As I process my brief experience in Cuba, I am left with many questions, especially about the Cuban health care system and the status of religion. Mostly, I can convey what we were told by guides and academics. I pass this along without the benefit of direct experience.
Health care: Periodically the international media have covered the high quality of Cuban health care and the contribution of Cuban
practitioners to the ebola crisis in Africa and the Haiti disaster. On our trip, we heard about the comprehensive health care system, the heart of which is the family physician. The government builds a 3-story house, at the bottom of which is a clinic. The doctor lives on the middle floor, and the nurse upstairs. Each doctor is the assigned provider for 120 families’ basic health, pediatrics and gynecology. There’s an emphasis on prevention.
Patients get same-day appointments Monday through Saturday from 8 a.m. – 12 p.m., and, -here’s a shocker – from 2 p.m. – 4 p.m. the doctor makes house calls. Now there’s a novel idea. Specialists are available to consult every week. But because the doctor lives right in the community, he or she knows every single patient. He sees them in the grocery store and on the street. You can ask a question right there, and he/she won’t put you off with, “Make an appointment.”
Eighty percent of medical care is delivered in family practice. The next step is public clinics, site of dental care, labs and minor surgeries. In an emergency, you go directly to the ER. The next level of care is provided by general hospitals, and, if problems warrant, (say, for a transplant) then research universities. Care is free (including, shockingly, cosmetic procedures like botox or liposuction), as are prescriptions provided in the hospital. You pay for other prescriptions, but the prices are very low. For diabetes care, for example, ten Cuban pesos a month……pennies on the dollar.
Many patients come to Cuba for medical treatment, and those patients pay much more than locals but far less than in their home countries. They come from Central and Latin America and Africa, as do students seeking medical training. Apparently there are some poor minority individuals from the United States who get their medical education in Cuba.
It all sounds highly professional, robust and affordable, with much to admire about how they do health care. I’ve also heard that hospitals are outdated (like much in Cuba) and that standards keeping things sterile are questionable, including reuse of needles. I can’t vouch for the condition of equipment or facilities because a planned visit to a private home of a family of doctors was cancelled, and no explanation was given.
Religion: One’s image of religion in Cuba is either that it is, of course, a Catholic country or, alternatively, that, as a Communist state, it is void of theology. So, here’s what we learned. The Cubans may be divided by color and class, but not by religion. No census form has ever asked for religious affiliation. Just some 2 1/2 percent of Cubans are practicing Catholics, though more are baptized and married in the church, the extent of their participation. Experts say this reflects a residual aversion to the predominantly Catholic Spanish occupiers. Through the centuries, the Church has usually been on the side of economic powers-that-be, and the wrong side of the people. Today, the Castro government has come to an appreciation of the social services provided by the church, especially funds from Catholic charities outside the country.
But if religion is not a popular concern, it is still true that many many religions find a home in Cuba, from Protestants, Bahai, Taoists, Buddhists, Rastafarians, Christian Scientists and Muslims (about 1500, split between Sunnis and Shiites, and no mosques yet) to the Afro-Cuban religions (e.g., Santeria), which were forbidden until 1988. Pentacostals are the fastest growing group. Those practicing spiritism are in number second only to those in Brazil.
The first Jews in Cuba came with Columbus. There are six Jewish cemeteries in Cuba, a testament to the past. Today about 1000 Jews remain, served by a handful of Jewish synagogues, mostly in Havana, and some informal community clusters outside the capital. A member of a Sephardic synagogue told us that Cuba has always been very hospitable to Jews, and added that, unlike most of the rest of the world, Cuba may be anti-Zionist, but it is not anti-Semitic.
Back in 1954, only 17 percent practiced any religion. By 2004, University research showed that 15 percent were religious, 15 percent were atheists and 70 percent displayed “religiosity based on symbols.” The explanation for that, we were told, was that, with all the political and economic turmoil, people gravitated toward superficial religious involvement as a kind of insurance, as opposed to deeply held beliefs or consistent observance of rituals.
The reported religious tolerance is both interesting and commendable, but anti-Semitism, anti-Catholicism, anti-just about anything can also be subtle. Unless you live in a place (or at least visit longer than nine days), you can’t know for sure if what you’re being told is true.
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