I am writing from Havana, Cuba. This is my third year of medical school. I study at the Latin American School of Medicine (Escuela Latinoamericana de Medicine - ELAM) with 4,000 students from more than 100 different countries. I will be here for the next 3 years...

These are my tales of Medicine and Mischief...

Wednesday, February 15, 2012

Dang Dengue

They suspended the semester! The entire student body, at every hospital in Havana, has been mobilized to take on the dengue epidemic where it starts…In the STREET! I heard that there are around 5,000 students that have been called to the job. We’ve been paired up, given a Dengue kit, which consists of 2 thermometers and an official pen from MINSAP (Ministerio Interior de la Salud Publica) and assigned a square block. There are no less than 150 people living on top of each other in my half of the block. Our job for the last month and a half has been to go into their homes, check for fever, teach them about the symptoms of Dengue, point out mosquito breeding grounds, and tell them to change the water on their altar to San Lazaro daily. My education is now as an educator. This is seriously an example of Public Health in action. Cuba has clearly dealt with epidemics before. They have already eradicated tuberculosis, yellow fever, and malaria through similar processes. It is a very unique medical training that I am getting here. And on top of it, I am making a lot of new Cuban friends. I’ve been invited to many ceremonious cups of coffee and tea as I’ve gone around the block (which is probably 30 times by now). The Cuban people are so giving. Some of the little old people that we’ve come across don’t get out much, so we sit with them and chat, take their blood pressure and let them tell us how wonderful their cat is. There is a little old man with diabetes that speaks fluent English. He said that he learned as a child from a Jamaican who always had a cigarette dangling from his lips. He has a Jamaican accent and curls up one side of his mouth as if he were holding a smoke with the other half. He gave us pineapple chewy candy. Then there is Savina. She put a spread in front of us one day to the likes of Thanksgiving. People have opened up there homes and in a short time we’ve become an integrated part of their lives.

I had my first Cuban Christmas. I needed to save the travel money to pay for my board exam this summer. It was hard not being at home, but I had a great time anyway. The first half of the break I spent studying hard, practicing putting in 10-12 hour days like I will do before my big test, and then for New Year’s I went with some friends to a little Cuban country town some 4 hours away to dance into 2012. My good friend Cassandra has family from this small town, Cumanayagua. We went there 2 years ago to see her cousin marry and that’s when she met Meinrel, her cousin’s best friend, the man she married a year later. That’s a whole other story that involves a bus full of drunk medical school students arriving 2 ½ hours late to a rowdy Cuban wedding! (and they waited for us! We did have the flower boy and the photographer on board!) So, over the past few years the connections to this small town have grown and given some surprising twists. It was a great way to bring in the curiously doomed year of the Maya.

I finished a good book recently, the first leisure reading I’ve done in med school, Michael Pollan’s The Omnivore’s Dilemma. It was a long discussion on how detached we have become from the food that we eat. It was interesting to be in Cuba while reading this book because clearly it was written about the average westerner. Cubans are intimately involved with the food that they eat. There is a neighborhood garden plot right next to my apartment. My first meal of the New Year was a nutria stuffed empanada. We don’t eat nutria in the US (they might in some places in Louisiana). They are oversized rodents (like the ROUSes-rodents of unusual size found in the Fire Swamp of the Princess Bride movie) and my friend considered himself lucky to have crossed paths with one. He spent hours preparing it. It started with butchering it and it ended up shredded and pot roasted in a garlic tomato sauce. It took a good amount of courage to open my mouth as he brought the fork-full closer. In that moment I thought of my BFF Boozy saying “I’m a pediatric nurse, it’s OK. Now open up wide, here comes the airplane!” The Cuban boys with their rudimentary English were calling them empanadas of the great mouse throughout the day. It was a charming food experience. Of another charming food related experience, my friend Adrian named his new breeder pig after me. She is the runt and they call her la flaquita after me, la flaca (the skinnyone). Her full name is “Como se dice la puerquita flaquita Heather.” My name here is always proceeded with “how do you say…” because it is a hard grouping of consonants for them to pronounce, and then they say “you know, the skinny one” as they make a fist and shoot their pinky finger to the sky.

