Second Year Student Blog: Anne Kure

Wednesday, August 1, 2018

Anne Kure, PA-S
Anne Kure, PA-S

A Whole Other World

As the plane gently touched down at the Havana airport, a fellow passenger turned to me and said, “Welcome to a whole other world.” I looked out the window to see tarmac, swaying palm trees, and airport workers hurrying about. So far, this was looking a lot like Florida. However, once I stepped out of the airport and saw several American classic cars cruise by, I knew that he was right. Cuba is a unique place that remains a bit of a mystery to most people in the U.S. I knew I was not likely to encounter another opportunity to explore Cuba and its health care system, so I jumped at the chance to travel there with my classmates in the Duke Physician Assistant Program.

Havana

PA students in Cuba

Our van stopped in front of the hotel and I stepped out of the air-conditioning into the heavy, warm evening air — our tour guides weren’t exaggerating when they said it would be warm! Starting to sweat, I took my first good look around downtown Havana. I saw a mixture of gleaming new hotels next to buildings that looked frozen in time, now showing years of neglect. The streets were teaming with activity and every mode of transportation you could think of. Our hotel was called a “casa particular,” which is like a Cuban bed and breakfast. Staying at the casa allowed us the opportunity to meet a Cuban family and gain some insight into their daily lives. Another benefit of staying in the casa was the delicious breakfast the family cooked for us each morning. This typically included eggs, freshly baked bread, salad, cheese, fresh tropical fruits and juices, and coffee. Oh, the Cuban coffee is really something! I am from Seattle and admit that I am rather particular about coffee, and this coffee did not disappoint. The casa was ideally located in the heart of Old Havana near the Capital building and many of the popular sites and activities. There was something for everyone there. Over the next few days, we all had opportunities to explore our interests, from music to food to art.

Cuban clinic room

To begin our exploration of Cuban health care, we met Cuban social activists Norma Guillard and Dra. Rosaida Ochoa. Our discussion ranged from LGBTQ rights to HIV/AIDS medical care in Cuba. They unfolded the history of these concerns in Cuba and engaged us in discussion regarding the similarities and differences with the US. Next, we visited a senior citizen’s home called Casa de Abuelos. In Cuba, most senior citizens live with their families. However, they may be at loose ends during the day when family goes to work or school. The casa offers these seniors daily social interaction, activities, and some meals. Much to our delight, the residents prepared a song and skit in honor of our visit and presented us handmade gifts. We were so moved by their welcoming spirit and generosity, especially considering the years of political tension between our two countries they had witnessed in their lifetimes. Next, we visited the School of Public Health where the professors explained the history and structure of the Cuban health care system and informed us of Cuban health outcomes and costs. This provided us the foundational knowledge we needed as we traveled the next day to another city called Cienfuegos to experience the Cuban health care system for ourselves.

Cienfuegos

Cienfuegos is located about three hours from Havana. Known as the Pearl of the South, it is a lovely town situated on a large bay. Waking up the next morning, I remarked at the mixture of sounds that are so unique to Cuba. All at once, I heard the clopping of a horse-drawn cart interrupted by the buzz of a scooter and blaring horn of a car. Startled by all the noise, the rooster across the street and our casa owner’s dog, Ricky, decided to chime in, as well. After enjoying our morning breakfast and tanking up on coffee, we set out to visit the primary care clinic, called a Consultario. There are several Consultarios throughout Cienfuegos, each one caring for the residents living within a designated area surrounding the clinic. The providers live in the neighborhoods in which they work and know their clients well. If a patient does not show up for a scheduled clinic visit, the provider will simply walk to the patient’s home to complete the visit. This proximity and familiarity helps ensure close patient follow-up. We also visited the Policlinic, which houses many of the medicine subspecialty clinics, and also the local hospital. These facilities represent the various levels of the Cuban health care system from primary care at the local Consultario to tertiary care at the Hospital Gustavo Aldereguia Lima. Before departing Cienfuegos, we explored other aspects of Cuban health care including the Red Cross and a maternity home where expectant mothers with higher risk pregnancies reside to receive close medical monitoring.

Lessons Learned

Cuba has some of the best health outcomes in the world at a cost that is significantly lower than the U.S. The system is simple to navigate with high patient satisfaction. Most services are free to the patient, including some elective procedures. As I am nearing graduation and finding my role in the U.S. healthcare system, I will continue to reflect on my experiences with the Cuban health care system and providers I met. I will also remember the Cuban people. The unique challenges they have experienced have shaped their strength, creativity, and resilience. They are also some of the most joyful and fun-loving people I have encountered in my travels. Cuba truly is a different world and I am thankful I had the opportunity to experience it while a student in the Duke PA program.


Anne Kure was a second-year PA student with the Duke Physician Assistant Program.
 
Editor’s note: Duke Physician Assistant Program students blog every month. Blogs represent the opinion of the author, not the Duke Physician Assistant Program, the Department of Community and Family Medicine or Duke University.