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REPORT BY THE FUNDACIÓN AMISTAD DELEGATION TO CUBA ON THE
CURRENT STATUS OF WOMEN AND CHILDREN
1998
Table of Contents
Mission Statement
Message from President of Fundación
Amistad
Delegation Summary
Delegation Participants’ List
Education/Child Care in Cuba
Pediatric Health and Adolescent Mental Health
Non-Governmental Organizations (NGO’s)
Status of Women
Next Steps for Fundación Amistad
People And Places in Cuba
Mission Statement of Fundación
Amistad
The Fundación Amistad is a 501 (C) (3) corporation established
to arrange exhibits, seminars, and conferences designed to increase
U.S. persons’ awareness of Cuban history, culture and society and
to coordinate ways to improve life in Cuba.
Its president and founder, Maria de Lourdes Duke (Luly), a Cuban
American. She is also Vice President of The Harbor for Boys and
Girls, a sixty year old nonprofit in New York City that provides
education and counseling services to inner-city children and young
people. [ top ]
Message from the
President of Fundación Amistad
In my role as President of Fundación Amistad, and as an officer,
supporter and long time consultant with The Harbor for Boys and
Girls of East Harlem, it was extremely interesting for me to see
first-hand the services in Cuba offered to women and children. And
it was of great personal satisfaction to bring together an
outstanding group of individuals, eight women and one man, to add
their own professional opinions and expertise to the visit.
The delegation had three main purposes:
- To provide a report on its findings that can be widely
distributed.
- To be able to provide meaningful input to U.S. government
officials and Members of Congress in support of humanitarian
relief for Cuban women and children.
- To use its collective networks with other NGO’s and
nonprofits to collaborate with Cubans after our visit for
additional seminars, visits, relief services and other
identified needs. These will be, in part, coordinated through
Fundación Amistad.
The delegation to Cuba, March 8-15, l998, began an assessment of
the condition of a representative sample of Cuban women and
children, in the areas of health care, social services, women’s
studies programs, and education.
Education and the mental health needs of children and adolescents
was also a target priority. In addition the delegation devoted
special attention to the issues of infant and child health care,
reproductive and prevention services, vaccination programs for
childhood diseases, average daily diet and national nutrition needs
for children and pregnant women.
Our timing was intended to occur after the historic visit of the
Pope, to see if the enormous press coverage and actual changes
brought about in Cuba for his visit would provide more lasting and
substantive changes in the way of humanitarian concerns.
Throughout our visit, we observed Cuban pride, its sense of its
own rich cultural history, and a deep concern for women and
children. But the absence or lack of up-to-date equipment and
supplies struck us all as being both a problem for and a detractor
to efficient handling of the needs of so many women and children of
Cuba. Despite the remarkable emphasis of the Cuban government on the
needs of young children, the lack of supplies hinders the philosophy
greatly.
The children themselves were alert and displayed all kinds of
abilities, and quickly took advantage of the small gifts and
supplies we brought to the centers. The teachers of personnel were
deeply appreciative and literally begged our group “not to forget
us — your visit gives us strength” and not to fail to send along
additional needed items such as children’s Tylenol.
This kind of personal contact at such a professional level can
only enhance good will and practical relationships between groups
from the United States and Cuba. The negative stereotypes between
both groups are ameliorated by such personal visits, and
particularly those visitors who bring vitally needed materials at
this critical time in Cuba.
Luly Duke, President
Fundación Amistad
[ top ]
Delegation
Summary
With extensive subsidies from the Soviet Union, the Cuban
government has invested heavily in a system of free and available
education and health care since 1960. There are 11 million Cuba
today, and 60,000 doctors, or one doctor for every 150 people. Even
today, the small island nation compares favorably in these areas to
most developed countries. The infant mortality rate is low, literacy
rates impressively high and the maladies that effect both the
developing and developed nations, (death by curable disease, extreme
poverty, crime, and drug abuse) remain diminished.
However, with the collapse of the Soviet Union, the eastern block
was no longer in a position to buoy Cuba's economy and Cuba found
itself suddenly bereft. Reduced resources now make it impossible for
a Cuban citizen to live for a month from a month's supply of
government rationed food. In order for the average person to
survive, extras must now be procured from the black market which
operates mostly in dollars. With the peso now hovering at around 25
to the dollar, the average professor's wage works out at about $10 a
month. Aside from those fortunate enough to work in Cuba’s tourism
industry (waitresses, bell hops, cleaners, taxi drivers, etc.)
everyone we met who was willing to discuss the issue had been forced
to take on a second career. Hence university professors become cake
bakers by evening, research scientists become taxi drivers; and
almost everyone with a room big enough -- film makers, teachers,
engineers and scientists — become amateur restaurateurs.
With the recognition of the American dollar as legitimate
currency, monies sent from family members and friends of native
Cubans in the States have helped to ameliorate the sinking standard
of living of the average Cuban citizen. Some even suggest that such
personal subsidies provided the single largest block of hard
currency to the Cuban government with estimates ranging up to $800
million per annum. As one professor-turned-baker with no foreign
based relatives told us one afternoon: "The American money
helps not just the families who receive it, but all of us. When I
bake a cake, I sell it only for dollars. Most often the cake is
bought by families with money from the states. I then spend that
money in the black market in exchange for soap or cooking oil. In
this way the money passes from hand to hand and helps many more
people to live than the initial relatives themselves."
However, the scarcity of basic items such as food, medicines,
clothing, paper and cleaning materials means that black market
prices remain almost unattainably high to the average Cuban citizen.
One eighty nine year old woman told us that she couldn't remember
the last time she had seen a piece of fruit. Then she quickly
corrected herself and added: "Well, I have seen them of course,
but I have not been able to eat them because of the price. Dollars
are very expensive."
