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Guantanamera: Healthcare Delivery to Women in Cuba Ivana Kohut University of Pennsylvania

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Guantanamera: Healthcare Delivery to Women in Cuba Ivana Kohut University of Pennsylvania In Situ Issue 1 In Situ 2016 Article 2 5-14-2016 Guantanamera: Healthcare Delivery to Women in Cuba Ivana Kohut University of Pennsylvania This paper is posted at ScholarlyCommons. http://repository.upenn.edu/insitu/vol5/iss1/2 For more information, please contact [email protected]. Guantanamera: Healthcare Delivery to Women in Cuba Cover Page Footnote Ivana Kohut, Anthrofest 2016 This article is available in In Situ: http://repository.upenn.edu/insitu/vol5/iss1/2 Kohut: Guantanamera: Healthcare Delivery to Women in Cuba Guantanamera: Healthcare Delivery to America, and is deemed the “healthcare model” Women in Cuba for many Caribbean countries (Paul Farmer). In addition, “at approximately nine deaths per Ivana Kohut every one thousand newborns” (Randal), Cuba On December 17, 2014, President Obama has one of the lowest infant mortality rates in the stated that, “In the most significant changes in world. The study was developed in order to ex- our policy in more than fifty years, we will end an amine how Cuba translates written health policy outdated approach […] and we will begin to nor- into practice. Logistically, how does the Cuban malize relations between [Cuba and the United government explicitly protect women’s health in States]. Through these changes, we intend to terms of services and broader systems? In turn, create more opportunities for the American and how are these systems accessed by the average Cuban people, and begin a new chapter among Cuban woman on a daily basis? What makes the the nations of the Americas.” The political state- current system practical and impractical? That is, ment has and most likely will continue to inspire the research studies the effectiveness of the cur- change, notably change pertaining to travel and rent, general health system for women through qualitative interviewing procedures. A total of trade restrictions. The United States of America’s 1 desire for a new relationship with Cuba has more- 89 interviews were conducted in 9 provinces over created an intense fascination, a unique (Pinar del Rio, Artemisa, La Habana, Mayabe- Cuba Locura, in USA media. Travel agencies, que, Matanzas, Cienfuegos, Villa Clara, Sancti as an example, paint Cuba as unique due to its Spíritus, and Ciego de Ávila) with an average of scenic beaches and greenery. The rich architec- about 8-10 interviews per province. Interviewees ture in Old La Habana and cobblestoned streets were categorized into three cohorts (ages 18-32, frequented by cars that would make any collector ages 33-69, ages 70 plus) so as to assess the green with envy, are strong pieces of evidence to healthcare system’s delivery at various stages of the fact that Cuba has been frozen in time. And development. The collected data evaluates which primary, reproductive, and geriatric care services though these qualities are uniquely Cuban, they 2 are by no means the only characteristics that are delivered effectively. Access to medications, set Cuba apart from other Caribbean and even to physicians, and to health information were Latin American countries. Universal access to analyzed when measuring effectiveness. healthcare, and an explicit prioritization of wom- Availability of general practitioners, free en’s health during pregnancy, constitute a unique of charge, constitutes a defining quality of the facet of the Cuban healthcare and policy. Cuba primary care system. The Consultorio Médico de boasts one of the highest doctor-patient ratios, a la Familia (CMF, the Family Doctor Consultation statement that separates the country from many Center) is an establishment supported by the Cu- others in the Western hemisphere. The Cuban ban government to increase access to physicians state has likewise implemented many resources (in both urban and rural areas). A CMF is spe- to revolutionize healthcare so that the right to cific to each town, city, or community equivalent health is as fundamental as any other right up- (based on location boundaries, such as in more held by the state. rural areas). The CMF is a two-floored structure The Hassenfeld Family Social Impact in which a general practitioner sees patients on Foundation through the Center for Undergraduate the ground level and lives permanently in the Research and Fellowships (CURF) at the Uni- center on the second level. The state encourages versity of Pennsylvania, funded my three-week these physicians to live in the CMF for an extend- research opportunity to Cuba in the summer of ed period of time (a decade or more) so as to 2015. The study I conducted aims to analyze truly get to know and understand the community the unique and renowned Cuban healthcare 1 84 valid interviews. system currently in practice. With