Sex, Drugs, and Public Health

November 23, 2017

Cuba, número tres

Filed under: Uncategorized — cbmosher @ 12:26 am


De Soto, a fluffed-out peacock, struts onto the Malecón. Potential mates drive by, chrome gleaming and whitewalls spinning, flaring their erogenous zones with colors both bold and pastel.

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The Gulf splashes against the seawall, but not, at the moment, onto the street. A diorama flows by as if De Soto were a slow camera. Tour Guide Lady chats, mixing English and Spanish.


Invisible Observer: “Is this your full-time job?”


“No,” she interrupts her diorama comments. “I work at a hospital. I’m a dermatologist. Now over here you see – ”


“Wait. If you’re a physician, why do you guide tours?”


“I want for that the world sees,” she smiles, “how beautiful are the people of Cuba. Also, I need the money.”


From Vedado we cruise past Central Havana – the most color-less and run-down section of the city. Paralleling the sea, we curve slowly to the right where centuries-old fortresses guard the harbor’s entrance.



Close your eyes. See the Conquistadores in Peru surrounded by hundreds of magnificent gold sculptures. See them melt these into bricks. See them load the bricks onto their ships (well, honestly, the Conquistadores don’t do the work. The local residents such as the Inca’s people do the hard work because they love the Spanish so much that – z-z-z-t! Wrong record.)


See these gold-laden ships make their last stop here in Havana before crossing the ocean to feed the rapacious Siglo de Oro of Spain. See the English, Dutch and French pirates drooling over the gold.






“Here we have Havana Vieja,” Tour Guide Lady-Doctor announces. De Soto disgorges us onto the street. We walk. Our phones take pictures. Quickly we discover that “Old Havana” is two places: first, it is el número uno tourist trap. Also, it’s a sclerotic but dignified City of Ghosts.


First, the Tourist thing because it is the more distracting and you have to get beyond it: cheap cigars hawked in the street; three-peso “Che” coins for only $5 (worth 12 cents at the bank); Hemingway’s bar #1; cigar-smoking ladies in colonial dress available for photos and tips; The Best Mojito in Cuba! ; hawkers for restaurants; Hemingway’s bar #2; music (don’t need to hear “Guantanamera” again); The Best Mojito in World!



City of Ghosts:

           Within a couple of decades of Columbus claiming Cuba for Spain, this satellite Madrid began to grow. With the help of indigenous residents (who proved to be of “weak constitution” for slavery, and were therefore banished early to extinction) and of imported Africans, they used local materials to build streets of wood – – –



And buildings of fossil- bearing stone.




Here, gold played out quickly. They established sugar plantations on the backs of slaves.


473 miles to the east, Spain set up a second capital at Santiago. African slaves in this “oriente” region worked themselves to death growing tobacco, sugar and coffee which were sold by Spaniards and Criollos (those born in Cuba with white skin). Thus were created the two wealthy classes of Cuba: Spanish loyalist land-and-slave owners in the west (Havana) and Criollo land-and-slave owners predominantly in the oriente east. Also was born the far more populous Poor class that worked the flat valleys.




Remember this geography. It will haunt Cuba over four centuries.


Cuba’s Tea Party:

So, while feisty white-skinned English speakers started a revolution in “The Colonies” 90 miles north, feisty white-skinned Spanish speakers on the island revolted against Spain’s Tobacco Levy. Common cause trade between the two colonies began, and grew both economies. Sugar, coffee, slaves.


By 1841 there were 1.5 million African slaves in Cuba. On a subsequent visit to the sugar fields, a Cuban woman showed us around a long-deserted mansion and plantation. “Only men were kept here,” she synopsized her own ancestry. “Their life expectancy was 25 years. Women were kept on breeding farms somewhere else.”


She also gave us a dramatic insight into post-Revolution Cuba. But that’s for later.


Two things Latin America has in abundance are statues of long-dead people and various public streets and parks named for long-dead people. Ghosts whose faces you can see and names you can hear.


Ghost # 1:



This is Céspedes. “Father of the Country.” He owned a plantation in the east. Got tired of the Spaniards telling him (and other Criollos) what to do. Of course, he told his slaves what to do, but that was different.

He was different. In the same decade that the U.S. proclaimed the Emancipation of its slaves, Céspedes freed his own slaves and started a revolution. Somewhat successful for a while. Got himself installed as president of the country. Spain didn’t recognize him, but it recognized his son, Oscar. They captured Oscar.

Here’s the deal, Spain said (probably with that annoying lisp). Renounth your prethidency and your thon retunth to you. Famously, mythically, Céspedes is reputed to have said “I do not have just one son. All Cubans are my children.”

