Two Minnesota psychologists were in Havana, Cuba, with wives, to learn about how Cuban psychologists are trained and practice in the Cuban health care system. We were scheduled to meet with 25 leading psychologists and psychiatrists at a Cuban cultural center near the University of Havana, and were eager to meet our hosts and the group. We had three boxes of textbooks and professional supplies donated by Minnesota colleagues, and had been looking forward to this event for months.
We had a major problem, however. We had been asked to be at the Quinta de los Molinos Cultural Center, at 9:00, with the meeting to start at 9:30. Our cab took us to a building that did not look very much like a cultural center, but it was right by the campus and there were obviously many students bustling in and out of the building. We paid the driver, set up a plan for him to pick us up in a few hours, picked up our boxes of books, and began looking for our hosts.
We quickly noticed that everyone wore a white medical coat, which did not fit with what we knew about Cuban mental health professionals (they prefer casual and comfortable attire). And, there was a strange racket coming from the building- it sounded like a LOT of dental drills. In fact, it sounded like a sound track to a nightmare about having all of your teeth drilled all at the same time.
We quickly learned that we had been taken to the U. of H. Dental School, the dental students and professors did not speak much English, did not recognize the names of our hosts, and they had no idea where our meeting was located. It was 9:15 and we were in trouble!
This project had many ups and downs prior to this crisis. My colleague, Scott Kamilar, Ph.D., and I had worked hard to set up a US State Department-compliant “person-to-person” trip to meet with Cuban psychologists. I began the project by doing an Internet search on options for Americans to travel to Cuba. There are two State Department-compliant options. The most common is to travel with an organized group using a travel agency that is licensed by the State Department for travel to Cuba. These trips are, however, expensive, usually starting at $5,000 per person. APA has organized two trips like this, in 2012 and 2014. See the end of this article for information about an interesting trip that APA is currently offering, which is priced very reasonably.
There is another option, which was our preferred choice, which is to set up your own person-to-person itinerary following State Department guidelines. I searched online for information about American psychologists, or mental health professionals, traveling to Cuba independently. I was able to locate only three independent mental health Cuban outreach projects. A Canadian psychologist visited Cuba on his own in 2013. His blog article about his experiences provided helpful information about what to expect in Cuba, but obviously did help with how to get there, as Canadians can visit Cuba without restrictions. A group of US counselors – not psychologists- visited in June, 2015, but apparently used a (prohibitively expensive, for our group) US State Department-licensed travel agency, and focused more on missionary work.
The third one was much more of what we were looking for- a psychologist from Atlanta, Georgia, Howard Drutman, PhD. organized a trip for a group of professionals specializing in child custody cases, including a judge and lawyers. Their activities included a meeting with psychologists and students at the U. of Havana and social gatherings with Cuban colleagues. They were warmly received, had a wonderful time, and could not wait to return. Their group also used a State Department-licensed travel agency, but Dr. Drutman’s blog posting provided much helpful information about independent professional outreach options, especially with the Psychology Program at University of Havana.
We decided to try to set up our own person-to-person trip, in compliance with State Department regulations, using Dr. Drutman’s information as a template. He had worked with Miguel Angel Roca Perara, Ph.D. and Alexis Lorenzo Ruiz, Ph.D., both on the faculty of the U. of H. and leaders of the Cuban Psychological Society, but I could not locate any contact information for them.
The next step was to research the Psychology Program at the U. of H. The U’s website is in Spanish, but could be translated by Google. I eventually located an email address for a U. of H. staff who handled what sounded like exchange programs for “Caribbean, South American and North American countries.” I sent her an email explaining my proposal: to set up meetings with staff and students to learn about how Cuban psychologists are trained and how they are integrated into the Cuban primary care system, to have small group meetings with psychologists, and to bring donated books and professional supplies to support the U. of H. p sychology program.
