Saturday, October 22, 1994

5AM comes awfully early, but we have to get to the airport for a 6 o'clock flight.  We're going to Granma Province in the southeastern part of Cuba.  (Granma is named after the boat on which Fidel and his revolutionaries came from Mexico to Cuba in 1957 to start their war of liberation.  It was purchased from a Scandinavian, or so the story goes, who had literally named it for his grandmother.)  We only need a small bag with a change of clothes, as we'll be coming back tomorrow night and they have arranged for us to keep our rooms at the hotel, so things can be left there.

On the bus ride to the airport I talk a little with Stephen, who just returned from Belorussia in time to take this trip with us.  He was working there with teams of physicians (an international effort, I believe) attempting to deal with the health problems of child victims of the radiation fall-out from Chernobyl, nine years ago.  He says they have found thyroid cancer to have increased by a factor of 100.  Leukemia is up by 22% and they find a general lowering of the level of the effectiveness of the immune system.  25% of the gross domestic product of the area is spent in dealing with the on-going effects of the radiation.  He says the psychological damage alone is monumental and the continuing cover-up on the part of the government is scandalous.  (He refers me to a book by Gregor Medvedev, called "The Truth about Chernobyl.")  He says 25% of the population in Belorusse has been contaminated and probably the same in the Ukraine; 2.5 million in each area.  He says they use T-cell count to measure contamination (as with AIDS) and B-cells as well.  He says children who get a 180 day period of rest and good nutrition out of the area of contamination show a significant improvement.  (One problem is the lack of iodine in their diets.  Iodine-deprived thyroids take it from where they can get it, and one of the radioactive elements in the atmosphere there is Iodine 131, or something like that.  Anyway it goes straight to the thyroid gland.)  He also says that once they are cleaned up and the stuff is out of their systems, returning them to the contaminated area can possibly re-infect them, so alongside whatever efforts at clean-up that are going on are these international efforts to get groups of kids out of there and treated.  Some are here in Cuba and we'll see them next week.

At the airport, evidently a local field, the only plane visible must be ours.  It's a small jet liner with the entry ramp in the rear.  We go through the perfunctory passport check (so perfunctory that one of our party who left his passport back at the hotel is passed through anyway), through an electronic scanner and into a little waiting room, where it looks as though we're the only passengers to Granma.  Our little party has grown by a couple, though.  Fernando, the Party man from the Dept. of International Relations who we met at dinner last night is going with us, as is the Public Health doctor who spoke to us at the Ministry yesterday.  Lola, the Ministry assistant who has been with us on and off, is with us as well.

Pretty soon we're loading up.  I'm almost right.  There is one other passenger; a little old woman who sits by herself and doesn't say much to anyone, as far as I can see.  Walter indulges in a little gentle chiding of Janet, who doesn't like flying (and was not particularly happy with the hard landing when we came into the country - not that any of us were) who in turn reminds me of a daredevil flight we took together in one of King Hussein's helicopters in Jordan a few years ago.  Finally we settle in and take off.  On the way up Ivonne reassures us that this "is one of the best Russian planes," which causes some to note a possible contradiction in terms. 

We're up quickly and the green, flat, cultivated land stretches out below us.  Shortly the land changes a bit and a few small hills and lakes take shape as we fly eastward.  Suddenly I can see both the northern and the southern coasts, one on each side.  This really is an island, and not a particularly large one, particularly when one considers the giant presence it's been in our lives for so long.

Moving around the plane gives a chance to catch up with some of the others. 

- Jack is engrossed in a large map of Cuba, checking out where we're going.  The city where we'll be staying, Bayamos, is the largest city in Granma Province and gives us access, among other things, to the Sierra Maestra Mountains, the famous area where Fidel and Che and their army held forth during the revolution.  Jack, with quite an eye for the ladies, is also enchanted by the stewardess on the flight, a lovely young woman with, as he notes "a beautiful smile."

- Frank is talking to Jack and Fernando about the problems created for Members of Congress like his boss who are willing to speak out against the embargo.  He shows us a newspaper article about two New York area Congressmen who had personal visits from Jorge Mas Canosa who expressed his unhappiness in no uncertain terms.  One of them said Canosa threatened him, though perhaps obliquely.

On the subject of the violence of the Miami exiles, I ask Fernando what he thinks of the speculation involving some of them in the assassination of JFK.  He mentions a book that was written fairly recently in which a Cuban general made available some information from Cuba's intelligence files on that subject.  I would love to get a copy of that for my son, I tell him, who has inherited an interest in the subject.  He says he'll see if he can find out the name of it.  We then talk a bit further about the human rights frictions.  He tells of an America's Watch (now Human Rights Watch/Americas) visit here years ago in which Juan Mendez and Patt Derian took part.  As best I can get it, he seems to feel that their report was going to be less critical of the situation here, but then was either put aside or superseded or overwhelmed by another report, this one featuring some ugly (and, he suggests, untrue) charges by a Cuban émigré.  He also talks about his own past, about leaving the university at which he was a student to join the military during the years ('64 - '67) when there was a "Contra" (counter-revolutionary) force active in the mountains, and about rising in the Party, eventually to return as a "professor" at the university from which he had not graduated.  He says he then did complete his studies.  (The idea is a strange one to me, but Paul tells me later that it's not unusual.  When he was a missionary in Bolivia years ago, the practice was that one was able to teach up to one grade level below that which he or she had achieved.  He said he knew a man who had studied at a school where the teacher had only completed the fourth grade level, so could only teach up to the level of grade three.  This man, he said, took the grade three level courses for four years in a row, "so he could be sure he'd gotten everything the teacher knew.") 

