Street Medics See Cuba As A Model For COVID-19 Response In Vulnerable Communities
In Miami, Dr. Armen Henderson was outside of his home loading his vehicle full of tents and supplies to distribute to homeless people the week of April 12, something common for the doctor known for working with the homeless population, when he quickly found himself in handcuffs.
A Miami police officer said Armen was stopped for trash in his yard, however the doctor pushes back against this, knowing it was because of his race.
“I’ve had encounters with police before,” Henderson told Shadowproof. “And I know one wrong move could have landed me in a coma, I could have been dead, I could have been shot. So I know how to handle myself in that situation.”
Henderson said he had to remain calm despite the outrageous circumstances.
“He put my life in danger because he was in my face without a mask during a pandemic, at my house in my yard,” recalled Henderson. “I had every right to tell him to get the fuck off me, to leave me alone. But I restrained myself because I knew I had other important shit to do, and because if I reacted how he wanted the outcome would have been very different.”
The incident was symptomatic of the racial and class disparities present in all aspects of the pandemic response in the United States.
In the U.S., Black people have been hit the hardest, particularly Black men in urban centers.
As weeks have stretched, the data shows Black people comprise at least 30 percent of confirmed COVID-19 cases despite making up only around 13 percent of the population.
The Navajo Nation has been devastated by the virus, with Doctors Without Borders dispatched to help with the medical disaster impacting an indigenous population.
Prisons and detention centers filled with poor, Black, and undocumented people are increasingly the largest sites of infection.
According to Henderson, the glaring health disparities are not only predictable but the norm.
“There’s a swift divide between those who are rich and those who are poor in Miami. Those who live in Overtown, a historically Black neighborhood, are literally miles away from where celebrities like Diddy live, which isn’t uncommon for any major city across the U.S. And in those poorer places, we see lower life expectancy, less access to healthcare, and so forth.”
“Every year in Miami we live in crisis,” Henderson added, pointing to hurricane seasons made more violent by climate change each year.
For many, this pandemic feels like a natural disaster. When the hurricanes come, poorer people cannot flee, they do not have money to stock up on reserve foods, and cannot afford the financial hardships that can come with loss of work.
Henderson said the complete breakdown in local and state government and organizations like Federal Emergency Management Agency (FEMA) as the crisis heightens is reminiscent of the carnage during and after Hurricane Irma. Poor people, elderly people, neighborhoods and communities largely below a class line are left to fend for themselves.
Because of this total “breakdown in the response from the government on all levels,” Henderson said it forced him and others to create the Community Emergency Operation Center (CEOC), a coalition of organizations that activates during crisis situations.
“We’ve been doing [CEOC] since 2017 and we just activated for the pandemic because it’s a crisis situation,” explained Henderson. “And because we know that those who are most at risk are those living on the street, we decided to focus on those who are unsheltered. We’ve been giving people tents because the government was saying you got to shelter in place but not providing any hotel rooms or anything secure for these individuals who are on the street.”
Lack Of Emergency Protocols Fuel Medical Disaster
Dr. Henderson questioned why Miami doesn’t have an emergency protocol in place for homeless people considering the region’s perennial natural disasters. Compared to other countries like Cuba, where crisis response efforts typically leave no one behind and stand as positive examples of government, he contended the U.S. is an embarrassment.
In fact, the response was so embarrassing and deadly that Henderson said he tried to get in contact with Cuban health workers for advice at the onset of the pandemic.
“Knowing that they have a lower mortality rate, and that they have a lot of medical milestones that they don’t usually get a lot of recognition for because our country gives them a bad rap, I just wanted to know more,” Henderson added.
Henderson isn’t the only Black doctor in the U.S. considering Cuba for help. Historically, many other Black doctors, such as Dr. Melissa Barber, have received free medical training in Cuba and have used that training to help their communities respond to the pandemic.
“I’m in solidarity with Armen’s concerns that you have in respect to the situation, but it is a difficult thing,” explained Dr. Marta Galvez Cabrera, a specialist of over 35 years in comprehensive general medicine in Havana, Cuba. “It’s difficult because first of all you have to create basic premises that at this moment do not exist [in the U.S],” she said, adding, “Before the problem is there you have to prevent it.”
Prevention is key to the successes of Cuba’s free and universal healthcare system, which is a direct result of the revolution’s progress. Some of their health achievements include one of the highest doctor-patient ratios in the world, a higher life expectancy rate than the U.S. and many so-called developed nations, accessible clinics in almost every neighborhood throughout the island, and the development of several successful vaccines and treatments.