Lack of basic materials is also inflicting damage to Cuba’s
social and academic infrastructure. Though it is still illegal to be
unemployed in Cuba, guaranteed employment is a thing of the past,
and as the Cuban people are left increasingly to fend for
themselves, so the once vaunted advances in education, and health
care are begin to deteriorate. Already many university professors,
doctors and scientists have left the country. Others are leaving
their jobs for the more profitable tourist oriented trades.
University places are shrinking, medical technology is in danger of
becoming redundant and the once grand general educational system --
whose students are forced to share long out of date text books and
scraps of recovered paper -- is in danger, quite literally, of
crumbling. It is our opinion that a well educated work force can not
last much beyond a generation under the current circumstances. As
Cuba’s highly skilled work force is a genuine and legitimate
national recourse we feel that dramatic changes need to occur to
prevent further disintegration.
Members of the delegation noted the following as a result of its
visit:
- Over the part five years the average caloric intake in Cuba
has fallen from 3100 calories per adult per day to 1800. Meat,
fish or other protein sources are scarce and preventable
disease, including the outbreak of Neuropathy with resulting
temporary blindness in 50,000 adults, was documented between
1992 -93 due to lack of B vitamins and sulfur containing amino
acids.
- General and wide spread shortages of medicines, especially
children’s Tylenol, vitamins, antibiotics, steroids,
chemotherapeuticals and technological equipment have greatly
reduced the effectiveness of the medical system. Lack of basic
necessities such as paper, disinfectants and bed linens are
undermining effective hospitalization, and access to up to date
medical information is also hampering effective medical
treatment of Cuban citizens. It is noted that lack of access to
the Internet is due both to technological and internal
restrictions.
- Lack of paper, pens, crayons, linens, bandages, toys, and
cleaning materials (detergents, soap etc.) have seriously
impacted the state of child care and education in Cuba.
- In schools, shortages of building materials have led to
overcrowded classrooms in substandard conditions. There is a
dramatic shortage of paper, pens, chalk, copying equipment and
other materials. Computers are rarely seen. Out of date
textbooks are shared by as many ten students at a time, even at
Cuba’s most and a lack of sufficient food supplies mean many
children arrive at school without having eaten breakfast.
- Reductions in child and health care facilities is forcing
women and girls back into their more traditional roles of caring
for the young, sick and elderly. Lack of basic goods has led to
an increase in tourist oriented prostitution and access to
condoms (the only disease preventing form of contraception) is
non-existent. Shortages of other available contraceptives are in
part responsible for Cuba’s extraordinarily high abortion
rate.
- Low salaries, poor living conditions and difficulty of
transportation is contributing to greater familial mental health
issues. Divorce and alcoholism, both associated with economic
stress, are currently on the rise in Cuba.
[ top ]
Delegation
Participants’ List
Maria de Lourdes Duke (Luly): President of Fundación
Amistad, a nonprofit designed to increase US awareness of Cuban
history, culture and society, and to discuss ways to improve life
in Cuba. Also Vice President of The Harbor for Boys and Girls in
New York City.
Gail Furman, Ph.D: child psychologist. Chair of the
Children’s Task Force of the Women’s Commission for Refugee
Women and Children. Clinical Professor of Child Psychology, Child
Study Center, NYU Medical School. Member of several boards
focusing on educational/emotional needs of children.
Ruth Frazier: educational consultant in community
organizing .Former President of Futures for Children, a nonprofit
in New Mexico doing community work with American Indians;
established independent community educational organizations in
Colombia, Honduras, Costa Rica and Mexico.
Nancy Lublin: founder and President of Dress for Success
in New York City providing clothing and training for women
returning to work force. Author of book on the history of
women’s reproductive rights. Active in women’s issues.
Cristina Rathbone: journalist specializing in youth
issues, urban poverty, and education. Author of On the Outside
Looking In: A Year at an Inner City High School.
Eileen Stern: Director of the National Child Care
Program for the General Services Administration, oversees all
federal day care programs.
Mary Ann Schwalbe: consultant to the International
Rescue Committee and Save the Children, US. Former director and
current Board member of Women’s Commission for Refugee Women and
Children. Extensive work in secondary and post-secondary
education.
Clifford Tepper, MD: pediatrician, Professor of
Pediatrics, Albany Medical College. Chief of Allergy Division,
Ellis Hospital .Co-Founder of Physicians for Social
Responsibility.
Lindsay Thompson, MD: pediatrics resident at Dartmouth
Hitchcock Medical Center in New Hampshire. Extensive work with
homeless adolescents in NYC
[ top ]
Education/Child
Care in Cuba
CHILD CARE
Children are of utmost importance in Cuban society. They are
considered national treasures and are given priorities throughout
their young lives. Child care is one of those priorities. There
currently exists a three tier system for the delivery of child care
services in Cuba: Formal; Informal; and Familial. There are
tremendous variations in the quality of care in each of these
systems. We visited four formal “círculo infantile” child care
centers, three just to walk through and one for a more comprehensive
visit.
HISTORY
In the early 60’s, the State began to build facilities with a
capacity of 120 young children and no infants. These centers are
still operating; while we were told there were perhaps 200 centers
like this built, the actual number was just a guess. During the mid
70’s, the State built an additional 200 centers for approximately
200 children each, this time including infants. In 1989, an
additional 50 new child care centers were constructed, for infants
through preschoolers. While all of the other centers were of similar
physical construction, each of these centers .were unique in terms
of size and shape but they were all large (175-200) capacity.
CURRENT SITUATION
There are approximately 135,000 - 150,000 births a year in Cuba.
