The political drama between patriots in Cuba and exiles in Miami around 6-year-old Elian Gonzalez raises a key question: What are the boy's chances of growing up healthy if and when he heads back across the Florida straits to his dad? The bottom line is that he'll benefit from a system in which universal health care is entrenched as a "human right," but if he gets a headache his dad may not be able to afford to buy him an aspirin.
Such contradictions are not uncommon on Castro's island, as I discovered when I lived in Havana for almost a year. What I found, to my surprise, is that Cuba's essentially totalitarian regime is in the process of engineering something inherently democratic: the integration of low-cost botanicals and other natural medicines into its public health care system.
My story begins on a hot May afternoon walking my bicycle down crowded Obispo Street in Old Havana. The bicycle pedal scraping against my leg is only a trivial annoyance as I pass by Hemingway haunts, art vendors and 17th century architecture under repair -- until three days later a nasty infection from an earlier injury blossoms on my left calf.
Far from being a worry, the infection is my opportunity to test my faith in Cuban alternatives to mainstream medicine. In what amounts to a revolution in health care delivery, the Cuban government has been actively promoting low-cost botanical medicines instead of drugs. It's also encouraged doctors to reeducate themselves in "natural" medicine techniques.
Much of the credit goes to the continuing U.S. trade embargo. The economic disaster following withdrawal of Soviet aid in the early '90s made it impossible to access many medicines and pharmaceuticals. So the Cuban health care system was forced to search for alternatives. It didn't have to look far, because medicine verde, or "green medicine," has been part of Cuba's culture for centuries.
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I'm in the home of Enrequito Hernandez Armenteros, at 81 one of Cuba's better-known priests of Palo Montes and Santeria. As a practitioner of Afro-Cuban religion, Enrequito knows the country's thousands of healing plants and herbs. A shrine to San Lazaro, surrounded by floral offerings, graces his front yard. A prized memento in his private consulting room is a photo of himself with Fidel Castro taken last year at a reception for the country's senior babalaos. The photo shows the tall Cuban leader with his arm draped around the diminutive Enrequito.
I have it on reasonably good authority that Fidel, far from being a heartless atheist, is an "hijo" (son) of Babalu-Aye, the orisha in the Santeria pantheon who causes and cures illnesses. I've also been initiated as an "hijo" of Babalu-Aye in a Santeria ceremony as part of my exploration of Cuban archetypes. And I made the 50-mile pilgrimage on my bicycle to El Rincon to the church of San Lazaro, the Catholic saint paired with Babalu-Aye. This act of devotion on my part should certainly protect me against some trifling leg infection -- shouldn't it?
I'm visiting Enrequito to introduce Tracey Spack, a Canadian Ph.D. student in medical anthropology. She's conducting research on how Cuba is introducing natural medicine into its public health care system. She says that before Castro the use of plants and herbs was relatively common and accepted in Cuba. The revolution brought in modern medicine, vaccinations and antibiotics, so natural medicine faded into the background. Cubans who grew up in the Soviet-backed economy of the '60s through '80s didn't exactly embrace natural medicine with open arms. "But," she says, "they found out to their surprise that it actually works."
She adds, "In Cuba there's more of a sense of community around medical care, and patients are seen more holistically. There's more consideration of the person's life situation: marriage, work, etc." The contrast in North America is that we tend to want to "kill an infection, deal with a specific pathology in isolation. In North America it's more difficult because people want a quick fix."
Speaking of which, as I sit around Enrequito's Arthurian round table, sipping aguardiente rum, I'm starting to panic. The infection is making the sore on my leg start to weep. For Enrequito, my problem is a no-brainer. The solution is to simply apply leaves of the caisimon tree, hojas de caisimon, which are readily available at the four corners market in Havana. But wait. Today is Sunday and the market is closed. No problem, says one of Enrequito's sons. He dashes off, returning in 20 minutes with a couple of dozen large, dark green, heart-shaped caisimon leaves.
"And if that doesn't work," jokes one of Enrequito's followers, "we'll do an amputation."
As I gratefully depart clutching the caisimon leaves in a plastic shopping bag, Enrequito advises me to rest the leg for two days.
That evening my Cuban girlfriend lights a red candle and takes one of my cigars as an offering to San Lazaro. I go to bed with a caisimon leaf wrapped around my leg, and in the morning it looks as though I'm on the mend. The episode with my leg is giving me a direct experience of medicine verde. Still, I have some fear. Maybe I should go to Cira Garcia, the hospital for foreign visitors, and get antibiotics. But I don't like antibiotics, and I want to test the herbal treatment.
Since I'm feeling better, I decide to head off in a taxi -- instead of on my bike this time -- to an interview Tracey has set up for me with a young doctor at a newly opened government clinic in the Havana suburb of Miramar.
When I arrive, Orlando Sanchez, just two years out of University of Havana medical school, is placing tiny acupuncture seeds in the ear of a middle-aged woman. He's practicing the ancient art of auriculotherapy. His patient is being treated for post-menopausal problems, he says. On the opposite wall hangs a symbol of the tao, which is not only an unself-conscious declaration of his faith in traditional Chinese medicine, but also a symbol of the remarkable 180-degree turn Cuba has taken back to centuries-old healing techniques.