We had high hopes for a response…and heard nothing for two weeks. I sent another email, this time in Spanish, thanks to Google Translate. Again- no response. Now we were starting to get worried. We had already enthusiastically, but perhaps unwisely, purchased a travel package from Air Canada Vacations and our departure date was Feb. 8, and it was now early January. I did deeper research, and located the phone number for what appeared to be the office of the U. of H. Graduate Psychology Program. I had begun to study Spanish, and anticipated that the person who answered might not speak English. I wrote myself a script of what to say in Spanish, called the number, a very young sounding woman answered and, in response to my request in Spanish to speak with someone who speaks English, she said, simply, “No” and hung up.
I did yet some more online research, and was able to locate the name of the Rector of the U. of H. Graduate Program in Psychology, but, once again, there was no contact information. Feeling increasingly desperate – our departure date was now less than 4 weeks away- I did an Internet search on his name, and was thrilled to find that he is on Facebook! His page even identified him as a faculty member of the Psychology Program at the U. of H. I promptly sent him a message via Facebook, with high hopes that this would be our break through- and again got no response.
Our situation was now offically dire. I wrote Dr. Drutman and basically pleaded, “I know you don’t know me, and I know that you had a great experience in Cuba – can you please, please help us out with contact information?” Howard responded promptly and enthusiastically. This turned out to be the breakthrough that we needed. He, understandably, needed to vet our group. We had a long phone discussion and at the end he collegially offered to contact Drs. Roca and Lorenzo to see if they would consider my proposal.
Dr. Roca responded with a welcoming and warm message, and things quickly started to fall in to place. It was the break that we needed! Drs. Roca and Lorenzo are both on the faculty at the U. of H. Dr. Roca is the Secretary of the Scientific Council of the Faculty at the U., Vice President of the National Court of Scientific Degrees, and is President of the Section of Clinical Psychology of the Cuban Society of Psychology. Dr. Lorenzo is the Research Project Coordinator for Psychological Health and Welfare at the U., President of the Cuban Psychological Society, and President of the Intercontinental Convention of Psychology – Hominis 2016. We clearly were fortunate to, thanks to Howard, be connected with such highly regard Cuban colleagues. They quickly became our new friends Miguel and Alexis.
I immediately learned that we could not do anything that involved the U. of H., as this type of activity must be cleared by the Cuban authorities (Cuba is still an authoritarian state) and this takes at least three months This may be why my naïve email messages to the U. of H. were ignored- I was not going through the proper channels.
Alexis was, however, able to set up the gathering at the Quinta de los Marinos center, under the auspices of the CPS. Also, Miguel and Alexis were very receptive to our idea of bringing donated books and professional supplies. Thanks to the generosity of Minnesota colleagues, we checked three boxes, weighing a total of almost 150 pounds, on our fight to Cuba.
We had yet another anxious moment, however, upon our arrival at Cuban customs. The two customs staff, who appeared to be about 18 years old, looked very concerned when they learned that we had a large number of books to declare. They called for a supervisor, who looked about 21, and in a very officious manner he directed his young assistants to put on latex gloves and examine every book. They appeared to make a show of doing a very thorough examination – slowly flipping through every page, turning each book to look at the front and the back, and examining the binding. Meanwhile, the Minnesota visitors put on an exhibition of smiling, being relaxed and friendly, and ignoring the fact that we had a bus waiting to take us to our hotel, and everyone else from the flight was long gone and we had no idea whether the bus would wait for us.
Eventually, the supervisor seemed to get bored, and signaled that his staff could discontinue the search- for what, it was never clear- and we were free to go. The bus was still there, we piled on, and we were in Cuba, with the books and a full schedule of meetings and cultural exchange activities for the week!
But, to get back to our situation at the dental school, we had 20 minutes until our most important meeting, communication with the dentists and students was challenging, we had a background rukus of dental drills, and nobody could tell us where we needed to go.
I flagged down a cab. Cabs in Havana range from really cool old cars in pretty good shape to some that are barely working. It took me about five minutes to flag down a cab, and I did not have a choice about what we got. It was a 60 year old Toyota delivery van that had been converted into a passenger vehicle, and it was a wreck. The engine had barely enough compression to function and the clutch slipped out of gear periodically. The driver was young, spoke very little English, and ate a sandwich during most of our time were with him, but seemed sympathetic to our need to get to a very important meeting, pronto.
