Cultivating The Facts, and two other stories

This week I have a small beef with Michael Moore.  If you haven’t seen his documentary SiCKO, I would recommend it. It’s quite an eye opener on what’s wrong with the U.S. health system and how other countries’ public health systems function.  His ability to exercise the right of free speech is magnificent, and should make every American proud; however, his agenda is somewhat like an enormous truth vacuum sucking in everything that is and looks like truth.  While I do believe he hits the nail quite on the head with the majority of SICKO, he fails cultivate all the facts while executing his shock-value stunt in Cuba.

            For anyone who has not seen the film, a quick synopsis:  Moore takes about five 9-11 heroes on a cruise to Cuba for free medical care that they have been refused in the U.S.  They stop off at Guantanamo Bay, where they are refused entry.  They end up at a hospital in Havana where they receive the tests they cannot afford, and the treatments they need free, and their prescriptions cost a fraction of the U.S. equivalent.  They are also received and honored by the Havana fire brigade in a special ceremony.  The entire scene should be and is touching. 

            First off, let me say that I have no doubt that what was filmed was exactly what happened here in Havana.  Cuba has profound respect for heroes and I’m sure that it was a pleasure and an honor for the doctors who treated our 9-11 workers.  However, the circumstances represented are highly unusual, but are more or less represented as the usual transactions of health care in Cuba.  While health is a right in Cuba and no one would be willingly denied medical care based on their ability to pay, SICKO represents that the only questions asked in order to receive medical care are name and age, and in reality this is not the complete truth. 

1. Cuba is a country of limited resources; a country like this cannot afford to pay for both citizens and tourists/visitors to have complete medical care (their just isn’t enough to go around).

     a. If you are a tourist/foreigner needing care for something other than an emergency, you will go to a tourist clinic and you will pay for your medical care.

     b. If you are a Cuban you will go to a poli-clinic or see a doctor in your home, and you will pay nothing.

2. If you have an emergency you will go the closest point of care possible and every resource will be used to bring you back to health, without any thought to your ability to pay.

a. If you are Cuban you will pay nothing while hospitalized.  Once you leave you will pay for ridiculously affordable prescriptions.

b. If you are foreign, and you are able to, you will most likely be asked to pay, but I will assure you it is no where near the cost of medical service in the U.S. … and when you leave the hospital, your prescriptions will be ridiculously cheap probably $3 -$7.

3. Your very best option for medical care is to know or be related to a doctor.

a. Having a personal friend or family with medical skills is key as your normal doctor may be working out of the country, or the wait to see her may be very long.

b. If you are a foreigner who happens to know someone, you could be treated outside of a clinic at no direct monetary cost.  Non-monetary gifts of appreciation are expected.

4. Your medical care is affected by available resources at the chosen point of care.

a. Example: If you need a shot, but there are no needles… you will have to wait, come back, or go somewhere else.

b. Certain resources are carefully saved for emergency situations and remain in hospitals… everyone is thankful for that.

c. I believe alongside many Cubans that if the U.S. embargo were lifted, these medical resource problems would be significantly reduced.

While I’m sure there is a lot missing from even my representation, I want to modify the notion Moore creates that simply entering Cuba entitles any human being to free medical care.  It is true you would not be refused care, but if you are not Cuban, you will be asked to contribute.  It is a quite reasonable request.  And, while Cuba’s resources may be slim, their brainpower is not.  The Cubans are very proud of their innovations in medical science and technology and I hear continually of their progressive medical practices.

As a last note, I want to clarify that I am qualifying Moore’s film not disputing it… Cuba’s medical mentality is slightly inconsistent, but commendable.

If you are interested in public health systems check out the list of media to your right.

Magaly. (2 of 3)

Magaly is a petite, 30-something woman who manages a casa particular.  She is hard working and intelligent and keeps the details running smoothly.  She’s the person I went to when I needed something…if it was pineapple, she knew which market to go to… if it was black market eggs, she knew who was selling.  Her family was from a town 10 hours away and she had come to the city almost 10 years ago to work.  She now has a boyfriend in Italy who visits a couple times a year, and she works 7days a week, 12hrs a day.  One day when I came home rather late, she was lying on the couch looking very ill.  On an inquiry, she told me she had so much stomach pain she could not walk.  I asked about feminine cramps, but she insisted it was something different.  I told her, as best I could in Spanish, that you shouldn’t play around with abdominal pain… too many organs sloshing around in there.  But she couldn’t leave the house, and insisted it was something she ate and it would lessen. A day later she felt better, two days later worse, and four days later she was in emergency surgery.  She stayed in the hospital for four days and returned home with a banana-size scar across her lower belly.  Although a little anemic, she was fine. The doctors warned her to be careful, if she had not come in when she did, she would have died.  Over the next couple of days, neighbors and friends showed up at her door with red meat for her anemia, and soon she was more or less back to herself.  She paid nothing for her medical attention, emergency surgery, and hospital stay.

