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Posted September 10, 2004 by publisher in Cuban Healthcare

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Seema Kakud | dukenews.duke.edu

Duke student summer project explores Cuban approach to educating teens about health
Editor’s note: Seema Kakad, a junior from Charlotte, spent several weeks this summer studying health care in Cuba. Here is an excerpt from her journal.

The sounds of Usher, Beyonce, Beanie Man and J-Kwon blasted from the central Havana street of Belascoan, as young teen-age boys and girls, some older men and women and even a few abuelas (grandmothers) took their seats inside Cafe Salud.

Posters about National AIDS Day adorned the shabby, beige-colored walls, along with a poster of a man’s hand and a woman’s hand forming a triangle. Underneath their hands was written: “The triangle of love—you, me and the condom.”

It was 4:15 p.m. on a Wednesday, and Cafe Salud (“Health Cafe” in Spanish), was about to begin its weekly karaoke program. Cafe Salud is a health project funded by the Cuban Ministry of Public Health to promote awareness and prevention of HIV/AIDS and sexually transmitted-diseases (STDs) among teen-agers. While during the day it sells 10-peso cheese pizzas and five-peso ham and cheese sandwiches, its main purpose is to provide a location for young Cubans to talk openly about sexuality, HIV/AIDS, STDs and safe sex.

I was in Cuba during May with nine other members of a Duke undergraduate organization called Students of the World (SOW). Founded in 2000 by then undergraduates Courtney Spence (‘02) and Patrick Lanier (‘00), SOW’s purpose is to offer a cultural immersion and documentary research opportunity to undergraduates each summer.

I and three other students were doing research on the Cuban public health system. Seen as one of the leading countries for health care in Latin America, Cuba has one of the lowest rates of HIV/AIDS in the world—0.03 percent—as well as free health coverage for almost the entire Cuban population.

In a land where there is free health care and free education, but no freedom to speak out against the government, where you can buy a pizza for 10 pesos (40 cents) or a pizza for $10 on the same street, and where teen-agers wear American flag T-shirts while describing President Bush as a fascist, we wanted to make sense out of these contrasts. We ended up at Cafe Salud, greeted by the familiar sounds of the U.S. Top 40, performed, however, in a much different context than we were used to.

Wednesday-Karaoke got off to a start with an introduction of Cafe Salud’s 20 volunteer health promoters. All 20 are between the ages of 15 and 25 and have been trained and passed a qualification test to be HIV/AIDS health educators.

For the next hour and 20 minutes, members of the audience were called up on stage to sing karaoke from a TV that faced the entire audience. Interspersed between each karaoke act were creative games or trivia questions about HIV/AIDS and the spread of STDs, designed to keep the audience interested and involved in the program.

In one of my favorite games, the promoters chose two volunteers—a boy and a girl—both about 16 years old. Each person was given one minute to kiss as many people in the audience as possible. (The boy could shake another boy’s hand if he preferred.) As both the boy and the girl puckered up and ran frantically down the aisles and into the crowd, the audience laughed and cheered them. The point of the game, the promoters said, was to demonstrate that just as the number of people they kissed differed, so does the time it takes for the HIV virus to turn into AIDS.

In one activity, three girls had to practice what they would say to a guy who they wanted to have sexual relations with, but who refused to use a condom. All three said the same thing to the guy: Forget it.

Another of my favorite games involved a round piece of wood, with five different-colored plastic penises attached, and five female volunteers. Each girl, in turn, had to correctly place a condom on the penis, while describing to the audience exactly what she was doing. Although many of the directions in the beginning were muffled by the embarrassed giggling of the girls, members of the audience listened and watched intently - often letting out a snicker or two themselves.

While getting volunteers for games and activities was like pulling teeth, the audience certainly did not hold back when it came to karaoke. I quickly learned that Cubans take their karaoke very seriously. One 14-year-old girl was even booed off the stage after consistently singing off-beat to a popular Thalia song. We Duke students certainly embarrassed ourselves during our first visit to Cafe Salud, after volunteering to sing “Hey Jude” by the Beatles - the only English CD they had. The audience simply couldn’t understand why we were laughing hysterically (out of embarrassment) and singing out of tune (lack of talent).

