Heading off this evening, all packed up and ready to go home! Last night, my “cuban family” organised a lovely dinner with everybodyaas a goodbye present. It felt lovely to be part of the family, and I’m truly sad to be leaving, although I’ve no doubts this is not a goodbye, rather a see you later!

More updates when I get back home! Chau!

Quick update about the last few days. I started the International Dengue Course here at IPK on Monday, a prestigious event which unites some of the most important scientists involved in Dengue Research. In addition, a number of government officials, epidemiologists and other specialists have come from all the countries of the americas (the latin-americans) to discuss guidelines laid out by the WHo and other bodies. basically, it is a very interesting and enriching experience, and a great glimpse into the world of research (ranging from sociology to genomics) and socioeconomic organisation of public health strategies. This way, I am able to see all this world from a fly-on-the-wall perspective, and learn quite a lot about Dengue. Needless to say, some of the genomics and molecular research presentations were a little tricky, but nonetheless, I’m quite excited about entering that world next year.

I also met with the chief of vector control at the institute, called Dr Rene Gato (his office door doesn’t bear his name, rather a photograph of a cat), who also sometimes gives me a lift home on his Jawa motorbike. His team gave me a very comprehensive tour of the department, including the mosquito larva farms and the labs in which their research is performed concerning insecticide and biological control methods against mosquitoes. A senior member of his team, both an eminent entomologist and cabaret singer (!) named Israel Garcia, kindly signed and gave me a copy of one of his training manuals concerning the use of biological methods in control of mosquito larvae. He also made me promise that whenever possible, I should make my way back to Cuba to learn some entomology in his lab, an oath I hope to stand by!

I also had a chance meeting with a certain Juan Carlos Finlay, great grandson of Carlos J. Finlay, the great doctor and scientist who discovered the cause and transmission of yellow fever. An eccentric old man, he sat next to me on the bus home and insisted that I write down his phone number. He asked me to call him so that I could meet his youngest son (a 23 year old engineering student), whom he was convinced would make an excellent match for me. All this occurred accompanied by the sounds of laughing from the other staff seated around us! What could I do but humour the eccentricities of a man with a great ancestry? Some days feel a little less real than others!

That’s all for now, I’m off to cool off at home for a bit before my evening run. Temperatures are hovering around the 38C mark, meaning that the only running I can do is in the late afternoons at sunset, although I really think that this is when Habana is at its most beautiful.
Chau!

Fortunately, I was able to find another computer with a better internet connection which would allow me to upload a few photos:

My parasitology professor, el Profe Beltran

The microbiologists!

Tachino, or fried plantain… absolutely delicious (and probably very bad for one’s health…)!

My “Casa particular” or guest house:

Playing with the boys, Manuelito and Jose Ignacio, in their grandmother’s swimming pool (my host)

My visit to Varadero beach was one of absolute relaxation. After a painfully early start (5.45 a.m. bus!) and a 2½ bus ride through the gorgeous lands East of Habana, I arrived, after crossing the sweet little town of Matanzas, at the final destination. Here, miles upon miles of white sand and turquoise waters gave way to hotel resorts and tourists. Despite my often openly expressed disgust for such places, I have to say that I did fall in love with the seaside at Varadero. The water was of a lovely warm temperature and clear as crystal, and I spent a long time swimming around and letting the sun destroy my skin push me towards a wrinkly, leathery future. It was, in a word, blissful. I spent most of my time swimming, or reading under the shade of a parasol with a cool can of “Naranja”, fizzy orange juice which tastes EXACTLY like the Fanta you get in Tanzania! On the way back, exactly halfway between the provinces of Matanzas and Habana, the bus stopped to rest at the Mirador, where the tallest bridge in Cuba towers over a great expanse of green, bordered on the north side by the sea, and the south by small valleys and mountains. Here, I was advised to taste what is said to be the “best piña colada in Cuba”. Coconut, pineapple, sugar and a touch of lemon, chucked into a blender and then poured into a hollow green coconut with a straw makes for a tacky but delicious refreshment!
After that long day of hard work, I crashed into bed early, ready to face the new week. Same schedule for the most part, although I was able to spend a morning in general surgery on Thursday (with a militant communist vegetarian cardiothoracic surgeon), and was given a little lesson on leishmaniasis by one of the parasitology research fellows at the institute. My morning rotation in surgery included the removal of skin lesions, a gastroscopy and discussions on lung cancer resection, as well as a bit of DIY helping the workers finish off the new theatre. The skills I learnt: how to remove skin lesions using a lozenge excision, a number of different suturing techniques, and how to install a window and use a silicon gun.

