Interview with Dr. Bita Amani, on the CDU Public Health Department 2023 Trip to Cuba, Part 2( continued)
in the United States who you don’ t often see the value of not practicing medicine but instead, for example, working in a restaurant or café. What is the significance of this for those of us who are visiting another country to learn more about its history and current reality?
You’ ve got to listen much more than talk in order to really understand what’ s going on. That’ s what I say. That’ s the short answer to me. You need to listen with humility. Put all the things that they’ ve told you in preparation to come and let the people tell you what is going on and express their feelings, and not see yourself in any role other than as you say, you’ re an authority figure because you have money, regardless of race and ethnicity. For many of the 3rd world, they see us as Americans with money, because that’ s their frame of reference. For some students, this cultural nuance was also something that they were learning for the first time. This isn’ t something we are traditionally trained on within our field of study.
People are driving around the island in 1956 Chevrolets that they have rebuilt and rebuilt and rebuilt and rebuilt from these used parts. And there’ s a level of dignity that you understand. That car is as valuable to them as the new Mercedes or Tesla that you might drive. The message is that people’ s values aren’ t always about tangible things. They’ re really about dignity. What you’ re saying makes a lot of sense. We need to think about cultural humility, structural competency, and a critical review of the history, when we are traveling outside of the United States. CDU prioritizes this kind of orientation when it comes to SPA 6 and we’ ve been able to extend this framework to our international work. The students themselves have a great deal of exposure to this during their training with us at CDU, and the international travel challenges them to extend these frameworks to other places as well.
The people in Brasil, Malaysia, Africa, and elsewhere that I’ ve encountered in my various trips have been very, very, very receptive. Whether you come to their country or not, they’ re going to have Dr. Bita Amani a certain amount of joy.
In the United States, when we visit patients in the state subsidized hospitals, clinics, or health institutions, there are often negative assumptions about who our patients are, especially if they are Black or Brown. Our students are very sensitive to these historical assumptions that undermine care for patients, and so they pride themselves on prioritizing patient needs around comfort and privacy. Our students wanted us to prioritize privacy over their own learning in Cuba as well given their experiences in the United States. We brought up this concern to our Cuban colleagues, who asked us to think about privacy in a different way and instead see it from their point of view. They wanted us to challenge our students to go up to the patients in Cuba and strike up a conversation and ask them how they feel about their care, what they do, and where they live instead of assuming they did not want us to talk to them.
Given the high literacy of the population( 99 %), they noted that most of the patients are employed as professionals in fields such as medicine, nursing, education, law, engineering, and political science. What does that mean then for the patient who is a doctor to interrupt her rest while pregnant to want to talk to you? Does this patient see themselves as separate or part of this maternity home? There is a fluidity between the people serving and those being served within Cuba because those that are serving are also serving themselves, because they are the direct recipient of the system that they’ re building. This challenges the typical idea of privacy and comfort.
Often, in the US when we go into a hospital, we don’ t see this as our hospital. We don’ t see ourselves as an extension of the system. There are so many reasons why this is the case and we could argue that patients
CDU College of Medicine | PG. 29