Surprisingly, the most well-represented group of singers were young teenage boys, singing intense love songs about broken hearts, broken promises, and undying love. “Mi vida sin tu amor no es ms el crudo invierno de mi soledad” - my life without your love is nothing more than the cruel winter of my solitude, sang one young man. “Se que en tus brazos, ya no habr noches desiertas” - I know that in your arms, there will be no more lonely nights, sang another 15-year-old boy.

In addition to attending a few weeks of karaoke at Cafe Salud, we were also able to join the promoters as they did their weekly community project - walking around the streets of Old Havana, talking to people about HIV/AIDS and STDs, answering questions about safe sex, and passing out hundreds of free condoms. Although free condoms are readily available at every neighborhood health clinic, Adrian, one of the promoters in my group, informed me that you have to keep them hidden, or else there will be a mad rush of people who want them. “Los cubanos,” he says laughing.

It was so unique to walk the same streets of Old Havana, where I ate my breakfast every morning and bought bottled water, and watch the promoters try to convince a 40-year-old man that he, too, has a risk of getting AIDS if he does not practice safe sex. It became clear then that the energy of the promoters is really what keeps Cafe Salud going strong. Almost all have known someone with HIV/AIDS, and a few have had friends that have died of AIDS; a lot of their work involves dispelling myths about people with AIDS.They understand the importance of their work, and teach others about it in a fun and positive way.

From our first visit to Cafe Salud, it was clear that the promoters loved the attention they were getting from the americanos and used every opportunity to practice their English on us. Our walk around Old Havana was filled with entertaining questions about life in the U.S. “In America, you have nude beaches,” verdad?, asked 15-year old Reyniv with a huge grin.

Cafe Salud was Cuba at its finest. Teenage boys and girls belting out the words to sappy love songs after learning about HIV/AIDS and how condoms are used correctly; a teenage boy asking me about nude beaches in the US, while teaching people on the street about safe sex and the spread of STDs; and most importantly, people talking openly about sex and sexually transmitted diseases.

Coming from a country that has been trying for decades to curb HIV/AIDS rates - not just at home, but abroad - perhaps we have a few things to learn from Cafe Salud and the Cuban healthcare system. Are President Bush’s abstinence programs really worth $90 million - one-third of all federal money allotted for HIV-education? Are kids taught enough about AIDS and STDs at school?

Maybe it is time to reevaluate the effectiveness of abstinence programs, and instead, put money into increased HIV-testing of the population, increased HIV/AIDS awareness programs at school, and like Cafe Salud, use young people to make everyone understand the direct relation between using a condom, and minimizing the risks for sexually transmitted diseases.

Cafe Salud was just one of the many experiences in Cuba that made me think about how our own American system can be improved and, on the flip side, how their system can be improved with some of our ideas. Perhaps a day will come when the sharing of ideas and trade between the countries is no longer a crime, and subsided hostility between our governments will give way to new innovations and strategies, even beyond the issue of HIV/AIDS. Until then, though, it’s time we face the current problem at hand, and get American people to talk more openly about sex - safe sex.

For more information, contact:
Seema Kakud| email: .(JavaScript must be enabled to view this email address)

  1. Follow up post #1 added on September 11, 2004 by Jesus Perez

    Miss Kakud is a perfect example of the type of American influence we should apply in our relations with Cuba, dialogue, not hostility, the sharing of ideas and trade as she aptly put it.

  2. Follow up post #2 added on January 16, 2008 by Sanjeev Prabhu

    I deeply appreciate the work that Seema has done in her short span at the university and am sure that all that India and the World has to offer will be made us of to the utmost by this exceptionally talented yound lady. Cheers to her.

  3. Follow up post #3 added on January 16, 2008 by Sanjeev Prabhu

    What little I know of her is as under:
    A photographer par excellence.
    Great taste and a more than tasteful traveller.
    Impressive knowledge of world affairs.
    Most committed and convinsive in debate.
    Cheerleader cum laude.
    I think that is enough for the moment… Cheers once again to Seema you and your lovely family too..

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