In today's Cuba a teacher without a degree gets a salary of 203 pesos per month - with a degree, 230 pesos per month.  (Black Market equivalent of $4 to $4.75 per month)

Coming down now toward the airstrip at Bayamos we can see the Sierra Maestra off to the south.  The one thing I've noted as we've flown over the major portion of the island is that fact that virtually every habitable patch has been cultivated.  In the mountains to the south, of course, except for the tillable areas they've been able to carve out of the mountainside, it's more wild.

As we come in to land, Paul points out that the airport is named for Carlos Manuel de Cespedes, a wealthy landowner who freed his slaves in 1868 and armed them with machetes so that they could join the fight for freedom from Spain, thus initiating the war for Cuban independence.  Legend has it that the Cuban National Anthem was first sung in this area.

A good landing and we unload, carrying our bags.  It's a typical, outlying airfield without much in the way of amenities.  No security of any kind is visible and we are met by a young woman who is Ivonne's counterpart here (though Ivonne is still with us) who takes us to yet another bus.  (Like the other, this is fairly new, comfortable and equipped with air conditioning, which is appreciated because it's noticeably hotter here.)  We load our bags and some of the boxes of Jack's medicine, which will be given to a pediatric hospital here.  (The decision as to who gets what has been worked out by the Public Health Ministry in conversation through Ivonne with Paul and Jack.)

The road into the city is typical of my experience in the Latin American countryside (more so than had been the case in Havana).  The foliage is more tropical, more dense, and the dwellings we see by the road are more prone to wood with tin or thatched roofs, the poverty more visible.  As we approach the city we see large cement-block structures, obviously, like the "projects" in our own cities, housing for those in need.  These have a more Eastern European, Socialist-Bloc look to them.

The city itself is very old, with a kind of rabbit-warren look of different kinds of structures and materials mixed together, bordering the narrow streets.  The houses themselves appear to have been repaired, maintained, and in some cases enlarged, with the use of whatever material was available and with the work done mostly by the resident.  The result is a kind of organized disorder, a chaos that becomes routine through repetition.  There is an energy to the city, and a kind of charm.  Horse-drawn carts, for which the area is noted, appear regularly.

The Sierra Maestra Hotel is a fairly large (5 story), modern-looking structure with a big, open, tiled lobby.  The inevitable trio of Cuban musicians welcomes us and we go through the routine of being assigned rooms and head upstairs.  There's some question about the elevator, which is enough to convince me to not even try, so we wend our way up to the fourth floor and our rooms.  Decidedly more spare than the hotel room in Havana, this one has a loud air conditioner going, for which I'm very grateful, tile floors, two soft, narrow beds and a funky lighting system.  But it's home.  In the bathroom there is a stall shower (well, more a shower area, separated by a sheet of hanging plastic) with a permanently open wooden louvered window above it which makes me wonder about the effectiveness of the air conditioning, and a toilet without a seat that promises an interesting exercise in balance.  But at least there's a toilet.

In the lobby, we're once again treated to a welcome cocktail.  Mojitas all around.  I assume this is part of the program to encourage tourism.  If so, it's very effective.  Everyone is extremely pleasant.

Into the bus and through the narrow streets, past the beautiful old town square we go.  The horse-drawn buggies are quaint and the buildings continue to be a crazy quilt of styles, some older brick, some wooden shacks, some square cement block.  There is a lot of decorative wrought iron work visible, many balconies without railings of any kind, and bicycles everywhere.

At the Pediatric Hospital we're welcomed by the staff which is lined up outside as we arrive.  There's a lovely, kind of festive atmosphere to the occasion, as though they don't often get visitors (which is probably the case).  The unfailingly pleasant manner of these people is impressive - and kind of infectious.  The unloading of the boxes of medicine is done quickly, without fanfare, but with such an obvious air of appreciation that it's very touching.

Inside, we're welcomed by the physician in charge who introduces a number of his staff as Ivonne interprets.  Paul, in fluent Spanish, makes a short statement about who we are and why we're here and then we're led on a tour of the hospital, accompanied by a happy throng of nurses, attendants, parents and kids who are probably patients.

The 174 bed hospital has a clinic, a four-bed intensive care unit, a tiny admissions office and a small, fairly primitive lab.  Everything looks a bit dingy and run-down, and I'm sure the sense of dinginess is emphasized by the lack of lighting.  The shortage of light bulbs requires that they be used sparingly and only where needed. 

We're shown a ward where the patients are children under one year with respiratory problems.  An attempt has been made to seal off this room in a way, so that air conditioning can be used to advantage.  Things again have a kind of soiled look, though the children are well cared for.  It is a practice here that the mother or father stays with the child, which I like.  Earl, who has had a fair amount of experience in dealing with need in the Third World, asks what the primary needs are here.  ("What are your three basic needs?" becomes his mantra.)  The doctor says that medicine is the most difficult thing for them to get, particularly certain kinds of anti-biotics.  Next, he says, would be paper.  They don't have paper to write medical histories, they don't have paper to cover examining tables, they don't have paper to wrap patients in.  He says that next would be X-ray film.  They have enough doctors and nurses, but they don't have the basic equipment with which to treat the patients.  They have, for example, advanced microscopes and other instruments of high technology, but don't have spare light bulbs for them or other parts, so once in need of repair or simple replacement of a part they are useless. 