About a week and a half after the surgery, she was still recovering and was headed back to see the doctors who had saved her.  She showed me the presents she was bringing them in appreciation.  A nice sweater for one and I actually can’t remember the other gift.  I later learned that presenting your doctor with a non-monetary demonstration of your appreciation is the norm.  While doctors cannot receive financial compensation, gifts are a way for the Cuban people to care for their doctors, and to show appreciation.  

The idea is actually quite heartwarming.  Often people cannot do very much and they give soaps or food items.  My cousin told me she once received a clove of garlic from a patient, and another time a huge Papaya.

My medical fiasco (3 of 3)

As a contrast from the story above I would like to share a little story of my own.  January 2008, New York.  Me and my friend Fransçios had just finished a solid Thai meal in Chelsea and were headed to Gramercy for an ugly sweater party.  It was cold and I was wearing three thick layers, and so when my back began to itch in a place I couldn’t reach, I backed up to a building corner and made like one of those black bears you see on a nature film (no, I had not been drinking).  A few blocks later I was still itching and we stopped for coffee, now my palms were itchy.  By the time we got to the party I felt funny.  We were there 10 minutes when my stomach started itching and my face felt funny.  I walked into the bathroom to discover I had hives and my lips had begun to swell.  SHIT, anaphylaxis, definitely not a good party look.  I got the address of the nearest emergency room and I split without saying goodbye (the lip thing was somewhat embarrassing).  I walked two block petrified that the reaction would speed up and I would not be able to breathe.  By the time I walked into the florescent-lit white hospital hallway, I was so anxious I could barely get the words “allergic reaction” out of my mouth, but then I really didn’t need to as my lips now appeared as though my plastic surgeon had a seizure during my collagen injection.  They sat me down clipped something on my finger and began asking me questions… someone took my blood pressure and pulse… someone else shot something in my arm… and than something in one of those vitals must have been off because everyone got serious started moving faster.  They layed me down and stuck an IV in and gave me Benadryl.  Just before putting it in a male nurse warned me it might feel funny. 

Suddenly, I felt as through someone poured hot water on my head, then on my stomach, the same intense warmth… and then it shot down my legs.  The shock of it made me try to sit up, but my whole body felt like it weighed ten thousand pounds, and I couldn’t lift my arms.  The epinephrine and steroids came next… but didn’t make a dent in the Benadryl and I felt like I was in a dream.  It was just about this time where a black gentleman walked up to me and began asking me questions about my health insurance.  Communicating was like being tied up and underwater with two big bananas for lips.  All I knew was that he was there to make sure the financial side of my emergency was on track.  When he asked for my ID and Insurance, I’m pretty sure he had to get them out of my purse for me.  Then he asked me to sign several papers. To this day I have no clue what they said… I lifted my hand, but could not hold a paper, much less a pen.  So, he stuck a pen in my hand and closed his hand around mine and I made a scribble motion.  I never saw that signature, but I’m pretty sure it looked like part of a Kandinsky abstract.  And, for all I know I signed a contract to donate my body to science. 

Well, hopefully you get my point.  The U.S. health system is so caught up with paying the bills, it is somewhat inhuman about the process and care.  Someone in anaphylactic shock has no business signing anything, nor worrying about how much the live saving care will cost.

Finally back in Cuba

This time, as I headed back to Cuba I dreaded some of the difficulties of life here.  In fact I had been doubting how much I really loved Cuba, especially Havana with her dirty streets.  But when the plane landed and I finally stepped out of customs intact, Lina (my Cuban sister) kissed my cheek and I was at home.  I went straight to Mirella’s (my Cuban mother) apartment by the harbor and unpacked.  And so here I am in the most incredible rooms I have ever lived in.  Painted a cheery aqua it has 12+ foot Ceilings, a private bathroom, a 10ft long closet, a queen size bed, incredible art work, and the best part is an enormous east facing window with morning light and a view of 6 monuments, two famous walkways and the harbor.... the room is filled with light all day. But just so you don’t think life is a cinch here, I will let you in on the not so glamorous side…the queen size bed is so old I can feel every spring, the street below is full of noise at all hours of the day and night, the toilet in the bathroom doesn’t flush correctly, the shower is a narrow cold stream of water and I bathe out of a bucket, and the pollution and dust from the street blow in and cover everything regularly.  But really, I couldn’t care less, because, I am living with the people who have taken me in as family, and I am continually and unconditionally loved, not to mention that I am filled with purpose here in Cuba to study sustainable agricultural. 

            Below are some more stories for you…enjoy. Besos.

