University of Minnesota

“If It Isn’t Fun.” – Part 4 – Medical Mission to Cuba, Summer, 1949

(Or, Why I’m Not a Missionary)

“All you gotta do here in Cuba is plow under the cut cane stalks and they pop up again, twice, three times a year.” So we were told by the American foreman of a sugar plantation in the tropical paradise of Oriente Province, the summer of 1949. Clearing and fertilizing were needed only every three or four years. Irrigation was unnecessary. So we were told.

Surrounding the broad cane fields in Oriente’s lush green valleys were exotic palms silhouetted on gentle mountain ridges. Each village displayed a church steeple and a handsome new schoolhouse marked Escuola Batista. We were told that most of the latter were inhabited by local Batista cronies and never used as schools. The villages themselves were dirt-poor, quite lacking in charm, their people barely subsisting.

My Cuban colleague and mentor, Dr. Santiago Bueno, was educated at the Sorbonne and at the University of Pennsylvania. Rather than opening a lucrative specialty practice in Havana, he had long ago returned to Bayamo in the foothills of the Sierra Madre to serve his home folks. A more devoted, intelligent man in the practice of medicine I have never met. But he looked so melancholic, with sad brown eyes, wide brow, and heavy black spectacles. I soon found out why that might be.

We left Bayamo together on a three-day trip by horseback through the Cuban backcountry, the same region from which Fidel Castro would one day emerge to lead his revolution against Batista. Dr. Bueno carried in his saddlebags a metal case of heavy lead alloy that we placed in whatever coals of whatever fire was available. This provided sterile instruments anywhere we went for emergency surgical procedures that were often lifesaving.

The distinguished itinerant physician and I, his temporary assistant fresh out of a Chicago internship, held a series of informal clinics in the anterooms or patios of homes in which we were invited to spend the night. Each morning, after a triage of the many waiting patients, we would get to work with the minor surgery and pill dispensing, boil lancing, and D&Cs on bleeding women. We diagnosed advanced pulmonary tuberculosis, epilepsy, and breast cancer. We attempted to send two women, with the telltale “orange peel” sign on the upper outer quadrant of a breast, to Santiago for treatment. They, and most people here, simply shrugged their shoulders at our recommendations. It was economically impossible for parents to leave their homes and families, no matter how critical their condition — or in some cases how infectious they might be to others.

After one particularly hard clinic day that extended far into the tropical evening, a noisy motorbike pulled up outside our temporary clinic. Its messenger urged, “Please, Doctors, come as quickly as you can!” He named a neighboring village some miles away over a nearly impassible road. We closed our makeshift clinic and commandeered a local car to follow the messenger home, eventually arriving in a darkened mountain village. There we were led to the home of a family with an 18-year-old girl who bore the classical stigmata of fulminant typhoid fever: rose spots on the skin, a palpable spleen, and bloody diarrhea from hemorrhage (of Peyer’s lymphoid patches) of the intestines.

I had brought from Chicago a supply of the new “miracle drug” chloromycetin, highly specific for her salmonella dysentery. We carefully outlined with the family a detailed regimen for administering the capsules and for maintaining the patient’s fluid balance and nutrition, indicating that we would return in 24 hours after completing our circuit by horseback.

On our return visit we learned that before we had been gone an hour the family had sought a “second opinion” — from the local hoodoo shaman! He had immediately countermanded our medical orders — under grave spiritual threats to the family. He then danced about, chanted incantations, and massaged the young patient’s belly for some time, after which he administered a dose of castor oil, “to get rid of the flux.” The lovely girl died several hours later of an exsanguinating bowel hemorrhage.

Such encounters in Cuba threw me violently off the trail of missionary medicine. I was no Albert Schweitzer — he who preached: “to save one is to save a world.” Rather, I was horrified, frustrated, and then depressed by the ignorance and superstition in the Cuban countryside, and by the lack of people’s faith in their kind physician, Bueno — he who had sacrificed “the good life” to care for his own back-country folks.

I also began to see that the causes of the common illnesses among these sweet, sad people lay in their widespread poverty, ignorance, and oppression under the decadent Batista. The death throes of that tyranny in those days in the late 1940s seemed to be accompanied by the greatest misery. And these overriding social issues suddenly seemed to me to dwarf any real effects of modern medicine and to negate the piddling efforts of any missionary physician. Without realizing it, I was on the way to a different view of medicine, a population-wide, public health, and prevention view of the world, not to replace, certainly, loving and skilled care for the individual patient, but as its essential complement.

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