One of the patients I had been following the progress of, an HIV/AIDS patients with a suspected meningitis, was eventually diagnosed not with cryptococcosis as we had suspected, nor with neurotoxoplasmosis (the second most common option), but rather with TB meningitis. The day after the final diagnosis, she (lets call her Anna) eventually succumbed to the coma which had been threatening to occur for a couple of days, and passed away the next morning. The day before, I had been foolish enough to think that she was going to survive once treatment had started, and had asked her partner if he would kindly wash Anna’s hair, which, after 2 weeks of tossing and turning, vomiting and sweating, was matted and dirty. It was a lesson in keeping things in perspective. I had been naïve, and knew too little about her situation, and due to inexperience, hadn’t know the true risks she was faced with, and instead had focused on details.
However, another “special” patient whom had been suffering from a TB lymphadenitis or “scrofula” (a patient with HIV/AIDS status as well), began to progress well after the doctors decided to change his treatment to include medication against atypical/non-TB mycobacteria. I was asked if I wanted to do some studying on the subject (using the microbiology and infectious disease textbooks in the library, obviously only available in Spanish) and gave a small presentation on the subject to the consultant and registrars on the ward round.

After finishing my scheduled time in parasitology, I spent my afternoons working with the clinical microbiology staff. Although a topic which I find a little less exciting than parasitic diagnosis, microbiology was still a good chance to reinforce some of my previous knowledge and learn a few things, namely: how to make cultures and the uses of different media (blood agar, chocolate agar etc.) as well as how to interpret and inoculate a number of other media and biochemical tests. The chief technician even made me a few special slides and fixed them so that I could take them back with me and use them for revision. My afternoons in the microbiology lab weren’t only work though! The chief technician, a suave and charming host, would make all the staff coffee and toasted bread, and fruit juice and all sorts of other lovely treats in one of the side labs. Probably one of the most unsafe procedures to undertake in a microbiology department, but nonetheless, very tasty and very fun!

The weather, which previously was unbearably hot, has turned into more “normal” summer weather, with hot mornings and windy, rainy, stormy afternoons. As a result, the electricity has been a little more sporadic than usual, with frequent (but short) “Apagòn”s (or black-outs). However, this makes for cooler weather for running in, making my 5-6km runs in the mornings/afternoons a little more bearable. I’ve taken to going to and from work using the “Gua Gua” or Bus, an old school bus for the IPK staff which picks me up a 10 minute walk from the house. Early mornings and late evenings (the bus picks me up at 7.10 am and drops me off at 6.30pm) take up a lot of my time, but make for an enjoyable trip!

This weekend my plans to visit Trinidad, Cienfuegos, Sanctu Spiritu and Santa Clara (“La ciudad del Chè”, where he is buried) were quashed due to time restraints. Instead, I plan on taking it easy and hopefully taking the two little boys who live in my house to the national aquarium nearby either today or tomorrow. Last night, I had dinner at my friend’s house (the lovely Dra Thelma), who’s husband Guardito made us pizza (!) and pasta. An avid cook, we talked about food and other things, and then went for a drive to look at the sea, which is literally 5 minutes walk from the house. I feel extremely lucky to have found Thelma and her family, a lovely group of people who have seriously helped me feel a lot more comfortable and supported during my stay.

Next week is going to be very busy. By fortunate coincidence, my last week coincides with the first week of a world-renowned course on Dengue held by the institute every 2 years. Specialists from South-east asia, latin America and WHO staff will be attending to give lectures and presentations on the technical and practical aspects of Dengue fever. The whole course lasts 2 weeks, but I’ll only be able to attend the first, which is not a problem since the theoretical portion will mainly be on this week. Needless to say, I’m truly looking forward to learning and meeting some of the professors and specialists who will be attending!