A Visit From Shakira

As I was coming out of my room just about dinner time, 8:45 or so, when I noticed Nena (Mirella) coming out of the kitchen white as a sheet with a broom stick in one hand and a pot in the other.  She begun muttering “it’s so big, like this”  her hands about 10 inches apart.  It took me about 30 seconds of the muttering to figure out she had a rat in her kitchen.  He had run into the kitchen from the washroom and hidden under the sink.  So, I calmly took the stick and began cautious poking around and moving things out from under her sink until I spotted him…huge indeed!  His big black eyes looking quite wild and desperate as he made a break for the other side of the space and hid in a plastic container.  At this point I asked for a bucket and made a trap…turns out, rats are pretty damn smart, definitely smarter than my trap.  He dodged he by sliding between the wall and the curved edge a few times before I stuffed plastic in the hole and he had no choice but to get in my bucket.  But as I began to slide the top over him, the bugger saw the heist and made a break for the laundry room coming straight toward me.  I screeched and all but climbed the wall as those big wild eyes leapt toward me.  He made a quick stop under the china cabinet and then hid the laundry room behind a shovel.

I carefully followed him in.  In the background I could hear Nena calling for the neighbor and inside I laughed a little, because although I was sure the neighbor was a big strong man, I had sized up the rat and knew I could eventually capture him and put him out without any help.

I had positioned myself above the rat on the edge on the wash basin and had just begun poking the hole when the rat ran from hiding into the kitchen.  At the same moment, I heard the rapid noise of something with nails running on traversite, and the tinkle of an animal collar, and around the corner came a daushound sliding a little as he turned in the hallway to dash into the kitchen….what followed was like a scene from The Lady and the Tramp, with the horrible squeaking and shrieking of El Ratòn and the nasal snarls of the daushound.  All the while a man in nothing much more than boxers shouted from the doorway “Da le Shakira! Da le!”  (Come on Shakira! Come on!)… I couldn’t watch. I remained cringing in my perch listening to the horrible ruckus, Nena yelping, and the man cheering it all on.  When the shrieking stopped, I peeked out to see the loser laying on its side as Shakira trotted away looking quite satisfied. At this point several other people had joined the hallway audience, including a boy wearing not much more than boxers.  The man instructed Shakira to take the rat out.  In she walked, picked it up and took it very proudly to the end of the hall, where it was scooped up and taken to the street.

            Now mind you, all the while the 4 felines that live with us were huddle together in the back bedroom…scaredy cats.  Still, I have never seen anything like this in all my life, four cats that won’t touch a rat and an attack daushound…I don’t think I will be calling them wiener dogs anymore.  Thus ends the tale of Shakira.
 (Although I don’t ever like to see an animal die, for anyone who cares El Ratòn’s death was very quick and natural in the way that wild creatures behave).

The story I could not title

Mirella spent three hours at the special Miami-bound airport terminal with me mostly waiting till the last moment before I needed to enter security.  I had a beer and she had a coke and we talked about what I would do when I got home and when I would return, etc.  When it finally came time to get in line for the security, the line was a huge crowd and slightly hectic.  I was little caught up with travel nerves, but as the crowd got closer to entering customs there was a palpable heaviness. And then, it began.  I noticed a little boy in front of me crying softly, and then his father, uncle, bothers, grandmother, and mother.  They began to kiss and embrace each other as though we all stood on a sinking ship, holding so tightly they could not breathe and crying without shame.  The inconsolable kissing and hugging continued until the focus seemed to rest on a couple.  The woman’s face was red and streaked with make-up from the tears still coming, her long black hair pulled away from her face, and the strong but slender man sobbing on her shoulder had taken his glasses off to wipe away the tears.  They held on with everyone around them watching and crying, and I began to think that they couldn’t let go.  Then the customs agent called her and as she pulled away, the man collapsed down to head in hands, sitting on his heels.  His brother bent down to lift him up and hold him and they sobbed together.  Then the small boy followed his mother through the one-way door, and the family watched and wept for every last glimpse of them.  When the door closed they watched for a moment longer… before turning solemnly to return home.  I became so caught up in their grief that my throat tightened around a lump and I blinked hard to keep back the tears.  I noticed other couples and families crying softly and saying goodbye.  And as Mirella and I stood amongst the crowd I could feel her doubt I would return, I could see her tears forming at the corners of her eyes, and her lips pull tight to hold back her emotion.  And at that moment I felt it, the truth of the embargo, of the US travel restrictions, of the economic state of Cuba, it was like a huge monster crushing us and throwing us helplessly about.  I tried to reassure Mirella I was coming back and I would see her in a month, but I knew she could tell that I had my own doubts… would I really come back?

After I myself went through the door, I could not find much reason to do anything, but sit soberly until we touched down in Miami and the half-empty plane erupted in applause.  And then I remembered the same thing happened when I first landed from Miami in Habana, we had all made it across 90 miles of political conflict and 50 years of estrangement, and going back would be just as hard

Brindemos!