Inside the Cuban Healthcare System
Photo taken by Radio Ciudad del Mar
After surviving a heart attack and having a thrombolitic procedure I was relegated to the Intensive Care Room. The hospital where I was receiving care was called Hospital Universario Doctor Gustavo Aldereguia Lima. To be very honest, the doctors, nurses and technicians saved my life. I will forever be grateful.
Believe it or not, I found this near death experience completely captivating. There was so much going on. I mean, there were things happening with my own body, there were wild thoughts occurring in my mind, and there was so much activity happening inside and outside of the hospital with other patients and staff. I tried to make sense of it all.
Once I was relocated to the Intensive Care Room I was connected via electrodes to a heart monitor, provided an intravenous therapy and was given supplemental oxygen. Every few hours one of the nurses would check my condition and provide me with some medicine.
The first nurse that attended to me was Ishmael. He had a thin build, maybe 130 lbs, stood about 5 foot 6 inches with slightly graying hair. He wore eyeglass and if he was not wearing medical scrubs, you might think that he was an engineer. I'm guessing that he had been a nurse for many years. He certainly knew his way around the Intensive Care Room and was knowledgable about how to provide care. He was super efficient at checking charts, dispensing medicine, changing IVs and attending to patient's questions. He would do twice the work in half the time with greater accuracy compared to the other nurses. He often made little jokes to keep a light mood in the Intensive Care Room. He actually talked a little like a muppet.
For the first 24 hours after my surgery I was advised to rest and recover. I did not know if I was still recuperating from the dehydration, from the surgery or just from all the drama of the previous day, but I did feel weak. I found everything that was happening around me so very intriguing. I wanted to stay awake and observe all the activity. However I was feeling tired, so I would drift in and out of sleep.
When I was awake I found myself watching my heart rate monitor bounce up and down and make beeping sounds. Just like in the movies. However, realizing that the machine was connected to me was a sobering thought. Every now and then, I was given some type of medicine through my intravenous therapy tube. I don't know what type of medicine it might have been, but it felt like adrenaline. When the nurse induced the liquid I would feel a rush. My heart would start pumping at a faster rate and my body would tingle. It was thrilling and scary all at the same time. One time my heart was racing at such a fast pace that I called over the nurse to see if everything was okay. The nurse adjusted the drip of the intravenous therapy just a little bit and my heart rate returned to normal. Every once in a while the alarm on my heart monitor would go off. All my symptoms would be okay, the nurse would just punch a button and then continue working. Kind of scary to be awaken in the middle of the night and then realize that it was your heart monitor alarm. It was bizarre.
My second nurse was named Hanoi, as in Hanoi, Vietnam. In Cuba there still exist a kindred feeling with Vietnam. Both countries had revolutions which followed Marxist ideology and are still Communist. There are statues, streets and I guess a few people that are named after Vietnamese people and places. In appearance, Hanoi was a contrast to Ishmael. He had a thicker build, stood about 5 foot 8 inches, 170 lbs and had a manicured look with a quaff of hair that a boy band singer would be proud of. He was very professional in his own way. He would direct other nurses in the proper way to provide care. He was very friendly to me, very respectful to the doctors, but demonstrated just a bit of attitude toward his fellow nurses.
Barbara, the lady from the International Section, visited me at my bedside to check up on me. She inquired how I was feeling. I told her that I was feeling much better. I wanted to put on a strong facade in the hope that I would be able to leave the hospital sooner.
I actually wanted to get out of the bed, leave the hospital, board the next airplane to the US and check into a hospital in the US. However, I knew that this probably was not going to happen.
Every so often I would hear a phone ring in the hallway just outside the Intensive Care Room. I did not have a phone at the little table next to my bed as is the case in most hospitals in the US. I asked Barbara if there was any way that I could call my family to let them know what had happened. I shared that I had a Cuban telephone card in my wallet to pay for the call.
Barbara said, "I know that you want to call your family. You probably want to call them for your own piece of mind, not for the benefit of your family. If you call them right now, they will just worry."