I’m finally feeling really settled here. It might have something to do with having more space and no longer being on lock down within the confines of an old military base turned medical school. Havana is a crowded, dirty city with beautiful crumbling buildings and I am happy to be here. The other night I watched the moon rise through the skeletal structure of a once grand palace with only columns and staircases left making it a landscape where Escher meets Dali. The transvestite was hookin’ right in front and my buddy and I were catching pieces of conversation from the crowds of people walking home from the baseball game. There were way more people in the street than there were cars. It’s a phenomenon I encounter on a daily basis. People leave their homes and walk up the street to gossip with their neighbors. They sit on their stoop and shout friendly hellos at people passing by. The man selling flowers from a milk crate on the back of his bicycle rolls by. One woman walks around selling pastelitos (baby cakes) at 4 every afternoon, a man selling sesame crackers passes at 9 at night. The best word to describe Cuba is charming. The people are, the scene is, the humor is charming.

Sunday, October 2, 2011

Short Tale, Long Tail

Long Tail, Short Tale

This is a short tale of 24 hours. Here is the background information. My buddy and I moved into an apartment with a Cuban named Tony. Tony moved onto the couch. We found Maida, an endearing mother figure of 56 years of age to cook a pot of beans on Mondays. The “sopa de sustancia” (soup of substance) that they serve in the school cafeteria is thin and mysterious…and can you think of a more communist name for soup!?
So Buddy and I started talking. The Cuban on the Couch scenario was getting old quickly and for the price, we agreed that he was exploiting us by not leaving (and eating our food to boot). We came home from school on Monday having decided to confront him. Maida was in the kitchen preparing to cook the pot of beans. There was a long frozen tail in the pot, at least a foot long and tapering to a fine point. It was rigid and gray, with coarse hairs missed in a quick shave. She said, “for sustancia!”…mystery solved. I walked back to my bedroom, where I hide from Tony and saw that he had moved a bed into his room. Buddy and I said something about how great it was that he got a bed and would move off the couch. Maida chimed in, “Yes, Cosita (the neighborhood nurse) loaned it to me…so that I can take better care of you!” She was moving in.
It was a friend’s birthday and we were meeting up at the famous chocolate truffles and decadent drinks spot in the mall, “Chocolates de Baracoa”. The menu alone looked good enough to eat. The Birthday girl started, “I’ll have the Chocolate mousse.” Well, she got the only one. From that point on, the 17 year old girl with the prickly personality of a 65 year old diner waitress would respond, “We’re out of that, what else do you want.” Everyone ended up with chocolate milk…the choice was “Hot or Cold.” Buddy said, “It’s so commi! Let’s go get some peso beers!”
I went to the hospital today for my 6th day in a row. I am learning the Physical Exam in the Geriatrics ward. My patient, a 78 year old with diabetes, hypertension and now Dengue was going on her 6th day, too. I assessed her and we talked about the sky, “It looks like it might rain.” I told her she would be going home tomorrow and we would have to say good-bye today. She hugged me and kissed my cheek. “Let me give you my phone number so that you can come and visit me.” She said, “We are poor, very poor, but what we have we give with our hearts.” The old lady with rheumatoid arthritis in the bed next to her agreed. And it is true, Cubans are poor. But where else in the world can you make $20 a month and have your own Rheumatologist?