At this point in the story you hear a fusillade of executioners’ rifles.



Invisible Ghosts:

There are no statues of slaves. Shocker.

There were to be many slave rebellions, however, in addition to the repeated attempts at revolution against the European colonizer (Spain) by Criollo patriots.



Ghost # 2:

Replica of the statue of Jose Marti arrives in Havana


Name is Martí. This guy lived for a while in the U.S. – Cuba’s major trading partner. Somewhere between Cuba and the U.S. he caught independence fever in 1892 and formed the Cuban Revolutionary party.

Martí’s rebels brought Revolutionary War from the oriente (see the geographical pattern?) right into Havana. Spain was pissed. And militarily stronger. It launched a “War of Extermination” and drove the rebels back to the east. But Martí’s writings inspired many, right down to the 1950’s.



Ghost # 3:



Battleship Maine. No photos; it sunk. U.S. excuse for intervention into the Cuban War for Independence. America destroyed the Spanish fleet and got control of Cuba. Also, took ownership of Puerto Rico, the Philippines, and Guam.



Skipping details, next comes a period of U.S. military occupation, a new Cuban constitution with an amendment demanded by the U.S. allowing us to intervene in Cuban affairs at will, a series of corrupt presidents, large sugar companies displacing Cuban farmers, and another uprising by Blacks and Mulattos.


The pattern of a handful of rich dudes and millions of poor, continues into the twentieth century.


Ghost # 4:

Remember Vedado? It grew during the Boom Era of sumptuous homes built along the Malecón in the 1920’s by U.S. capitalists (they controlled 70% of Cuba’s sugar and much of its infrastructure), by corrupt Cuban politicians, and by colorful gangsters like Meyer Lansky who built hotels, casinos and prostitution rings.




Here’s a Cuban description of those halcyon days, translated by someone with a poetic eye but a tenuous grasp of English: for thousands nine hundreds were built great villas, amazing and rich palaces – – – and new population nuclei formed thus fashionable. Very beaten to the sea it receives from this all his light and magic. Along the Malecón you enjoy near the sea how the sun is lost in the water after the horizon – – – the progressive light dimming.


The 20’s, 30’s and 40’s were lots of fun for American tourists. Wonder if Jay Gatsby still haunts the opulent halls of the gangster-era Hotel Nacional?


The 1920’s also brings the birth of the University Student Movement. Restless, naïve kids fighting injustice. Oh, oh.


Ghost # 5:



Fulgencio Batista. Military dictator who undermined an uprising by soldiers, students, and workers. And who took over, by military coup, the government in the wealthy post-WW II era. Supported by the U.S. which was, as usual, protecting its financial interests.


Out of these University student movements comes, in 1953, a young lawyer. Name is Fidel, of whom we’ll hear more –

               Hey! What’s this?



His wife and daughter wait as Carburetor Man does a re-build on the street. He and wife are perfectly happy to allow a photo. Their teenager daughter sits in the back seat displaying an age-appropriate sulk.



During the entire morning we’ve seen no police and no signs of street-living Homeless.

I. O. turns to Tour Guide / Dermatologist: “Does the government keep the Homeless off the streets in tourist zones?” he inquires, thinking Santa Barbara or Miami.


She stops walking Havana Vieja to explain in English for us. “In the evenings, comes through Social Workers. Anyone they discover with no dinner or bed they offer a place to sleep and a few pesos for ration-card food. To those people with mental illness, they offer care. If they refuse, at least they get food.”


“So, they can get medical care?”


“Everyone can get medical care. No cost.”


I. O. has heard about this for years. But how is the quality? “Please, I would like to see a clinic, a Centro de Salúd. I would like to speak with physicians, if it is allowed.”


“Of course,” our Dermatologist smiles. “I will arrange it.”


We finish the day, back in Vedado, enjoying how the sun, all his light and magic, is lost in the water, after the horizon, the progressive light dimming.




November 15, 2017

Cuba, número dos

Filed under: Uncategorized — cbmosher @ 11:22 am



Mildew gnawed at the houses. Wires overhead drooped, entangled each other, some dangling like amputated jungle vines. Tree roots heaved up fractured chunks of sidewalk. Residual puddles from yet another hurricane-driven ocean surge festered with algae in front yards, basements and flooded garages. The street had more potholes than a California freeway.


As I said, the flavor of dark and dingy.




Russians, of course, had been here. They of the Block-of-Cement school of architecture. But this was Vedado – reputed to be the snazziest neighborhood in Havana. It had been a dense forest left untouched as a barrier to pirates until the late 1800’s. Then, over the first five decades of the 1900’s, Vedado had spawned houses for the wealthy and casino-brothels for U.S.- based gangsters. This house was no decaying Russian box. It was a decaying home of some long-gone wealthy Cuban, its Art Deco exterior slowly evolving into a laboratory culture plate.




