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Cuban Health Care: Rutgers Students Witness a Different Way to Serve Patients

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Students in front of a health clinic they visited in Cuba.

A group of Rutgers students spent four weeks this summer experiencing the complexities of life in Cuba – a country with an underdeveloped economy but highly effective health care system.

They went door to door with a doctor in Havana who checked Cuban residents for signs of dengue fever, and instructed them to eliminate any standing water – the breeding ground for mosquitos that spread the disease.

The students observed the country’s maternal care as they assisted a doctor who delivered medicine to patients who were pregnant and questioned them about their health. They participated in an exercise program for senior citizens and helped distribute condoms and literature to the transgender community in the most popular gay nightclub in Havana.

For the 10 mostly public health majors who explored a country that has been economically and diplomatically closed off from the United States for decades, traveling to Cuba gave them a chance to witness a dramatically different way of caring for people through a system of socialized medicine.

“It was a great opportunity to see a free system,’’ said Connie Villanueva, a fifth-year public health major from Burlington. “Money is such a big issue when you deal with your health care. Instead of focusing on the money I think we should focus on health and start from there.’’

The experience was part of a service-learning course to study health and wellness in the isolated Communist country offered for the first time by the Center for Global Education (CGE) at the Centers for Global Advancement and International Affairs (GAIA).

Rutgers is joining a wave of universities developing programs in Cuba since President Obama relaxed academic travel restrictions in 2011. Rutgers University-Camden already has an ongoing relationship with the University of Havana and sent 25 students for a two-week service-learning course the year the restrictions were lifted. Rutgers University-Newark offers law students a weeklong educational visit to Havana to learn about Cuba’s legal system and career prospects.

Elizabeth Amaya-Fernandez – a health education specialist with Rutgers Health, Outreach, Promotion and Education (H.O.P.E.) – worked with GAIA to design the six-credit course. She wanted to develop a program for students in Cuba ever since she completed her graduate work in Havana nearly 15 years ago. The relaxing of travel restrictions finally made it possible.

She became interested in Cuba while she was working on a master’s degree in public health at Tulane University and learned its health-care system is considered one of the best in the world.  Despite the country’s limited economic development, average life expectancy in Cuba and the United States are virtually identical – 78.7 years in the U.S. compared to 78.3 years in Cuba.

Photo: Courtesy of Connie Villanueva; Elizabeth Amaya-Fernandez (center) with the students in front of the National Cathedral in Havana.

The socialized health care system in Cuba is built on a foundation of prevention and education to provide care to all its citizens. Family doctors live in neighborhoods and visit residents in their homes. Urgent care centers and hospitals provide additional levels of care.

“I think we are very ethnocentric and believe that because we are Americans we have all this to teach,’’ Amaya-Fernandez said. “I think it is important for students to understand that we can learn a lot from other countries.’’

But organizing the service-learning trip to Cuba involved several challenges. Rutgers holds an educational general license through the U.S. Department of Treasury, which permits the university to send students and faculty to Cuba for academic travel. But the U.S. embargo that has been in place since 1960 forbids Americans from spending money in Cuba – making travel complex.

Students are normally required to arrange and pay for their own airfare for study abroad programs. However, independent travel to Cuba is not permitted from the United States, so the Center for Global Education had to work through an authorized travel provider to organize group flights, as well as to legally make payments to the host institution in Havana, explained Gregory Spear, service-learning coordinator at the center.

The National School of Public Health in Havana hosted the students during their trip. They started each day with morning lectures in Spanish from local faculty members, and spent afternoons in the field with health professionals to see the different aspects of care firsthand.

The students also experienced some of the challenges of a country that suffers from a lack of resources – partially the result of the embargo that prevents Cuba from trading with the United States.

Victoria Ramirez, a fifth-year student from Leonia majoring in public service at Rutgers University – Newark, said she found basic hygiene amenities like soap, toilet paper, toothbrushes, mouthwash and floss hard to find. And although the country has an aggressive sexual health education program, Ramirez learned through a conversation with a shopkeeper that there was a shortage of condoms in Havana.

But she was also impressed by the personal care in the country, that doctors visited patients' homes and health care services were available to everyone for free.

“A lot of people in the U.S. don’t go to do a doctor until they are sick and that creates a lot of problems,’’ Ramirez said. “The prevention and promotion they have in Cuba is what we need over here. It is hard to do preventative care in the United States when care costs money.’’

The experience made an impression on Ramirez.

“It is important to change our health care system so all people can be healthy,’’ she said, “not just people who have the money to be healthy.’’

Amaya-Fernandez had a similar reaction working in the Cuban health care system as a graduate student. She said she believes in “health care for all’’ as a result of her experience, but that was not necessarily the message Amaya-Fernandez was trying to instill in the students.

She just wanted to challenge and broaden their way of thinking.

“It’s humbling to see how much you think you know and to see there is so much more out there,’’ Amaya-Fernandez said. “Whether they think it is a great system or they think it is failing, I hope this spurs students to want to learn more and see how they can contribute to their communities here.’’