I said, "I think that I know my family pretty well. I think that they would like to know."
Barbara said, "It is probably better that you not call them right now." I was not able to call.
I understood. I was not in agreement, but I understood. In the US we are very accustomed to having what we want, when we want it. I was not in the US. I needed to abide by the rules of the hospital and the rules of the country. I was in Cuba. I assumed that they did not want me to call my family in case I experience further complications. I felt a little trapped. I knew that I was too weak to leave the hospital on my own strength. I probably could have called for an evac (emergency evacuation), but that would have been expensive and unnecessary.
Be patient… Troy... be patient.
I'm always assessing my surroundings. Partly, I like to observe my surrounding because I'm a curious person. Partly, I evaluate my surroundings because I like to always have a plan in the event of an emergency. In this situation, I was not in an emergency. However, I scanned my surroundings and looked for a possible escape route in case I needed to make a break. Also, I tried to assess how strong my body was at the moment. Unfortunately, there was only one exit out of the hospital and my body was not strong. I would not be going anywhere for the foreseeable future.
One of the more interesting things that I observed during my stay in the hospital was that there were a number of people walking around the Intensive Care Room. These people were not staff of the hospital. These people were relatives of the other patients. I observed how they walked freely in and out. They would sit and talk with their relative. At first I thought that this was peculiar because these people seemed to be present 24 hours a day. They would bring in food for their relatives. And once a day they would bring in clean linens, charge the sheets of the bed and bath the patients. The sheets, towels, pajamas, food and water were not provided by the hospital, rather they were provided by the family and friends. I did not know if this form of care was to encourage the patient or to save money for the hospital and healthcare system. I have a feeling that this tradition was to save money for the healthcare system. This activity was a little distracting at times because these caregivers would often receive mobile phone calls. They would then have an open and load conversation right in the middle of the Intensive Care Room. I learned quite a bit about my fellow patients' illnesses, conditions, families, friends, food preferences, likes, dislikes, etc. just by listening. I was not eaves dropping, all of the conversations were out in the open. In Latin America and in Cuba privacy is practiced differently. There really isn't privacy as we are accustomed in the US. People observe other people. People ask direct questions. And sometimes people talk loud. I found it difficult to sleep for more than 2 to 3 hours at a time because there was always someone making some noise.
So what about me? I obviously did not have any family or friends to take care of me in Cuba. Well, almost. I had a new friend named Jorge, the owner of the casa particular. Jorge helped me call the ambulance and actually accompanied me to the hospital. He was in the emergency room during my operation and guarded all my personal possessions. And, as soon as I was allowed visitors. He showed up to greet me. He brought me some basic necessities like some juice, toilet paper, toothpaste and a toothbrush. Because I was an international patient I was provide pajamas, sheets, pillowcases, a urinal and food and drink by the International Section. I had a special chef that would prepare me food. I was always served food before the regular mealtime. The other patients were always curious what I was being fed. I felt a little awkward eating while other people were watching me eat, but I got over it knowing that I needed nourishment. I also realized that I would probably end up paying for all these things out of my own pocket.
The Cuban Healthcare System promotes that it offers free healthcare to its citizens. I learned that there are some minor costs. One of the nurses confided in me that patients often take advantage of the free healthcare. When someone is feeling like they want a little special attention they will check into the hospital with fantom symptoms. The hospital and the staff will provide them with air conditioning and attention, while their family members will bring them food and drinks. I may have witnessed one or two of these cases during my short stay.
Website by Radio Ciudad del Mar
During my first 24 hours I was in one of the Intensive Care Rooms. Then all of the sudden me, my bed, my medicines, my monitor and my possessions were being packed up and transferred. I thought that maybe I was going to the International Section, but it turned out that I was being transferred into a newly remodeled Intensive Care Room. This room was larger, cleaner and had some more modern features. Some of the bed stations had new lamps, outlets and monitors. There were newer air conditioning units that were much quieter and colder.
