Travel can break through mystique about countries, people

While the United States was debating health care reform in January, Marilynne Wilson, a registered nurse with the Hyperbaric and Comprehensive Wound Care unit at Deaconess Medical Center, participated in a 10-day Witness for Peace health care research delegation to Cuba.

Marilynne Wilson stirs a pot of beans, after gaining new appreciation for them in Cuba.

She found a country with a third-world economy and a first-world health care system that challenges assumptions about U.S. health care.

Three years ago, she had been surprised to read about the quality of Cuban health care. She mentioned her desire to learn more to former directors of the Peace and Justice Action League of Spokane (PJALS).  Last year, they told her of the Jan. 8 to 18 delegation—eight days in Havana and two in La Esperanza.

“We may have the best health care in the world, but it’s for people who have good health insurance,” she said.

 “I think we have a moral responsibility to take care of each other and to help those who do not have enough,” she said. 

Marilynne believes Americans should travel abroad more to learn about other cultures and people.

“We can learn from each other and can see that people who are not Americans or Christian are happy and doing well,” she said.  “So, if we dislike Cuba’s government, we need to go there and see what is happening.”

While she is aware the 10-day trip planned by Cubans with interpreters may have been slanted, she still felt organizers at the Martin Luther King Center in Havana provided a broad experience.

On the visit, Marilynne confirmed her belief that the United States should not be afraid of universal, single-payer health care.

Growing up in the wheat-farming town of Almira, Wash., she fed her interest in international issues by reading National Geographic.

After earning her degree in nursing in 1968 at Pacific Lutheran University in Tacoma, she came back to Spokane to work, met her husband, Lew, and then spent five years in Seattle, while he studied at the University of Washington School of Law, and she worked at Providence Hospital.

When they returned to Spokane, she was a field nurse in home health, providing in-home skilled nursing care for six years.  She earned a master’s in nursing administration at the Intercollegiate Nursing Center in 1987.  Then she worked in administration at Family Home care until 2003.

Marilynne, a member of Westminster Congregational United Church of Christ, has been involved in PJALS for many years.

When she learned about the trip to Cuba, Marilynne invited her daughter, Margaret Navarro, a registered nurse in Arlington, Va., to join her and 25 others.

Witness for Peace informs people about Latin American affairs related to U.S. policies.  They arranged for the health care delegation to enter Cuba legally, despite the U.S. travel ban and embargo, which they would like to have lifted.  Groups can go there for research but not vacations, Marilynne said.

The schedule was full, meeting with health care workers at all levels of practice and with Cuban and American government workers.

With the health care debate going on in the United States, she wanted to learn how Cuba could provide health care on limited funding.

“The average Cuban earns $25 a month, but life expectancy there is just six months less than the U.S. life expectancy,” she said, “and infant mortality is equal to or better than here.”

Marilynne said a primary-care doctor in every neighborhood serves 350 families.  Since the Soviet Union fell and Cuba lost its oil imports, fewer people drive cars, so doctors were moved to neighborhood primary care clinics and live above the clinics.

“Preventive care is encouraged, because it’s less expensive than curing an illness,” she said.  “People die of the same diseases we do: cardiovascular disease and cancers—breast and lung for women, and prostate and lung for men.  Many smoke cigars.”

“I like preventive care.  In home health care, I worked with families to fix the cause of problems, rather than just fixing problems,” she said.

While people die of malaria and typhus in nearby Haiti, Cuba prevents those diseases with vaccinations and health promotion, and treats them with medications.  Because of the embargo, Cubans have had to research and manufacture their own medicines, Marilynne said, adding that they also use alternative medicines. 

For example, a psychiatric clinic uses aromatherapy, essence therapy, massage and ballet.

How do people subsist on $25 a month? she wondered.

“Education, housing and health care are free.  Electricity and oil are subsidized.  Everyone has access to the arts and baseball.  People receive food vouchers for staples, including rice and beans, which they eat for most meals.  Pork and chicken are available. Few eat fish or vegetables.  They eat three meals a day, but do not have access to our sweets and carbohydrate snacks,” she said.

Fifteen primary care clinics feed into a polyclinic, where people go for Xrays, MRIs, mammograms, other tests and treatments such as physical or occupational therapy. 

Every metropolitan area has a general hospital, an outpatient psychiatric clinic and outpatient physical rehabilitation.  There are also maternity, pediatric and psychiatric hospitals in each province.  There is one leprosarium and an HIV sanitarium in Cuba.

For leprosy and HIV, which still bear a stigma, health care workers teach people how to live with the diseases so they can be in the community, Marilynne learned.

She also learned that doctors are a commodity.  Cuba trains many doctors, so they “export” doctors, trading them for oil. 

The Latin American Medical School pays for any Latin American who passes the entrance exam to study there. 

Some North Americans are also trained there free, so they are debt free once they graduate.  They are expected in return to go to an area of high need, Marilynne said.

“Here we have a pill for everything, but there the doctors listen, and may offer prescriptions along with exercise and diet changes, believing that pills are not the answer for everyone.  They also use herbal medicines, aware of proper dosages and the purity of herbs,” said Marilynne.  “Some people who come to our wound clinic in Spokane are on 20 or more medicines.”

She found the quality of care good despite worn-out hospital facilities with chipped enamel crank beds, bare walls and people bringing their own linen.  Rooms need paint, but were clean, she said.

“Medical personnel were first-rate, up-to-date professionals.  The neonatal intensive care unit had modern monitors, drips and lights,” she said, noting that the latest equipment is not necessary to provide good health care.

“Health care here is big business,” Marilynne said.  “There it’s a constitutional right.  Cubans recognize that because it is accessible, many overuse it, so they are starting policies to correct this.”

She shared some statistics: 

• Government health care expenditures in Cuba are 10.8 percent of their national budget, but 19.1 percent in the U.S.

• Infant mortality in Cuba is 5.85 per 1,000, compared with 6.26 per 1,000 in the U.S. 

• Life expectancy there is 77.45 years, compared to 78.11 years in the United States. 

• Cuba spends 9.1 percent of its budget on education, and the U.S., 5.3 percent.

“Growing up, I knew that we in the United States have ‘stuff’ in abundance.  We are a rich, wasteful country.  The U.S. is my home and where I want to live, but traveling abroad I learned there are good things in Cuba, too,” Marilynne said, “just as there are in Japan, Turkey and Europe, which I have visited.”

For example, she said there were some advantages to not being able to afford to drive cars.  Cubans have a well-used bus system, walk more, ride bikes, use horses and carts, and use oxen to plow and fertilize fields.

“It’s idyllic and a paradox.  It’s a beautiful country that takes us back in time.  Because internet and cell-phone access is limited, I didn’t see people with earphones in their ears,” she said.  “People talked to each other.” 

At 1 a.m. the evening she arrived, she heard the murmur of conversations of young people filling the boulevard in front of her hotel. 

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Copyright © April 2010 - The Fig Tree