In Cuba’s health care system, the profit motive is largely nonexistent, which many experts suggest is a key factor in the country’s incredible achievements. It is highly common for medical workers like Cabrera to make dozens of house visits a day, with rural communities and people outside of major cities or in poorer neighborhoods receiving regular care.
Cabrera explains that once the COVID-19 outbreak began, they moved swiftly to “classify and move patients immediately” to predetermined locations which already existed. “If it is an incipient case you send them to the centers, but if it’s a case that they have already confirmed, you send them to another center.”
Medical workers in Cuba performed sweeping at-home check-ups to identify those with the coronavirus. “Depending on the state in which we find them, we relocate them to another established location that we have already created,” Cabrera shared.
“We have places for isolation, where we have suspected cases. We have a hospital for those who are already confirmed. The benefit for us is that we are not collapsing the hospitals, because if you have a case that you suspect you are not going to send them directly to the hospital, you are going to send them to an isolation center.”
Maritza Lopez McBean, an Afro-Cuban organizer in Havana and the founder of the Black mutual aid network Red Barrial Afrodescendiente, said there are no racial inequities in the Cuban health care system.
“Here, independently from the perfecting that the system needs, doctors don’t see if the person is black or white. They don’t see their religious belief. They attend to that person, however they are,” Lopez McBean said.
*Research for this report was done in collaboration with Belly of the Beast, a Havana-based media outlet covering Cuba from the inside. “Cuba’s Isolation Center” follows one journalist as she covers one of these centers from the inside.
Cuba’s Revolutionary Health Care System
While Dr. Henderson describes confusion in the U.S. from both local and national administrators, criminalization for attempting to help the dispossessed, and exacerbated conditions of the neglect which was already present, Dr. Cabrera talks of protocols and action plans already in place for such a catastrophe.
The Cuban health care system is not perfect, however, most problems are a direct result of the U.S. economic blockade.
The decades-long policy has created a scarcity of medical necessities, like respirators and basic medicines, as well as a lack of soap products, which public health professionals internationally have lambasted as breaking international humanitarian law.
Most recently, the blockade prevented Cuba from obtaining medical supplies needed to combat the pandemic.
Cuba’s 1959 socialist revolution put specific focus on the country’s health care system, which was impaired by racism, class inequality, and geographical barriers. Prior to the Revolution, Cubans living in rural mountainous areas or along the coast were harshly neglected and struggled to access health care. Afro-Cuban neighborhoods across the island were impacted as well.
The Revolution’s emphasis on health care led to the establishment of El Servicio Médico Rural (the Rural Medical Service) and hundreds of polyclinics in the destitute areas of the island. The initiative was led in part by Marxist revolutionary Che Guevara, a physician himself who saw firsthand the lack of medical access in Cuba’s rural areas while hiding out in the Sierra Maestra mountains.
Cuba’s medical revolution was accompanied by radical land redistribution, housing reform, literacy programs, and racial and gender equity programs, most of which were praised by both the UN and WHO.
In the medical arena, the Cuban Revolution specifically aimed to uplift the margins of society, “to revitalize health services for those most in need, whether because they are poor, in precarious health or live far from urban centres”.
Yet even with the comparison in health care systems and pandemic responses in context, questions still linger. Does it take a revolution to get this level of dedicated healthcare? How can doctors in the U.S. help the most vulnerable during this pandemic without facing criminalization? How are communities finding ways to help, and what initiatives exist currently that we can support?
Serving Unsheltered People In Their Own Environment—Or ‘Home’—Can Be Transformative
Suhaib Abaza, program director for HSTAT Street Medicine in Atlanta, got his first taste of “street medicine” while working in Palestine’s Aida Refugee Camp.
Accompanying community health workers and physicians during his first year of medical school, Abaza made house calls throughout the West Bank and saw first hand the public health detriments created by mass incarceration, occupation, and state violence. This is the framework through which Abaza practices street medicine in Atlanta, and which he’s carried into combating the pandemic.
“I began to see the Street Medicine Unit I was working on in Atlanta as a way of doing ‘home visits’ for homeless people, treating them in their own communities, and transforming our understanding of how diseases are manifesting in these populations,” Abaza said.
He explained “street medicine” as an emergent collaborative health initiative between medical workers, formerly homeless folks, and community advocates and organizers working to give medicine to those who typically sleep on the streets.
