leva 8
“At - Betional and local. Represen-
~ he Communist Party, the
ast League, the Confeder-
Cuban Trade Unions, Federation
nse of a Committee for the
titations Si Revolution and other or-
Progra Participate in carrying out
ve of health care which they
Brcvanced workers and Com-
nady x Members are chosen as
ates to mediate when dif-
Ting any © with health workers con-
gy eye aspect of health care. This’
tits 47 opie feel free to register com-
oY Can = ey receive no satisfaction,
‘s. The ty their complaints to higher
£ Used jcuannels for complaints are
is s Constructive suggestions.
sug pepuraged to express opin-
— Stions freely, and in many
>in and other facilities
8 oie personnel with peo-
dh ting c tives are held regularly,
at, Thus ae to constant improve-
; “ants inthe citizens are active
QUE of heal € formulating and carry-
Consig
: Tent j

th policies.

i tion ig fecBligible or free, that edu-
H sch . and compulsory through
ine higher at Students are supported
ep oa €ducation, that there are

d whi ae for the retired or dis-

i 30% of their former wages
Ele have every reason to
to work hard for these

an @
er
ng that health care is free,

Ure

United i
Neo, Y study: States can learn
ee can done what_a relatively poor
y lism, eer themselves when, under
YA ane Can organize their own

y Sop isti Country like ours, with a
Won sated knowledge and tech-
a would think, have the
ing Statistics in the world.
On the statistical criteria

8 Wo Ader socialism a countr

not * have limitless possibili.
B ibd In the field of health of
thety opport under capitalism we
in ¥Stem Uuntities to improve our

Won tiers
80 the ie by our government

A Medio. ¥® could ue Cuba were removed,
jy, 2 Xchange Wve free scientific and
tia S have 4 Traditionally, our two

d of medi Ways had close ties in

en galt tru Sa dating back to the
leg thier, hae €s against malaria and
tery the Spirit 'S time we renewed those

a Es x Mutual respect and non-
Ny oaiMtain j a has fought hard to win
8ocia}j S revolution. This first

In our hemisphere.

itis
aa has much to teach that

Ur country.

By Joseph Reynolds

efore our revolution,’ Dr. Sidney

Orrett said in a voice edged
with anger, ‘there were 5,000 to 6,000
ill-fed, ill-clothed and ill-treated pa-
tients in this hospital. There were 12 to
15 deaths a day — on one day there
were 89 deaths! What were the caus-
es? Malnutrition, a disease of neglect,
and bacillary dysentary, a disease of
filth. Our death rate now is 5 to 6 a
month.”

It was a warm April day and the
Cuban sun was shining on the many
brightly colored buildings. I was part
of the U.S. Health Workers delegation
visiting the Havana Psychiatric Hospi-
tal on the outskirts of Havana. Dr. Or-
rett, the institution’s vice-director,
greeted us and told us the hospital’s
history.

“This was a political plum for the di-
rectors during Batista’s regime,’’ the
tall, grey-moustached psychiatrist said.
“Qne director told me that he made
$12,000 a month by keeping 15 out of
the 20 cents a day allotted for each
patient’s food. We have ended all that!”’

Throughout our tour of health facili-
ties in Cuba, the same intense feeling
was expressed by the health workers
in the polyclinics, hospitals and medi-
cal and nursing schools — bitter hatred
for imperialism and the pre-revolution-
ary system and dedication to bringing
about changes for the benefit of the
people. | :

The Havana Psychiatric Hospital is
indeed unique. Dr. Orrett apologized
for the absence of the director, Dr. Ed-
uardo Ordaz Ducunge. Dr. Ordaz had
established the first field hospital for
Fidel’s revolutionary army in the Sier-
ra Maestra mountains. Now he was cut-
ting sugar cane.

The first unusual thing we noted as
we toured the hospital buildings was
the absence of any patients in the wards
—unlike so many U.S. state mental in-
stitutions where most of the patients
are sprawled in bed or sitting on
chairs staring vacantly at the walls.
Also, there was no asylum smell in the
spotlessly clean rooms, with their spa-
cious living areas and extensive grounds
dotted with little parks and flower
gardens.

Where were the 3,300 hospital pa-
tients? Our tour answered that ques-
tion. Some were working on the Poul-
try Raising Farm, caring for 70,000
chickens. ‘‘These chickens are turned
over to the National Poultry Raising
Combine,’ Dr. Orrett commented, ‘‘and
the patients know that what they are do-
ing is socially useful.”

Many patiens were working in the
numerous hospital workshops, making
toy cars, baskets, hats and wooden art-
icles. Others worked in the Agricultur-
al Development Plan, tending 150 acres
devoted to the growing of beans, cit-
rus fruit and coffee. Still others were
working in the rose gardens and mani-
curing the many green areas.

Several hundred patients were par-
ticipating in various sports’ activities
on the huge athletic field. There is a
large stadium with an excellent base-
ball field and an outdoor movie thea-
ter.
We also observed a large classroom
where about 25 patients were attending
elementary school—they were remark-
ably attentive to the four teachers, one
for each of grades 3 to 6. Near the
classroom was the art workshop where
about 15 patients were drawing and
painting. “There have been exhibitions
of the art work of our patients In Swe-
den. Norway. Moscow, Bulgaria and
Denmark.” proudly declared Dr. No-
emi Perez, the woman psychologist who

was accompanying us.

Joseph Reynolds was a member of a
U.S. Health Workers’ delegation to
Cuba earlier this year.