When I was wheeled into the new room I was given bed numero uno (number one). I was the only person in the entire room. I made a joke to one of the doctors, "Mira, El Chinito Americano es el primer patiente en el nuevo cuarto, el cuy!" (Look, the Chinese American is the first patient in the new room, the guinea pig!). He laughed and retold the joke to a number of the staff. The staff laughed and retold the joke to other staff. Then the doctor took a photo of me in bed number one and said, "El cuy, jajaja!"
The room was nice, quiet and cool compared to the previous room. It felt very peaceful. I thought that I would certainly sleep much better.
After about an hour of having my own personal Intensive Care Room my quiet and comfortable world was rocked. Other patients were slowly wheeled into the room. One by one the room filled up with other patients until every bed space was filled. Oh well.
The photo at the top of this post was actually taken by a journalist from a media company called Radio Ciudad del Mar that was reporting on the new remodeled Intensive Care Room. She took many photos of the room, but of course she chose the photo with the Chino Americano in bed numero uno to accompany the article. Jorge saw the article and sent me a link to the website so that I could read it later. I made a screen capture of the online article as a keepsake. If you can read Spanish you can enlarge the photo and read the whole story. Who else would or could read this story in Cuba was a mystery to me; the internet access in Cuba is very limited.
Many of the doctors, nurses and administrators were walking around the new quarters inspecting all the new beds, fixtures, air conditioners, desks, chairs, shelving and medical equipment. There was a little discussion about where the medicine shelves should be located. There was a big discussion about where the new television would be located. There would be only one television for the entire room, so the location would be key. The doctors, nurses and administrators all had an opinion of where the new television should be located. Even some of the patients got into the discussion. In the end, one of the head doctors entered the room. The administrator asked him where he thought the television should be located. The doctor pointed to a space on the wall at one end of the room. End of discussion.
There were eight other beds in the Intensive Care Room and eight other patients. Patients would come and patients would go. There was one older gentleman that had some type of accident. There was a middle aged lady that was experiencing exhaustion. There a pastor that was having gastrointestinal pain. There was an old lady that had hurt her arm. There was a military officer that had a cardiac issue. All the rest of the patients knew my story and why I was in the Intensive Care Room. Whenever the doctor would talk with me the room would get very quite so that everyone could listen and find out everything about the Chino Americano (Chinese American).
In the afternoon, a group of young medical students would enter the Intensive Care Room and practice their bedside manner by chatting and writing reports on the condition of the patients. Cuba has a spent a great amount time and money over the years cultivating their healthcare system. They send doctors around the world to "friendly" countries. They also allow medical students to study in Cuba for free. The students must pay their own room and board which can be pretty minimal, but the education is free. Some would say that this is a goodwill gesture. Others would say that it is propaganda. I had a number of the medical students talk with me. They were from Russia, Ghana, Venezuela and Ecuador. Some were very good. Some were very bad. One student asked me a number of good questions about my case and finished the entire interview in about 30 minutes. Another student asked me the same questions over a 2 hour period and still got many of the facts wrong. It became tiring repeating my case time after time. After 2 or 3 of these interviews I would pretend that I was sleeping so that the students would not disturb me. Some of the new patients were quite eager to share their stories with the students. However, after a few days the patients would pick up on my trick and they too would pretend to be asleep to avoid the inquisitions.
As I mentioned before, each patient had one relative that could stay at their bedside 24 hours a day to provide care and basic necessities. There were visiting hours when larger groups of people could visit inside the Intensive Care Room. However, outside of those visiting hours family and friends, except for the one caregiver, were not allowed inside the room. This did not prevent some people from visiting at all hours. The relatives would stand outside of the room on the balcony/walkway and talk or signal to their relative inside. This evolved into entertainment all on its own. Sometimes the people on the outside were trying to communicate with the actual patient and sometimes they were trying to communicate with the caregiver. Sometimes it was very touching to see family members communicating with just a glance or smile. Sometimes it became very annoying when us patients were trying to sleep. The nurses tried to put an end to this informal visiting hours by placing curtains in front of the windows. The families quickly discovered that they could stand in the bathroom that was attached to the Intensive Care Room inside one of the stalls and continue with the communications. If you wanted to use the bathroom you might first have to see if the stall was being used as a gossip room.
