Cuba and Barbados

TSS Visit to Cuba and Barbados, 14 – 25 March 2010

This first visit of the TSS to the Caribbean was also the first to have Jon Baines handle the travel arrangements: he sent us much advance advice and the visas to attend a Cuban hospital as well as a Policlinic, the Latin-American Medical School and the Institute of Public Health (for a talk on Cuban healthcare).

The visit was facilitated by Geoffrey Glazer (former President of the TSS) and his erstwhile colleague from St Mary’s Hospital (Paddington) David Rosin, now Professor of Surgery at the University of the West Indies in Bridgetown, Barbados. David had welcomed numerous surgical groups to the Queen Elizabeth Hospital during his two year tenure so far and offered us a busy two day programme there, meticulously organised for the TSS and surgeons and trainees from all over the English-speaking Caribbean.

We flew Virgin Atlantic from Gatwick to Havana, where we stayed at the Hotel Telegrafo, two doors away from the Hotel Inglaterra once frequented by Ernest Hemingway for whom daiquiris at the El Floridita bar had proven irresistible.

During our week on Cuba we had youthful Mayen Vincench as our excellent guide who worked tirelessly to acquaint herself with medical terminology for the simultaneous translation (from the Spanish) for all our visits, particularly to the Policlinic in Santa Clara and our afternoon of TSS presentations at Cuba’s main state hospital, the 24-storey Ameijeiras block founded 28 years ago close to Havana’s waterfront.

The two facilities could not be more different, for the Policlinic offered basic outreach care (simple investigations such as those available in an English general practice) together with physiotherapy, dentistry, opthalmology and some complementary medicine, with occasional specialist elective clinics to support basic local medical care throughout the community.

By contrast, Cuba’s Hermanos Ameijeiras hospital – which we did not tour, though a College visit last year was more privileged – had all the super-specialties of a tertiary referral centre. It was disappointing not to hear any Cuban presentations here, nor did we have the opportunity to talk to any of its doctors though senior surgeon Dr Quevedo offered us a courteous welcome and overview before the TSS proceeded with five presentations, including two from our Travelling Price Thomas Fellows, Ian Cutter and David Macafee.

Cuba is world-famous for its healthcare and education, to which much of its resources are dedicated. The Latin-American Medical School (ELAM ) takes up to 2,500 students a year from all over the world (chiefly from South America), teaches them Spanish then trains them so they can return to their own countries and deliver basic community healthcare, particularly in deprived areas.

There is a high literacy rate nationally, the elderly are well-cared for by their families if they have such, but by the State-run social service system of community workers and by facilities financed by tourism, such as the geriatric day care centre we visited on the site of the former Convent of Our Lady of Bethlehem which has 600 seniors on its books, mainly those with no relatives (family-life is strong in Cuba, a largely Catholic country). We also saw a small crowded medical geriatric outpatient facility where nurses and a female doctor provided ophthalmic and other services.

In the Institute of Public Health the Cuban healthcare system was proudly explained to us – translated from the Spanish – by public health doctor Dr Nancy Melera using PowerPoint. The community healthcare schemes had their roots in Fidel Castro’s speech.

History will absolve me in which he pledged resources to provide healthcare for all and eradicate infectious diseases and illiteracy. These general aims have been largely reached, a considerable achievement when considered against the background of extreme poverty for which this autocratic communist state largely blames the ongoing American economic embargo. Simple measures, such as maintaining clean toilets, could however make a world of difference, and observation suggests an absence of individual initiative.

The shops were virtually empty, the fertile fields untilled, and there was a dual economy (three Cuban convertible pesos to the pound sterling, only obtainable in Cuba) with tipping encouraged for even the slightest service. Food was uninspiring (rice, tomatoes, cabbage) with the choice of main course limited to pork, chicken, beef or fish, and beer (Bucanero or Cristal; wine was very expensive) then dessert and coffee, and a surfeit of live Cuban music.