Tuesday, September 13, 2011

Breaking out of Quarantine

I broke out of quarantine on day two with the help of my buddy, Sarah, and my Cuban friend, Yeilette. They went with my bags and I strolled out the front door a minute later with my eyes set forward. The male nurse caught me, I noticed from the corner of my field of vision, but the heat and the line of kids waiting for their daily dose of malaria drugs kept him from making half a gesture keep me there.
That same day I moved into my new place in central Havana. Said Buddy’s boyfriend’s Aunt lives in Havana, and she knew someone whose daughter’s boyfriend knew that Tony was renting 2 of the 3 bedrooms in his apartment. We moved all of our stuff from the beach town of Baracoa to the bustling city streets in a bright red ’52 Plymouth.
So here we are within 2 miles of everything, in the smack dab middle of the city. The apartment is rustic…layers of dingy paint on concrete. The whole building is concrete…exterior walls, floors, countertops, interior walls and all. You have to turn the water on from the back porch to wash dishes or take a shower. All faucets in the house then pour at once. The lights take at least 10 seconds to flicker on. The gas stove is hot wired at the base of each burner so that when you touch the naked wire running from out the side of the nearest socket to it, it sparks and you get your cook fire. We share the land-line phone with the neighbor next door. If it rings and then seconds later rings again, it is for our side of the concrete wall. If you answer it and they ask for any of the 7 people next door, you say, “Please repeat the call.” On the outside, the street is busy. People walking, city buses, tractors, flat-bed trailers, loud motorcycles with side cars all going by. There is an urban garden plot next door. I can see basil from my bedroom window. If you walk around the backside of the complex and down a block there is a little farmer’s market tucked between the baroque façades of two old buildings, where you can get fresh green beans, avocados, guavas, platanos, yucca root, squash, dried beans, limes, tiny bananas, mangos, tomato paste, garlic paste, guava paste, and a peanut sugar paste that reminds me of a Reece’s PB cup.
I think I’ve found a stable place to be, but nothing in Cuba is a sure bet. Another friend of mine isn’t so lucky. She paid to have her room held during the summer vacation months and came back expecting to have it waiting for her. Instead, my 25 y/o beautiful Persian friend is sharing her room with a 14 y/o boy, son of relatives of the owner of the place… “They will be gone soon,” his dream come true.
School starts the 19th of September. I will be in an open aired, white washed hospital ward with French style windows and colonial columns studding a wrap around porch, treating “patients with fever of unknown origin”, but mostly it’s hemorrhagic dengue. With that, I start my clinical based education. The self-financed kids start this year, too. Cuba has decided to open up their medical training program to capitalism. Based on recent publications, it looks as though Cuba values my education at @ $96,000USD (not including the room and board, and $4 stipend I get every month!). Thanks for the scholarship, Fidel!

Saturday, April 23, 2011

White washed door, polished concrete floor…me, alone, bikini and breeze. I’m reading Ernest Hemingway’s collection of short stories. It seems appropriate. From my rustic rooftop abode I am looking at the choppy water that inspired him to write the Old Man and the Sea. This is romantic…

Monday, February 21, 2011

A loud rhythmic banging woke me up from a nap this afternoon. In my lifting dream state I was convinced that it was the Argentinean girl down the hall practicing her traditional stoic boot-clad foot-stomping dance. It turned out to be the Dominican girl with a meat cleaver and a chicken. Didn’t my last entry start out like this? Well, food is essential. The cafeteria has been serving you guessed it, beans and rice! It has been yellow “chicharros” for a month and a half. They are pretty good, especially when accompanied by the pink jello. And, I have found my sustenance. Popcorn! It gets me through the late night study munchies. I bought both the oil and the corn to pop here in Cuba. It is renewable as long as it can be found on the grocery store shelves, intermittently at best. Sometimes when you walk in the store, one whole aisle on both sides will be stocked with one thing. The last time I went it was Nestle Quick strawberry flavored powdered drink mix…and no popcorn. Knowing the likelihood, I bought 10 bags the time before. I’m figuring it out as I go along. I just traded my government soap for sugar from the tia who cleans the bathroom. Tomorrow, if all goes according to plan, I will get some powdered milk. Good days are punctuated by small victories as such. A good night means studying for 6 or more hours and then falling asleep easily. Right now, midnight Saturday, I can see the Brazilian boys in their dorm having a good time throwing knives at a wood block. It has all together been much quieter around here since the School of Sports kids left. The School of Sports is another scholarship program in Cuba where kids from all over the world come to play. They moved in to the medical school in late November because their school broke. If you could just imagine for a moment a typical mid morning here…medical students in freshly pressed white and navy blue uniforms walking from histology class to gastrointestinal physiology class having to weave between School of Sports kids practicing throwing each other on the ground. It was oil and water here for a couple of months!

