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Tuesday 26 February 2013

Travel: A Psychologist in Cuba

Ride to the beach in 1950s style. Trinidad, Sancti Spiritus province.
I recently travelled across Cuba, staying with Cuban families in casa particulares (homestays) in Havana, Cienfuegos, Camaguey, Trinidad, Santiago de Cuba, and Baracoa.

Along the way I had an opportunity to speak with a psychologist about the practice of psychology in the country. For what it's worth, here's a bit of a summary.


Since shortly after the revolution in 1959, Cuba has been relatively isolated due in part to the Cuban government’s policies and partly to the United States embargo that remains in place, with some minor shifts, to this day. US citizens are still restricted in their ability to travel to Cuba, but the rest of the world (particularly Canada) has made it into a middle-league tourism destination.

In recent years Raul Castro has begun the process of economic and social reform, perhaps in recognition of the fact that the economy has not prospered under the communist system. For decades Cuba was supported by the former Soviet Union until it fell (precipitating what the government called the “special period” starting in 1991 during which the economy virtually collapsed).  More recently it has relied on other allies – notably Venezuela and China – to keep afloat.

In terms of exports and material wealth of its citizens Cuba has not done well, though the US embargo has paradoxically muddied the cause for this, enabling observers (and the government) to attribute economic problems to US policy rather than to the command economy. Some of the Cuban citizens I spoke with suggested that the primary effect of US policy had been to unite the country under the Castro government, supporting the very situation that the policy was supposedly intended to disrupt.

Health and Education
Not the best accommodation, apparently.

On at least some aspects of the social front, Cuba has done markedly better. The arts occupy a prominent position in Cuban society, and appear to be supported more than in either Canada or the USA.

Cuba, like Canada and most “first world” nations other than the US, has a socialized medicine system that covers all citizens. Unlike Canada, dental care is also included free of charge.

Infant mortality rates are correspondingly low: in the most recent 5-year period reported by the UN, Cuba beats Canada by one spot, while the USA sits 8 positions down the list (just behind Lithuania, just ahead of Belarus).

In life expectancy Cuba does not do so well, sitting at 37th (78.5 years) on the UN list for 2005-2010, behind Canada at 11th (80.54 years) but still ahead of the USA at 40th (77.97 years).

Young revolutionaries on school trip, Camaguay.
The education system is reasonably well-regarded internationally. School and University are available at no charge to students. A 1998 UNESCO study of Latin American countries ranked Cuban 3rd and 4th graders first in math and reading, far ahead of runners-up Argentina, Chile, and Brazil. On international rankings of literacy, Cuba (5th) passes both the USA (22nd) and Canada (34th), though varying definitions of literacy and country self-reporting make this a somewhat less reliable data point.

Traveling across Cuba one constantly sees packs of children in school uniforms in the early mornings and late afternoons, and seldom during school hours. A 3 or 4-room school I visited had a “computer lab” but was equipped with only a few fairly antiquated machines.

Psychology in Cuba

Sr B, with almost certainly unnecessary confidentiality.
I met with a psychologist in one of the cities I visited. Although he spoke excellent English, I was not quite able to fully explore the question of how appearing in an internet blog might play out with his employer. There was absolutely no sign from anyone I met in Cuba that talking with foreigners is a problem at all, but I'm naturally cautious.

He repeatedly waved his hand saying “no problem” but I’m still not entirely sure he knew what a blog was. Access to the internet is quite restricted in Cuba, though it has been showing signs of opening up a bit recently. Consequently, let’s just call him Sr B.

Our psychologist works on a medical ward of the local hospital, assisting patients receiving dialysis with the emotional consequences of their conditions. He also provides services to a community high school, diagnosing and treating psychological conditions and dealing with circumstances like parental neglect and coping with the consequences of divorce.

Treatments are largely psychotherapy-based. We did not have time to get into the details of technique, but it seemed that basic counseling practices formed much of what was done. Much of the work is family-based, and Sr B described home visits that would be carried out to see how patients lived and got along with other family members.

Taxi, Baracoa
I discussed cognitive behaviour therapy briefly and it was clear that this was not prominent in psychological training – interestingly, given its predominance in many other countries and its focus on immediate problems and practical strategies. It would be tempting to get all gung-ho about exporting CBT to Cuba, but the sobering experience of reading Ethan Watters’ book Crazy Like Us (about which I wrote a 4-part review here, here, here, and here) makes me hesitant.

Psychologists, like other professionals in Cuba, appear to be dedicated to their work. They labor at challenging jobs despite extremely limited remuneration. Psychologists and physicians make an average of 20CUC (about $20 CDN or US) per month (yes, per month) – plus some perks involving housing and childcare – along with the universal ration card that allows citizens to purchase some basic foods for sharply reduced rates.
Old Havana

This rate of pay is double what some workers make, but still only allows a very basic life, even with the low prices in the Cuban economy. The real money comes from any job outside government employment, or a job with a government agency that allows for tips (the very best job, multiple people told me, was taxi driver). Consequently, many professionals moonlight at jobs that provide private income. The desserts at one restaurant were baked by a local physician, and the casa I stayed at in Baracoa was run by a dentist, who made breakfast for guests before heading off to the clinic for the day.

I’d been briefed by other travelers that books, clothes, and other supplies were extremely welcome throughout Cuba, so I gave up my Canadian Psychological Association t-shirt and with some embarrassment handed over a copy of my assertiveness book, which I had narcissistically packed and which he enthusiastically (and perhaps somewhat politely) received.

Recently restored square, Havana.
I also made a point of stressing the Canadian custom of paying for the time of busy professionals and enclosed a “bookmark” (with some anxiety: too small? too large? offensive?). The following day I ran into Sr B on the street in town, where he thanked me effusively and said that now he could afford to buy a pair of shoes for work that he had seen in one of the stores for local citizens.

If I go back, which I may – Cuba is a beautiful country and the casa particular system allows for a kind of mixing with local people that you seldom get anywhere in the world – I will look up Sr B again, perhaps with some advance warning so that I can get more of a sense of practices in his country.

In Sum
You can watch the change coming.

Cuba is changing fast. Under Fidel's brother Raul, the economy is opening up in a hurry and the next ten years look like they will be startling for Cuba's citizens. It was only a little over a year ago that hundreds of thousands of private businesses were permitted to start up. Just three weeks before my visit the international travel restrictions were significantly relaxed. Havana's streets are torn up and being repaved as we speak.

Talking with people I heard the same refrain over and over: "Cuba needs to change. But right now it's changing too fast."  There is a real fear of a Russian-style collapse and a race to kleptocracy-style capitalism that will provide much-needed cash but sacrifice the real gains Cuba has made over the past 50 years. They want to keep their successes: their education and healthcare systems, the sense of equality, the care for the poorest in the society. Can they do it?

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  1. I just read through the entire article of yours and it was quite good. This is a great article thanks for sharing this information. I will visit your blog regularly for some latest post.

  2. I think that your perspective is deep, its just well thought out and really fantastic to see someone who knows how to put these thoughts down so well.

  3. And for me, I'm OK with the limited availability of resources in Cuba. There could always be delays or services that aren't available. I understand that.

  4. It is a good article. I loketo read things on Cuba. I actually grow up in Isla de la Juventud, Cuba. I have been to Havana and other parts of the country many times. It is my desire to go back when I complete my education .

    Thank you for sharing.