For the next 10 minutes we roared about the neighborhood – as much as a 60 year old vehicle with very low compression and a failing clutch can roar- and asked three different groups of people for directions. Our driver finally talked to a group of students who huddled with him for several minutes, passed around the message with the information about the meeting, and after much conferring they concluded that the our destination was a building in a park about ½ block away!
The cab driver rushed us, as best he could, to the entrance to the entrance to the park. Miguel and Alexis were standing on the sidewalk, looking more than a little worried, and everyone was glad when we piled out of the jalopy with our boxes of books, laughing and exclaiming in English and Spanglish, “We’re here!” It was 9:30 on the nose.
25 Cuban colleagues had gathered to meet with us and discuss how psychologists are trained and integrated into the Cuban primary medical care system. A child psychiatrist began the discussion by describing how psychiatrists value the skills of psychologists in medical settings. The group reported that this had not always been the case, and psychologists had worked hard to expand their skills and to gain the trust of physicians. They now, however, are clearly valued members of the primary care team.
We learned that the Cuban medical system has three levels of care:
- Primary care clinics, located in the community. Each clinic serves 100 families and is staffed by a physician and nurse. The staff may live in apartments in the clinic, or may reside in their own home. The preferred model is apparently for them to sleep on site. The clinics are open for routine appointments during normal business hours, but people may come to the clinic for urgent care at all hours. The clinics do not have psychologists on site, but have a protocol for calling a psychologist in for consultation if needed, and apparently psychologists are nimble and able to get to a neighborhood clinic promptly. We had the benefit of meeting Alexis’s family at another gathering, and his wife is a physician who works at a neighborhood clinic. We learned a lot from talking with her about her role in the medical system and how psychologists are valued by their medical colleagues.
- Secondary medical centers. If the neighborhood clinic is unable to meet the patient’s medical needs, the patient is referred to a higher level of care at a regional medial center, also known as a “polyclinic.”
- Tertiary care. The highest level of care is provided by specialized institutes. For example, while traveling around Havana, we saw institutes that provided, exclusively, maternity, orthopedic, dental and ophthalmology services.
We also learned that there is no independent practice of psychology in Cuba- all psychologists are required, by law, to work for the State. When they complete their graduate program they are assigned a job placement for three years, which is considered to be a “social service” placement. They are then free to choose where to work within the Cuban health care system, either providing more traditional psychology services or health care services. Many of the presenters at our gathering provide interprofessional consultation services, and work closely with medical colleagues. We learned the largest psychiatric hospital in Cuba, Hospital Universitario Psiquiátrico de La Habana, has over 1,000 beds and has 32 (!) psychologists on staff. The premier Cuban geneneral hospital, University Hospital “Hermanos Ameijeiras”, has a program that provides psychological services for the cancer patients and families 24 hours per day.
As a result of being highly integrated into the care teams, psychologists are viewed by the Cuban population as a valued member of their medical team. There is less stigma to seeing a psychologist in Cuba than is typical for average American medical patient.
Finally, we also knew from previous research that psychologists are paid the same as everyone else in the Cuban socialist system- about $20-30 per month. Therefore, if you eat at a nice paladar (a “private”, non-government restaurant), your server may be a moonlighting psychologist, or other professional.
Howard had written about the warmth and generosity of Miguel and the others he met on his trip, and predicted that we would have similar experiences. We found our Cuban professional colleagues to be, as predicted, welcoming, warm and generous with their time. We also had a wonderful informal gatherings with Miguel and Alexis and their families. Our time with the Roca and Ruiz families exceeded all expectations, and was very special. Miguel and his wife Idena grilled part of a pig, Cuban style, and provided a bottle of Havana Club rum for our gathering. Alexlis and his family gave us a personal tour of Old Havana and we shared a wonderful meal at an elegant hotel.
We now feel that our families are all friends and look forward to returning to spend more time with them. We look forward to a thawing in US-Cuban relations that will enable them to visit our homes and offices in the US. We aspire someday to host a gathering on our deck in South Minneapolis, perhaps with gourmet brats and some Surly beer for our Cuban friends.
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