I had been looking for a way to explore a little bit of Cuba when an avenue presented itself through the People to People Ambassador Program. This Program was offering an educational exchange opportunity to members of the American Association of Public Administration who wanted to visit Cuba as part of a delegation of public officials and college professors. Since Cuba was a great unknown for me, the Ambassadors Program seemed to be a good way for an adventuring woman, traveling alone, to go. I have been to other Latin countries and to Ecuador many times, but this was my first excursion to this Caribbean nation. I wasn’t sure what to expect because so many negative things are heard in the United States about Cuba. I made all sorts of preparations ahead of time based on what turned out to be faulty information. Upon recommendations, I left my wedding rings behind and bought a cheap watch. However, I knew there was poverty in Cuba, so I went prepared with school supplies, clothing and toiletries as gifts. I did get all of the recommended vaccinations.
Maybe it was just my particular travel experience, or maybe it was because our delegation was situated in a protected “tourist” area but I was not bothered by anyone in my brief forays away from the group. Through my readings in preparation for the trip and as confirmed by others, I learned that most Cubans were not allowed in the hotel area. I reasoned that maybe this was why I wasn’t bothered. The trip left me with the desire to return to meet Cubans. I hope to do this if the opportunity presents itself.
Entering and leaving Cuba was no problem--if anything, the long lines entering and leaving Nassau, our point of assembly for the delegation, were the most troublesome part of the procedure. It was in our orientation in Nassau that we learned that there had been many snafus and frustrations for the People-to-People staff in scheduling meetings and appointments with various government officials. Many of the delegates were there with funding from their universities or governmental agencies and so to have a fruitful experience was of the essence. Once in Cuba and after two days of cultural visits, four of us would eventually go to the delegation leader to request that he handle the problems with securing the appointments and then meet with the delegation to inform us of outcomes.
Communist governments are heavily bureaucratic. This meant that according to Cuban protocol the burden was on the assigned national tour guide to determine the manner in which he would make certain that the seminars; forums and interviews would be permitted. Fortunately, all of the events and such that had been scheduled were permitted. Since the United States Government had only recently agreed that cultural and educational exchange could occur between American and Cuban groups, this was the first delegation of public administrators and college professors through the American Association of Public Administration to come to Cuba so there was some speculation that the nature of the group might have had the reason for some of the difficulties. However, I learned after my return that most groups visiting Cuba, no matter who their members are, have experienced the same bureaucratic difficulties. The plans for this delegation had been under discussion between the People-to-Peoples Program and the Cuban Government for over eight months, with little response from the Cuban intermediaries. People-to-People had tried to establish a United State exchange in 1990, but a badly bungled itinerary caused the People-to-People Program to cancel that visit and all further delegations until 1999 when it was decided to try again. Perhaps, the sudden change in the economy with the loss of Soviet support in 1991, and the upheaval this caused in Cuba with the loss of over 50% of its funding from the Soviets created an internal crisis. .
I was very aware that both Cuba and Puerto Rico had been annexed by the United States as prizes from the Spanish American War of 1898. Cuba disentangled itself from the United States six years later, though Puerto Rico remains a territory or commonwealth, as it is now called. However, Cuba’s path has not been smooth, its political system dominated by dictatorships, many fully funded by the United States. The last changes took place 42 years ago. Today it is a communist or socialist country.
Inside Cuba
I was interested in what obvious differences there may be between a communist/ socialist country and a capitalist country like the United States. I noticed that everybody had the same amount of material goods. I didn’t see the poverty I have seen in other Latin countries, but I did notice that everything seemed drab. There were very few decorations to signal that the Christmas season was with us.
What About Religion?
There was a church close to the Melia Hotel where the delegation was quartered and some of the group went to visit. The church was in disrepair. But the delegation would soon see that this state of affairs was no different from what we would observe with many public and private buildings in Havana. There are 57 denominations in Cuba. All but the Catholic Church belong to the Cuban Council of Churches. Our American journalist speaker noted that the largest denomination is the Afro-Cuban Church, which mixes santeria with Catholicism. Children are baptized Catholic, but raised in santeria. St. Barbara’s church (or St. Lazarus, as recognized in santeria) was filled to overflowing with people and the preparations being undertaken for the celebration of that saint’s day gave the delegation a sense of the people’s mix of the two religious beliefs.