“There’s a street medicine unit in most major cities,” he explained. “It’s basically a little bus that goes to outdoor encampments of unsheltered folks and provides them with primary medical care like wound dressing changes, medication refills, blood pressure and blood sugar checks, and also social services such as connecting them to housing or veterans benefits in their own communities. It’s made of social workers, PAs, nurses, physicians, and student volunteers.”
Most people don’t know about street medicine, Abaza said, “because it’s usually a small operation, made of a couple practitioners and volunteers that know the streets well.”
“In conversation, it’s usually lumped in with any number of other ‘charitable’ services to the homeless, so we rarely get to explore how transformative it actually is to practice medicine in the service of unsheltered people in their own environment or ‘homes,’” Abaza said.
“It’s a very different medical practice than seeing the same people in the clinic. You immediately get a sense of how to tailor your care because you see the context in which you’re expecting them to ‘follow up’ or adhere to the care plan. By being there in the communities of unsheltered homeless people, you get a correct idea of what barriers exist in their care.”
The notion of meeting the people where they are has parallels to the Cuban Revolution: intervening in barriers to medicine and improving the health care landscape for the most disposed communities.
Both Dr. Henderson and Abaza work with dozens of homeless people facing substance use disorders and mental illnesses, as well as individuals entangled in the prison-industrial-complex in one way or another. It’s a complex problem that requires a multi-faceted response, something that street medicine coalitions are attempting to address.
Abaza works with a local homeless shelter and the Justice 4 All Coalition, a group primarily composed of formerly homeless people. They work closely with grassroots organizers to build trust in the community and better care for patients.
Distributing food, bandages and basic medical supplies, tents, and hygiene kits alongside administering medicine to homeless people and sex workers has allowed them “to do outreach in areas where most traditional outreach services would never go,” he said.
Building community relationships also fosters has allowed them to bring a political element to their work, fostering the space for them as medical workers “to create and support demands aimed at local government to advocate for unsheltered people and sex workers, like advocating against street sweeps and evictions, decriminalizing sex work and homelessness, and so forth.”
It also allows them to be instructed and led by the vulnerable populations themselves while learning about their specific needs.
“With the shut-down of primary care services and outreach that unsheltered folks generally rely on, his services and the services of others like Dr. Henderson, who continue to care for the most vulnerable on the streets is more than essential,” he said.
“A constant source of fear and anxiety that you’ll hear about from unsheltered populations is interactions with law enforcement, and from the encounter with Dr. Henderson, it isn’t difficult to see why.”
Potential encounters with law enforcement discourages many unsheltered people from going to COVID19 testing centers, hospitals, or shelters. Abaza points to ordinances in most U.S. cities that explicitly outlaw ‘urban camping’ to criminalize unsheltered people.
Many homeless people in Atlanta weren’t aware of the virus at the beginning of the pandemic, according to Abaza. They did not realize the seriousness of the situation until their sources of income, such as basic commerce and panhandling, began to dry up.
When the “nonessential” outreach services homeless people rely upon for food, social services, and material distribution stopped visiting them, Abaza said they started to see encampments disappear. Whether they moved to areas of better support or were evacuated by police is unclear.
“The recommendations for hand-washing, masks, and social distancing hadn’t reached these folks, and even when unsheltered communities were made aware, bathrooms and restaurants they could visit to wash their hands were now shut down. Following recommendations by the [Centers for Disease Control and Prevention] becomes near impossible in this situation,” Abaza added.
Cabrera suggested doctors do not have these same problems in Havana, stating “there is equity here,” and explaining that all residents in her neighborhood, including her 1000+ patients, receive the medical attention they need.
The acts of Henderson, Abaza, and countless other individuals are noble but do not excuse the scarcity of state and national coordinated efforts.
While individuals and coalitions perform essential work, the larger issues around street medicine, pandemic responses, and helping the most marginalized remain. They include the government’s failure to fund initiatives, the limits medical workers face in these conditions, and lessons that can be learned from other countries with superior medical care, like Cuba.
In cities like Atlanta, where at least 80 percent of COVID19 patients are Black people, the deadliest disparities in health care are visible. Henderson is out in the streets every week, nearly every day, attempting to help in his own capacity. But his efforts have been hindered by the structures of policing, inequality, and economics that surround him.
“Putting profits over people does the most damage,” Dr. Henderson somberly concluded. “The people who are dying at the highest rate are working class, poor, essential service line workers, all who have to choose between feeding themselves and catching the virus and potentially dying. And that’s basically what capitalism does, right? It makes you choose between living or dying working, and that’s the response that we’ve had here.”