Here’s another week’s worth of information. I reserve some of my thoughts for after the trip, when I’ll have more time and more peace of mind to discuss them.
Chau!

P.S. I apologise for the lack of photos… the very slow internet connection makes it almost impossible to upload photos, and it´s a time-consuming and painful activity best saved for after my return to Geneva!

Week 2 : The attack of the mozzies

End of week 2. At the moment, as I write this entry, I’m at my laptop in my new accomodation. Obviously, through lack of an internet connection, at some point between now and when you’ll be able to read this, I’ll have gone to a nearby grand hotel and requested the use of their internet. However, in the meantime, here I sit, in the lovely living room of the house in which I have been welcomed as nothing less than a member of the family. The only problem: mosquitoes! Recently, plans to build a new Hotel nearby have resulted in the cutting down of an area full of trees, where obviously, all these lovely Aedes mosquitoes usually live. Uprooted from their homes, they swarmed into the nearby neighbourhood, including the house. Everyone in the family, consisting of a Grandmother, two families of 4, and myself, are constantly doused in insect repellent, and usually assisted by mosquito nets. Nonetheless, the magnitude of the attack is considerable. In this case, I don’t think any degree of scientific or pagan Santerìa (a sort of animist version of Catholicism, born from the mixture of cultures from the era of slave trade in the Caribbean) will help, and so I’ve decided to alternate between two states: safely huddled under my mosquito net in my room, or outside on the front porch, inhaling the fumes of mosquito repellent, hoping that there is some truth in the belief of Public health authorities that Dengue is about to disappear in Cuba. On another note, things are going really well. Having spent two weeks walking the corridors of the institute, I now know my way around without much trouble, and feel a lot more comfortable filling my time. My mornings doing ward rounds are interesting and a good chance to ask questions, but my true highlight are the afternoons, when I get to sit down at the microscope and identify parasites. Sad as it may sound, there’s something beautiful about those little larvae, cysts and eggs, that more than makes up for the discomfort of working with faecal samples in 37°C temperatures. It is HOT. And smelly. But the atmosphere in the labs is fantastic, and the staff always come round for a chat with the professor and I, or to steal us away for a half hour coffee break. The Cubans like their coffee strong, small and sweet, and in constant supply. Over the summer, I’ve had the chance to build a good resistance to caffeine, so that now I’m still able to sleep after countless cups of the stuff. Today I was meant to go to Varadero, said to be one of the most beautiful beaches in Cuba, but unfortunately, was unable to sort out travel arrangements. Hopefully, a short trip to the tourist office this morning will sort things out so that I may go tomorrow. The rest of my free time this week has been taken up by discussions with family members about all matters, reading “Cien horas con Fidel”, a series of interviews (some about Fidel’s life, others about the history of Cuba, all pertaining in some way to the Revolution), and going for runs on the 5ta Avenida, a street which runs approximately 8km long through this part of the city and a regular meeting point for runners, walkers, and other similar “deportistas” or “sports-people”. Running in the heat and humidity of the tropics is slightly different to running in the frost of January in Glasgow, to say the least. Last night, I tasted “Tamales”, a sort of Polenta (hot preparation containing maize flour) cake filled with vegetables, and cooked in corn leaves. The rest of my diet mainly consists of rice, rice, rice, beans, rice and on occasion, plantain. All this accompanied by as many mangoes as I can eat without putting my intestines at risk of melting away into nothing. And the occasional avocado, probably my favourite fruit in the whole world, and in one word: wonderful. The house in which I am staying is in many ways similar to my grandparent’s house in Rome, and contains all sorts of mementos from its owner’s travels. A retired Ministry of Health epidemiologist, she has traveled in a number of countries, especially in Latin America. Having worked with Fidel, she tells me of her meetings with him and describes him to me, each time with an obvious respect and great admiration for his ideas. It seems that here, El Comandante remains a near legendary figure, something which seems unusual for me, seeing as in most countries I’ve visited, the government is always seen as the enemy, even by those who have voted in favour of it. Perhaps it is this strong and intricate complicity between man and leader which makes Cuba so different from a lot of other nations. I hope to go to Santa Clara next weekend to try and visit the grave of El Che, and experience which is said to be almost spiritual for even the most atheist of Cubans. In fact here it seems that religion, although it does play a part in the country’s sociocultural make up, is not as strongly present in the daily life of every Cuban. Churches exist, most remnants of the 19th century, but many professionals with whom I’ve worked do not practice towards any religious belief, and neither do many patients. The patients I am currently working with are mostly HIV+, which makes for an interesting crowd. This disease, similarly to many countries in Europe where prevention campaigns and chemotherapy are more readily available than say in Africa, (where this disease is almost commonplace), tends to be limited mainly to homosexuals (or men who have sex with men, MSMs, as we were taught to call them at Glasgow Uni), making most of my patients male. Many of them have been rejected by their own families for their sexual orientation or due to their seropositivity, adding a number of challenges to their well-being. For example, those who suffer from opportunistic infections with TB, requiring months of Direct Observed Treatment, have to be housed within sanatoriums (basically, homes for the sick) to ensure that someone is able to care for them and provide them with food and other services. These individuals are lucky enough to be able to access these facilities completely free of charge. I can’t stop stressing this fact: Everything. Is. Free. As it should be. Alright, time to drink my coffee, shower and head out to enjoy my Saturday morning! Chau.