The “Special Period”
It was obvious that Cuba is adapting from the loss of major financial support from the now defunct Soviet Union. The public health researcher from the University of Havana told us during his seminar on Cuban health that the past ten years since that financial disaster had come to be called by Fidel Castro as “the special period.” The Foreign Investment Minister would tell the delegation during his forum that now in this lean time in its history, Cuba had been able to see the effects of the changes caused by its own revolution. He said that Cubans have been surprised by some of the changes brought by the revolution. They have learned that it is difficult to develop a socialist system in an underdeveloped country without a strong financial base from which to start. It is very difficult to develop a retarded infrastructure and move it forward. The same American journalist who spoke to our group remarked that one of her fellow journalists had written a book in which she said that the revolution had produced a circumstance in the country that was neither good nor bad, but someplace in between. Some new infrastructure was introduced with the Russians’ help, said the Foreign Investment Minister, but it wasn’t helpful. While Russia did try to help Cuba solve its social, political and economic problems, the infrastructure in which it tried to do this was so fragile that the attempt ultimately was pointless. Although the Soviet Union’s ideas were helpful for addressing these problems, they were limited in the sense that the Soviets were proposing the introduction of just one type of system.
The severe belt tightening that has resulted has been particularly hard on the Cubans’ daily lives. Visits to the ration store are a fact of life. Every month, individuals receive 5 lb. each of rice, sugar, salt and black beans. Children up to age 6 and the elderly receive a special extra ration of milk and meat. The health indicators have been good, even better than that of the United States said the public health researcher from the University of Havana, despite the shortages of food, clothing, shelter and gasoline. However, the American Association for World Health Report of 1997 states that suffering and malnutrition are a fact of life and is the consequence of the U.S. embargo which denies food and medicine to Cuba. Meat is rarely available for the Cubans. Consumers have three choices for shopping: at the state store, that is, the ration store; direct from farmers which is the most expensive; or at the food cooperatives, whose prices lie in between those offered by the ration stores and the farmers. If nothing else, utilities are cheap.
Public transportation is scarce. The cost of gasoline is astronomical because it has to be imported. Cubans were urged to adopt the bicycle after the Russians left and 30,000 were purchased from the Chinese. When I looked out my window in the morning, I could see hordes of people on bicycles riding to work. People guard their bikes as an American might guard a car. What cars there are in Cuba are the American cars left over from the 1950s? The Russians brought the Lada, a little car, with them and left it without replacement parts. Since parts get scavenged for other cars, the Lada has not been particularly useful. Many of the American cars are beautifully maintained but infrequently used because of the cost of gasoline. Parts come from all kinds of vehicles even parts from the little Russian car are crafted and shaped by the Cubans to be used in the American cars.
When the American cars are used, it is for second income as limos for weddings and special occasions. Some are used as taxis. However, such use is done very carefully as operating a private car as a taxi would require payment of a prohibitively expensive tax and in any case is forbidden. We could see men constantly tinkering with their cars out on the street. We became acquainted with the “coco” taxi; a tiny open-air cab built in the form of a “C”, accommodating two passengers and the driver. The cab looks like a carved out coconut shell. Buses are infrequent, very overcrowded, and as noted, costly. There is one type of bus that is built in the shape of a camel—very large with a slightly drooping middle section resulting in the appearance of two humps—and is called such by the people. People make use of trucks; hitches rides, and jump on whatever is moving when they need to get a ride from one point to another. The government employs a class of worker generally called the “yellow man” because he is dressed in yellow. His job is to halt vehicles that could take on more passengers so that people don’t get lost in the crunch. And again, there is always the bicycle.