Since all family members now must work, about 500,000 child care
slots are needed. There is an extreme shortage of slots in the
State-run formal system; some say only 20% of actual needed space
exists. This shortage forced a change in the system: child care
services used to be provided from age three months to six years. Now
care starts at six months. Mothers get up to one year maternity
leave but only three months is paid leaving a gap of three months
for all parents, whether in formal or in informal settings - to find
care for their children. Anecdotal evidence suggests such a severe
shortage that it is now necessary for both parents to bring letters
to the círculo infantile stating that they are working and
specifically that the mother is working in an education or health
related field.
It is anticipated that there will be a decrease in the already
low (less than 1%) birth rate. This is a very highly educated
population with total access to birth control that is faced with
harsh economic circumstances and severe housing shortages. This
group will postpone beginning or increasing families’ size for as
long as possible in anticipation of some change. Most families live
in multi-generational settings with women retiring early to take
care of their grandchildren so that their daughters and/or daughters
-in-law can continue to work. This system will work for this
generation, but probably not after that since the women in question
will be at the height of their careers and the leaders in their
fields when their children need child care.
OVERALL SUMMARY
FORMAL SYSTEM
There currently exists an outstanding infrastructure within the
formal network of child care centers. The staff was extremely well
educated and undergoes continual training. The class room
supervisory ratios were extraordinary, and there exists age
appropriate groupings of children in warm, friendly environments.
The health practices were excellent with both doctors and nurses on
site; this health care is integrated into the local primary health
care system. Hearing, eye, and dental exams were overseen by the
medical staff at the child care center site. There were outstanding
classroom health practices: including, individual toothbrushes,
individual personal towels, individual potties, showers in the
bathroom areas. The center provides clothing for all of the
children; they change into these clothes upon arrival and all
clothes worn by the children in the center were washed every day.
Meals were served in family style.
There were, however, some very severe problems including a lack
of very basic materials - both sanitary and program related. There
was no toothpaste, no hand-washing soap, no toilet paper, no mops,
sponges, etc. There was very limited food, even though the children
get priorities. They were totally without any teaching materials:
books, paper, pencils, paints, toys, etc. The teachers hold up old
flash cards in front of the classroom to teach colors and shapes.
The physical plant was deteriorating. There were no light bulbs and
overcrowded rooms. Despite a strong on-site medical presence, there
was no sick child care.
This fee for this type care is based on income and ranges from 40
pesos per month (about $1.50), which is what most people pay, to a
maximum of 80 pesos a month. The fee was standard regardless of the
age of the child, and includes food and diapers.
INFORMAL SYSTEM
This system resembles an unlicensed version of our family day
care system in that several children were cared for by a woman in
her home. There was no regulation or licensing by the State (which
was, in and of itself, amazing since everything else was totally
regulated). The homes were usually much too small to accommodate any
additional children as several generations of one family were
usually already crowded into a few small rooms. In general, there
was no specialized equipment or educational materials. Since there
was no regulation by the State, this becomes the parents’ problem.
This type of care costs approximately 80-100 pesos a month, plus
food and diapers, for each child.
Since there was no licensing, the provider pays no taxes and is
able to keep all of the money which is a real incentive to keep this
system unregulated. However, in an effort to upgrade the quality of
care provided in these type settings, the nearest círculo infantile
often sends a team of teachers and health care professionals to
these homes to provide some training materials and basic guidance to
the parent in charge. This is done on an informal basis.
FAMILIAL
This system was exactly what it implies -- a relative or close
friend or neighbor watches the child while the parent works. It may
or may not involve some form of payment. There was a facility within
each community for use as a resource for these care givers. This
facility has a playroom and some professional staff who can offer
advise and assistance.
DETAILS OF VISIT
What follows is a summary of our visit to the Círculo Infantile
los Niños, “Sueños del Che”, established in 1989. The Director
was Rodolfina Varna. The center serves 193 children from six months
to six years and was open from 6a.m. to 6p.m. five days a week.
There were 24 teachers and educators; 15 support staff (cleaning
staff, laundresses, cooks); 1 doctor and 2 nurses. The Director has
28 years experience, 9 in this center. Each classroom was headed by
a teacher with a university degree who earns 300 pesos a month. The
assistant teachers earn 150 pesos monthly. The Director earns a
little more than the head teachers. Secondary school students who
were interested in pursuing degrees in early childhood education can
intern in a center for a full month during their last year as well
as part of each school week. There were no male teachers working in
any child care center in Cuba. (There were male primary school
teachers, however.)
The State provides two snacks and lunch each day. The Director
claims they were short of protein but on the day we visited, they
seem only to be missing animal protein, which Cubans believe is
essential. There were outstanding medical health records on site and
a total integration of the school and family health system.
The age groupings of the children were: 6 months to 1 year; 12-24
months; 2, 3, 4, and 5 years. Immediately on arrival, each child
changed into clothing owned by the center and back into their own
clothes when they left. The center’s clothing was washed every
day. This system may not still exist in all centers as there was now
an extreme shortage of clothing. Cloth diapers were provided and
washed on site as well.
The bathrooms were old but very well laid out, with each
including two small showering areas for the children. In addition to
pediatric toilets, each child had a personal potty for toilet
training, as well as a clearly identified toothbrush and towel. For
those children who were too young to read, easily recognizable
symbols or pictures were used. There were few toys and they were
clearly inadequate for the number of children and many were broken
or missing parts.
The classrooms were sparsely furnished and the furniture that was
there was well worn and occasionally broken. The walls had some
commercial pictures up, but no projects made by the children were
visible. The physical layout was problematic with possible head
entrapment area in the rooftop outdoor play yard fencing. Termites
had eaten the large wooden doors that covered entire sides of the
classrooms and so the rooms were open onto an indoor play area and
therefore quite noisy. There were no play structures inside or out
and cement floors throughout the entire area. There were no soft
areas anywhere.