The Russian contribution to all this was their withdrawal from Cuba in 1991 leaving fewer resources for Public Works.


We’ll see if the people are as beaten down as their infrastructure.


Tita, beside her husband, welcomed us at the threshold with a broad smile and flashing Castillian eyes.


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Inside: tile floors, high ceilings, thick walls. What the well-to-do in Latin America demanded to combat the heat. Everything, though old, was clean. Furnishings were sparse.


Our room: two beds with sparkling clean sheets, a tiled bathroom, and the best feature – a modern air conditioner.


“Do you manage this house for the government?” the Invisible Observer asked Tita.


Her black eyes flashed. “This is my house. You are my guests. Breakfast will be ready en seguida,” she smiled.


Her son, Alberto, in white shoes, sox, pants, shirt and cap, headed to the kitchen.


He takes his role as chef seriously. Sartorially.




Our travelling partners, Dr. Robot and Flyboy, joined us for fruit, pastries and coffee. They caught us up on their previous twelve hours on the Socialist Island. Tita had directed them to a restaurant a couple of blocks away which they described as “great.”


Turns out that, seven years prior, a policy change in Cuba allowed small to medium sized self-employment enterprises like Tita’s “casa particular,” Taxi Man’s business, and paladares such as where our friends had enjoyed a dinner “as good as any in the States.” There are several hundred such categories including hairdresser and auto mechanic.




Abel, Tita’s husband, smiled as we ate, then settled into a stuffed chair to watch TV. Official news flickered, focusing on stories with very different slants from those seen in the U.S.


Still puzzled by Taxi Man’s dissent, I.O. asked Tita about her parents and the Revolution.


“I come from Camaguey,” she straightened a little with pride. “Where we speak the best lexicon in Cuba. I was born in the 1960’s – after Fidel’s conquest – but both my parents supported the Revolution. And so do I. Did you have enough to eat?”


Our tour guide knocked at the door. “Your car for the day,” she flourished her arm toward a pristine blue and white De Soto. If any of us were disappointed that it wasn’t a convertible, we kept it to ourselves. Perhaps we were too busy breathing. The air was so thick, that inhaling felt more like sucking. It was only nine A M but our shirts were soaked with sweat and our skin as sticky as chewed bubble gum.




De Soto Man had retro-fitted air conditioning into his 1950’s engine compartment. Ah-h-h. Forget convertibles.




We would learn in the coming days that several things we’d seen were not as they appeared. Many of the 1940’s and 50’s era cars no longer drank gasoline. People were subverting the T V propaganda dished out by official channels, and Alberto’s white clothing (which we would see on many others) had nothing to do with the kitchen or his role as breakfast chef.


But on this muggy De Soto-ed morning, we set off to discover historic Havana, music and the 200 year-old ghosts that haunt Cuba to this day. Even older ghosts awaited us in Cuba’s mountains.




November 8, 2017

Cuba, número uno

Filed under: Uncategorized — cbmosher @ 10:43 am







“That Hijo de Puta Raul Castro,” blurted our dreadlocked taxi driver. “We need someone younger to lead this country.” His words of insult and passion spewed, incongruously, from a wide smile.


Everyone’s Friend, on the seat next to him, ventured “are you allowed to talk like that here in Cuba? We ” – he indicated this Invisible Observer in the backseat – “don’t want to go to jail with you.”


Taxi Man removed his hands from the wheel to adopt the position of the Cuban shrug: elbows pulled against his sides, palms outstretched, facing forward. “Como no. why not?” he laughed.


So, even before the Havana airport had receded in the taxi’s decades-old rear-view mirror, we were into politics.


Everyone’s Friend prodded him on with his chortling Spanish. Horse-drawn wooden wagons and smoke-belching motorcycles passed us on the other side of the divided highway.


“We’re a different generation,” Taxi Man continued. “The Revolution was already over when I was born. We need to elect new leaders – younger leaders. We want more freedom, a better economy.”


“Who owns this taxi?”


“Me. With the earnings, I can feed my family more than just what I buy with the ration card.”



How Capitalistic of you, I.O. thought in the back seat. A billboard filled with Che’s iconic face flowed by, flanked by tall palms and a stray horse who chewed the lush grass. But mental gymnastics attempting to link that face with Taxi entrepreneurship were interrupted by the word “Trump” from within E. F.’s effusive Spanish.