Earl says the situation is "upside down."  In his experience in the Third World, he says, there is often, in emergency situations, a surplus of medicines and supplies that have been sent in, but what is lacking is trained people to put them to use.  Here, there is this extraordinary supply of trained and willing people ready to do what they can, but who find themselves without the basics with which to do the work.

In a ward for infants up to three months of age, again with a working air conditioner - "What are your three basic needs?"  Clothing, sheets, towels, paper, anti-biotics.

Here, the doctor says, a government plan is being used to encourage mothers to do breast-feeding only - at least for the first four months.  He says the Family Doctor program helps to ease the burden on the hospital.  For example, by law, a Family Doctor who doesn't sign up a pregnant woman by her 10th week is sanctioned by the Public Health Ministry.

In the halls, and inevitably in wards as well, flies are a problem.  The moist tropical heat and the lack of soap and other antiseptics create a dangerous combination, it would seem.  The doctor explains that they have two generators for their air conditioners, but sometimes they break down and sometimes there is not enough fuel to run them.

Outside, we see that their ambulance is up on blocks, useless because they don't have tires for it.

Passing into another ward, this one for an assortment of sick kids, it all becomes nearly overwhelming.  Kids on IV set-ups, some with tubes in their noses, all sweet, smiling when they can, patient with us as we work our way through.  Many parents are in these wards, also gracious.  Walter has been producing candy and gum out of a backpack he's carrying, bribing and charming some of the kids.  He and Janet have to explain to one of the children what the gum is.  The plastic wrapper has him completely buffaloed.  Mary is taking it all in.  Formerly a professional photographer, she's stealing shots where she can.  Frank's camera is busy as well.  Stephen, Earl and Pauline, who is a nurse, are quizzing the physician in charge and I spot Jack casually lagging behind, unobtrusively handing out $1 bills to each of the kids as he passes by them.

Finally we say our good-byes and head for the bus, once again behind schedule.  It's hard to leave this place, in a way.  In another way it's hard to keep from running out screaming.  Smiling, friendly, grateful faces wave us off onto the streets of Bayamos.

Back at the hotel for lunch, we're given some choices that include spaghetti, so I grab that.  My much-sought beans and rice are available here, but they're already mixed with meat, so it's spaghetti for me.  Spaghetti and bread.  Doughy, but filling.  The service here is slow and a bit confused, but we come to the conclusion that it's a function of not having much in the kitchen and making do as best they can.  Our group is proving to be very congenial and many laughs and stories are shared.

Next stop is at the home/clinic of one of the fabled family doctors.  This woman, one of 1,514 in the province, lives on the second floor of a small two-story house and has the rooms on the first floor divided into office, examining and treatment rooms.  A pretty, charming, dark-haired, regal-looking woman in her forties, I'd guess, she seems impervious to the heat and the flies.  Everything about her suggests grace and intelligence.  She welcomes us and, through Ivonne, tells us that she is open at all times, treats a constituency of 600 people and divides her time between health promotion and disease prevention, teaching and rehabilitation.  She is a General Medicine specialist and has been here for 5 years.  Because of the current crisis she has been working in areas of "green" medicine, by which I come to understand that she's referring to the use of herbs.  She is teaching the use of herbs for self-medication as well as using them in her practice when regular medications are not available.  In addition, she teaches nutrition and is also focusing on trying to bring down teen pregnancy through sex education and information about contraception.

Q. - What are the most common conditions with which you deal?

A. - Viral upper respiratory problems, bronchial asthma, high blood pressure, diarrhea and vaccinations.

Q. - Why, in your estimation, does the program work?

A. - It is the intention of the government to provide health care to all on a local level.  The idea is to have the doctor involved in the community and to see people on a regular basis, as needed.

Q. - What are your three basic needs?

A. - Light bulbs, antiseptics and cleansers, and medicines.

Our schedule pressing, we're offered a short tour of the four-room facility and then encouraged to get back into the bus for the next stop.  The last ones aboard say that she had invited them up to her living quarters and when they got up there, saw that she had laid out fruit and bread for all of us.  We're awash in guilt about having to rush away, knowing that the expense to which she had gone can't have been easy on her budget.  (These doctors are paid about 3 - 400 pesos per month, the black market equivalent of $6 to $7.)  Last on the bus is Jack, who I see peel off a number of $20 bills and ask Ivonne to take them to the doctor.)

Our next stop is a maternity home run by the government for young pregnant women who have anemia or other medical conditions which aren't severe enough to require hospitalization but might create complications during pregnancy or in delivery.  It's also for women who live out in the country too far from the hospital to get there safely for the delivery.  A small house, no different from the others on the street, its main room is hot, full of flies and jammed with young, pregnant women.  Some there, we learn, are on an out-patient basis, living at home but using the facility for medical treatment, nutritional counseling, other kinds of care and education (including, we're told, some beauty services) all at government expense.

Q. - Who decides who gets to use this facility?

A. - Teams of doctors who interview pregnant women in the area.  The program is aimed at reducing the rising rate of low birth-weight babies (about which we've been hearing).

Q. - Do they live in?  A. - Yes.

Q. - What is the size of the area this facility services?

A. - There are 60,000 people in this municipality.  This is the only facility.  We are setting another up now.  We need five.

This program started in 1960 when only 20% of babies were delivered in hospital.  Now over 90% are.  Because of the embargo this program is being emphasized now.  There is no charge to anyone.  The only requirement is that those who are out-patients eat their meals here.  (Experience indicates that if they are allowed to take the food home it will be given to their other children.)