impressively 2 Note that the only healthcare system made low TB, AIDS and malaria mortality rates, Cuba available to Cuban citizens is the government provid- is the frontrunner for healthcare delivery in Latin ed care. Published by ScholarlyCommons, 2016 3 1 In Situ, Vol. 5, Iss. 1 [2016], Art. 2 that s/he serves. The program fosters stronger the Maternity Law, a woman’s employer must patient-doctor relationships in which the doctor grant her paid leave of absence post-partum. quite literally serves the community as a doctor of The law states that a woman is permitted up to a the people (a concept inspired by the health sys- year of paid leave after the birth of her child.5 The tems in the former USSR). As a result, the doctor paid leave of absence is furthermore flexible. For becomes family-like within a town, and in this instance, if the woman gives birth to multiple chil- way practices her/his profession better since s/ dren, to a child with disabilities, or to a child born he gains the trust, and in many cases the love, of prematurely, she is automatically eligible to re- the greater community. The CMF system hence quest more paid time off from work. In some cas- reduces the lab coat boundaries between doctors es, women can also be eligible for a paid leave of and patients for the better. absence up to two weeks prior to her due date. This is especially the case if the woman has had The CMF system additionally facilitates a difficult or high-risk pregnancy. The state largely a more logistical access to the physician. As an supports paid leave for these women and protec- interviewee stated, “Here in Cuba, a child can be tion for pregnant women in the workforce, so that without shoes but never without vaccines.” Again, women do not have to choose between being the CMF enables such an incredible feat consid- professionals (and being active participants in the ering that through this institution, the doctor is Revolution thereof) versus being mothers. made available, is trusted, and is able to firsthand observe the community and act according to the The state additionally provides Hogares health needs s/he witnesses as not just a doc- Maternos (Homes for Mothers) for women who tor but as a community member. For instance, experience a high-risk pregnancy. (These preg- 88.10% of the interviewees stated that they have nancies can be deemed “high-risk” based on the easy access to a doctor because of their local medical health, emotional health, and or domestic CMF.3 The CMF doctor is most often a gener- circumstance of the mother.) These homes are al practitioner considering that the CMF rarely fully staffed with medical personnel 24/7 and are houses specialists. Even so, the only specialist environments that offer a strong, reliable commu- who frequently visits the CMF is the OBGYN nity for women during a vulnerable time. Again, specialist. The CMF physician is obligated to re- her stay in the Hogar Materno is fully funded by port any pregnancies that occur in her/his vicinity the state. and to contact an OBGYN specialist to visit her/ Likewise, in the event that a woman gives his CMF. The pregnant woman then meets the birth to a child prematurely, the state offers her specialist in the CMF of the district she lives in.4 If the opportunity to stay with her child in the hospi- the pregnant woman consistently refuses to keep tal. This hospital stay is fully funded by the state her appointments with the OBGYN specialist, the so that the mother can: a) learn how to care for specialist is legally obligated to visit her in her the child and b) breastfeed her child regularly. home and conduct the tests there (even if she The concept of breastfeeding is interestingly a does not want to undergo examination). This ex- recurring theme in the interviews. One hundred treme measure ensures not only her own health percent of the women interviewed stated that during pregnancy, but also the health of her child. they breastfeed/fed their children (the average is All of which contributes to impressively low infant a period of 1-2 years post-partum). According to and mother mortality rates in childbirth. many of the interviewed women, the state en- Through health policy, notably the Materni- courages breastfeeding so that mothers can nur- ty Law, women’s reproductive health is designed ture a relationship with their children and because to protect all women (medically and in the work- access to infant formula is incredibly limited. force) before, during and after pregnancy. Under Under the current healthcare system, the 3 Access here is defined in terms of walking state also ensures that most women have access distance. 4 In some cases, she can meet appoint- 5 Details concerning pay are ultimately de- ments in a polyclinic or hospital. termined by the employer. http://repository.upenn.edu/insitu/vol5/iss1/2 4 2 Kohut: Guantanamera: Healthcare Delivery to Women in Cuba to contraceptives.
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