplishment.

  • talkingcuba

    Th fact that things are bad here in the US related to health care is no help for the bad conditions in Cuba. I know that Cubans who come to the US are often angered that they can’t walk into a clinic and get free care. But I’ve also seen the condition in Cuban hospitals, many are dirty and understaffed unless you have money or position.

  • Kate McShane

    This was so nice. In Michael Moore’s film, my favorite part was in “special features” — the conversation with Che Guevara’s daughter (Dr. Aleida Guevara) and I have watched it many times. This conversation reminded me of that, except that it was in English, which made it more accessible. These women were a joy to listen to, and their energy was so different from that of so many medical students and doctors in this country. They were free. Their intuition has been enhanced, not silenced, the way I’ve seen in many women doctors in this country, where education seems to silence it. I feel that these women were trained to be healers. I remember when I was a kid, I knew two doctors (an M.D. who was our family doctor, and an osteopath whom I met only several times, because his office was much farther away). Both of them were wonderful diagnosticians, as well as really wonderful men. That disappeared as insurance companies and medical training changed. As things change politically in this country, allopathic medicine looks more authoritarian to me and I wouldn’t say that doctors are unable to heal people, but with the dominance of the pharmaceutical industry, I believe they often make people sicker than they were, and with the very short time they spend with patients, along with the lack of intuition operating, they are infinitely less useful. Most people will continue to go to doctors for everything (assuming access)but more and more people will look to alternative treatments, e.g. acupuncture, reiki, energy medicine of all kinds.