Trainee Report – Cuba Exchange 2014

A number of trainees from the University of Leicester Doctorate of Clinical Psychology were offered the opportunity to complete a placement in Cuba. Here is the first of their reports on the experience, written by 2nd year trainee Mandy Underwood.

Image1The sunshine greeted us warmly in Havana and the sight of all the old cars was a great introduction tImage2o a fascinating country.  We had a brief experience of the hustle and bustle of Havana before travelling to Camagüey by coach.  A whole coach for the six of us.  On the long nine hour journey we passed many people waving their money at the coach driver to try and get a lift, as well as national transport buses that were jammed full of Cubans.  Feelings of guilt began to creep in as I thought about the relative luxury in which we were travelling and living compared to the Cubans, a common theme throughout our trip.  My favourite sight of the journey however was watching someone walk a pig down the road, not something we see every day in the UK!

I felt immediately drawn to Camagüey and was blown away by its simple beauty – colourful buildings, picturesque churches, quaint windy streets and vibrant town squares where the locals hang out.  Camagüey celebrated its 500th year anniversary the weekend before we arrived and has been significantly renovated over recent years in an effort by the government to promote tourism and generate income.  This got me reflecting on the difference a pleasant environment makes to our day to day feelings.Image4

Whilst in Camagüey we visited the Children’s Hospital, a polyclinic (for more standard treatments developed to take the burden away from hospitals), a family doctor’s surgery (with live-in doctor and nurse), an inpatient maternity home for struggling mums-to-be and an equine therapy centre.  When we visited the oncology department of the hospital, doctors explained with frustration that it was not always possible to obtain the required medication due to the US embargo.  It seems incomprehensible that such a political decision taken decades ago is still causing problems for Cubans today.

I was impressed by the family doctor who knew all of her patients personally and visited each one at home at least once a year.  The fact that it was not even necessary to have a sign outside the building identifying it as a doctor’s surgery suggested to me a lot about the community the doctor was a part of.  The equine therapy centre for children with developmental disordeImage5rs, learning disabilities and neurological disorders as well as physical health difficulties was a great example to us of how different types of therapy could work well together.  Combining physiotherapy, horses, speech and language therapy, psychology and art therapy the centre boasted good outcomes, particularly in children with autism who demonstrate improvements in communication, behaviour and socialisation as a result of the centre.

The all day workshop was packed full of interesting presentations with some highly creative, innovative research.  It was striking though how difficult it must be to conduct quality research with only minimal access to the internet and journal articles.  It is not for example possible for Cuban researchers to carry out the in-depth literature searches that we would conduct to inform the direction of a new research project.  The internet is certainly one luxury that I take for granted on a daily basis.  Throughout our visit I was permanently reminded of the unfairness of these inequalities.

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I was surprised to learn that the tourist rep supporting us whilst we were in Camagüey was a fully trained lawyer.  Apparently this is quite common in Cuba.  University education is free and highly valued, resulting in many well qualified people but unfortunately not enough qualified work.  The huge discrepancy between the two currencies in Cuba is also contributing to the problem.   Tourists for example regularly give tips that are the equivalent of over a week’s wages to the Cubans, making the tourism industry extremely lucrative.  Is it right that a waiter should earn so much more than a lawyer or a doctor?  I was left doubting whether socialism could ever truly survive in a consumerist world.

Hannah and I spent our second week in Holguin visiting our psychology colleagues, staying in private homes to give us more of a sense of the real Cuba.  I loved the fact that the Cuban men sit round a table in the street and play dominoes in the evenings.  Basic groceries are sold direct to people’s homes via bicycles and trailers.  There’s a real sense of community – everyone seems to know each other and has time to stop and chat.  We visited the University of Holguin and met with colleagues from the psychology department.  We exchanged presentations on psychological services and training in the UK and Cuba and discussed similarities and differences.  Therapies in Cuba are varied and eclectic, depending on the needs of each person, with less of a focus on cognitive behavioural therapy than there is here in the UK.

Image10Next we travelled to the hospital via horse and cart and visited a neuropsychological service.  We sat in on a neurological assessment of an older lady and observed a cognitive rehabilitation session with a young man with memory difficulties.  I found the degree to which the family system was considered to be somewhat humbling in both cases and vowed to include the wider system more in my own practice.  I also admired the creativity and ingenuity of the Cubans and hoped that I would have the freedom to be creative in my career.  In fact, as our trip to Cuba drew to a close I realised I had much to contemplate…

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