Careers
Cuba’s communist/socialist system, combined with the changes resulting from the economic rationing needed to keep the country on course, of course affects the career paths available to the island’s people. These factors shape what jobs a person may choose and may also produce job loss when it is determined that one’s profession is no longer useful to the country. One example could be seen from the experience of the wife of one of our speakers. Trained as an architect, she lost her position and had been out of work for about three months when we met her. Their daughter was helping them out financially because she had an in-demand job in the tourist industry. We learned that there are many cases in which sons and daughters are helping to support parents whose professions are not in demand.
The personal economic status of professionals is no different from that of a taxi driver. Actually, hotel attendants make more money than the professionals do because they are currently a needed resource for the country and they can receive tips. A doctor makes $25.00 a month, but there are no tips. Many find that having a second job is critical to make ends meet. Many of those employed in the tourist industry are college graduates whose specific academic skills are not presently needed by the country, but are useful in tourism. For example, our “national tour guide,” was a college graduate who makes $120.00 year American money plus tips. Since it was suggested to us that the amount of tips we give be at least $3.00 a day per person, a program such as ours lasts more than one day can represent a substantial boost in income. Even so, our guide did not own a car and rode a bicycle to work every day.
Education
The official from the Higher Education Ministry who spoke with the delegation said that the Education Ministry of Cuba administers only 15 of the 59 programs available in the country’s educational system. Such other state bodies as the medical school and the Ministry of Culture administers the others. The Ministry of Education oversees a basic program for teacher training and another program for the professions that emphasizes basic sciences and social sciences. Doctoral programs emphasize research and apparently do not include teaching and community service, as do universities in the United States. Once the degree is obtained and the researcher is in the field, the person finds the lack of resources to facilitate the research acute and frustrating.
To gain admittance to the university, students must take an entrance examination and provide records of their studies from the lower grades, from elementary school on up. We visited two elementary schools during our stay. We observed students at the school for the arts in Havana who were preparing work for their portfolios to accompany their exam results in their university entrance application. Those students who can pass the entrance exam and demonstrate that they have the needed skills and talents benefit from having their education subsidized through graduate school. The numbers admitted depend on the country’s needs for specific careers over the next 5 to 10 years. It generally takes 5 years to graduate and 6 years if it is medical school.
Students who earn their university diploma receive a job assignment upon graduation. Although accepting it is not necessary, that it is available means that college graduates do have a guarantee of employment. Such an offer would be taken seriously since there is high unemployment in the country. In special cases, as can now be seen with the advent of the biotechnology and telecommunications industries, people are sent abroad to acquire additional education because having skills in these areas will be helpful to the economy. Presently, there are 110,000 to 120,000 students in the universities. There were 300,00 prior to the embargo that began in 1961. Economic conditions make it impossible for everyone to attend who might want to do so. Today, one of every seven Cubans is graduating or has completed the university. The University of Havana has 700,000 graduates since the revolution. There are 59 universities spread out over the country. Prior to the revolution, there were only three universities. By law, non-traditional students such as working adults can attend the university full-time or part- time, although to attend full time requires permission. While in school, they continue to receive their salary. Many adults go to correspondence school.
The biggest problem for the universities is a lack of such material resources as computers and other equipment. The Episcopal Church in Cuba has helped the Education Ministry to acquire more modern computers such as first series Pentium-chip based models. The Ministry has been trying to generalize use of computers all across the country. More are needed, but financing and transporting to the country are expensive. Help from non-profit organizations and other churches abroad in no way can make up the difference between the need and their ability to provide assistance.
Public Health Services
Over 3500 medical professionals left Cuba at the time of the revolution including most of the Faculty of the Medical School at the University of Havana. The overall loss was so great that people were sent to Germany and to Russia to train in medicine and engineering. Today, 10% of all scientists of Latin America are in Cuba. Some of the newly trained doctors formed the core of the teaching faculty for the medical school at the University of Havana.