End of week one : Patria o Muerte, Venceremos !

It’s been little more than a week since my arrival, and I have to say it has been one hell of a whirlwind! My first few days at the hospital have been really great, and I’ve learnt loads in terms of treating HIV+ve patients. Because the Instituto is the Cuban reference centre for treatment of HIV/AIDS patients, we see patients with the most severe cases of HIV-related problems. This week I saw people with end-stage AIDS (wasted away to nothing, unable to walk due to exhaustion and weakness), young men with all types of atypical TB (miliary, lymphatic, etc.), as well as those who were responding well to treatment, even after 11 or more years since their diagnosis. The spectrum of this disease is so huge, and would have been much thinner were it not for the universal availability of the majore antiretroviral drugs, produced locally by governmental pharmaceutical organizations and provided ENTIRELY FREE (yes, and so is your hospital stay, yes yes, thank you very much) by the state.

This week, amongst other things, I learnt how to put in a central venous line (subclavian), announced to an HIV+ve woman that she was 3 months pregnant (mierda), and finished my week-long course in Malaria lab diagnosis (Queen of the trophozoites? I think so!). This, and other things were all done in what you could call an uncomfortable climate: approx. 35°C temperatures, with a 92% humidity, and a broken air-conditioning system (phew!). I discovered that the museum at the institute contains a number of specimens which are incredibly important in the medical history of Cuba, some of which belonged to Dr Carlos J Finlay, the man who discovered the vector and defined the organism responsible for yellow fever, as well as other achievements. Basically considered the father of modern Cuban medicine, he’s a little bit important (just a little).

On Thursday, I was kindly accompanied into the centre of Playa, (the part of Habana where I live), by a doctor who lives near my hotel, in order to take some passport photos to get my “staff card” (exciting!).
After inviting me into her house to meet her family (including her dog “Bebe”), we spoke at length about Cuba. It seems that no matter whom you speak to, everyone understands why the country is still poor, and knows that the reason why the people of Cuba lack luxuries which are often taken for granted in Europe, for example. She told me that it was because she knew that Fidel (and Raul) were directing the country’s (very small) budget towards matters of greater importance than new cars, fancy gadgets and exotic foods.

