Ronda Alexander, MD
This March, I had the great opportunity to travel with a mission group to La Habana, Cuba. It was a result of some conversations I shared with my co-fellow over the course of our year together. While at the AAO-HNS meeting in 2007, Nazaneeen Grant (of Georgetown University Medical Center) took me to the Humanitarian Committee meeting and introduced me. I had been looking for a way to make my professional life even more fulfilling and this fit the bill. So, with her encouragement, I went to the Academy’s Web site and looked for a trip that I would be able to fit into our busy fellowship year. While political difficulties delayed our journey by 12 months, it was well worth the wait. While I’ve always wanted to visit Cuba, I had no idea of the effect this trip would have on me.
The experience was organized through Resource Exchange International, a non-profit organization founded in 1990 that currently has active programs in 11 countries. Its mission is to “encourage, equip, and empower people in developing nations to strengthen strategic sectors of their countries.” REI works to connect American professionals and their local counterparts in order to facilitate the kinds of relationships that can lead to lasting progress in the host nations. While the organization works with teachers, business leaders, scientists, and others, this was a medical team composed mostly of Otolaryngologists.
During our mission to Cuba, we were hosted by the Ministerio de Salud Publica (the Public Health Ministry) and the National Otolaryngology Society. The first night included a kind welcome in the home of a local clergyman who has been working with REI for many years. We reviewed our goals as a team and divided the donations we brought as well as the work of teaching and translating between the two hospitals where would be having the exchange: Hospital Hermanos Amejeiras and Hospital de General Calixto Garcia.
Upon arriving at the hospital on the first full day of work, I was impressed with the technical skill and enthusiasm for learning displayed by our Cuban counterparts. On previous trips, they had been taught techniques for endoscopic sinus surgery and were eager to share how they had refined their skills. I, however, was mesmerized by the junior resident who was performing a tonsillectomy on a teenage boy under local anesthesia— awake. I think she was surprised that I was so interested in learning from her, and she taught me a technique that I was not able to learn during my own residency. The next day, I lent guidance as we treated two patients with bilateral vocal fold paralysis after thyroid surgery performed out in the countryside. Over the remaining days, my Spanish language proficiency meant that I spent a good deal of time facilitating communication between our team and our hosts so that the messages would be clear.
As I talked with patients and translated, the similarities between our situations became clear. Cuban Otolaryngologists struggle to provide good care for their patients with limited resources—many of us are familiar with this on a lesser scale. Cuban patients are making touch choices between medical care and family obligations—our urban and rural colleagues here see the pain in their patients’ eyes when we propose expensive treatments to patients with limited resources. While they repeatedly apologized for being a ‘small third world country,’ I was excited by the things that they were able to accomplish with so little.
Some of the best times were in the evenings over dinner when we were able to just relax with our hosts and share our interest in them. Many of them were curious as to why we want to come to their country when we allegedly hate them. This misconception is surprisingly common, and our response was that we genuinely wanted to help them help their people. The professional connections made over patient care were warmed into friendships as the week marched on, and by the time we were ready to leave for our own home soil, I was nervous that I might not be able to leave the island since I was being called a Guantanamera, and being mistaken on the street for someone’s cousin or sister.
This trip served to reinforce for me the fact that, worldwide, we are all one people. While our governments may disagree, our open hands were clasped by those of our Cuban brothers and sisters. While they often lack material comfort in their professional and personal lives, I found that our friends certainly possess a richness of spirit and passion for medicine. This renewed the idealism which inspired so many of us to go into medicine in the first place. I plan to return for years to come, and I hope that I can continue to build on the relationships already in place as we seek to minister to the bodies, minds, and souls of the Cuban people. Until then, I hope to be more patient, less wasteful, and more grateful in my own daily walk.