Cuba emphasizes family medicine. New graduates of the medical school are obliged to serve as a family doctor for seven years in one of the many countryside communities. Doctors have several options to choose from regarding where they would like to practice, but they do have to do this initial obligation. It was noted by the public health researcher that the deployment of physicians in the countryside was philosophically good, but hard to cope with in an economically underdeveloped country like Cuba. This emphasis sending physicians to the countryside has resulted in a loss of medical capabilities for Havana and other big cities. Havana’s hospitals today are poorly maintained. When we asked the American journalist as to why this had happened, she had told us that prior to the revolution, people in the rural areas had to come down from the mountains to board a boat to go to a city for medical treatment. There was no medical care in the rural areas. There were so many deaths on those trips that some 26 cemeteries were constructed near the harbor to bury those who died trying to get to the boats. In desperation, whenever there was a lack of medical assistance both in the city and in the countryside, people would, and still do, often call on a folk healer, a curandero, to provide herbs and psychological help when people get sick.
Our delegation stopped at two clinics during our trip to learn about treatment and the availability of the needed medical supplies. Since neither were planned stops, no one was prepared for us so we saw what there was. The clinics were ill supplied. There is a shortage of medication, but when it is available it is cheap. As is the case anywhere, people can die if the right medication or the equipment needed to treat a particular condition is not available. At both locations, we were told the major illnesses in the countryside are parasites and heart problems.
From the standpoint of the bigger picture, the speaker from the Ministry of Public Health said that due to preventive medicine the biggest health problems have changed from tuberculosis, diphtheria, polio, tetanus, measles, whooping cough and infectious hepatitis to those experienced by other industrialized nations of cardiac disease, malignancies and stroke. The first two causes of death in Cuba are (1) complications in birth, and (2) accidents. Although Cuba has the lowest infant mortality of all South America, it is now up to 60 deaths per one thousand today. Serious nutritional deficits among pregnant women are a contributing cause to infant mortality and the above-mentioned complications in birth. This is as compared to 16.5 in 1985 when the improvements in the Cuban health system were still at an optimum.
Financial help from such countries as Great Britain and France has helped Cuban doctors and medical scientists make some important discoveries. These have included vaccines for dengue fever, medicine to treat AIDS, the transmission agent of yellow fever, a vaccine against meningitis B and a less expensive interferon drug for hepatitis A. Clinical trials have been done in Cuba, Latin America and Scotland for all of these vaccines and medicines. Cuba wants investment returns for this research before it releases these vaccines to other countries.
The last segment of our interaction with the public health community came with the delegation’s visit to Celia Sanchez Psychiatric Hospital. This was a very large facility that can accommodate up to 4,000 patients. It held 3,500 at the time of our visit. The treatments given and the environment of the hospital was quite similar to that which could be found in state psychiatric hospitals in the United States some twenty-five years ago. Occupational, recreation and art therapies are used as well as psychotropic medication. Electro shock treatment is rarely used now in United States hospitals, but is still used here for paranoid schizophrenic patients. Schizophrenia in fact is the major mental illness as it is in the United States. The average time of stay is close to five years; in contrast, stays in the United States are limited to five or six weeks with discharge to community mental health centers, a luxury that is not available in Cuba.
Recharging the Economy
Discussion with the Ministry of Foreign Investment reiterated the information that development of trade with the Soviet Union began when the United States imposed the embargo on Cuba in 1961. During that time, almost 80% of Cuba’s economy became dependent on Russia’s.
When the Russian government discontinued its subsidies to Cuba in 1990, the lack of energy resources (oil and gasoline) and other raw materials was acute. The country also experienced a 35% drop in its gross national product. The Cuban Council of Ministers took stock of its opportunities and the threats it faced and prepared a new national strategic plan. The opportunities it has seen have been taking them in a new direction outside of planned socialism. This has forced a modification of the government’s philosophies regarding the use of shared partnerships in foreign investment and the tourist industry.