Q. - If these women have other children, who cares for them while they are here?

A. - Usually the rest of the family.

Q. - What is the Cesarean rate in the country?

A. - 15%, which is too high.  (To which Stephen disagrees.  He says the rate in the U.S. is 25%, in Russia 6%.)

Q. - What about natural childbirth?

A. - It is encouraged.  As is breast-feeding.

Q. - How long is the average hospital stay after birth?

A. - Locals are encouraged to leave as soon as possible.  Three days if the mother lives out of the area.  Five days for Cesarean deliveries.

Q. - Is ultra-sound used? 

A. - Yes.  On all pregnant women.  (One woman in the group, due today and looking like it, says it made her feel safer.)  (Stephen comments that this indicates a "very advanced system.")

Q. - What are your three most urgent needs?

A. - Sheets, clothing, nutrition aids and medicines.

Q. - Are women required to come here?  What if someone leaves?

A. - We do everything we can to persuade them to come back.  There is much social pressure to take advantage of the program.  The family doctor also encourages it.

Q - What is the average stay?  A. - 25 days.

Q. - (Earl asks of the women themselves) What are your three main problems?

A. - Lack of soap, food is a big problem, baby clothes.  Another adds, lack of kitchen utensils, lack of clothing, lack of ingredients for food "so we can cook with our hearts."

A very heartfelt expression follows from some of the women as they thank us for coming.  (I note there is a tendency here to make speeches, speeches of introduction, speeches of gratitude, almost as if it's been taught as a social form.  It's a curious thing because there is often a lack of ease with it, as a grade-school student standing in front of the class might show discomfort, but the content, if you let it in, is almost always moving.  Sincere and very touching.)  Gail, who has been interpreting, is moved and embraces the woman who has been speaking.

And away on the bus.  What an odd experience to drop in and out of people's lives like this.

Away into the countryside we go, toward the province of Guisa in the foothills of the Sierra Maestra.  Here are more houses with thatched roofs and wooden sides.  Fernando points out the wires and says that now 90% of the homes in the country have electricity.  Again the dense, lush foliage encroaches except where it has been swept away for purposes of cultivating the land.  Into the mountains the road curves between orchards, cornfields, farms and well-tended croplands.  Soon we near a town and are greeted by a stand of "projects," the soviet-style cement-block apartment houses that provide housing for so many.  And again into the countryside.  Livestock on the side of the road near some of the small huts.  Two interesting things come to mind.  One is the neatness of even the poorest looking homes, the other is the absolute lack of any sign of a military presence.  I don't think I've seen a soldier since I got to the country.

We stop and unload at a small house by the side of the road.  This is the Ortega Settlement in the Province of Guisa and is an example of the progress that is being made in the area.  A Unicef grant has made possible a water project here, where campesinos in the past had to walk long distances for water.  This is one of four that have been built in the countryside to the benefit of many families.  It is a gravity-run aqueduct system that provides potable water to 200 families 24 hours per day through pipes run from a spring up in the mountains and has made a giant difference in these people's lives.  The Unicef grant was matched by money from the Cuban government.  This unit cost $7,000.

We are escorted through the house of Pancho, who is a teacher who also raises livestock and grows coffee.  The small, wooden, two or three room house is rustic and very clean.  In the back it looks as though a motion picture production designer has made up the perfect farmyard.  Chickens cluck around, stabbing at the dirt, a cat wanders through, the water runs through the pipe, at request, into a barrel where it is saved.  A small, obviously hand-made shed on the other side of the yard provides an area for coffee beans to dry and where hay is neatly stacked.  With the clear blue sky above and the earnest, lined faces of the campesinos gathered around so terribly proud of their accomplishment it's enough to bring a catch to the throat.  A gray-haired woman, probably in her sixties, says she carried water the four kilometers from the source many times a day for years.  "This is better."

One of the men gives his presentation about the creation of the water system and it's again as if he's giving a report at school.  But to watch his face and hear the pride in his words even before they're translated is to be witness to something of great beauty: the dignity of man made manifest.

After breathing in our fill of this rural outpost we board up again and drive off to gracious waves from our hosts and head up the four kilometers to see the reservoir that makes all this possible.  After seeing the result and hearing of the differences it's made in their lives, the reservoir itself is a bit of a disappointment.  A hollow cement square with an inflow pipe on the uphill side, a few smaller ones on the downhill side and a trap door to put in the chlorine, it seems no great feat of engineering.  But I guess that's the point.  It is simple and inexpensive to build and makes an enormous difference in the lives of so many, so why was it never done before and why do we brand the government that has finally achieved it as being so loathsome?

We've been told that an example of the depths to which the U.S. Government will sink to express its distaste for this regime is the fact that the State Department deducts from its contribution to Unicef, on a dollar for dollar basis, an amount equal to any moneys that organization has spent on programs in Cuba.

Into the bus and back toward the Sierra Maestra Hotel we go.  It's been a long day and the brains have absorbed a lot, so a kind of goofiness sets in.  Walter, who is a very bright guy and a wonderful writer, starts running off a series of jokes that keep us all either laughing or groaning the whole way back.  One of them is a very complex and well-told kind of shaggy-dog pun that ends so badly, with an arcane reference to a slogan from a breakfast cereal commercial, that no one could believe he had gone to the trouble.  There was serious consideration given to leaving him on the side of the road.