The 2011 US pre-meds got here a couple of weeks ago. They are here for the next 6 ½ years. It makes me feel good about only having the rest of this year and 4 more to go. They moved into the room next to me after being let out of quarantine. It was funny hearing them talk before going to the city for the first time. “I’monna get some black pens and a bottom sheet.” “I need a light bulb and a fork.” They really thought they were going shopping! They came back 7 hours later with some onions and a better idea of where in the world they were.
Of school…January was final exam month. One exam a week left plenty of time to start some self guided (in other words, tangential) study. We had an MD from Brooklyn come down last week and present us with some information that will be on the boards but is not included in the curriculum here. I really appreciated her anecdotal teaching and wisdom from years in the field. It was the first class I’ve had in English in a couple of years! I also had the opportunity to take an elective course. By that I mean that I hunted the professor down for 4 days to get into his class. He had to ask the permission of director of the laboratory where the class was to be held. She happened to be his wife and so that part at least went smoothly. The class, Histocompatibility in the Transplant Patient, entailed 5 days at the National Institute of Nephrology. We learned about the monumental collaborative national effort involved in organ transplant medicine. I saw the refrigerator where the serum of every person in Cuba with end-stage renal disease is sent on a monthly basis. We had a brief overview of organ transplant genetics and immunology and then went into the laboratory to view the process of determining tissue compatibility with a microscope. Most other countries have access to an international pool of organ donors, making finding a match more likely. Cuba’s pool is confined to its own population, making finding a match far more difficult. This is one of the far reaching and sinister effects of the US embargo on Cuba.

Last week we started the spring semester. The school gave out brand new books to 2000 students. It is my final semester at ELAM before moving to the big city to study in the hospital setting. I have medical microbiology, genetics, pathology, epidemiology, psychology and of course PE to look forward to doing for the next 4 and a half months

Life is good here. I study a lot. I also find a little time to enjoy the small beach town life. My buddy has a bicycle with a rack on the back. That’s where I sit. I’m the bumper sticker that says “Candela!” We cruise up and down the drag on Friday nights drinking cold Buccaneros and trying to stay on the bike through the potholes…

Once again, This blog is my work, my income. This is how I intend to support myself through the next 4 years. I need your support. I don't have the same access to loans and grants that other medical school students have. While Cuba has given me this full scholarship to study medicine there, it does not cover the cost of books and supplementary materials, nor does it cover the cost of traveling back and forth from the island once or twice a year to be with friends and family.

Donations large and small are very appreciated. I would also be interested in a personal loan. Life in Cuba is really fascinating. No doubt there will be some great tales to come! Please feel free to leave comments and ask questions. Also, share this blog with anyone you know who is interested in medicine or mischief! Thank you so much for your support! Heather*

Friday, November 12, 2010

The Mortal Wound and The Pitcher

The screaming of a pig pleading for its life woke me early this Sunday morning. I’ve heard them scream before, but never from below my window. I got out from under the covers and stood on my bed to peek through the thin metal slates of my window. The family that lives in the apartment below was there. No one was talking but everyone knew what to do. It was quick. The little old man put the point of his knife under her armpit and straight to her heart. His little old wife was right behind him with the pitcher for her blood. The father and son are butchering her with a machete, now. It already smells like chicharones.