Tourism has become an increasingly major source of income. It is controlled because it creates a “pleasure” orientation that the government believes is destructive to their way of living. Association with tourists is off-limits for Cubans, who have reacted in turn by calling this “tourist apartheid.” Joint ventures with other countries, particularly Spain, have resulted in part in the building of new hotels like the ones in which our delegation were housed in Havana and Vedadero. Secondary industries related to tourism such as the joint venture between the Port Authority and the international cruise industry to expand the harbor are slowly being added to support the hotels and the tourism venture. A company that is a joint venture between Cuba and Canada operated the bus that was assigned to our delegation. Programs such as People-to-People, although not a tourist venue, certainly are a secondary adjunct to this effort. Cuba is learning their socialist system has not been well adapted to planning programs for foreign tourists. The government has not been accustomed to accommodating outsiders, so it is finding that it must ease up on its tight controls.
The Cuban Constitution had to be changed to permit foreign investment. Along with the joint ventures and the tourism industry, the prospect of foreign investment has helped create the need to reform the country’s banking system. The central bank concept meant the system lacked the necessary flexibility and procedures to handle the large amounts of foreign exchange now entering the country.
At present, there are over 400 joint partnerships with 45 foreign companies. All ventures are decided on a case-by-case basis. Joint ventures cannot be concluded in the fields of public health services, education services and the military. The government would like to believe that foreign investment is not the only way it has pragmatically available to handle its monetary difficulties, but the harshness of the economic realities is forcing them to reluctantly accept what in other circumstances would be unpalatable. The government fears that this would result in too great a loss of ownership of one’s own country, we were told. Joint ventures have been pursued with companies from Spain, Italy, Germany, Canada, Panama, Mexico, France, Chile, China and Israel. The profits made are returned for the rejuvenation of the industry in which the joint venture is taking place. This is being done in such areas as nickel mining and sugar and the citrus plantations. Slower progress is being made in telecommunications.
In our visit to one of three Cargo Free Zones, we saw office spaces and warehouses for goods arriving from countries involved in joint ventures with Cuba. The Zones were created in 1992. They provide all the services needed for their customers who in turn must provide profit-oriented imports under license. The government’s goal is to import only 25% and export 75% of the goods created here. A company can operate tax-free for its first five years here and then they must pay a 50% tax for the next three years on all profits and income, after which the amount drops to 30%. These taxes are earmarked for social security. Companies have to have their banking references checked and can then apply to the government to do business in the Zones. Approval takes 45 days. Companies have been bringing their own employees but their ultimate goal is to train and then employ Cubans instead. Salaries are 400 to 700 pesos a month (or $20.00 to $60.00) depending on position and experience.
Allowing Cubans to make more money in the Free Zones has created inequities in the political system. One way to address the inequity has been to impose a tax on those who receive more income such as the employees of the Cargo Free Zone. This would include the hotel employees and the taxi drivers. The government also seeks to build in incentives for those whose professions, such as teachers and health care professionals, are important to maintaining the quality of life of all of the people. The government has been able to establish a budget with just a 2% deficit and without use of external finances.
Conclusions
All in all, this was a compelling trip, exposing all 27 of the delegates for the first time to the panorama of Cuba. We spent a considerable amount of time in preparation for this adventure. The library of books we all read comprised a small mountain. Participation was intense; comments made about observations were thoughtful and reasoned. And all of us were interested in making a return trip to the island. What did we learn? What we heard is true. Cuba is someplace in between now in terms of how it sees the revolution. It’s not the socialist republic it had hoped to be and practicalities forced many ideological shifts when the income was no longer available to put bread on the table. It’s an uncharted course because of the increasing inclusion of other countries in the business of the country. It requires a MBA type of Cuban to negotiate business between the government and the companies from other countries. The government can’t forget the economic needs of its people, most of who remain loyal to the reason for the revolution and who do not want a return to the inequities of the previous regimes. They suffer shortages today in terms of food, clothing, shelter and nutrition because they stay true to the reasons for the revolution. If the United States were to release its embargo, it’s hard to say what would really happen in Cuba. It might feel as though it was negotiating another foreign venture, or it might feel dependent, as it had become under the Soviet Union. That would require another kind of adjustment. Release from the embargo could exact a price that would be unacceptable, for Cuba enjoys its sovereignty and that is non-negotiable at any price.
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