Assessing Cuba

By Erin Hoekstra ’04


The small propeller plane circled the entire island before landing. We, the passengers, saw the single city on the coast with tall buildings but no skyscrapers. The rest of the island was green, there were some plots of farmland, but it was mostly overgrowth and palm trees.

Highways without cars, like empty veins, spread through the green. Smoke from burning trash rose in tiny puffs into the sky. Our plane landed at a deserted airport and parked next to a large Delta jet. Outside of the airport, old 1950 Chevys in the parking lot blared salsa music, and adults and children, who were barely walking, danced. Bulletin boards expressing political statements and featuring images of Ché Guevera and Fidel Castro lined the parking lot. The humid Cuban air felt heavy even though the sun had almost set.

On the ground, the passengers had a professional purpose. Professor Thomas McGowan of the Rhodes Anthropology/Sociology Department and I traveled to Miami Jan. 2 to meet some 15 representatives of two U.S. universities, then spend a week in Havana. Once our group of faculty and students from Thomas Jefferson University in Philadelphia and Columbia University in New York City had met, we realized the diversity of our interests.

Prof. McGowan and I traveled in the capacity of sociologists: he as a medical sociologist and I as his research assistant. My task on the trip and in this undergraduate research project was to evaluate the service learning experience of the other participants on the trip. I traveled with funding assistance from the Rhodes Chaplain’s Office, Associated Colleges of the South’s Latin American Studies Committee and Rhodes’ Service Learning Committee. Debra Tupé, a professor of occupational therapy at both Thomas Jefferson and Columbia and a Ph.D. student at Temple, organized the trip and possessed the travel license with which we were able to go to the “forbidden” island. In the rest of our group there were practicing occupational therapists, occupational therapy students and professors with different specialties, a filmmaker, a boarding school teacher and a geology undergraduate student. As the trip continued, we recognized the richness that these varied interests lent to our experience in Cuba.

The purpose for our weeklong trip to rural and urban areas of Cuba was to conduct a needs assessment of occupational therapy, a new and emerging discipline there, and explore how it may differ from practices in the U.S. Occupational therapy, or OT, provides treatment that helps people to function as independently as possible in society. For instance, occupational therapists typically will work with children born with disabilities like cerebral palsy, with people who have had accidents or surgeries that have left them without basic daily life skills like feeding themselves and individuals with mental health problem or eating disorders. In the U.S., one must have several years of training and an advanced degree before practicing, while all OT training in Cuba is basically informal and on-the-job; anyone who is so inclined may practice OT.

Through this cross-cultural encounter on the professional level, we took into account differences in practice due to the two countries’ cultural definitions of occupations or of basic daily life skills. On a personal level, the experiences of the political and social contexts of Cuba informed us of the country’s culture and repositioned us so that we could see our own political and social system from an outsider’s point of view.

Upon our arrival, we encountered, and oriented ourselves to, the culture of Cuba and its capital city. On a tour of Havana, we listened to a rumba concert at Hammel’s Alleyway, covered with murals by a Cuban artist and practitioner of santería . The religion of santería, which is practiced primarily in Cuba and Puerto Rico but also in the U.S. and the rest of the Caribbean, blends West African Yoruba beliefs with Catholicism. It originated when slaves in the Caribbean were forced to convert, at least nominally, to Christianity. Santería views the world in terms of ashé , or spiritual energy, and the orisha , or deity-like beings who correspond to the saints in Catholicism, govern the forces of nature and all aspects of human life. The murals in the alleyway, inspired by the orisha , filled every inch of the alley’s walls with color and movement; sculptures and shrines paid homage to santerían deities and beliefs. Dressed all in white, santería initiates explained the murals to us, sold herbs to other practitioners and played drums in the alley.

One evening, we ate at a paladar , or a government-licensed backyard restaurant in the suburbs of Havana. These family-based eateries tout authentic Cuban cuisine. The Doña Carmelo paladar fed us rich homemade flan with the consistency of cheesecake. On a rainy evening, we visited the meeting of a CDR , or the Committee for the Defense of the Revolution, a rough equivalent to a neighborhood watch program in the U.S. All of Cuba is divided into CDR s, which have weekly meetings to discuss issues within the neighborhood. Usually, these meetings end with a neighborhood block party complete with salsa dancing in the streets. This particular evening, we were met with gifts of gladiolas and a cultural program. The neighbors stressed that though an economic embargo exists between our countries, we could maintain friendship and solidarity.

During our trip, Cuba celebrated the 45th anniversary of President Fidel Castro’s entrance into Cuba so schools let out for the holiday. Beginning the evening before the actual anniversary, students in red or khaki uniforms (signaling their level in school) lined the streets, waving flags, singing and cheering. The next morning we were awakened by a rally in the parking lot of our hotel. Brought in by trucks and busloads, hundreds of people attended the rally that featured children and adults singing, reading poetry and giving speeches.

During our stay, our group visited and toured a family doctor’s office, a center for neurological rehabilitation, a grandparents’ club, and a school for hearing impaired children in Mantanzas and another center for rehabilitation and a school for autistic children in Havana in order to conduct this needs assessment of OT in Cuba. At the school for children with hearing impairments, the students lined the pathway and gave us flowers. They performed a musical program of national songs of Cuba, including some about Ché Guevera. At the end of their performance, they grabbed members of the audience to dance to salsa music on the stage. Our group toured the school and received a demonstration of a speech therapy lesson for students who were entirely deaf. From this glimpse of the health care and medical system in Cuba, we drew several conclusions that seem paradoxical.

First, the socialist economic and political systems and the rich history of Cuba have given the culture a deep sense of community that manifests itself in many ways. The parents and families of OT patients take quite an active role in the treatment of the patients. In the rehabilitation center in Havana, parents could be trained to work as staff there, a testament to both the communal nature of the culture as well as the lack of formal training for Cuban OTs.

At the same time that the economic and political system fosters a sense of shared history and biography among the Cuban people, it also allows for a strong health care system. Each CDR in the country has a family doctor’s office, and supposedly, there is a doctor and a nurse for every 170 Cubans. The doctors know their patients personally, and because of this relationship, they are able to focus on preventative medicine.

On the other hand, the poverty of Cuba has left OTs and other doctors without sufficient or technologically sound medical equipment. The OTs have had to use outdated equipment and practices creatively in order to treat their patients. The repercussions of the U.S. embargo on the people of Cuba are obvious in the field of OT, not simply because of the lack of resources and up-to-date equipment but also because of the absence of the exchange of medical information from country to country. Our trip, and I hope similar trips in the future, will rectify that lack of informational exchange.

The group will return to Cuba this summer to work with the Center for Neurological Rehabilitation in Mantanzas in a reciprocal exchange of information. Given that the travel license continues to remain valid, future institutional collaboration will be fused with students and OTs from Thomas Jefferson and Columbia Universities. Rhodes students and faculty hope to continue to be a part of the service learning and undergraduate research that is occurring in cross-cultural encounters in Cuba.