Back at the hotel everyone goes in different directions.  I wait with Paul, fighting off drowsiness, because someone has told him they'll locate the man with the key to the dollar store in the lobby.  (The dollar store, as the name implies, is a store that has items for sale only for dollars.  It's one of the government's attempts to get hold of some of the dollars in the economy.)  It might be fun to find something to take home to Shelley and the kids, I think, though it turns out there isn't much of interest except a couple of bottles of water that I take to brush my teeth with.

Jack, it turns out, has taken off with Ivonne and the bus driver, and, using a Canadian credit card he has, buys a load of light bulbs, a bunch of clothing for little kids at the hospital and arranges for five tires ("Well, they've got to have 
a spare.") for their ambulance.  Quite a guy.

Dinner at the hotel is a mass of confusion.  Everyone is as nice as they can be, but it's hard to get what you want, even after they tell you what they have.  We seem to have the same private dining room set aside for us, and a very enthusiastic trio that plays and sings (this one has added an accordion) with abandon.  I still haven't been able to come up with rice and beans (without meat) to save my life.  What I manage to arrange for this time is more doughy spaghetti plus rice and potatoes, which, along with the bread, means I'll be able to starch my shirts from the inside out tomorrow.

Walter, apparently indefatigable, has been busily organizing an outing tonight to take in the town and sample the local cuisine, so when he shows up at dinner it's a surprise.  But, he insists, he's going to give the night life a try even after being told there aren't any restaurants in town.  Frank is going to go with him.  And I think Earl is as well.

Stephen doesn't show up for dinner at all, which is a source of concern, but someone says he was simply worn out and was going to go to bed.

Begging off the trip into town I head up the dark stairs to bed.  It's been a long day and tomorrow is another early one.  We're heading into the mountains.

Sunday, October 23, 1994

5AM.  I crawl out of bed and grope my way to the shower.  The water is very cold and shows no sign, even after my most fervent prayers, of changing temperature, so I'm soon very much awake.  Showering in cold water is one thing, I decide, but shaving would be taking my life in my hands, so I'll go into the mountains scruffy.

We meet in our special room for a quick breakfast and I find eggs, which is a rare treat.  Walter, Frank and Earl are full of happy stories about the wonderful time they had last night in town, dancing and singing with the locals.  One of them, I think Frank, says he wants to bring a bunch of American teenagers down here and let them see how a group of kids their age can have fun and still be sober and respectful at the same time.  Obviously they had a good time.  Stephen is rested and ready to go.  And so we do.

Outside, there's a bit of a wait as the bus isn't there.  Some sort of confusion on the time, so we wait a bit.  Not a big deal, except for the fact that the mosquitoes are out in force and all seem to want my blood.  Jack is amazed by it and can't keep from laughing as he points out that they're all buzzing around me and leaving him alone.

Finally, the bus takes us down the familiar highway to the town we went through yesterday in Guisa, but this time we stop in the town square and wait for the vehicle that will take us into the mountains.  Ivonne says we're going to need a "double-traction mountain bus" to get where we're going.  We roam around the little town square for a bit, admire the statue of Jose Marti (in 1868, the revolution against Spain started in Bayamos and went on for ten years before it failed.  Jose Marti, who was a Cuban philosopher/poet, left for the U.S., where he studied history and the writings of some Americans, notably Walt Whitman.  Returning in 1895, he re-ignited the Cuban revolutionary movement and is considered one of the country's primary heroes, even though he was killed in the first day of the war that finally freed them from Spain).

Fernando tells us that this town, which now has a population of 25,000, had only 3,000 people before the Revolution and no electricity.  Full of facts, he also says that after the Triumph of the Revolution (it's always said as though it should be capitalized) agricultural land was 80% State-owned, 12% cooperatives and 8% privately held.  As of the changes of one year ago, it's now 90% cooperatives as part of the government's current economic experiment.

The "double-traction mountain bus" shows up.  It's a monster.  German made, it has a truck cab and a separate bus-style section in the back, big, double-axle wheels and looks like it's been through some rugged use.  We climb aboard and head out, along with some men who have been waiting with us and are evidently going along for the ride.  This no-frills rig is certainly not as comfortable as the one we traded in, but it's kind of fun.

Before long we come to the end of the paved road and this thing begins to earn its keep.  The countryside has gotten more and more rough with every mile and this dirt road begins to climb up into serious mountains, with switch-backs and ever-steeper declines on one side or the other.  Over a stream we go, bouncing and tossing, rocking and rolling.  Once, twice, three, finally four times we cross the same stream, each time more dramatically.  The huts on the hillsides are now almost all thatch-roofed, though some are made of wood and a few still have cement block walls.  The remarkable thing about them is how neatly kept they all appear to be.  The view is absolutely beautiful as we climb, though the cliffs to the sides are getting more and more hairy.  The notion of rolling down one of these cliffs in this mammoth rig isn't comforting and I have to confess it occurs with more and more frequency as the road becomes more steep and less wide.  (There are a couple of times that I can see the wheels below me quite literally scrambling for purchase on the edge.  Though I can tell myself that it's a double-wheeled rig and there's plenty of surface for traction, it doesn't seem to help and before long I'm thinking seriously about getting out and walking.)