I was given a presentation on Friday morning by Prof. Kourì, explaining the past and current health status of Cuba, and how the changes that had been implemented since the revolution had assisted in changing Cuba into what it is today: a country where there is 100% literacy, and where the major killers are similar to those in the developed world: Cardiovascular disease, acute respiratory infections, cancer and accidents/trauma. A country where the infant mortality rate is less than 5%, the first country to eliminate polio in the world (1962), and where so-called “Tropical diseases” (a synonym of diseases of the poor” are only responsible less than 1% of yearly deaths. Diseases such as Malaria, Filariasis, Yellow fever and cholera have been eradicated, mostly since before the middle of the last century. I can’t help but be amazed at how such a small country, with such a heavy past of corruption and slavery to the US could turn around, face and defeat its invaders (first the Spanish in the 19th century, then the USA in the 20th), and turn into an example for all the other nations of the Third World. Nonetheless, the Cubans are clear about this: there are some problems that need to be corrected. For example, the double economy created by the use of two currencies with very different values, the apparent mismatch between people’s job specialization and their salaries, and the difficulty Cubans have leaving the country. However, all of those with whom I have spoken, many being intellectual and intelligent people, from all walks of life (from the taxi driver who drove me into Habana Vieja to the professor of epidemiology at the Institute for Tropical Diseases, passing through the Maid who looks after my hotel room) seem confident that with time, and with the united spirit of the working Cubans lead by their government (in which they hold all their confidence and trust), the country can only get better. Today is the 26th of July, a day in which the failed attack on the Moncada Garrison took place through the efforts of Fidel Castro and his revolutionary supporters approximately 50 years ago, symbolizing the beginning of the struggle against Batista and his corrupt regime (puppets of the US, of course). Today, in the city of Holgìn, in the Eastern part of the island, Raùl Castro is giving a speech to the people, reminding them of why this day is so important to them, and reminding them of how hard the nation fought to have the independence it enjoys today. This independence remains to this day unmatched by any other Latin American country, and arguably, by any other nation in the developing world.

We also discussed the devastating effects of the US blockade, a shadow which seems to linger on every issue concerning Cuba’s socioeconomic development (or “desarroyo, como se dice aquì”). We also spoke at length about other countries in the developing world, and most importantly, about Africa, a continent which suffers almost 25% of the world’s morbidity yet is provided with only 3% of the world’s health staff, and only 1% of the world’s expenditure in health. Over the last months, aided by the doom and gloom which comes with medical school exams, I had begun to forget why exactly I had ever wanted to become a doctor. It’s easy to lose perspective in these situations, and become obsessed with the minutiae of one’s own life. However, this summer is truly shaping my ideas, and is reminding me of what I set out to do with my life and (what I hope will become) my career.

On Saturday, my first day off since starting at the institute, after a late breakfast (at 9am! GASP! The decadence!) I decided to break the cycle of fear which had built up in me since the slightly stressful previous attempt, and headed into Habana’s centre. Here I visited the Museo de la Revoluciòn, guided by a young man who spoke excellent English, where I saw a number of little relics related to the revolution, as well as learning a bit about the history of Cuba, from before the Spanish invasion until the present day. Amongst hand-made grenades produced by revolutionary “campesinos” (or country-men) stood photographs of El Che, blood-stained prisoners’ clothing belonging to captured (and tortured) golpistas, and busts of important intellectuals and poets who were involved in the effort to rid Cuba of outside intervention. All in all, quite an entertaining hour and a bit.

Next, I headed to the Museo de las Bellas Artes, where the permanent exhibition holds some of the most beautiful paintings I have ever seen. If I haven’t felt like painting in a few years, this trip certainly has brought back the desire to start doodling again.
After that, fairly exhausted brain-wise, I walked around Habana Vieja, taking in all the tourist-y sites such as Calle Obispo, where street vendors selling second-hand books mingle with locals and lost tourists. After peering into a few places my Lonely Planet Guidebook told me to (like La Bodeguita del Medio, one of Hemingway’s regular haunts), I booked myself a trip to Pinar del Rio the next day, in true Tourist Style (oh yes). In the evening, the lovely Dr Thelma and her husband invited me for dinner, and then we drove to the fort near Regla (on the other side of the bay of Habana), to watch the firing of the canon (“cañonazo”), a traditional event which takes place every night, a pastiche of the similar event which took place at the time of the Spaniards as a guard against pirates (the true Pirates of the Caribbean!). We then went to see the massive statue of “El Cristo de la Bahia” (The Christ of the Bay), a towering figure which stands and looks over the port of Habana, built in 1958 by a female Cuban artist by the surname of Madera. The platform on which it stands was perfect for watching the whole of night-time Habana sparkling across the water.