Despite the fact that there were severe shortages of all
consumable goods:( no paper, pens, crayons, linens, bandages, soaps,
etc). the staff was highly motivated and doing an excellent job
without any materials. The children seemed engaged and friendly and
there was an outstanding teacher to child ratio. At times it was
amazing how many adults were in each classroom. Students on
work-study made up many of the personnel. This compensated somewhat
for the physical limitations of the facility and the lack of
materials in the classrooms as well as contributing to the positive
interactions in the classrooms.
PRIMARY AND SECONDARY EDUCATION
Our delegation visited several education centers, including one
of the most selective and demanding secondary schools in the
country.
Children in a child care setting get a good start on their
elementary school education both from the socialization that exists
for young children and from the professionals under whose care they
are included. The songs they learn, the group activities, and the
sharing of even the limited number of toys and learning tools have
already helped them for future learning.
PRIMARY SCHOOL
The primary school that was visited --Hermanas Giral — was in a
building that had been a magnificent private home before the
revolution. Now there were 392 children in this school in 13
classrooms. Primary school children wear red pants or skirts, white
blouses or at least white collars, and a blue scarf. Children
between the ages of 5 and 15 were called Pioneers. The 1st
grade classroom in which we spent much of our time had 36 children
and only one teacher. She had their total attention, and though they
were crowded into this classroom (ideal circumstances would have
held no more than 18 children), there was no problem of discipline
or learning. All these children can read by the middle of their
first year. A look at their writing and writing books showed that
their letters were clearer than most 3rd grade students
in this country. They were fully focused on their work. If any child
was having problems with writing, the classroom teacher worked with
that student individually after school.
At the request of the child psychologist in our group, each child
was asked to draw what he or she wanted to be as a grown-up. The
response was instant. Each child began drawing with fervor.
Ballerinas, baseball players, astronauts, and teachers were the
favorite occupations with very imaginative drawings. Children told
what their mothers did— mostly professionals such as doctors,
dentists and teachers. The children loved the drawing project,
particularly when left with additional paper and crayons and pens
for their own uses.
There was an active Parents Council at the school and one of the
mothers chairs the Council. It meets monthly. There were health
professionals at the school and a dentist comes on a regular basis.
The students begin learning English at this school in the 5th
and 6th grades, the last two years of elementary
schooling. Other schools now start English earlier. Until the
breakdown of the Soviet Union, Russian was the other language
taught. The phonic method for reading was the one recommended, but
teachers were allowed to use any method that works for them and the
children. They learn to read first and then to write. There are no
standardized tests in the school until the 6th grade when
students are tested in Math and Language for placement in their new
schools.
One of the interesting teaching philosophies, at least at this
school, was that the same teacher stays with a class from
kindergarten through the fourth grade. This may explain why the
children seem so comfortable with their teachers and also why they
were reading and writing so well at an early age. As more
specialized subjects are introduced in the 5th and 6th
grades, children are less likely to have the same teachers at that
point in their development.
Classes begin at 8:10a.m. and were 45 minutes long. If mothers
are at home, children go home for lunch. If mothers are working,
children stay at school and are given lunch. They all bring snacks.
For working mothers, there was someone at the school every day from
7:00a.m. until 7:00p.m. Evening hours were spent playing and in
group activities. Every two months there was a parent-teacher
conference. Hermanas Giral school has only four computers (very old
ones using ancient TV's as monitors), and computer classes don’t
start until the 5th grade.
The library was pitiful. It has almost no books, and those it has
were very old. The children, nonetheless, love to come and check the
books out. They were encouraged to do this but could be much more so
if more books were available. The staff at the school seemed
excellent, thoroughly professional, proud of the school and their
students, and happy to be working in a school.
SECONDARY SCHOOL
We also visited the Lenin School for Science and Technology, a 3
year boarding school for extremely advanced students. It was a
highly selective school which takes only the brightest and best from
the Havana district. Entrance was based on tests in Language and
Math and on prior school records. Only one in three applicants makes
the cutoff. There were 3048 students currently, 300 teachers and 600
staff. The students were bussed to and from the school every week.
One week they were there from Monday morning to Friday night and the
next week until Saturday night. There were two girls for every boy
in the school, and the main subjects taught were math, chemistry,
biology and physics. There is one school like this in each of the 14
provinces, but the Lenin school was the most prestigious, although
the students are also from the most privileged families.. Most of
the students go on to universities and many into professional life.
The school year starts on September 1 and goes till the end of June.
If a student fails a class, it is made up in July. There was a
hospital close to the campus with 6 doctors and psychologists
available to the students. There was an 86% retention rate, with a
goal to improve this figure. Students get up at 6:00a.m and lights
are out at 10p.m. As at the elementary school, parents were active
and meet with teachers every two months. Half the day for students
was spent in the classroom, and an equal amount of time was spent
working and doing chores. We observed a group of students painting
cabinets for an exhibit in their natural history library. The chores
vary from cleaning to working in the fields surrounding the school
and students rotate their chores.
In the past 24 years, the Lenin School has had over 20,000
students. Of the medical students in Cuba, 85 to 90% come from here.
Some of the graduates have come back to teach and many come back to
visit. We met with two leaders of the Student Council. These boys
were very impressive. We asked one if he would consider politics and
he adamantly said “no.” We found this interesting, later, when
we discovered he was the son of a high ranking government official.
The boys described the Student Federation which has three units, one
for each grade. When asked what they liked best about their school,
they mentioned their teachers, the quality of their education,
living with the other students, and the challenges of the work. When
asked what they liked least, they missed homes and families,
disliked the food, and said there were some behavior problems with
students. There was an enormous amount of pressure their final year
in terms of testing for the university level, but the school helps
prepare them all semester, so it was easier when they finally take
the tests.
