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Hi Everyone, I know no one posted much this last semester, but I decided I wanted to try to get this HCSC site going again.

This slide show was my final project for a photo journalism study that I did while studying in Havana, Cuba last fall. My focus was on primary care doctors and how they perceive the Cuban health care system. I conducted interviews with about ten doctors, most extensively with two women who worked at a walk-in community clinic in down town Havana. This little clinic wasn’t very well equipped, but the doctors were very caring and interesting.

As an American, the macro organization of their primary health care system was fascinating. Primary care doctors are assigned a geographic area - two city blocks in this case. They had the name and address of each person in their area (from government tax info), and they were expected to care for all those people. From 8:00AM to about noon each week day they would see patients in the clinic, and after that they would go from house to house to try to find people who might need their services but that hadn’t made it to the clinic. In Cuba, it is the doctors responsibility, rather than the patient’s, to see that everyone gets cared for. Ultimately, I think this take on community medicine, where responsibility shifts towards those who are most likely to be able to cope with it, is the reason Cuba has better health indicators than the US despite drastic resource shortages.

I hope the pictures are interesting, and I’ve posted a few more to our flickr account if you’d like to look deeper. You are also welcome to read my imperfect paper or contact me at isaac.holeman [at] gmail [dot] com if you would like more of the juicy details.

cheers

Isaac

Photo by Isaac Holeman
One of the reasons we switched the HCSC site to a blog format is so everyone could share stories while they are abroad. Right now I’m studying in Havana, Cuba. My program here revolves around learning Spanish, exploring Cuban culture academically and as a participant, and pursuing an independent photojournalism project. I’ve chosen Cuban Health Care as the subject of my journalism project. Just a few days ago, I was interviewing a prominent Cuban actress and her words struck such a chord with me that I’d like to share them with you.

“I want to tell you a personal story. I am a cancer survivor. I was diagnosed in 1992; I had an operation, they did chemotherapy and gave me a medicine called tamoxicin. 1992 was in the Special Period, during which we had nothing. I don’t know why they call it the “Special Period”. “Special” usually means wonderful. But no, it was horrible. Horrible. You guys don’t know the meaning of “nothing”. Sometimes we ate just white rice with oil. And my husband, who is North American, never called his mother to tell her “Mom, we have no money, we don’t have shoes.” Never. He said, “I chose to live here and my problems are my own.” So in ’92 the food ration was minimal.

When they operated on me, all of my coworkers gave me their rationed fish, their rationed chicken- protein so that I could get better. This is worth it. This is worth so much more than money. And I got all of my medical care for free. When I was in the US I had a friend who had terrible cancer and the chemotherapy cost her so much she couldn’t pay for it. The tamoxicin was costing her $499 a month. I took it for ten years for free. I have never had to pay a cent. And now they have me on a drug that costs $800 a month and I couldn’t live without it. So of course there are things that are worth it. There are good things that are worth fighting for.
Nobody has to say “I’m going to die because I can’t pay.” How awful for someone to say “I won’t get treatment because I can’t pay.”And that the US, such a powerful country, doesn’t have a medical system that can take care of the health of its people, well that’s terrible, no?

I know that Cuba has a lot of problems. Tons. I never, ever said that Cuba is perfect. I’m not religious. I don’t believe in perfection. I believe that all human beings have to fight to make life better. This I believe in. And I believe that people are good. And you can’t convince me of the opposite.

I believe that Cuba has achieved a crucial social interaction. We help each other out- everyone. We share, we lend each other clothes. I don’t have much. But if someone needs something I’ll give them everything I have. We have learned in the way to be more human I believe. We know that we have to help everyone and not just ourselves. I think that his has helped Cuba a lot. This is the truth. We have learned that people are different for different reasons, not for racial reasons or religious or sexual. We are more than just that. And these are values that I hope we don’t lose to materialism, this is the spiritual material that we have to fight to maintain. These are so much more important than material values. And I understand material values. I love things, I love them. And I think it’s pretty important to have something to eat, too. But you have to fight more for those spiritual things- the things you believe in.”

Health care in Cuba is far from perfect. The whole country is so poor that they don’t always have money to buy the more expensive drugs, and tourists do get preferential treatment. At the end of the day, however, the structure of their health system says that they have figured out that the people - every last one of them - are the most valuable part of their society. Life in Cuba is imperfect, like life in the US is imperfect, but there are so many things worth fighting for. For example, lets all fight to build a society where “nobody has to say ‘I’m going to die because I can’t pay.’”

Check out my blog if you would like to read more.

cheers

Isaac