LACONIA — There were Cuba Libres with top notch rum, the best cigars in the world, delicious seafood, beaches, street art and music during Dr. Nancy Dirubbo's recent trip to Havana, but there were also tours of nursing homes for the elderly, local health clinics, and emergency rooms during the health-related trip she hosted for a group of nursing practitioners from around the country.
Dirubbo who, operates Beacon Continuing Education for nursing practitioners and Travel Health of Laconia, designed her trip with the assistance of a U.S. State Department program to learn about health care in Cuba.
"In order to learn something, the best thing is to go there," she said, saying all the lectures and Power-Point presentations in the world can't come close to being there.
She learned that Cuba is still a poor country with very few resources but said Cubans are some of the most resourceful and energetic people she's met. Dirubbo described the ingenious ways Cuban mechanics keep their 1950s cars not only running well by "jury-rigging" parts and being creative mechanics.
She said that unlike the United States, the government has put nearly all of its available medical resources into prevention, giving them equal or better results than most developed countries. She said prenatal care is extraordinary, with special hospitals set up specifically for women with problem pregnancies, that they have one of the highest immunizations rates in the world and one of the lowest rates of HIV/AIDS.
"One of Cuba's biggest exports is doctors," she said, noting the government has agreements with Qatar, Venezuela and other countries to send Cuban doctors there in exchange for hard currencies. She said physicians go to school for six years after high school and nurses attend school for five years. Students are chosen and directed into medical programs from a young age. They make the equivalent of about $22 to $25 monthly when practicing in Cuba.
Dirubbo said the city is broken up into communities of about 500 people each and each community is assigned a doctor and a nurse who live among them. "That's a very high service-to-client ratio," she said.
Dirubbo said the national government created an organization call CENESEX that specifically addresses sexual health. She said homosexuality is addressed openly, birth control is available to all women between the ages of 14 and 49, and abortions are legal – things that surprised her because of Cuba's Latino and Catholic roots.
"Everyone in the Caribbean comes to Cuba to get get abortions," she said.
She said all clinics are named after national heroes or significant national holidays. She visited a clinic called the September 7 Clinica that commemorates a day in the Cuban Revolution.
Dirubbo said clinics have little to no medications and have almost no access to pain killers. She said one of the doctors told her he would love to have access to analgesics – like aspirin and ibuprofen – and things like cold medicines and Vick's VapoRub and other items that can be bought over the counter in western pharmacies.
Medical equipment is scarce but is well maintained. The lab in the clinic she visited has a microscope and a refrigerator. She said the occasional dose of Novocaine for dental services is given with glass hypodermic syringe with a reusable needle – something she barely remembers seeing in the U.S. or in other parts of the world.
There are dengue fever control units, she said, noting they are rare elsewhere.
"There are no disposable needles, but they use good techniques (for sterilization") she said.
"I was very surprised at the conditions of the nursing homes," said Dirubbo, noting the one they let her visit was pretty crowded and the people were near starvation. "I can only imagine how bad the ones we didn't visit are like."
Dirubbo said most elderly people are cared for in their own homes or the homes of their relatives. She said the majority of the people in nursing homes were elderly women who never married and had no children.
For the most part, she said, the people were very friendly. Many speak a smattering of English and many on her tour speak Spanish, including Dirubbo.
"Fidel is everywhere," she said. "Sometimes (his depictions) are paternal, sometimes they are as a teacher and sometimes they are with a gun."
There were very few pictures of current President Raul Castro, Fidel's brother, but photos of revolutionaries Che Guevara and Camilo Cienfuegos are everywhere, she said.
People told her they loved socialism because they get their housing, their education and their medical care but also want to be able to earn a little money on the side and not pay taxes on it. She said the businesses that are private are heavily regulated and the business owners must pay taxes on themselves and for their employees.
She said one quick way for Cubans to make a little money is to charge $1, which is about the equivalent of one convertible peso, for pictures of themselves – especially posed in front of their cars. She said elderly people sit in public restrooms and charge a peso for a few squares of toilet paper, and that street musicians and artists charge a few pesos for music and photos.
While most of her team members were greeted with open arms, many said they were afraid the American businesses would come down and force them from their homes to provide more hotel space. Dirubbo noted that she has seen where this has already happened.
And there was fun to be had. She said in an old casino in the Hotel Nacional de Cuba, a single roulette wheel is on exhibit to remind people about the evils of American capitalism and the mafia violence it brought to Cuba before the revolution, a fear expressed by some locals who don't want to return to those times. She said even the parking meters are gone because people associate them with coin slots.
The group went to the old Sloppy Joe's in the old city to see where Ernest Hemingway, Frank Sinatra and the "gangsters" hung out before the revolution. She said they took of tour of Revolutionary Square where she was surprised that there were no vendors.
Dirubbo is leading another group of medical professionals back to Cuba in April. She is also leading a Florence Nightingale tour of England in September. She said there is still room on the Cuba tour and any medical person interested should contact her at her offices in the Busiel Mill.