David Macafee 2010

I travelled to Cuba and Barbados with the TSS in March 2010, having applied for a Price Thomas Fellowship the previous November. This was a very generous award that enabled unique insights into these two countries and the opportunity to be involved in academic and clinical meetings across surgical specialities and continents.

We arrived in Havana and promptly visited two “elder” day centres which were remarkably similar to our own in terms of structure but provided a more holistic underlying ethos – “looking after the souls” of the older person. This was an unusual facility to be visited by the TSS but it was a reminder of what can be achieved with limited resources as long as you have dedicated, enthusiastic and well supported staff. The walking tour around the old city of Havana by the architect spearheading the renovations provided a fascinating insight into the challenges facing the city and their aspirations over the next decade.

The scientific meeting followed the next day with a limited number of Cuban colleagues. Giving a lecture on the health economics of colorectal cancer screening with simultaneous Spanish translation is certainly the most challenging presentation I have yet given. Despite Mayen’s superb translation, the topic does remain on the drier side and lacked relevance for a country which (perhaps luckily) does not have an “internal market”. Piercing but relevant questions ensured that “I earned my keep” that day.

Later that week having travelled by bus to Cienfeugos, we visited a polyclinic which is a level up from family doctor care but below hospital care.  The range of services provided was impressive (e.g. 24 hour dental care, ENT, eye care, obstetrics) but anything requiring a cannula seemed to be immediately diverted to hospital (e.g. blood transfusions).

We then flew to Barbados via the somewhat circuitous route of Panama then Trinidad. The 1.5 day meeting organised by Professor David Rosin covered many areas such as morbidity and mortality audit, academic papers, development of the Medical School in Barbados (University of West Indies) and the mock trial presided by Judge Glazer. The programme was contributed by both local staff and TSS members with Mr Terry Irwin’s talks on improving our Powerpoint presentations being particularly insightful. One TSS member undertook several joint cases in the theatres upstairs.

We attended a sumptuous reception at the British High Commission on a balmy evening amidst the palms. There was much discussion aided by wine; senior Caribbean surgeons discussing the differences between training in the UK and Barbados, junior trainees having a night off from revising for the “old (good!?) style” FRCS exam and medical managers reminding us that ensuring fair distribution of finite hospital resources is a very challenging and responsible job.

Whilst the people in Cuba and Barbados were just as friendly with the same passion for fun and life there were some striking contrasts. The need for Spanish translation (no matter how good) can detract from some of spontaneity and discussions needed for academic debate; the old US cars are testament to the mechanical skills of the Cubans and remind us it is possible to recycle almost anything and the more varied Bajan culinary dishes and spices are a delight to ones taste-buds. Finally, it reminds us how ubiquitous our consumer culture is in the UK in contrast to Cuba’s persisting sanctions; it is worth experiencing this as well as the warm welcome, beautiful beaches and blue skies. Hopefully some day you can take a short flight or boat trip to Barbados afterwards as it remains a paradise that I look forward to returning to some day.

The highlights of this trip for me included dinner in the privately owned “paladar” restaurant in Cienfuegos, Cuba, and at Fisherpond House in Barbados, the architecture in Havana, the beaches in Barbados and the sun!  What we missed most on our return however was the TSS group – my wife and I were made to feel so welcome from start to finish and we made some good friends.  We would highly recommend the experience to anyone and I am indebted to the Travelling Surgical Society for enabling this opportunity.