Honestly, I was not sleeping very well in the Intensive Care Room because of the constant activity and noise. Almost every day one of the staff would mention that they were planning to transfer me to the International Section of the hospital where they said I would have a suite, more privacy and an individual television. I imagined that it would be great. Almost every day I would politely inquire when I might be transferred to the International Section. Almost every day I was told, "Very soon, they are preparing a room for you." After a number of days I had almost given up hope.
Then on my forth day in the hospital late in the day I was told to get my things together because I would be transferred to the International Section. My things were quickly compiled. I said my goodbyes to all my fellow patients. Then my bed and I were whisked away. I was transferred to my own private room… in the International Section. In fact, I think that I was the only patient in the entire wing. I had my own doctor, nurse and chef.
Also, I have my own television. Interesting enough, while I was in the hospital, on the news they were reporting that the US made it official that Cuba would leave the list of terrorist countries. This step would pave the way to remove the embargo and open up the country to commerce and tourism. I watched this from a bed in a hospital in Cuba.
There are so many interesting little stories that I would like to tell about my experience in the Cuban Healthcare System. I'll try to share more of these stories in the future.
After four days in the Intensive Care Room and three days in the International Section, I was feeling well enough to ask my doctor if I could be cleared to fly back to the US to seek care. After some discussions the doctors and staff agreed to release me.
There was still the matter of settling my medical bill. My bill for the ambulance, emergency room, intensive care room, international section room, medicine and food was about 4000 CUC or US$4000. I had only brought about US$2500 for my entire trip and had spent about US$1000, so I needed to have some money wired to me. I was unable to make the arrangements while in the hospital, because I would need to personally pick up the funds from a Western Union office. After some discussion, Barbara from the International Section informed me that Jorge had agreed to be responsible for me. Meaning that he would personally escort me to the Western Union office to collect money sent from the US and he would personally accompany me back to the hospital to pay my bill. So after seven days in the emergency and intensive care units I walked out of the hospital.
I hired a taxi to take me to Jorge's house and casa particular. There I met his wife Maria. She was an excellent host that cooked me numerous meals that nourished me back to health.
Their casa particular was one block away from the central plaza. It was eclectically decorated.
My room had everything that I needed for my short stay. A comfortable bed, air conditioning, refrigerator, bathroom and even some art.
Jorge hired a taxi to take me around the city to manage my affairs. We first went to the bank so that I could exchange the US dollars that I had for Cuban CUC. I had about US$1500 that equated to 1500 CUC. The next day we went to one of the department stores. Inside the department store next to the couches, beds and linens department there was a lady sitting at a metal desk. It was the type of desk that you might have seen in a 1960's office. On the front of the desk was a sign that said Western Union. I approached the lady and told her my name and that I was expecting a delivery of money. My brother made arrangements in the US to send me about US$3000. He provide me a code. I shared the code with the lady behind the metal desk. She pulled out a wad of Cuban CUC and began counting. 1, 2, 3 thousand CUC. Done deal. It was that simple.
I walked out the front of the department store with over US$4000 in my pockets. Jorge and I would hire a taxi and travel directly back to the hospital to pay my bill. I asked Jorge if it would be dangerous to carry this much cash in my pockets. He said that it would not be dangerous. Cuban was very safe. He was right, but I was still nervous.
We arrived back to the hospital at about 10am. I shared with Barbara that I had the money. She said that she was surprised that I was able to get US$1000 so quickly. I said that I didn't have US$1000, but that I had the entire US$4000. She was astonished. Typically Cubans are only able to receive US$1000 per month via Western Union. I'm not sure why I was allowed to receive a greater amount, but I wasn't complaining.