Which brings us to Sunday. I apologise for such a long entry, but it feels like a million things have happened in such a short time that I must write it all down before I forget it all! This morning, bright and early, I was picked up by my bus which took me (and many other badly dressed tourists, as per tradition) to Pinar del Rio province, the Westernmost province of Cuba. Here, I visited a tobacco farm, where they explained how tobacco was grown, dried and prepared. We were also allowed the opportunity to buy a few cigars off the campesinos for a cheaper price than normal, simply because they belonged to the small portion of cigars which the state leaves to the workmen to sell as they see fit. Hence, they do not have the paper “ring” around them, but we were guaranteed that they were of the exact same quality. I bought a small packet of Cohiba “Mareba” cigars as a souvenir (same as those smoked by Fidel himself, before he gave up smoking), and was given a Cohiba “Esplendor” (slightly longer in length, but of the same strength and taste) as a free add-on. We then drove to Viñales, passing by a mural painted by a student of Diego Rivera (Mexican artist, married to Frida Kahlo, really messy and unfaithful, but communist socialist, so maybe not entirely bad) Leovijildo Gonzalez, depicting the history of mankind on a huge rock face. Pinar del Rio, so called because of its famous pine trees and the river that crosses it, has been assigned the status of World Heritage Site, and truly deserves the title. The village of Viñales was small but perfectly formed, and surrounded by beautiful green hills. After visiting a cave (“Cueva del Indio”) where we were taken on a boat ride and the boatsmen pointed out strange-looking stalagmites and stalactites (including “crocodile’s head”, “the skeleton” and “the fish”), we had lunch in a very nice restaurant specializing in “cocina criolla”, basically, typical Cuban food. The meal mainly consisted of roast meats, accompanied by rice and beans (“moros y blancos”) and vegetables, all of which were delicious! After lunch, we drove up to the top of one of the hills around Viñales, were a number of famous paintings of the valley were created, and allowed some time to walk around and shake our legs. On the bus, I met a very kind man from Colombia, a mechanical engineer working in a petrol refinery in Cartagena, who provided interesting conversation during the hours of bus travel. These are some of the moments I love most about traveling, the people you meet on the way, and the stories you hear. He told me about his sons, who are a little older than me, and about the traditions of our native countries (that took a while, especially from my end of the conversation).

So that’s the short of it. I will try and be more regular in my updates, but I am about to move from my hotel and stay with the lovely doctor who helped me out last week, where there will be no internet. Her mother, a retired doctor who once was in the Ministry of Health as the nation’s epidemiology expert, offered me a room (meals included) for a great price, and with the promise of good company and conversation, I really couldn’t say no! I’m hoping that living with her will allow me to get a better glimpse into the daily life of Cubans, as well as a bit of social interaction! I will try and access the internet at least a couple of times a week, and so will try to keep you all abreast of things. In the meantime, know that I’ll be spending my last day in this hotel lounging by the swimming pool tomorrow, enjoying my day off (I just LOVE national holidays).

As the Cubans say: Chau!

Museo de la Revolucion, once the Presidential Palace, decorated by Tiffanys’. The main dome at the entry:

Bullet holes from a student attack on Batista, the last president before the triumph of the revolution.

Home-made tanks, which are actually tractors covered in sheets of metal… used during the revolution.

Museo de las Bellas Artes, a few of the scultpures in the main courtyard.

Part of Havan seen from the sea front.

Eating a new fruit at Dra Thelma´s house! I can´t remember the name of it just now, but it was yummy!

The shooting of the canon at the fort of Habana.

Cuban Campesino, riding around the countryside where we stopped to see a few sights in Pinar del Rio.

Cueva del Indio, a cave more than 5million years old. The stalactites and stalagmites grow 1cm every 100 years!

Vinales, seen from the top of one of the surrounding mountains.

TOURISTA!

The church of the Fort of Habana

So here we go, first days in Cuba !
Sunday was a mixture of both good and bad occurrences. Starting with the bad, I was mugged in Habana Vieja, probably because my lack of fluency when asking for directions to the Museo de la Revolucion. However, I was not harmed in any way other than in an economic sense, a relief. I do not intend to take this event as any indication of the nature of the Cuban people, as it is clear that the majority of the people who live in Habana are tremendously friendly and helpful. On to happier things:

On Sunday, I was dropped off at Plaza de San Francisco de Asis (my name-sake, promoter of Christian-Muslim dialogue, and patron saint of animals… funny coincidence!) by a taxi, and walked around the streets of Habana Vieja. Driving up from my hotel was like traveling through a time machine, as the buildings, the atmosphere, and even the music playing on the Taxi radio belonged to another decade. I could have been in the 50’s! In fact, Salsa, (the term used to describe the variety of musical genres that were born and developed in Cuba) is everywhere. Booming from car radios, playing from little stereo cassette players outside shops and being played in the streets by children and adults… it is hard for me now to imagine the Cuban Revoluciòn having taken place without the soundtrack of sad, strong “Sòn”. Being one of the most crowded places in Cuba, Habana Vieja and Central Habana (the latter slightly to the west of the former) are both filled with a mixture of locals and tourists. The locals in fact are such a mixture of ethnic groups, ranging from those who descend from Spanish lineage, to those who are of Afro-Caribbean origin, to Chinese. Everybody however, speaks a smooth, very (very) fast Spanish/Cuban, which is a little harder to understand than the Spanish I was subjected to during my years at school. However, after 2-3 days of constant speaking and listening, I feel that I am slowly starting to become a little bit more comfortable. Thank goodness that the language of medicine does not change too much, antibiotics retain similar names, conditions do not really change, and most importantly, parasite “Genus species” remain in their original latin!

I spent Monday morning doing ward rounds with a group of clinicians and registrars. The Institute at which I’m working is the central body for care and treatment of those who are HIV positive and for patients suffering from AIDS in Cuba. The actual number of infected individuals is relatively small on the island, partly through an excellent system of prevention and primary and secondary care services for those infected. However, it seems that here at the Institute, every other patient is HIV positive. It is a great opportunity to see a number of opportunistic infections related to immunosuppression, such as Kaposi’s sarcoma(KS), Pneumocystis carinii pneumonia (PCP), and other problems related to symptomatic HIV. Most of the antiretrovirals are produced in Cuba, which is great as it allows early use of medicines to slow down the progression of the disease, at zero cost to the people.
However, caring for patients with HIV can seem heartbreaking. Yesterday morning, working in the dermatology surgery (or the “Salòn Dermatologia”), the doctor with which I was working had to take a skin sample from a young man who told us to call him by his stage name, “Madonna”, who had developed KS, as a complication of his HIV. He was complaining of a headache, of recurrent diarrhea, and looked as if he had lost a lot of weight very fast. He was crying during his consultation, and was too weak to get up and out of his wheelchair onto the bed, requiring us to lift him up off onto it. He couldn’t have been older than 25, yet he looked older than a man of 60. Similar scenarios paint themselves in many places, without forgetting sub-Saharan Africa. The main difference is that there, corrupt governments and Western political influence encourage and maintain the lack of resources that ensure that no one has access to antiretroviral drugs and proper maintenance care. (You don’t want to start me on that discussion!)
During my time in the dermatology theatre, I was allowed to inject local anaesthetic, remove skin samples for histology and suture skin, all very exciting for a junior medical student!
I am not alone doing the Tropical medicine course. A Cuban 4th year medical student at one of the Habana schools is also taking the course. It’s great to have some company, and also someone who is completely fluent who can ask “which way is the cafeteria” and so on! Without her I have a feeling I’d be lost all the time, and they’d find me stuck in a cupboard somewhere, asking for ward 9 or something along those lines (pitiful, the state of my spoken Spanish).
We were also given a brief tour of the museum of the institute, where a number of interesting little objects related to parasitology are kept. Jars of intestinal worms, next to slices of infected livers, and pinned insects, carriers of American Trypanosomiasis (Chagas disease), for example. Although I know it sounds terribly geeky and ridiculous, it was quite fun (I know, I know… please roll your eyes now…).

