Integration of medicine and psychology and the effect of the U.S. embargo on Cuba.
By Nabil El-Ghoroury, PhD
I visited Cuba with an APA group that attended the VII Conferencia Internacional de Psicología de la Salud (VII International Conference on Health Psychology), sponsored by La Sociedad Cubana de Psicología de la Salud (Cuban Society for Health Psychology). This trip was one month prior to the recent announcement that the U.S. and Cuba would normalize relations. American citizens may visit Cuba on organized tours for educational purposes, such as this conference. As part of our trip, we met with psychologists from the Ministry of Health, visited local primary care clinics, and toured a developmental center for children and adults with developmental disabilities, in addition to attending the conference. Most of what I am describing here is from what we learned outside of the conference.
Div. 54 members would be most interested in learning about Cuba’s primary care medical system. Given its limited resources (Cuban currency is not accepted outside of Cuba and the U.S. embargo has had a significant impact on the Cuban economy), Cuba has placed a significant amount of its health care resources into prevention. Cuba has 67.2 physicians per 10,000 residents, higher than the U.S. (24.2; WHO, 2014). A primary care office with a physician and a nurse is embedded in the community for approximately every 1,000 residents. What this means is that there is a medical office every 2 blocks or so in densely populated areas such as Havana, but more spread out in rural communities. For every 40 of these offices is a Polyclinic, which is a medical clinic with specialties such as dentistry, rehabilitation, physical therapy, and other services. If there is a need for greater medical care, there are general and specialty hospitals.
Where is psychology in Cuba’s primary care system? Psychology is integrated with medicine, from training to the doctor’s office and Polyclinic. Psychology is taught in all Cuban medical schools alongside medicine. In the medical schools, the psychology major is health psychology. The medical system was designed in the 1960s with psychology included from the beginning. A psychologist is assigned to every doctor’s office (psychologists may be responsible for several clinics and rotate between them). In addition, psychologists are located at each Polyclinic and the larger hospitals/specialty institutes. Finally, psychologists are represented among the leadership of medical schools and in the Ministry of Health. As a result of this integration, there are few problems between psychology and medicine (unlike the U.S.).
Given its focus on prevention, the Cuban medical system emphasizes maternal child health. Prenatal care is easily accessible through the community clinics and universal coverage. Psychologists train mothers about parent-child interactions, and follow high-risk pregnancies to identify any developmental delays early (Dominguez, 2010). These efforts have been successful in a number of ways, as infant mortality in Cuba (at 5 per 1,000 births in 2013) is lower than the U.S. (6 per 1,000; World Health Organization, 2014).
One important difference in the professional practice of psychology is the level of training. The U.S. is one of two countries that requires the doctorate to practice psychology. In Cuba, the degree to practice psychology is the licienciatura, which is a 5-year degree that is similar to the European model of training in psychology (Bernal, 1985). The training is focused on psychology (not like a U.S. bachelor’s degree with general education requirements), so there is a lot of psychology training, coursework and practicum during this time. However, a Cuban trained psychologist would not meet educational requirements for licensure in the U.S.
The effect of the U.S. embargo on Cuba and on health care is significant. While there are some exemptions for medicines in the embargo, the reality is that the lack of dollars to pay for equipment makes it nearly impossible for U.S. medicines and health equipment to get into Cuba. Colleagues who went to an oncology institute learned that for some prosthetics, the pieces required to adjust the prosthetics are from the U.S. and are unavailable in Cuba; as a result, larger amputations are done.
In sum, I learned the Cuban health care system has a lot to offer Div. 54 members regarding the role of psychology in mental health. Their prevention efforts, particularly maternal child health interventions, have been successful in reducing infant mortality. APA will likely coordinate future trips to Cuba, and I encourage those of you who are curious to go to Cuba, meet some friendly psychologists, and consider developing collaborations with them.
Bernal, G. (1985). A history of psychology in Cuba. Journal of Community Psychology, 13, 222-235.
Suarez, N. D. (2010, September). The work of the health psychologist in Cuba. In symposium Psychology in Cuba: A symposium, presented at the Cuba Research Forum Annual Conference, Nottingham, UK.
World Health Organization. (2014). Global health observatory data repository. Retrieved from http://www.who.int/gho/en/ .