There were only a few very old computers at the school. In spite
of this, the Lenin team has won at the Computer Olympics. Each
student was given one pencil a month and textbooks have to be shared
among ten students. There were usually 33 students in a class. While
athletic teams for both sexes were very popular, sports equipment
was very scarce, and there was an enormous need for baseballs, bats,
and soccer balls.
As in the elementary school, the motivation and dedication of
administrators, faculty and students seemed superb. The principal of
the school has been there many years and was proud of his students
and his faculty, and very willing and candid to answer questions.
COMMENTS AND RECOMMENDATIONS
It was clear that the educational system was outstanding, given
the lack of equipment and supplies. No one has paper, so even if
there were Xerox machines, there would not be the possibility of
copying anything. We learned that there were special schools for
other subject areas, but it did seem that science and math were the
most competitive areas of the schools. Others outside the schools
talked about their own educational experiences and that of their
children. Though the classes we saw were mostly teacher led from the
front of the classroom, we were told that cooperative learning
exists and was very much part of the learning scheme.
In order to make any recommendations on educational philosophy
and pedagogy, one would have to spend much more time in a school
than we had during our visit. We have no recommendations to make on
a philosophical level. We do feel that these teachers and students
need to have adequate materials with which to work. We believe that
this country should contribute and coordinate efforts through an
international organization to get supplies and textbooks to Cuba.
Though class sizes were large, they were not any larger than in
many schools in other countries. The delegation congratulates the
Ministry of Education on the rate of literacy in the country (over
95%) and on the ability of teachers to teach and students to learn
in far from ideal situations.
[ top ]
Pediatric Health
and Adolescent Mental Health
“Cubans in their first year of life get medical treatment
like those in the First World. Those older, like 20-year-olds,
are treated as if they live in the Fourth World.” An anonymous
physician
HISTORY
Cuban health care is a system of free and accessible medical
attention for every citizen. Since 1992 the quality of their health
care delivery has been severely compromised by the fall of the
Soviet Union, the Cuba Democracy Act (CDA) and the Helms-Burton Act.
The CDA provides for the sale of food and medicines to Cuba, but
under conditions so strict as to de facto prohibit them. The
Helms Burton Act prohibits U.S. suppliers from attempting to trade
medical equipment with Cuba.
The country is still able to report some of the best indices of
health in a setting where obtaining the most basic medicines can be
a challenge. The Cuban government has made health care a nationwide
priority by increasing its spending from 10% of the GNP to 15%,
according to the Ministry of Health, since the reduction in Soviet
aid. Despite efforts to ration precious resources to the populations
most in need, Cuba suffers from a lack of food, medicines and access
to medical information. A unique dichotomy exists between a well
designed health care system, and a miserable scarcity of resources.
The situation demands a rereviewuation of the economic forces that
are compromising the health of the Cuban people.
CURRENT SITUATION
Despite an excellent infrastructure in place to provide health
care, which includes a surplus of educated doctors and accessible
providers, Cuban doctors have few pharmaceutical options for
treatment of diseases. State officials claim that they can access
medicines in moments of dire need. All the doctors, however, to whom
we spoke cited shortages of antibiotics, steroids (basic treatment
for asthma), chemotherapeuticals (for cancer), and technological
equipment. Because of the embargo, we were told, medicines cost
300-500% more than they would if they were directly traded with US
companies due to increased licensing and transportation costs. For
example, a drug called prostaglandin, a life-saving drug for newborn
infants with heart disease, costs about $50 per dose in the US, but
$250 in Cuba. Thus the government is not able to afford to keep
newborns with these conditions alive. The government demonstrates
interest to buy the medicines, but over 90% of all medicines
available worldwide are manufactured in the US, and the Cuban
economy cannot afford these costs. To control costs, Cuba has
learned to make its own medicines, and they are able to manufacture
92% of the medicines available within Cuba. Despite this, they
cannot make sufficient quantities, especially since they can no
longer obtain the raw materials from the Soviets.
Because pharmacies are bare, patients and doctors turn to
humanitarian donations for support, but this is a fluctuating and
unreliable source. One week a simple urinary tract infection may be
cured by outpatient management with antibiotics, whereas the same
disease a week later may be fatal. Likewise, the Helms Burton Act
prohibits the country from obtaining medical supplies and parts for
equipment. Some intensive care units are well stocked with many
ventilators, but they lack critical parts that cannot be replaced.
Children and adults cannot maintain adequate health in a setting
that cannot provide basic medicines. Cuba has many highly educated
doctors who want to help, but they are unable to practice the
medicine that they were trained to do. One doctor lamented “we are
able to diagnose most problems, but are powerless to provide the
simple medicine to help cure.”
Nutrition is another aspect of health that has been dramatically
affected by the Cuban Democracy Act. The Cuban government, unable to
trade with old allies or nearby neighbors, has responded to this
crisis by preferentially providing better quality food to those with
the highest need. For example, only pregnant women, breast feeding
mothers, and children under seven can get milk. Likewise, sources of
protein and iron are scarce, as their ration cards afford no red
meat or leafy vegetables, and contain little soy. According to
OXFAM, the average caloric intake has fallen from 3100 calories per
day to 1800 over the past five years. Furthermore, an epidemic of
neuropathy, with resulting temporary blindness, in 50,000 adults was
documented between 1992-3 that was due to a lack of B vitamins and
sulfur-containing amino acids. As Dr. Francisco Valdes Lazo, the
Director of Maternal and Child Health, bluntly stated, “the
country is starving."
Maintenance of a clean water supply has become a major problem.
The equipment used to chlorinate and purify drinking water is
breaking down for lack of spare parts which can only be obtained in
the US. The result is a marked increase in water borne diseases,
dysentery, parasitic disease and hepatitis.