Jorge and I waited for the accounting office to add up my bill and hand write a receipt. It took about 4 hours. We passed the time in a lobby talking with an old friend of Jorge's who happened to work at the hospital. After the full bill was hand written we then proceeded to the accounting office cashier to pay the bill. The cashier was really something akin to a vault. I had counted and separated my wad of money into four neat stacks of 1000 CUC each. When I turned the money over to the cashier she promptly combined all the stacks into one big stack. Then slowly started counting bill by bill up to 4000. It took another hour or so to count all the money and hand write another receipt. It was close to 4:30 or 5:00pm when we finally left the hospital grounds.
I did have a chance to walk around the central plaza of Cienfuegos. This is an arch on one side of the central park.
There was a stone lion at another end of the park.
This nicely kept government building was on one side of the park.
This colonial style building on the other side of the park.
The Cathedral was also near the park.
And this statue stood in the middle of the park. That's really all that I saw of Cienfuegos. In reality I probably should not have been walking around in the heat. I had just had a heart attack 7 days prior.
It took me one day to gather money and pay the hospital. It would take me another 2 days to schedule a return flight back to the US. I actually was only able to schedule a flight from Havana to Mexico City. I would have to make my own arrangements once I arrived in Mexico City.
After 10 day, all was in order. I was healthy enough to travel. I had paid my bill at the hospital. I had reschedule my flight out of Cuba. And I had packed my bag. I did not feel that I was healthy enough to pack and carry my bicycle all the way back to the US, so I gifted it to Jorge. The bicycle was monetarily worth the equivalent of a years wage in Cuban. Jorge was touched by the gesture. I was more than grateful for all the help that he had provided me over the past 10 days.
Jorge made arrangement for me for a taxi with a friend of his. My flight out of Havana was leaving at 6am. We thought that it would be best if I took a taxi directly to the Havana airport. I think Jorge was a little concerned that if I spent the night or a day in Havana that I might try walking around the city and die.
So at 12 midnight a taxi picked me up at Jorge's house and wisked me away into the night. In typically Cuban fashion, the driver had made arrangement to take two additional passengers in the back seat. We drove through the night for about 4 hours.
The ride was swift. I rode with my window partially cracked. The air was cool. We made one stop somewhere along the middle of the route to rest and use the restroom.
Just like clockwork, we arrived at the Havana airport just prior to 4am. I got in line with the other passenger to check in.
After checking in with the airline, I still had some Cuban currency. Cuban currency outside of Cuba is worthless. It is unexchangeable. The was a Currency Exchange booth within the airport. There were a number of people that were exchanging hard currency like US dollars and Euros for CUC. There was one gentleman in front of me that was going to exchange US$500 for CUC. When you exchange US dollars for CUC there is a automatic 10% fee charged. This fee was instituted to dissuade people from using the US dollar. I asked the gentlemen if he would like to exchange US$200 for my 200 CUC, thus saving both of use the currency exchange fee. He agreed and the illegal transaction took place. We were both happy.
I then walked around the airport and spent the last few remaining Cuban Pesos that I had.
At about 5:30am I boarded the plane and at 6:00am I left Cuba. What an adventure.
I flew into Mexico City where I had to negotiate with United Airlines to exchange my existing ticket for a ticket for the next flight back to Houston. The next flight back to Houston was at 2:00pm in the afternoon. After some discussion I was able to reserve a flight back to Houston.
I landed in Houston and was welcomed by my mother. I think that she was relieve to see me.
After my return, I would spend the next month navigating the US healthcare system on my way recovery.
There were actually so many little stories that I have not been able to share with you. I was thinking about writing a book with more details about my Cuba experience, the Cuban healthcare system and the US healthcare system. If you would be interested in reading and supporting me in this effort please send me a message at email@example.com. I'll put you on the list for one of the first editions.
Thanks for being patient and supportive in reading this story. I hope that you enjoyed it.
Hasta la próxima,