Back in 2011, I met with a group of mental health providers from diverse backgrounds who converged in Phoenix for a retreat to share ideas and vision of integrative mental health. From that shared time, the International Network of Integrative Mental Health (INIMH) was born.One of our mandates was to connect with other countries regarding the shared wealth of knowledge about integrative mental health. James Lake MD, our current president of INIMH, had reconnected with a long-lost cousin in Cuba about 2 years before. They worked hard to pull the opportunity together.
MEDICC (a program in the US that facilitates Medical education exchange opportunities with the US and Cuba) facilitated the necessary steps for us to obtain visas and conduct a mental health educational exchange. An interesting point noted before and during this meeting was that we were not allowed to refer to it as a ‘conference’, due to the political situations with our respective countries.It appears that Cuba is succeeding in areas that the U.S. is still attempting to address with the health care that it provides for its people. One example of this is the birth rate in Cuba which is now the same as the United States. This was not always the case, but it happened due to the commitment of the public health mandates set forth by the Cuban government.
The five-day exchange of the nine mental health practitioners and one writer was a first step in what will hopefully evolve into an ongoing dialogue amongst those of us who took part. We are seeking to find ways to be a part of the process in a formal manner through the connections that we made this past February. It is hopeful that the connection may be possible with the help of the International Network of Integrative Mental Health (INIMH.org) who sponsored the trip.
The INIMH website is specifically designed for mental health practitioners and hosts a forum for sharing ideas and information about treatment protocols and interventions. Our Cuban colleagues have been asked to become a part of that organization.
Our time was divided into two days of tours to different programs around Havana , followed by three days of conversation and didactic exchange held at the Cuban Ministry of Health. The program was ambitious and yet allowed for a few cultural activities. We took in Old Havana which has been transformed to its former glory days. Cuban music spilled out from cafés, restaurants, hotels, and even from homes throughout the evening. The food had a Spanish influence though other cuisines were available, even Chinese in their Chinatown. We would typically have a meal in a local home known as a palladare. This has been one of the few ways that Cubans are able to earn money without political repercussions. There was a friendliness present everywhere we went. The Cubans appeared to welcome us…there was no hostility towards us, as they appear to view the US government apart from the American people.
The first day of the tour, we met at a polyclinic that provides a level of care just above the primary care level. Specialists there see people in the primary care clinic as well as out in the field. Occupational therapy, physical therapy and integrative medicine options such as acupuncture are also available there.
The medical director gave us an overview of the delivery of care in Cuba. She was clearly connected with her staff at all levels and had a personal touch that was evident when we later toured the primary care clinic.
One of the changes Cuba made early on in its medical system reform was to divide up communities so that for about every 2,000 people, there would be assigned a primary care physician and a nurse. They live as close as possible in the community. They also are expected to make home visits in the afternoon after having morning office visits. The mandate is that all the patients are seen in their home environment in a given year. There is a 4-level rating system involved so that those with high risk health issues are noted and brought into the clinic more often than those with few health risk factors.
The approach to pregnancy is significant. This requires close supervision of the mother up to time of delivery. The mom-to-be is allotted a special food ration and given folic acid. These are just some of the steps the Cuban government has taken to allow them to reach their improved birthrate goal.
With the U.S. embargo, there have been few pharmaceutical resources in Cuba. This has resulted in few medication options for many areas of medicine, including mental health. The Cubans have found the need to be creative in their interventions and how they support people. There has been an introduction of Chinese medicine that includes the various branches: acupuncture, herbs, massage, chi gung. This has come about out of necessity and has been low cost as well as effective.
One of the participants in the meeting was a nurse trained in acupuncture. He has become the national director of the program and one of his goals is to bring the training to different physicians. One recent focus has been teaching more psychiatrists in acupuncture. There is a lot of excitement to do so.
Another intervention promoted with great enthusiasm was Bach flower remedies. During one exchange, it was noted that variations on the theme of the remedies even assisted in the detox of a person in liver failure. He apparently was able to recover from the experience with little to no medication exposure.
We were not shown the data on this particular case report but I would welcome seeing it.
Our Cuban colleagues are up on the current research and were eager to learn about our perspective. They were familiar with the new antipsychotic medications but the cost as well as lack of access of them prohibits their use. In addition, they seek master level training in different modalities such as acupuncture, meditation, and public health.
Cuba has pushed for the last 20 years to produce more physicians, especially primary care physicians, and they have succeeded. In fact, they are exporting their doctors to other countries in need of physicians. Venezuela has been one such country that received the necessary care for its people. Hugo Chavez was a great supporter of the Cuba and furnished the oil and fuel that Cuba needs. With his death, there is uncertainty of the impact this has on Cuba.
During our visit, the support person from MEDICC, Diane Appelbaum, met with U.S. students attending medical school in Cuba. They are from underserved, poor communities from the U.S. and are receiving their education for free. One woman was from Oakland, California, another from New York City. Their intention is to return to serve in their communities.
Our visit was rich with tours of different levels of programs and facilities as well as an educational overview of both of our systems. One common theme was the growing number of elderly in both the U.S. and Cuba. There is a Century Club in Cuba and it is growing. Education and engaging the community were strong themes noted on the Cuban side of problem solving in how to approach care of the elderly or care of children. This was true as well for those with mental health issues.
Due to the unique approach to caring for the community as noted, there have been outreach programs already happening in the U.S. One such primary care program attempting to model the Cuban perspective but tailored to the local culture is happening in the South Valley in Albuquerque.
The exchange was successful in identifying common themes present in both of our health care systems that we would like to address together in more depth. There is an interest seeking ways to collaborate on possible educational exchanges specific to individual professions. Another possibility is an immersion program where a practitioner would shadow one of their colleagues of similar training or go on home visits to better observe the delivery of care. The door of cultural exchange has been successfully opened.