Information is another scarce resource. Because of the profound
lack of supplies and its political isolation, Cuba cannot exchange
critical medical knowledge with the rest of the medical world.
Internet access, a standard of care in modern medical facilities, is
just being introduced in a few hospitals and polyclinics.
Distribution of internet access may be slowed by both dollar and
political reasons. Confounding the problem, Cuba lacks a fundamental
product -- paper — to print or photocopy materials. One doctor
showed a torn and faded document on Pediatric Intensive Care that he
claims doctors around the country beg him to borrow for one hour.
The doctors are isolated from new advances and experimental
therapies.
Conversely, the US and the rest of the world cannot benefit from
the knowledge and research the Cuban doctors perform. For example,
almost all Cuban babies are born in hospitals, and the placentas are
then used in experiments for therapies and medicines for skin
diseases, a technique not used in this country. This could provide
the medical world with valuable information. Also, at least 15,000
children from the Ukraine, exposed to radiation from Chernobyl, have
flown to Cuba to receive treatments for diseases ranging from
leukemia to vitilligo. The Cuban doctors have not been able to
publish any of this critical data, again because of a lack of
resources.
PEDIATRIC AND ADOLESCENT MENTAL HEALTH
The delegation visited the Adolescent Mental Health Clinic in
Havana, for children and teens. This self-standing facility
established in l975 is unique in Cuba, as mental health services are
usually attached to the pediatric/adolescent wings of provincial
hospitals. A plan for proliferating the Adolescent Mental Health
Clinic model in every province has not been realized due to a lack
of funds. The Clinic is an inpatient and outpatient facility, taking
cases from Havana and its immediate environs as well as difficult
cases that cannot be handled at the local level. While we learned a
great deal about the Cuban psychiatric system from the doctors at
the clinic, it should be made clear that we did not visit any other
facilities or investigate adult psychiatric care.
Although there is a deep knowledge and respect for Freud and
other prominent theorists, the philosophy informing child and
adolescent mental health is largely practical, eclectic, and quite
sophisticated in its varied approaches. The Cuban system, as we saw
it and heard it discussed, can be described as community psychiatry
at its best. The Mental Health Clinic we saw is inventive and
adaptive with the treatment it offers. Both individual and group
therapy, as well as drug therapy, are used. In addition, academic
tutoring and parent counseling are generally included in each
protocol. The Clinic is highly attuned to learning disabilities and
sees a child’s mental health as closely tied with how he or she
performs in school.
The Clinic cultivates a comfortable and caring atmosphere.
Children’s artwork is hung on the walls. Music and sports programs
supplement treatment. There are no locks on the doors. Staff,
parents, and patients show kindness and respect to one another. The
three professionals we met, Drs. Frank, Resell and Gutierrez were
open, intelligent, and clearly devoted to their work. Visits to
schools and inclusions of other community support systems are
common.
In the inpatient facility, there are twenty-four beds and
twenty-four day beds. Fifty patients can be accommodated during the
day, but only twenty-two at night. Parents sleep in rocking chairs
next to a child’s bed. The average inpatient stay is 45 days.
There is a comprehensive 24-hour intake process, with a professional
on site at all times.
With outpatients, the staff of the clinic works in teams,
assigning a doctor, a social worker, and teachers to a case. A team
approaches a case multilaterally, combining nursing, occupational
and rehabilitation therapy, neurophysical examination and treatment,
alternative medicines, and speech therapy, when needed.
Throughout the Cuban system, work with parents is deemed critical
and is a core treatment support. The doctors we spoke with were
quick to cite a recent research project in which three treatment
methods were studied: working with a child in isolation, working
with parents in isolation, and working with parents and children
together. The final group had the greatest rate of success. At the
clinic, parents are required to accompany their child through the
outpatient and inpatient process. (It should be noted that any
parent of a hospitalized child is paid the his/her employer to take
time from work to be with the youngster.) Social workers also work
with patients beyond the walls of the clinic. They travel to a
patient’s home, school, neighborhood, and to the work center of
the patient’s parents. These outreach efforts on behalf of
families and treatment providers form deep connections between them,
which is extremely beneficial to the child under their care.
Knowledge of psychopharmacological treatment is very
sophisticated among the clinic’s staff. Everyone, however, we
spoke to was frustrated by the devastating lack of access to
medications and current research. There are no medicines such as
Prozac or Zoloft. Ritalin, Dexedrin, injectable valium, and
anti-psychotics are unavailable.
Everyone we spoke with at the clinic felt that the stress of the
economic situation in Cuba was contributing to greater familial
stress and more mental health problems among children, adolescents
and families. Low salaries, poor living conditions, and difficulty
of transportation all put pressure on parents that is easily
projected onto their children. Divorce and alcoholism, both
associated with economic stress, directly affect the mental health
of children and teenagers, and are on the rise.
Many types of pathology seen at the clinic are indicative of the
economic hardships faced in the country. Depression, conduct
problems, prostitution, and teenage alcoholism are all on the
increase. These social disorders are treated with a community
approach, involving a patient’s parents, school, and neighborhood,
but one can see the beginning of a crumbling of the community/family
as the economic pressures increase.
COMMENTS AND RECOMMENDATIONS
In sum, Cuba, like no other country in the world, lives under
such restrictions against medicines and food, even Iraq, an openly
aggressive country with weapons of mass destruction. The other major
communist country, China, enjoys an extraordinary trade with the US.
Cuba poses no credible threat to American security or American
interests. American actions, inappropriately continued from an era
of rabid anti-communism, are causing severe human hardships in Cuba.