Havana seems condemned to a fading glory of yesteryear, its mainly-Spanish buildings proud but crumbling and paint-flaky like a derelict film-set, an image heightened by the huge American cars from the 1950’s that spluttered their noisy way around town with an almost incongruous respect for pedestrians.

Nonetheless, as with so many poverty-struck communities, the people themselves were mostly well-dressed in clean clothes and had a ready smile, though begging was rife and there was much standing around. Television programmes were limited and one had to wonder what the man-in-the-street made of his lot, and what he knew of the affluent Western world to which his colleagues periodically sought access across the 90 miles of water to Florida.

Flying Copair from Havana to Port of Spain (Trinidad), we stopped in transit at Panama City where the airport bustled and the shops were packed with western goods: there was even Wi-fi, albeit unpredictable and possibly a source of viruses, but at least we could sit around or eat while awaiting our Copair flight to Port of Spain. Here we had briefly to immigrate on Trinidadian soil for a protracted fresh check-in with LIAT, followed by confiscation of alcohol already bought at the duty free shop and scrupulous examination of our luggage which had already been cleared when we left Havana.

It was a relief to land at the sparklingly new Grantley Adams airport, in the first shower of rain Barbados had received for four months. Our experience here was in marked contrast to the previous week. David Rosin arranged an excellent two-day meeting in the 200-seat auditorium at the 600 bed Queen Elizabeth Hospital built in 1960; there are plans to replace it in due course.

We were welcomed to our meeting by Senator Irene Sandiford-Garner (on behalf of the Minister of Health, called away to Brazil), and there followed papers from around the English-speaking Caribbean as well as from the TSS, culminating that afternoon in a mock trial attended by Miss Nellie Snufftit (who happily hadn’t).

The disgruntled plaintiff was a private patient suing over a common bile duct injury sustained at laparoscopic cholecystectomy performed on a small Caribbean island by an inexperienced local surgeon mentored at a distance over an ISDN line by Professor Ino Itall of the Amazing Skills Centre in Barbados.

Expert witnesses had already submitted written opinions in response to documentation prepared by David Rosin, and were now scrupulously examined by genuine lawyers, Trevor Carmichael for the prosecution and Tariq Khan for the defence, before M’Lud Geoffrey Glazer.

The jury from the audience had as foreman Pierre Guillou who professed no medical knowledge but delivered a damning indictment of the care, with all defendants found guilty except the Amazing Skills Centre: the bile duct should not have been clipped. It was all entertaining and hopefully educative, especially around the matter of consent though quantum was not decided on this occasion.

The next morning began around 7 a.m. with an audit and governance meeting followed by breakfast then a TSS teaching symposium on How To Do It, on six topics. The meeting received coverage in the local newspaper (the Barbados Advocate) though the article concentrated largely on medical accreditation and revalidation.

There was time enough to see the British Colonial Garrison buildings encircling the Savannah (the oldest equine racecourse in the Americas) which together with Bridgetown itself was being submitted for consideration by UNESCO as a world Heritage Site, the only current English-speaking Caribbean one being the Pitons on St Lucia.

In the courthouse of the Garrison we had a magnificent overview of the history and architecture of Barbados from one of its fiercest proponents, Professor Henry Fraser, a gifted orator and artist due to retire shortly from the University of the West Indies where he was Dean and Professor of Medicine.

There was a visit to Sunbury House, a traditional sugar cane plantation home, and Hunte’s Garden, opened four years ago in a sink hole and displaying a wide variety of tropical plants and trees, followed by an idyllic meal at Fisher Pond Great House where the dining has been rated the finest in the Caribbean.

The ladies visited the estate of JCB magnate Lord Bamford, and Middle Earth, the friendly home of Jan Powers whose company delighted the TSS as much as it did David Rosin. Together they had laid on a wonderful week, and the invitation to return to Barbados will be difficult to resist for the 42 lucky enough to attend this first TSS trip to the Caribbean.