Janet is not having a good time, either.  Her lack of appreciation for airplanes seems to extend to double-traction mountain buses on the very edge of oblivion, and I can't say I blame her.  Walter is doing a bit of teasing, but I think it's mostly to get his mind off the reality.  After one hell of a ride (I'm standing in the front of the passenger space by this time, hanging on to the cross bars, having long ago given up the idea of being able to stay in the seat), the road widens a bit and someone from the cab shouts back that we're almost there.  At least that's what I'm telling myself he said.  Sure enough, after a little while we see a few houses down what looks like a goat path and someone says that's where the family doctor lives.  Good enough.  Having spared myself the embarrassment of leaping out and walking along behind through sheer force of will, I'm ready to grab any excuse to get out, and I'm damned sure walking back down the hill.  The only thing I can think of that I'd less like to do than take that ride back up the hill again in this rig is to go down in it.

As we pause at the top of the goat track, and I'm expecting to vault out the door, this guy turns and heads down it!  I can't believe it.  Here we are in the Cuban Alps and this kind fellow won't think of letting us strain ourselves by walking a hundred yards.  Talk about killing you with kindness.

Well, sure enough, he gets us down successfully and stops, finally, just up the hill from a little two-story house built in the same manner as that of the Family Doctor's place back in Bayamos.  I find myself wondering if it's the requisite model prescribed by the government. 

Back on terra firma, I'm ready for anything.  First order of business is a round of applause for the driver who brought this lumbering giant successfully up that road. 

The view from up here is fabulous and we breathe deeply of the mountain air and shake the kinks (and in my case, jitters) out of our legs as we head over to the doctor's house.  Dr. Enrique, as he's introduced, looks to be in his late twenties as he welcomes us to his front porch.  A quiet man with a sweet smile.  One of the group that accompanied us on the ride up turns out to be the mayor, or something, of the municipality and expands his introduction of Dr. Enrique to explain that this is the area known as Santa Ursula.  He tells us further that this house was built in 1988 to house the Family Doctor and that four truck engines were burned out in the process of bringing up the materials necessary to build it.  (He says nothing about lives lost in fiery crashes, so I suspect we're not getting the whole story.)

Dr. Enrique tells us that the infant mortality rate here is zero.  He says he and a nurse take care of this area with special attention to pregnant women and children under one year of age.  There is a seventeen-bed hospital nearby, he says, for those who need it, and there is ambulance service available (that would be a fun ride!).  The hospital must be in the community we passed on one of the river crossings below.

Enrique says he will be here for a total of two years.  He says in the Family Doctor program you study for 6 years, work in a designated area for 2 years, then go back to study a specialization for 3 more years.

He indicates that there is not much asthma here (perhaps because of the altitude, it is suggested) and hospitalization is rare.  Parasites can be a problem, particularly with children who play in the streams or run around in bare feet.

He goes out to see the people in his community on a regular basis.  He used to do it on a horse until it fell, broke a leg and had to be destroyed.  Now he walks.

Asked how big an area he covers, he says it's "as far as you can hear a rooster crow."

A remarkably sweet and peaceful young man, he invites us in and shows us the small clinic.  It's essentially the same as the one we saw in Bayamos, lending credibility to my theory that it's a common design.  An interesting touch here is that the patients keep their own records, writing down each visit and what is told them.  It's a good way to involve them personally, make it less of a foreign procedure.  Frank notices that the children's file is arranged with each name represented by a cartoon animal character.

Asked what the single largest problem is that he faces, Dr. Enrique says "Alcohol."  He indicates that people up here drink a lot, in part because it is the custom and in part because of boredom.

Earl asks about the three most pressing needs, and his answer is "A horse or mule" for transportation, medicines and lights.  He not only needs bulbs, but has a problem with the fact that the electrical plant that serves the area is off and on because of a lack of fuel.

As is the case elsewhere, he encourages his new mothers to breast feed for at least the first four months.

Every Monday, Wednesday and Friday are office hours, when people come in for their regular visits.  Tuesday, Thursday and Saturday he goes out into the community to visit those who are too sick to come, can't get there for some other reason or are avoiding him.  Every Monday night he is on duty in the local hospital in Victorino (down the hill).

He too is using herbs in the face of the lack of medicines.  He says some of the campesinos (farmers) are teaching him the old ways.  For example, he uses dried guava leaves for diarrhea, and something called Cana Santa, as a tea, for high blood pressure.

As some go upstairs to see his living quarters, I step out on the porch and drink in the view and enjoy the incredibly fresh air.  Jack is there as well, beaming as he looks out over the Sierra Maestra.

We're invited into the home of the neighbors next door.  A handsome young couple with three gorgeous children, they're justifiably proud of their neat house.  Wooden walls and floor, tin roof, with walls inside that don't go all the way to the ceiling to separate the two or three rooms off the entrance area.  Hanging blankets serve as doors, helping to partition the space.  The three kids smile shyly as they stand together wearing their red school uniform smocks.  It's an enchanting picture of a simple life - he works on the local coffee cooperative, there are corn stalks and other vegetables in a garden at the side of the house - and again, everything is neatly kept and looks remarkably clean.  Mary records it all with her camera.

Some of the group is still upstairs in the doctor's house, others have come out onto his front porch or into the yard of the neighbor's home.  The driver of the rig that brought us here decides he's going to go further down the goat track to find a place to turn around (!) and Paul says we'll be ready to go in a while.  I tell him I'm going to walk on ahead, back down the road.  Janet, Mary and Frank have the same idea, so we head out, figuring the bus will catch up with us on the way down.  Somewhere on that hair-raising ride up I heard it said that it was either four kilometers or four miles.  Somebody else says eight kilometers.  Whatever it is, I figure I can handle it.  Gladly.