There must be an end to the Cuban Democracy Act for humanitarian
reasons so that Cubans can access adequate goods, medicines and
medical equipment to end this hardship. Furthermore, scientific and
cultural exchanges need to increase to provide an international
understanding of the country and the scientific knowledge Cubans
have to offer. Finally, because the future health of the population
is precarious, we recommend continuous observations of indices of
mortality and nutritional status.
The professionals met at the Adolescent Mental Health clinic were
highly motivated, intelligent and dedicated individuals who espouse
a multifaceted, sophisticated approach to child and adolescent
mental health. Unfortunately, the economic conditions have made it
extremely difficult to implement the mental health system to its
potential. A lack of access to medication, research, and basic
materials like paper and bed sheets, as well as exceedingly low pay
for professionals have all been damaging. Lifting the embargo would
not only allow for the trade of materials, but of intellectual
currency as well. There are many ways mental health professionals in
our country can support the Cuban mental health community and much
that our mental health professionals can learn from their Cuban
counterparts.
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Non-Governmental
Organizations (NGO’s)
We were interested in visiting those non-governmental
organizations, both indigenous to Cuba and those whose funding comes
from outside Cuba, to assess the type of services available to women
and children.
Non Cuban NGO’s are seen by the government as a threat and a
way to undermine the political system if they have as a stated
purpose to develop civil societies, a very common goal of many
NGO’S. Thus, foreign NGO’s must tread delicately in their work.
They are not encouraged to have conferences together, nor was there
much provided them in the way of offices and staffs. Health service
NGO’s, for example, must not be too narrowly focused in their
approach, but must be general and in compliance with State
initiatives.
HISTORY
One of the oldest Cuban NGO’s is the Federation of Women,
founded in l960 to involve women in the revolution, funded by the
State. It was to be the channel to have women considered at the
highest levels for their economic and political considerations. We
were told that the Women’s Federation was the voice for the
struggle for women’s equality, and while it has not produced a
perfect product, it was one that was just.
“Women comprise 40% of the labor force in Cuba, 27% of
parliament, 30% of the leadership in labor, and 65% of the skilled
labor force,” said the director of foreign relations at the
Federation. Women are charged $.25 per month to belong to the
Federation. In addition to its political role, the Federation helps
women with family and social problems.
CURRENT SITUATION
In 1990 the Federation began a series of community centers,
called Houses of Guidance for Women and Children. They provide legal
and social services for women and training, but are not battered
women’s facilities, which don’t exist. They are staffed largely
by volunteers in the community. A visit to one found the disconnect
surprising between what the expressed philosophy is behind the
centers, and the reality of the situation. All teaching is
theoretical, for example, and done without supplies. Computer skills
are learned not on computers, but from instructions written on
blackboards.
The delegation was told that a group of young women had come to
learn better grooming and hair-dressing skills for their own
edification. The women, however, told us they were really there to
learn to do hair-dressing and fixing nails from their own homes as
quiet and small businesses.
CARITAS CUBA
Caritas Cuba is one of the most influential and effective of the
local NGO’s. It exists in 3000 communities with as many volunteers
from its Catholic Bishops Dioceses, and has a working staff of 30
full-time personnel. It distributes $4- 6 million a year in
humanitarian aid which comes from Catholic Relief Services in other
countries, particularly the US. Caritas works carefully through the
Ministry of Public Health which warehouses its donated supplies,
doesn’t tax them, and delivers them where Caritas instructs.
Caritas helps rebuild houses damaged during hurricane
emergencies, and helps rehabilitate farm lands. Caritas also
develops services for the elderly, and collaborated with government
programs for a “Slips and Bloomers” program to provide
undergarments, a program which can be used to assess other needs of
the elderly.
Because of crowded living conditions, children are often left to
the streets to play and socialize. NGO’s cannot work inside the
schools, nor can avowed Catholics teach in schools. Caritas has
started after- school programs for 5-12 year olds. They also work
with women on sewing projects, despite a pitiful lack of supplies.
Caritas was proud to report that it will receive 72 boxes of
baseball equipment from the Baltimore Orioles, but will have to
negotiate with the ministry for distribution of this much needed
equipment.
“For NGO’s to be successful in Cuba,” said Rolando Suarez,
the director, “they must make decisions based on a knowledge of
Cuba.”
HEALTH/AGRICULTURAL PROGRAMS
A new NGO with just such a knowledge base is MEDICC, Medical
Education Cooperation with Cuba, a program of the American
Association for World Health. As of April, l998, MEDICC has begun to
offer US medical students the opportunity to team up with Cuban
health professionals in direct contact with patients. Courses are
also offered for graduate students in Public Health and Midwife
Practitioners.
OXFAM US, Canada and UK has a presence in Cuba with support to
Cuban groups actively engaged in organic methods of food production.
It also promotes urban rehabilitation and development through
community initiatives and the use of sustainable and ecological
approaches to food production. One sees lovely urban gardens
flourishing throughout Havana and many of these have been funded by
OXFAM’s efforts.
UNICEF also walks the fine line to cooperate with existing
governmental programs. It is heavily involved with water
purification projects, which is also a high priority of the Ministry
of Public Health. Two thousand rural communities have either
obsolete or non-existent water systems, and water is delivered by
the State in trucks. UNICEF has partnered with the State to develop
a National Hydraulic Institute which provides a simple technological
system of PVC pipes to get underground water at low cost. An
installation for more than a thousand people costs only $8-9
thousand for a complete water system. UNICEF also provided two
desalination programs in Guantanamo and Bayamo.
In addition UNICEF created a major program to encourage
breast-feeding and is also a major supplier of the twelve required
vaccines for infants and children. UNICEF is also trying to expand
the internet system called Infomed to outlying areas for much better
communication by and training of medical personnel.
“A strategic target of all UNICEF’s”, said its director,
Luis Zuniga, “is not to be only around with material things, but
with ideas.”