I’m in the kitchen, sitting at the table in my place in Baracoa, the small town nearest the school. The little concrete apartment came furnished with a wrought iron patio set, some 1950’s office furniture, a couple of beds, a pressure cooker, a one burner electric stove, a ¾ size fridge, 2 fans, and a bucket. We are set. I live here with Nate. He is a classmate and my good friend (the train-hopping punk from my first letter last year). We are living two blocks off of the Caribbean ocean. It’s a half hour walk to school in the morning. We leave in the early light and the sunrises are glamorous. It is nice to be here on the weekends. I sit and study for hours, getting up only to run down to the street to buy vegetables from farmers that pass by on their horse carts. People sell all sorts of stuff in the street…sugar, flour, avocados, green beans, bread. I get to stay home and the groceries are delivered by the people who grew them. My friend in the apartment downstairs, another classmate, is dating a boy from the countryside, Cumanayagua, who comes every weekend with coffee that he has roasted and ground himself. It is the most delicious coffee I’ve ever had…grown, roasted, and ground in Cuba’s backyard. My kitchen smells of it now, as well as sweet corn fritters, and banana flan.

Everything has a uniquely Cuban flair here, from the way you make coffee to the way you clean the floors. My medical education has an unusual adjunct Cuban education, as well. Things that I might not learn elsewhere in med school I am learning here, for example, small appliance repair. I fixed my one-burner Cuban made hot-plate with the copper wire and jewelry tools that Mom packed me with. Thanks Mom. I’ve also made some earrings to sell. It is one of the ways I am trying to support myself. I’ve learned how to make flan in a pressure cooker, how to make unripe platano into a delicious food, and how to push in a line (you are going no where if you don’t push and shove with the rest of them). As far as my actual medical education goes, I was running before my feet even hit the ground here. We took our final on the cardiovascular system last week. The first part was practical. I had to identify five anatomical details where different pins were stuck in dissected body pieces. The second part was the written final, like any normal final except that the seasons changed that morning while we were taking it. There were hurricane strength winds, the electricity went out, and rain came blowing in through closed windows. The class seemed to hardly notice. The final was difficult and encouraging. I am doing a good job with my studies. It is for real y’all. I am studying medicine. It is everything I’ve ever heard about…sleepless nights, stress, feeling like you are constantly behind in a race. I am also fascinated by what I am learning and so glad that I have made this choice. We start our final block of normal physiology this week. We are covering the digestive system, the respiratory and the renal systems over the next 5 weeks.

Thank you for keeping up with me. I am trying to make it home for Christmas, so if you are able please make a donation. I am also trying to come up with the money to register to sit for my first board exam, the USMLE step 1! Thank you Anna and Jason for your support! Thank you Sedonia and Portia! Thank you Leigh Ann and Elizabeth! I am truly grateful for the awesome friends that I have!

Love,
Heather Star

Tuesday, September 14, 2010

Stuck in Paradise

Today is a much better day. I haven't cried once. Yesterday, I cried from 5:30 in the morning when I didn't get to say goodbye to a special friend, until 8 o'clock last night when I fell into my hostel bunk bed in downtown Cancun. I slept for a solid 12 hours. I was physically and emotionally exhausted. It is now 34 hours later and I am holding out strong in the Cancun International Airport, waiting to see if I can fly stand-by to Cuba tomorrow. I am 2nd on the wait list, but the wait list has not been moving. I will otherwise fly out Sunday, 6 days after arriving disheveled and heart broken and without my luggage. I found a med school friend here in the same predicament. A cup of coffee later and her company to boot is helping me to see the humor in this all.

Thanks to many of you for your words of encouragement. Thank you especially to those of you who have helped me out so much through the summer. Thank you Boozy and Elizabeth for your open hearts and open home! Thank you Portia and Sedonia for providing me privacy and peace of mind for the coming year! Thank you Kinny for the emotional support that will keep me going! Thank you Mom and Dad for your continuous encouragement! Thank you Namaw for the books! Thank you Sarah and Ray for having me up to Colorado! I hope your home stays safe. Thank you Shelley Smith for your continued support and ever-flowing ideas! Thank you Barbara Gurtner for the blossoming friendship and the home town fun! Thank you Anneke for being the first one to hit the donate button! Thanks to my wonderful Austin friends who are planning a benefit concert to get me home for Christmas... Raina my sister, Mustang, and Jimmie Dreams with the Love Leighs, Raina Rose, Johann Wagner, Deemo with The Blue Hit, Jason Weems, Rebecca Loebe! Thanks y'all! I am so blessed!!!