It's a wonderful walk on a beautiful day in a gorgeous part of the world.  The dirt road looks considerably wider from this vantage point, of course, but none of us seems sorry we made the choice.  Frank, who says he's 69 years old and is used to swimming three times a week, is glad to have the exercise.  He's been an asthma sufferer all his life, so is particularly sensitive to the problems they're dealing with here.  Mary is a tennis player and is otherwise very athletic, so it suits her fine.  It also gives her a change to take some pictures.  Janet and I, I think, are just glad to have our feet on the ground our lives in our own hands.

At one point on the way down, two boys come out of the trees off to the side of the road and pass Frank and I as they go the other way.  We say hello and think no more of it.  Later, Janet and Mary, who had lagged behind, catch up and are walking with a woman who says she's the boys' mother.  As Janet relates it, the woman said that they had come to her after seeing us and asked, "Mama, are those Americans?"  When she told them that we were indeed Americans, they asked, "How come they aren't killing us?"

Further down the road before she turned off into the bush, the woman pointed out a small settlement off in the mountains and said there was a school there with four students - who had a full-time teacher. >

I'm not sure how long we walked, but we began to wonder what had happened to our companeros and the bus.  We passed by a number of small groups of neat, thatched-roof huts and watched a bunch of baby ducks follow their mother at one of the places the stream crossed the road.  Later we stood and watched a great group of piglets snorting and cavorting at the roadside.

Standing and talking by another of the stream crossings, two women came by on the road, going in our direction.  They were both carrying pretty good loads, but the older of the two looked as though she was struggling a bit with a sack of melons or pumpkins.  I asked Janet to see if I could help her with it as we walked along and she responded, "No thanks.  He looks as though he's tired enough already."

We passed a larger hut, built in the same fashion as the rest, which had a kind of corral affair beside it.  One of the women said it was the local military outpost, but there didn't appear to be anyone around.

Finally, we arrived at the spot where the pavement began again.  This was Victorino, where the hospital was located.  A number of people were waiting around at this spot for the bus to the center of Guisa, so we stood at the side of the road and chatted with people as they passed by, looked over the countryside and felt warm and happy and good about the walk.  Two women with whom Janet struck up a conversation gave us some bananas from their bags.  It is awfully hard, from this vantage point, to think of a reasonable explanation for the behavior of our government.

After what seemed like a very long time, the double-traction mountain bus came chugging around the corner.  We waved and they waved and laughed and made it appear that they were going to go right on by, but finally stopped.  As we climbed aboard they explained that after leaving Santa Ursula they had climbed up an even steeper and narrower path to get to a magnificent view point and that we had truly missed an experience.  I'll bet.

The stop at the hospital in Victorino is short because of the fact that we have a plane back to Havana this afternoon.  This is a small rural hospital that serves the whole area.  A cluster of small buildings, it has a staff of three doctors; a gynecologist, a pediatrician and a generalist; and at least three nurses.  That, they indicated, is the way the smaller local hospitals are usually staffed.  This visit is less formal than many of the others, probably because of the time crunch, but they are very sweet and hospitable and after they show us around have juice and sandwiches ready.

Again, the place is run-down, ill-equipped and a bit grungy, but the energy and sense of commitment is readily apparent.  Doing the best they can with what they have is the order of the day.  To deal with the lack of equipment, for example, the local hospitals collect all the needles and syringes they use, as well as gathering those used by the family doctors in their respective areas, and ship them to the provincial center (Guisa, in this instance) to be sterilized in a gas sterilization machine and sent back for re-use.  Aside from the prospect of their becoming dull from re-use, this practice is obviously not ideal from the point of view of hygiene.

Back in the bus, we again head for Guisa.  Once there, Jack points out how much more modern this little town looks than it did this morning, given where we've been in the meantime.  Our companions on this leg of the tour, the mayor and his guys, bid us farewell and thank us for coming and we load into the Havantur bus that has been waiting.  The air conditioning and padded seats are much more appreciated now than they were before, it's clear.

Running behind, as usual, we have only a little time at the hotel for a quick lunch, then to grab our bags and head back to the bus.  Whenever we approach the dining room, however, the trio is sure to come in and serenade us and this time is no exception.  Knowing we're leaving, the leader circles the table with cassette recordings of their music and we all stare at each other guiltily until Mary and Walter turn out to be the softest touches of the group.  Downstairs in the dollar store, Jack is arranging for yet another purchase of something for someone.  (I know he has literally given the shirt off his back - one he bought in the dollar store - to our driver, for all the extra trips he has made on these shopping excursions.)

Back to the airport and a round of the kind of formal good-byes that are evidently de rigueur here.  Again, the men who speak thank us for our interest in and support for their country and their work in a kind of touchingly sweet, almost little-boy way (I'm not being critical, you understand, I'm simply trying to convey the sense of discomfort and almost grade-school formality in the presentation and at the same time recognize the utter simplicity and sincerity with which it's offered.).  A round of applause follows each statement, then handshakes all around and then it's onto the same plane, with the same crew.  (Though I'm sure they didn't just sit here and wait for us, it has that odd feeling about it.)  Jack is happy to see the lady with the same beautiful smile.

The flight back is uneventful.  Our party makes up the entire passenger list, so it's fairly casual.  In fact, I get to try something I've thought about but never done in an airplane - lie down on the floor and go to sleep.