Sanchez says his parents were part of Cuba's pre-revolutionary botanical culture. He recalls that his career interest in medicine was ignited during his Cuban army service, when he was befriended by a medical school dropout who taught him tai chi and Qigong (traditional Chinese practices that aim to harmonize body energy).
He doesn't see a conflict between natural and conventional medicine: "We are trying to develop some sort of synthesis," he says, "the best of natural and conventional medicines -- to heal without damaging the patient." The clinic is aggressively promoting self-healing techniques by holding free classes in yoga, tai chi and stress management, even teaching school children acupuncture points.
Without any prompting from me he notes the problem with my leg, and I leave the clinic impressed with the Cuban health-care system's openness to experimentation and innovation.
Patients treated with natural medicine (acupuncture, homeopathy, herbal remedies) have more than doubled since 1996 to about 3,000,000 in 1998, according to Leoncio Padron, director of traditional and natural medicine for the Ministry of Public Health. Tough economic times forced the government to slash health-care expenditures to about half of what it devoted back in 1979.
However, Cuba has more doctors now than in 1979. "Health care is better now because we can do more with less," he said in an interview. Even if the embargo abruptly ended, he adds, Cuba would continue paying attention to natural medicine in the interests of developing "medical science." Medical consultations, hospital visits and surgery are free of charge in Cuba's public system.
The revolution in Cuban health care has not gone unnoticed by Cuba's neighbors to the North. Marta Perez, director of natural and traditional medicine for the Ministry of Public Health in Havana Province, told a dozen visiting health professionals from the United States last fall that the Cuban government promotes natural medicine because it's sustainable and cost-effective. "The special period has been a great teacher for Cuba," she said, "because in the midst of this difficult situation we had to find a way to fight back."
In 1992 the government set up organizational responsibility within the ministry for natural medicine, and a resolution was introduced that sanctioned herbal medicines and infusions made from plants, acupuncture and related techniques, as well as homeopathy and thermotherapy (sulfur baths and mineral mud baths).
Adding all such treatments to a system that was completely allopathic (conventional) hasn't been easy, Perez said. "We defended all of these treatments, saying we needed to have a wide range of treatment options." She added, "We looked mainly for techniques that we could defend scientifically." Pyramid power was not among them, she quipped. The practice of laying on of hands might work, she said, "but its scientific basis can't be measured and it can't be standardized."
Says an official of the Ministry of Public Health: "For Cuba's common illnesses -- skin problems, fungal infections, parasites and especially bronchial diseases -- green medicine usually works at least as well as the drugs, without the side effects."
Rita Beretervide, a doctor in her mid-30s, is a specialist in family medicine in the Havana suburb of Santos Suarez. Her salary is 500 Cuban pesos a month (about $24). A 1986 graduate of the University of Havana, she was trained in the old school before natural medicine started making a comeback. But last year she joined dozens of other doctors attending weekly neighborhood clinics on natural medicine. She now says she's comfortable prescribing herbal medicines and believes in their effectiveness.
A few blocks away customers gather at the counter of an open-air pharmacy carved out of the ground floor of a crumbling apartment building. A large sign lists the most popular herbal remedies. Pharmacists there report that the most common ailment among people over 50 in the neighborhood is hypertension, which can be treated with an herbal medicine derived from sugar cane, called cana santa, which costs the equivalent of 4 cents.
Not everybody, of course, is singing the praises of medicine verde. A Cuban women whose skin problems didn't respond to herbal treatment said, "Frankly, I don't believe in green medicine. If it really worked, the doctors in the United States and other rich countries would be using it too. We only use it here because there's nothing else."
But natural medicine has gained a strong foothold in Cuba, propelled by economic necessity, unopposed by the medical establishment and with deep roots in the culture. In her briefing to the visiting U.S. health professionals, Perez related an anecdote: The vice minister of public health for Cuba came down with a large and ugly lesion on his mouth. He was told the best natural medicine treatment was a combination of aloe vera, rosemary and a special herbal cream. "Within three days it was healed," she said, "and now no one can say a bad word to him about natural medicine."
OK, but I'm having trouble resolving the discrepancy of Cubans' raging because they can't afford to buy aspirins (one bottle costs about one-tenth the average monthly salary) in a health system capable of embracing natural medicine techniques with such alacrity.
These and other unresolved contradictions of life in Havana hang in the air as I climb aboard the Cubana flight back to Toronto two days later. I'm worried because the leg infection is looking scary again. I think I got overconfident and forgot Enrequito's advice to stay off the leg for a couple of days.
Back in Toronto I visit the outpatient department at East York General Hospital and get an antibiotic prescription; I'm willing to sacrifice my belief in natural medicine for a quick fix. I have options unavailable to my Cuban friends, even if their public health care is showing an openness and resilience to be envied by neighbors to the north.