Taxi Man’s reaction was swift “Está loco ! Completely crazy,” he mixed his languages. “Obama, he was opening things up. Now this Loco comes in and, for us, it’s four more years of Bloqueo.”


He swerved his rattling taxi down city streets, avoiding small lakes that were disguising large potholes. He let us out in front of a decades-old colonial style house. Paint peeled from it, as it did from most of the neighboring buildings. Our two companions waited inside for us.



“We are poor, Taxi Man smiled his parting words to us. His white teeth glittered against his black skin. “And you can see things are crumbling. But you will be safe in the streets. We like Americans. The Bloqueo and Trump? – this is just politics.”



November 4, 2017

Orthopedic Team to Ecuador

Filed under: Uncategorized — cbmosher @ 4:09 am

Here’s how it works. We arrive at the hospital in Cuenca on Sunday to find a large crowd of people hoping to get surgery by the North American orthopedic surgeons. The surgeons screen them (translators needed) and then refer them all to anesthesia, where I work.

We obtain histories, nurses check B P etc. and the anesthesiologists determine whether each kid is safe to go under. Most of these cases are complex and / or risky, so the Gringo surgeons will teach advanced techniques to the Ecuadorian surgeons in the O R.

Case # 1: Jordy – he broke his tibia at age 5 and has undergone four surgeries over the past seven years, but the bone never healed.


He hasn’t walked in seven years. His mother has placed her hopes and faith in the North American surgeons (a bit of a cultural problem, as it can undermine faith in the local docs). On the morning of surgery, the team of five Gringo doctors, two Ecuadorian doctors and I (as translator) stop at his bed. The ortho docs pull out X-rays and discuss them while the patient and anxious Mom watch.


“We shouldn’t be doing this case,” one surgeon shakes his head. “He has congenital psuedoarthrosis – it’ll never heal. What he needs is an amputation.”

The head surgeon begins an intense discussion with the surgeon who proposed this change of plan. Meanwhile, an Ecuadorian doctor tells the mother what has been said. Her mouth falls open in shock. Then tears overflow onto her cheeks. The doctors move on to the next bed.

“Señora,” I hold her hand as I trail the docs, “I’ll be back and explain this to you. Don’t worry.”

Rounds over, while the surgeons change into scrubs, I return to the floor. The mother is in the hall, listening to an intense young Ecuadorian.

Good, I think, some physician is explaining things to her.


I start work with another patient in a room, then hear loud yelling in the hall. Not just once – over and over.

What the hell?

I look out and see the young man gripping Jordy’s mother and yelling for Jesus to come down and heal something. The mother convulses in sobs.

I hurry down to the OR, get the head surgeon and implore him to come up and go over the issue with her. He assigns a different surgeon to go up with me.

Patiently, we explain to both Jordy and his mom that it was likely he had a condition which would prevent his tibia from healing. That the bone would remain in two un-united pieces. That this fifth surgery might fail, too. But it is their decision – they can go for repeat surgery, for amputation and prosthesis, or to go home and live with the crutches. But we stress that, even if it does someday come to amputation, his life with a prosthesis would probably be better than a life on crutches.

Mom is not ready to consider amputation. Surgery goes forward with these results:


In the Recuperación Room, Jordy smiles as soon as he is awake, and doesn’t complain of pain. His mother is grateful and happy.

Upon hearing the story, one of our nurses offers to speak with the Mom.

“About what?” I ask.

“I’m an amputee,” she reveals. “She can see how it hasn’t kept me from a productive and fun life. Let me know.”

As she walks away, I watch her gait closely. Can’t see a limp, a stiffness or anything abnormal.

Jordy’s mother, however, isn’t ready to hear it. She beams optimism and faith. “What can I do for my son to help him?” she asks.

I go over post-op care at home. I feel a responsibility to temper things a little. I remind her that we don’t know how well the tibia will heal, in spite of good alignment. Then I say something I seldom say. It seems appropriate in this case:

Señora, you can pray.”



  • Pentacostal “christianity” has penetrated deeply into traditionally Catholic Latin America.

* Congenital Psuedoarthrosis – if Jordy indeed has it – is pretty rare. About one in every 250,000.


Case # 2 – Too Cute

Filed under: Uncategorized — cbmosher @ 4:05 am

Look closely at her picture.  At her hands.



She came to us with congenitally misplaced digits on both hands and with mild club foot deformities.


The hand surgeon had me translate for the mother.  He said he might not have time to do both hands and feet. With which hand or foot did she want him to begin?


She said she’d noticed the girl drawing and playing with preference for her left hand. So the left hand was most important. As long as she wore shoes, she could walk without crying.


The surgeon did a “tendon and pulley reconstruction” in her hand using a plastic tube, giving her improved finger function.



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