COMMENTS AND RECOMMENDATIONS
NGO’s are an effective and efficient source of supplies,
training and a link for Cuba for grassroots development
methodologies. In order to continue to help the people of Cuba in
their daily struggle, effective NGO’s such as Caritas, UNICEF, and
the new work of the Fundación Amistad must be supported and funded.
Links need to be made between NGO’s to streamline efficiency
and increase communication about findings to develop new programs
and enhance existing ones. Simple gatherings of like-minded NGO’s
to exchange information would be a first step.
Congress has two bills in process which would lift the ban on the
sale of US food and medicine to Cuba. We
Most are young women who hold regular jobs during the day, and
who desire visits to nightclubs, gifts of clothes, drinks, food and
access to restaurants, which otherwise are inaccessible to Cuban
citizens, male or female. Many of the prostitutes are under sixteen.
Some are encouraged by their families in their pursuits, even to
marry foreigners. Such marriages must be made with the assistance of
the state which charges a fee for each ceremony performed.
Prostitution is not illegal in Cuba through recently, pimping as
well as less formal encouragements to prostitution have been made
illegal.
RECOMMENDATIONS
With the increase in tourism to Cuba, there will be more of an
opportunity for small, women-owned businesses to produce and sell
products and services with great success. Enterprises such as
hairdressing and baking not only require few resources and
elementary training, but they are also occupations well suited to
women of all ages and various family responsibilities. Supplies
should be made as widely available as possible.
The importance of sports to develop girls as confident, healthy,
equal members of society is well known in the US. Many people in
Cuba explained that there is a lack of organized activity for
children beyond the school day. While baseball is the national
sport, it is predominantly for boys, as is soccer.
There are many “girls” sports which require little space and
equipment such as double- dutch jump roping, cheerleading, dancing
and running. Such sports have a beginning, middle and end each year
and require little in the way of resources. Local NGO’s already
initiating such programs should be supported.
There is an intellectual isolation in Cuba due to a lack of books
and paper with which to publish. Libraries have hourly lending
limitations. Only one or two copies of a particular book exist in
the entire country. The delegation urges a greater supply of books
and journals to be sent through the University of Havana.
Create a Journal of Cuban Women’s issues. Follow the US law
journal format, where students apply and are selected to become part
of the journal staff. Duke University or other university students
could select articles (from a pool submitted by both Cuban and
non-Cuban women), assist in the editing and fact-checking process,
publish and market the journal.
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Next Steps for
Fundación Amistad
As a result of the delegation’s observations on its trip, the
Fundación Amistad recommends the following as opportunities for
additional support of the women and children of Cuba.
- The United States government increase educational and
professional exchanges between the United States and Cuba.
- A symposium in Cuba with day care directors, providers and
other educators in early childhood education.
- A symposium of elementary and secondary school teachers
and administrators with a particular emphasis on literacy
and successful teaching methodologies in each country
- Cuban physicians and psychiatrists, though well trained,
lack access to the latest research and new techniques in
their fields. Greater interaction with their US colleagues
will permit them greater access to such research. Conversely
because of the economic limitations in Cuba on publishing,
Cuban medical personnel can share their research with
interested colleagues from the US.
- Meetings between child and adolescent psychologists and
educators to exchange research and techniques for community
involvement.
- Private entities in the US create links between Cuban
and US organizations designed to foster greater understanding
and appreciation of each country, and to provide humanitarian
aid.
- Find and encourage organizations to provide basic
necessities for Cuban day care programs such as books,
crayons, clothing, developmental teaching aides, and
children’s medicines.
- Develop programs with private schools and organizations to
“adopt” individual day care centers, primary and
elementary schools for close, one-to-one links to do book
drives, special supplies fundraising, and other needed
tasks, as requested by the Cuban individual schools and
centers. The could be a model program for many cities
throughout the US to adopt with rural areas of Cuba, as well
as Havana.
- Support increased levels of humanitarian contributions of
medicines for hospitals and policlinics for greater
accessibility by family doctors. This will also minimize the
unpredictability of medicines needed by supplying those that
are basic and in constant demand.
- Develop a program with William Soler Pediatric Hospital to
support its creation of a pediatric neonatal intensive care
unit. And link organizations to this hospital to provide
basic necessities for children: bedding and pajamas. Create
a “Sabanas Y Pajamas” program.
- Continue to encourage, support and recommend increased
financial support to those many effective nongovernmental
working in Cuba such as CARITAS, UNICEF, OXFAM, MEDICC and
others. .
- Create additional Study Abroad programs with US
Universities.
- Create exchanges of art exhibits, seminars about the arts,
dance, music and literature
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Persons and Places in Cuba
Cuban Federation of Women
The House for Women and Children
Gonzalez Coro Hospital
Policlinico 5th de Septiembre
William Soler Pediatric Hospital
Hospital Hermanos Almejeras
Adolescent Mental Health Clinic
Dr. Elsa Gutierrez
Dr. Michelle Frank
Dr. Jose Baudillo Jardines, Vice Minister of Public Health
Carlos Fernandez de Cossio, Foreign Ministry (Minrex)
Círculo Infantil: Sueños del Che Daycare Center
The Lenin School for Science
University of Havana: Women’s Studies Program
Dr. Jose R. Mendez
Dr. Marta Nunez
Dr. Alberto Prieto
Escuela Hermanas Giral
Elsie Casaros, Director
Ester Hernandez, Subdirector
MEDICC
Gail Reed
OXFAM, CANADA
Martha Thompson
CARITAS CUBA
Rolando Suarez, Director
UNICEF
Luis Zuniga Zarate, Director
United States Interest Section of the Embassy of Switzerland
John S. Boardman
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