Our afternoons are spent in the microbiology/virology/parasitology lab, with a very talented lab technician, one of the founding fathers of the institute. Currently, we’re learning how to examine and identify the different forms of malaria under a microscope, and I’m beginning to feel more and more comfortable picking out my trophozoites from my schizonts, and my falciparum from my vivax. It’s hard not to enjoy working when there is the sweet sound of Salsa and Jazz skipping around the walls of the lab, and a great teacher to crack jokes with, as well as discuss the problems of the world. A cat lover as well (he has 14 cats, breaking our family record of 9), we discuss animals and parasites and his work in Angola and Jamaica while looking down the lens. He has been called to help with the containment of Malaria in these countries, and has been presented with prizes from the WHO and other Governmental agencies. Today, in between looking at slides, we discussed the state of the world, the great progresses which have taken place thanks to the socialist system in Cuba, and we expressed our hopes that similar things can happen elsewhere. However, not all our discussions are serious! We also discussed the greatness of ice cream, and other matters of similar (and much) importance.
My days are relatively long, starting at 7.30 when I am kindly picked up by the Prof. Kouri himself, and ending at 5-5.30pm. The rest of my afternoons are spent swimming or reading up on some of the things I’ve seen in the wards. This weekend is a long weekend, as Monday is part of a 3-day National holiday to celebrate the Cuban Revolution. As a result, I’m hoping to steal away into Pinar del Rio province, East of Habana, to a place called Vinales, for a day trip.

Today was a really good day, with ward rounds in the morning, followed by more malariology slides in the afternoon. Tomorrow, I’ll be “tested” on what I’ve learnt, and asked to identify different Plasmodium species and different forms of each parasite. I’m on a steep learning curve, both in terms of my medical knowledge and my Spanish!

Here are a few snapshots from my time in Habana on Sunday, merely as evidence rather than for any artistic merit!

“Aqui te dejo…

con la luz de enero, el corazon de Cuba libertada”…(de Neruda a Siqueiros)

In Cuba!

After a gruelling 10 hour plane ride next to a very fat, boozey Russian man (headed for the embassy, I believe) from Paris to La Habana, I arrived at Jose Marti Airport,was kindly picked up by a member of staff from the instituto and was taken to my hotel, where an early night was imminent. It is hot and humid here, daily temperatures reaching 33 degrees celsius (que calor!) and humidity being relatively similar to those I witnessed in Thailand. I´m about to catch a shuttle bus into Habana Vieja (old Havana) to see a few sights before my first day at work tomorrow.

First impressions? It really IS like in the television documentaries! The little I saw from the car revealed shirtless or vest-clad men lounging on chairs on their porches, smoking, people leaning over their balconies looking onto the street below, and most of all, the fact that every building, although in relatively good working order needs a good paint job. The ethnic diversity is obvious from my few glimpses. More on my thoughts when I´ve seen the centre of Habana. For now however, I´m feeling extremely satisfied with my trip (and with Air France, despite an hour long delay at Paris CDG), and my excitement is almost strong enough to erase my jet-lagged tiredness.

a few left overs

Back in Geneva! A few left-over photos from Thailand, from the last day in Mae Sot. Together with 3 friends from the guest house, I went on a 5 hour bike ride into the Thai countryside. Result: awe-inspiring scenery, painful calves and my first true sunburn… ouch!

These are smugglers living on the shores of lake Moei. They smuggle everything from goods to people who want to escape Burma and enter Thailand.

Bangkok was too busy for words, and I found myself feeling quite claustrophobic after spending 6 weeks out in the quiet of rural Thailand. The neighbourhood where I was staying (Pratunam and Ratchaprasong) is full of enormous shopping malls that cover the surace area of Mae Sot itself! After getting lost in these shopping malls and finding a new 50mm lens for my camera, I spent the rest of my time eating japanese food and taking long baths (BATHTUBS! TELEVISION! LUXURIOUS!). Bangkok gets lonely, but would be a great place to visit in a situation with more time, more company, and money to spend on shopping. The number of shopping tourists in that part of Bangkok was a little overwhelming.

Now that I’m back in Geneva (and my camera has been fixed), I’ve been trying to recover from the travel and sift through all my thoughts on the last 6 weeks. When I arrived on Tuesday morning, I wasn’t really too happy about the idea of travelling again. Nonetheless, after two nights of good sleep and some home cooking, things are much better, and I’m starting to get quite excited about seeing Havana. Knowing that accomodation is finally confirmed, and having an idea of what I’ll be doing once I’m there makes me feel a little more relaxed. The jet-lag coming this way hasn’t been too bad (although I don’t think I’ve ever felt this tired before), so I’m hoping the same will happen going back another few hours!