The Colgate Scene
July 2000
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Cuba 2000, a separate reality
by Ken Gross '74, MD
I walked through the Cuban streets on the fringes of Havana. It was approaching dusk; workers were returning home on packed buses that emitted stinking soot that billowed over the highway. The winding roadway was filled with jalopies, made 30 years ago in the former Soviet Union, and bicycles carrying laborers with satchels and grim expressions.

     I was in Havana attending the third International Conference on Coma and Brain Death. Participants at the symposium were grappling with definitions of a human being's death.

     Legally, when the brain loses electrical activity, a determination of death can be rendered, even though pulse and blood pressure can be maintained. Despite this declaration, there is some kind of "virtual governor" of the body that continues to modulate hormonal systems, changing things like insulin and electrolyte levels, within a kind of corpse that remains on a mechanical ventilator. It is as if this theoretical governor "lives" in a reality distinct from the life of our more concretely understood central modulator called the brain.

     Cuba too, felt like an entirely separate reality for me, although at 90 miles from Key West it was closer to my home in Miami than some of my friends up I-95 in West Palm Beach. Cuba is not simply an island nation in Latin America's reality, but it reflects images that invoke the formidable Soviet state revealed -- stark but competent, dirty but proud.

     There was the bleak appearance of a once-majestic Spanish church from what looked like the 1700s. It was now some kind of half-used dilapidated government building. In front of it in lush, unmowed grass, stood a ten-foot monument for the Cuban liberator from 1890, Jose Marti, except Jose Marti's bust was on the ground several feet from the base. Vandalism had toppled this revered leader and, with the overgrown shrubs around the broken statue, one had to look hard to even see the relic. There was a sense of "who cares anyway," a feeling there were more important things to do -- like get home from work or read the more up-to-date sign of Cuban existence across the street.

     The sign there was a bold 50-yard-long statement, written on a ten-foot-high wall that hugged the perimeter of the highway. Creemos en Fidel, la Revolucion y el Socialismo. Creemos -- We believe. And I believe the Cuban people did glance at the sign; that it served as a reminder that amid the soot and buggies and low wages and late or nonexistent buses, there was a purpose to life in Cuba or, better put, an alleged purpose.

     I say alleged because the people I met on the island were very proud to be Cubans, but they were not necessarily jumping up and down in celebration of the governmental motif portrayed through the message on the wall. Perhaps they were simply blunted in their political expression towards an American or maybe for some, who struggle so mightily to just survive a day, that creed on the wall was merely empty propaganda.

Ken Gross
     Religion is minimized in Cuba. The state is the religion, the rallying point at least when it is time for a mass gathering in support of Elian's return to the island. Elian is the archetypical national son, held in captivity, as per the railing of numerous passionate speakers at these events, by the "money driven" and those in the U.S. who want to deny anything positive about Cuba. There is every attempt by these speakers and many commentators on Cuban TV who rehash the "imperialistic" Spanish American War, as if it occured last Thursday, to not elevate the stature of anyone or anything American. There are few if any signature American tee shirts or hats with Tommy Hilfiger's name on them or some Dodgers or Braves logo. But if Cubans are "commodity nihilists," we Americans are certifiable "sensory overload freaks," In these and many other Havana streets, I was happy not to see the obscene profligation of billboard advertisement, so much the foundation of our country's landscape.

     Healthcare and education are the areas most often pointed to by Cubans as exemplary of national success. In fact, both are partial success stories; life expectancy is equivalent to that in the U.S., there is free medical care for all and the educational system is strong through many levels, with great numbers of scientists and some sophisticated biotechnology research underway.

     The other side of the achievement coin is conveyed through a story I heard from a 40-year-old Cuban doctor. She showed me a photo taken three years earlier. "You see, " she said, "I was 70 pounds. Almost dead. Hyperthyroidism, Graves Disease."

     Indeed she looked very asthenic, very sad, too, in the photo. And now looking at her -- around 120 pounds, seemingly healthy though smoking (a national habit in healthcare land) -- she had clearly improved her appearance. Still there was that sad expression. She revealed her thyroidectomy and intubation scars (she was briefly on a respirator) and pointed out the doctor at the conference who saved her life by making the diagnosis when she was at death's door.

     There are many aspects of this story I do not know, but what lingers in my head is the suspicion that the diagnosis was delayed because of inadequate evaluation. It's not necessarily so, because Graves can be quite fulminant, but it is only a very rare killer in the United States where the diagnosis and often non-surgical treatment are usually rendered early in the disease process, when only things like a rapid pulse and mild weight loss are noted.

     A hotel worker, who complained to me about back pain while lifting bed sheets, did not seem to know a thing about anti-inflammatories. When I suggested she might need an X-ray to start the evaluation there was a confused look. "What would that be for?" she asked incredulously. Most Americans, of course, are ready to order up their own MRI (not to mention their own personal injury/worker's compensation lawyer) for trauma-related back pain. There are actually only two MRI machines in all of Cuba.

     But this is in the context of Laboratories for Genetic Technology, even specialized labs for AIDS and shark cartilage research. Here's a country that produces scientists, but has few resources to deliver research results to the public in the form of even basic diagnostic and pharmaceutical offerings. A ramshackle sign knocked on its side along the road I walk on, reads "Interferon Laboratory." In the United States, we glorify the image of the starving artist. In Cuba, it is the starving scientist who is the kind of mystical figure, locked in the research lab with a Bunsen burner that works only occasionally, pondering Einstein's theories before a blackboard for which there is no chalk.

     I wandered again out onto the Cuban streets, hoping to play baseball with a group of boys in the middle of a game. I was happy to speak some Spanish, but I could not fully connect to their reality that I identified as including poverty and hardship but that they identified as their fun life of baseball and friends and family and national pride. I caught the ball they threw me. It was the same ball we use in North America. I threw it back against the glaring sunlight of Havana's blue sky.

Gross is a Miami neurologist, educator and founder and president of Fusion Clinical Multimedia, Inc. and the educational company NeuroFusion, which supplies an audiotape series for lay and professional audiences on dementia and other neurology programs. He attended the Cuba conference in February and looks forward to returning for additional academic work soon.
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