By Irving J. Crain, M.D. Fellow, American Psychiatric Ass'n. * ince one of the features of the Cuban Revolution is to provide complete and free medical care for the people, we now have the problem of pro- viding psychiatric services to all the peo- ple, including, of course, our large farm .population.’’ Dr. Claudio A. Palacios Mesa, Professor of Psychiatry at the Havana Medical School, was describing the changing scene in Cuban psychiatry during the past few years. My wife and I were traveling in Cuba the summer of 1969 as part of a multi- professional group she had organized under the auspices of Friends World College, where she was a staff member. My special interest as a psychiatrist led me to various psychiatric hospitals, clin- ics, and day hospitals affording me the opportunity to meet with many people in the field. Dr. Palacios, an attractive man in his mid-forties, and three of his young interns described the new problems in Cuban psychiatry. I asked if there was less need for psychiatric services, now that the people have free medical care, full employment, free education and other guarantees for a more secure life. “On the contrary,”’ he said, ‘now we have different problems. The ‘old pre- revolution problems of prostitution, drug addiction and delinquency are no longer the major concerns in our field, since they have been largely eradicated. Now our problems are more human ones — conflicts of family life, ‘machismo,’ separation of families due to work re- quirements, tensions associated with achievement, problems of love life, child development, boarding schools, sexual problems, work problems, etc. Do you realize that at this time we have only two fully trained child psychiatrists and are under-staffed in the psychiatric field in general?” I realized that the transition from col- onial status to socialism brought with it problems of human adjustment in values, morality, motivation and personal rela- tions in general. “Since we now have hospital and clin- ic facilities in all parts of Cuba, the medi- cal staff will refer patients to the psychi- atric service when necessary. Now that Irving Crain is a fellow of the Ameri- can Psychiatric Association. He is also a sponsor of the U.S.-Cuba Heaith Exchange. the average Cuban knows that he can get such professional help for his personal problems, we are overwhelmed with the demand for these services. Prior to the revolution we had a few private clinics and hospitals only in Havana, which could be afforded only by the wealthy; now such service is available to all Cubans in all the provinces. From a professional point of view, there is very little scientific -literature and experience to help us in developing our psychiatric techniques and theory when dealing with the special personal problems of rural population. Such services never existed before in our country.” I also interviewed Dr. Leopoldo E. Araujo, past president of the Cuban Psychiatric Association under Ful- gencio Batista, and now a strong support- er of the Cuban revolution. He spoke of the great need to develop psychiatric theory and practice consistent with the new socialist society. The previously held idealist views of the human mind and the metaphysical approach of Sig- mund Freund are under intense re-evalu- ation in order to develop a science of psychiatry that is materialist, objectively verifiable and consistent with the reali- ties of life for working people. — Dr. Araujo described various research projects they were developing in the study of depression, schizophrenia and homo- sexuality. A fascinating study was being planned in a specific section of Havana to evaluate the incidence of mental illness that existed there, and by changing cer- tain factors in living and working condi- tions, to see if the incidence of such ill- ness could be reduced. This study would not only help in the treatment of mental illness but also in its prevention and would deepen the understanding of theory as well. “TI remember the hectic days and nights at the turn of the revolution in 1960 when our Psychiatric Society de- bated the role we should play in the Cuban revolution. It is interesting that about half of our members subsequently left for the United States. Those who remained felt we had an important scientific re- sponsibility in helping the Cuban people meet the stresses and strains of a new, hard, creative and uncharted road ahead.”’ Throughout my visit I was struck by the fact that so many of the Cuban pro- fessors and clinicians were trained in the United States and had many past contacts and exchanges with leading North Amer- ican psychiatrists. They hoped that one day these scientific and personal con- tacts would be re-established for mutual benefit. Chronic patient fertilizing a coffee plant in the fields. PACIFIC TRIBUNE—FRIDAY, AUGUST 3, 1973—PAGE 4 Cuban postage stamp: Land Free from Polio By D.B.Kimmelman,M.D. Walking in Havana someone flicked a cigarette in the street. A young Cuban picked it up, remarking, “These are our streets now.’’ Could you picture that in New York? In the United States, organized medi- cines makes much of the doctor-patient relationship. But a good doctor-patient re- lationship is difficult to attain, even among those truly desiring it — a major- ity of patients, a minority of doctors. But in Cuba, as in all nations under socialism, there is neither resentment nor awe to- ward the doctor. And the doctor had no condescension nor feeling of dependence for income toward the patient. A truly healthy, open, mutually respectful atti- tude between doctor and patient is the rule. I was invited to Cuba by the Ministry of Public Health, to meet and work with Cuban fellow-ophthalmologists (eye spec- ialists). While there, I had:the opportun- ity to perform surgery, lecture, and have countless exchanges and conversations with them. Common to all of them was an intense interest in, and love for their work. unblemished by concerns about ‘‘making a living.’’ This had to reflect itself in a deeper interest in their patients. Their knowledge was current, mainly from their own literature plus the journals from almost all countries except the U:S., where boycotts prevented receiving the latest literature (a situation we are in the process of trying to correct). In the U.S.. the majority of physi- cians are political ‘virgins,’ which in ef- fect makes them prey to all the reaction- ary influences of all the media of the es- tablishment. It therefore was a breath of fresh air to experience the political aware- ness and concern of my Cuban colleagues. . What an amazing thing to find — a society where the majority of its physicians are politically a part of the ‘‘family’ that comprises their society! Is it any wonder that the doctor-patient relationship -is different there? Among the first concerns after a so- cialist revolution. aside from the defense of the revolution. are health. education. and housing. In 1958. before the revolution. the health budget was 25 million pesos: in 1968. it was 250 million. In 1958 most of the 6.800 physicians practiced in the cities only. By 1962. 3.000 of them had left Cuba. But by 1969 there were 7.500 physicians. and these were remarkably re-distributed so that all rural areas had access to medi- cal care. For example. in North Oriente David Kimmelman is an ophthomol- ogist and a sponsor of the U.S.- Cuba Exchange. humé province, in rural areas difficult’ hos? fh there are now over 3,500 where there were only 50 . While there had been only Mf school there now are three is graduates per year. Nursing i creased from six to 13. There® i new population of nurses, dent” gi workers, nurse’s aides, *T4) ji technicians, optometrists 4% not ambulance corps, etc. Thesé < not only the city health faciliter : since 1969, the newly-built 47? vd tals and 260 polyclinics scatle veh gically throughout Cuba. ne P town has its ‘“farmacia.” 7 mol the mountainous and most TE" areas must derive enormous a from the availability of health® r Since 1964, Cuba has had 00 - gl since 1968, Cuba is the 0” ‘ ih this hemisphere without mali Pan-American Health organ Hel hy of the United Nations Worle ii ganization, has stated thal ie only Latin-American COUR”. malnutrition. There is no uné sf no illiteracy, no hunger: z gambling and begging have % of) el @ tics hi The fact that health statist th Latin-American count! changed, and are about th revolutionary Cuba, 110 enormous improvements in alt due to recent advances 11 "ty. newer drugs, but come fro zation and increased attem” sony, has put into its health care sy Ne the consequences of the reribl that created the major CO” ‘4 neal remarkable improvemen we important are the imprOV" isdlh housing and water supP: ip | portunity to visit some TU ate Mt areas, with islands 0! f of small farms in the mids oder, fat owned land. I saw new jivind lt for families that had bee? og, Bil huts with primitive salt oft homes and apartments ha ger ty rooms, refrigerators. 4” was yt space. This rural housing - othe All school children were were ol state. Pre-school childre? nile in free child-care centers cof iil ents worked. The child-C4 iit ite nationwide. Many of t on private farms. see a) dren were provided 1." py @l)t there was nothing to 82" 14 JM" Jk their private ownership i vill | state enterprise. ; ‘ The constantly impr ditions. education in pet 7 pr06 nation-wide immunizati? tne | all been major factors ment of the health of the But all this would n° a sible without the aclY” (gaa the people through thelt i!