Touching down, smoothly, thank you, at the strip in Havana, we see a large helicopter and a couple of soldiers.  It occurs to me that these are the first soldiers I'm aware of having seen since we've been here, which doesn't prove anything, of course, but provides a very different picture from that of the rigid, Soviet-style Communist garrison state that is implied by the anti-Communist hysterics one tends to hear from whenever Cuba is mentioned.

The helicopter and the soldiers bring to mind the rumor that Raul Castro, Fidel's brother and nominal second-in-command in Cuba, was supposed to be in the Sierra Maestra at the same time as we were.  Maybe he's back, too.  (Raul, the whispers suggest, is the non-Castro Castro.  Someone said Fidel got the physical size, the strength, the deep voice, the powerful speaking ability, the charisma and the intelligence and Raul got what was left.  A bit cruel, perhaps, but it makes the point that he is not well regarded in the country and unlikely to be the one to take over when Fidel steps down.  That's why speculation has it that Ricardo Alarcon is next in line.)

Jack has been talking about all of us having dinner at the Bodegita del Medio in Old Havana and our schedule is jammed, so Ivonne sets it up for an early dinner tonight.  Jack has eaten there before and loved it.  It's evidently associated with Hemingway, a favorite watering hole of his, and he says it's not to be missed.  Once back at the hotel, those of us who are interested in this little adventure quickly gather in the lobby and head out.  Janet is meeting a friend and Paul has business, so it's Walter, Jack, Pauline, Stephen, Mary, Earl, Ivonne and I who set out.

Once we're there and seated, Frank shows up, having been left behind through a misunderstanding, but a cab solved the problem.  The Bodegita is a very crowded place with a bar in front (standing room only) and two dining rooms downstairs built around a patio.  On the side of the patio is a steep stairway that evidently goes up to other dining areas above.

The walls and tables are literally covered with the scratched, carved or scrawled names and dates of visitors from all over the world and the joint, even though it's early, is jumpin'.  A very loud group sitting in the next room (but very close by) is singing at the top of its collective lungs along with the inevitable guitar players (this time only a pair of them), but it soon calms down to a dull roar.

There are various specialties of the house (Red meat and different kinds of fish are very big in the Cuban diet.  The fish I understand, but the emphasis on the red meat is a bit of a surprise.), but the thing I'm thrilled to see is the beans and rice.  Without meat!  You can get beans and rice mixed together or you can get beans and rice separately.  What a great restaurant!

The food, when it comes, is great.  And plentiful.  Jack makes sure the Mojitas are flowing and there are stories and laughter.  We even survive an attack by the guitar-playing duo.  There is a choice moment when one of those night club photographers comes by and wants to do a group shot for $10.  None of us are interested, but Walter decides he wants a memento of this special event, so has the guy shoot a picture.  Jack, who doesn't believe in having his picture taken, scoots out of the way and the photographer keeps backing up to try to fit him in.  Finally he gets it and Walter gets his picture.  Sans Jack.  (Jack's unwillingness to be in any of the pictures that are taken during this trip has been a source of consternation to some, a challenge to others.  When asked, I've heard him explain that it's due to his belief in casuistry.  I've also heard him say it steals the spirit, or one of your lives, or something.  I think he's shy.)

After having stuffed ourselves (They not only had plentiful portions of rice and beans but also plantain and fried bananas.  Delicious!), we headed out into the night to walk over to the Old Square.  It's a beautiful sight, even without many lights.  The Old City is great, with narrow, cobbled streets and history emanating from every pore.  The only depressing thing about it is to see kids begging, something I'm told was unknown to Cuba before the last few years.

After a bit of a look around, we find the bus and head back to the hotel.  Later tonight part of the group is going to the show at the Tropicana, an extravaganza unique to Havana (and Las Vegas, I fear).  There's been some question as to whether we should bother and the responses have been careful ones on the order of extolling its uniqueness, its extravagance and its employment of Cuban dancers.  It seems no one wants to suggest that it's good, except relative to the situation, or in good taste, but it is thought to be something that you won't see elsewhere and we're here so why not?  So, I figure, what the hell?

The show itself is very much Las Vegas (or, perhaps Las Vegas is very much Havana.  Indications are that the Mob, when it was thrown out of Havana, chose to pour its money into Vegas as an alternative.).  It's done in an outdoor, bowl-shaped amphitheater that was once the botanical garden of a wealthy family.  A large stage is thrust into the audience, with raised platforms at each side and stairways connecting them.  On the upper levels to the right and left of the stage and at strategic places around the rim, are mini-stages where dancers appear periodically.  It is a colossal show, not at all to my taste, with very loud music and lots of singers and dancers holding forth from the different levels in sequins and tights and beaded and feathered head-dresses.  The songs are all in either Spanish or French, as I recall, but I don't think one has to be a linguist to appreciate the show.  The bodies of the men and women dancers are quite extraordinary, for the most part, but unlike Vegas there is no nudity and over-all the effect is perhaps overwhelming but hardly erotic.

There is a kind of unreality about it all, as I think about it.  My understanding is that the government shut this show down after the Revolution, which makes sense.  Later, they decided to re-open it to attract the tourist dollar.  That's the part that's tough to reconcile.  I guess it's a "means and ends" thing, but it seems to me that this kind of show is so totally inconsistent with the notion of the revolutionary ideal that it's a kind of non-sequitur for me.  (I don't mean to be too stuffy about it.  Perhaps if it was a show more to my tastes I'd have felt differently.)

Back to the hotel to crash.