Our second report on the Cuban Exchange is from second year trainee Hannah Istead.
As you enter the country, the spirit of Havana hits you with a riot of colour, music and passion. It’s easy to become intoxicated by the faded grandeur, of the eclectic collection of colonial architecture, with its art deco and modernist styles, peppered all the while with Soviet style utilitarian blocks. I was swept away from day one. Like many before it has been described as a place full of contradiction and I certainly would agree, which can leave you puzzled, enchanted and in a spin all at once.
My first impressions evoked memories of the writings of Gabriel Garcia Marquez and the realm of magical realism, I later discovered that he had been a friend of Castro this was juxtaposed with the writings of native, Pedro Juan Gutierrez and the gritty realism captured in “Dirty Havana Trilogy”. To me it is certainly where my feelings about the place first lay.
Cuba left me in a state of flux. At times I was both enchanted by the magic of the place from the surface level, to simultaneously being shaken to reality by some of the lengths I observed that people would have to walk to pick up resources they need and restrictions placed by the US embargo where important resources such as medicines were not available.
A few days were spent in the town of Camaguey, which had undergone a transformation as part of its 500th anniversary celebrations. Camaguey is made up of a myriad of streets easy to get lost in and its World Heritage status cements its beauty and cultural heritage. It is here that we were first introduced to a series of services, rehabilitative clinic, GP practice, Polyclinic, maternity home and a hospital. It is widely recognised that healthcare in Cuba is at a high level. Health care is free of charge and publically funded. Cuban care is organised into a system with some similarities to ours, the same labour seems to drive the service, however the premises are striking in their difference to those of the UK.
It was the visit to the GP practice that highlighted this stark difference in approach. In essence it felt like the GP was embedded in the community, not only physically, but also socially. The GP talked of having a systemic knowledge of their patients and not seeing the individual as separate from their context. I could only think this must serve to meet the needs of their community very well and having insight to each person’s family, community and also province. It could only serve to offer a better understanding of the individual within their context and the reciprocal relationship between the two. The vibrancy of Cuban life will be also be etched on my mind when we were invited to the “casas de la cultura” (house of culture) to watch a local youth group dance. It was here that my view was cemented again that community life and the sharing in this celebration of life was communicated and shared widely, with enthusiasm and passion.
Holguin is a much smaller province of Cuba and it was here that we managed to spend some time with Psychologists in the university and also the neuropsychology rehabilitation clinic in the hospital. We exchanged ideas with the Cubans about psychological practice in the UK. They talked about an approach for them that encompasses viewing a person holistically and thinking about the historical socio–political context and its influence. They also talked about an eclectic approach in which psychology would be taken from various resources and used when it was found to be useful.
We also learnt about the ongoing discourse analysis taking place and how this was being used to consider the gender-sensitive components fundamental to population health, national policy and public consciousness. We were informed that gender-stereotyped roles continue to act to reinforce women’s status in the family and also within the wider society. Interestingly, Mariela Castro (daughter of Raul Castro), is currently leading the debate on this topic and is optimistic about pursuing change in this area for more equality among the sexes.
In summary, this has been an incredibly important experience in my training as a clinical psychologist. It has fed my ideas about the importance and value of community psychology and that the individual is best served when formulated and seen from their context. It also reinforced how our interactions are dependent upon the relationships we forge with others and in turn how this is important for our general wellbeing on an individual level as well as at a population level.
I cannot ignore that there was noticeable poverty in places and the hygiene practices especially in the hospitals were questionable (no resources to wash hands). Equally, the disparity in salaries challenges some of the core beliefs that exist for me.
As an outsider, I was constantly aware of the presence of the concept of an idealised notion of Cuba, based on a trinketization (Hutnyk 1996) of their culture, which is at times both appealing but also contradictory (in my eyes).
What was inescapable however and remains clearly with me weeks after my return is the fundamental human side to Cuba. Present both in the psychologists I met to the simple interactions in everyday life, the importance of collectivism has clearly been rooted in the fabric of society. If this is one legacy of the Cultural Revolution, then we would be well advised to take note from it!
Hannah Istead (trainee clinical psychologist 2014)