Another vital feature of the psychi-
atric care of the hospital—patients re-
ceived 15 to 75 pesos a month for their
work, depending upon the number of
hours they put in. This compares to the
average pay of 150 pesos a month for
Cuban workers (the peso is roughly
equivalent to our tumbling dollar).

Dr. Orrett put heavy emphasis on
what he called ‘“‘ergotherapy” (from
the word ‘“‘erg,”’ a unit of work): ‘We

have shown that patients are not fierce

animals to be confined in cages, and
fed through the bars, as they were be-
fore our revolution. They are capable
of work—this is the most important
therapy for their rehabilitation. Work-
ing in production with others, and pro-
vided with other forms of group activ-
ity, the schizophrenic patient—68% of
our hospital population—can best over-
come the schizophrenic tendency to so-
cial isolation. When they are ready for
discharge, they can find jobs in pro-
duction and can better integrate into
their community. Our programs are
aimed at getting them back into nor-
mal life. Treat a patient like a human
being and he will act like a human
being.”

Dr. Francisco Duarte, Chief of the
Psychiatric Department, explained other
ways of involving patients in social
activities: ‘‘They help decide the work
assignments for themselves and for
each other. There are regular commu-
nity meetings of the patients and staff
of each ward, where patients are en-
couraged to speak, to make suggestions
and, above all, to make criticisms.”

Another psychiatric feature of the
staff’s approach was the division of
patients into different levels. Level 1
represented the most severely ill while
Level 5 was for patients closest to dis-
charge. ‘‘There are groups of patients
at levels 4 and 5,’ Dr. Perez pointed
out, ‘“‘who are building a hospital in
Camaguay Province, helping construct
Lenin -Park near. Havana, and. working
on a housing project in the country-
side.”’

€

Throughout our tour, I had been
struck by the genuine concern of the
entire staff for the patients. This con-
cern was reflected in a dramatic in-
terchange:

“What would you do, Dr. Orrett,”
asked a member of our delegation, “if
you caught a member of your staff
abusing a patient?”

“Td turn that staff member over to
the law!”’ he burst out angrily.

Most patients go home often and ef-
forts are made to counsel their fami-
lies on how to respond to them. Dr.
Orrett stated, however, that much re-
mains to be done to overcome the ten-
dency of families to either reject or
overprotect the patient: “We are using
the mass organizations—the trade un-
ions, the Federation of Cuban Women
and the Committees for Defense of the
Revolution—in a national program to
reach and educate the masses regard-
ing mental illness.”

“What other forms of treatment are
used?"’ we asked.

“Qur approach to psychoses is a bi-
ological-genetic approach,” replied Dr.
Orrett. °‘Psychosis is a disease that
has little basis in social conditions, as
far as its origins are concerned. Neu-
rosis, however, does originate from
social factors—but that can be treated
on an outpatient basis. Our treatment
of our population of psychotic patients
is aimed at rehabilitation to the great-
est degree possible, while we and

world scientists seek for the cause and-

cure of psychosis. Individual therapy
has small effect on psychotic patients
but we do use group therapy — in
groups of 8-10 — as an effective thera-
peutic form.” :

“We are doing research here on psy-
chosis,”’ added Dr. Duarte. “For ex-
ample, we are experimenting with lith-
ium for manic-depressives. We do not

use psychosurgery—the brain should
not be mutilated to change behavior.
We have a large outpatient department
which treats patients after their dis-
charge, as well as treating many neu-
rotic patients.”

“What about the -use of drugs?’ I
asked Dr. Perez.

“Most of our patients are on medi-
cation. °Psychopharmacology is an im-
portant form of treatment. But for our
patients, their involvement in. all the
various activities,“as well as their so-
cial relationships, reduces the need for
heavy dosages.”’

From the responses of the staff and
from my own observation, it became
clear that the patients were treated
with dignity and respect—‘‘our staff
relates to the patients as friend to
friend.’’ It was also clear that the goal
was to re-socialize the patients and to
involve them in useful work and cre-
ative activities.

The staff openly acknowledged prob-
lems and inadequacies in the hospital:
patients still wear uniforms, ‘‘but we
hope to eliminate that soon’; there is
a shortage of fully trained nurses (male
and female); much more intensive re-
search on the chronic patient is need-
ed; the staff must be given more pow-
er to obtain jobs; apartments, etc. for
the discharged patients; and there is
an overall need for more psychiatric.

. facilities (‘‘a.600-bed psychiatric hospi-

tal is now being built in Camaguay—
with our own patients part of the con-
struction crew’’).

One index of the quality and human-
ism of a social system is its treatment
of mental patients. Perhaps the .most
vivid single event in our visit to the
Havana Psychiatric Hospital. was_ the
hour-long performance put on for our
benefit by a large number of patients.
The patient-performers—old and young,
male and female, black, brown and
white—sang songs in chorus or as solo-
ists, performed dances, and played the
rhythmic drums and guitars of typical
Cuban music. ee :

We were very moved by the per-
formance—we had in mind that these
very patients would have been living
like animals in their own excrement
had not the Batista gang been over-
thrown and imperialism booted out of
Cuba.

As we left the hospital; one of Dr.
Orrett’s statements ran through my
mind: ‘‘We believe that we have open-
ed the way for the world in the hu-
mane treatment of the chronic patient.”

a)

<_
_ —« aN

Well-cared for in a child-care center

PACIFIC TRIBUNE—FRIDAY, AUGUST 3, 1973—-PAGE 5