#mittaleof2countries

While in Cuba, I had the distinct misfortune (though perhaps a fortunate opportunity) of visiting urgent care. Prior to visiting Cuba, I had heard of Cuba’s world-class healthcare system. For more info on that, read this Huffington Post article.

MY OWN PATIENT JOURNEY THROUGH THE CUBAN HEALTHCARE SYSTEM

My patient journey begins upon waking up at 5 am in the morning, unable to feel my lip and a heavy eyelid. Concerned, I looked in the mirror to self-examine only to find an ogre staring right back at me. An allergic reaction had taken over my right eye-lid and lower right lip. After trying my own hotel remedies (cold towel compress and anti-itch cortisone wipe), I could see that the swelling was not going down. Around 5:30, I woke up my husband (@amklearns), who fortunately was also on the Cuba study tour with me, and we went to the lobby to inquire about health services. We were informed that the hotel doctor does not come in until 9 am, and that we could visit the hospital about 15 minutes away via taxi. So, 10 minute slater, a bright blue old American car arrived to take me to urgent care (see image above).

We pulled up to the hospital, and our taxi driver helped us show us to urgent care. I approached a sleeping front desk attendant, pointed to my eye and lip, and showed her my passport. After waiting in an empty waiting room for about 10 minutes, I was then called by a white-haired, friendly-looking doctor. Fortunately, I have some conversational Spanish skills, so I was able to tell the doctor about my demographics, my ailments, the condition of my face, what foods I had eaten, etc. After the consult, he prescribed an injection of hydrocortisone and cortisone. I went back to the waiting room for only a couple minutes until a nurse called me up so that I could get my injection administered. She explained what would happen and took out the requisite aseptic equipment and drug solution. She cuffed my arm with a rubberband, cleaned up my arm with an alcohol swab, found a vein, and inserted a needle with syringe. While the solution was going into my veins, I closed my eyes and wondered whether the needle was actually sterile... too late for that (see image above). I went back in the waiting room for another few minutes until I was instructed to the finance window where I would pay my bill. Nervously waiting to hear how many CUCs this visit would cost, I was pleasantly surprised to see a bill of 45 CUCs, or the equivalent of $45 USD. This amount is probably equivalent to the coinsurance/copay for the same services provided in the United States! I was in and out of urgent care in an hour.

Our first stop on the Study Tour “Tale of Two Countries” was Cuba, arguably the stop we were all most excited about. The allure of this inaccessible and drastically different country captivated us all and in large part motivated our interest in this study tour. Landing at the Havana airport and traveling to our hotel, it seemed that we were transported back in time. The old cars, the outdated infrastructure, and the lengthy processes at the airport and the hotel check-in desk confirmed the stereotypes we all had with this island.

However, over the next 3 days, we were exposed to a Cuba that we hadn't expected: one open to change and anxious for economic progress in the post-Fidel era. The excitement around Obama's visit was palpable in the pedestrian streets of Havana Vieja. One Cuban donned a t-shirt with Obama's smiling face and the American and Cuban flags intertwined. Our beloved tour guide Alessia gushed about the changes she has seen since Obama took over the presidency.

Andrew and I prepared a proposal to make the lionfish a gourmet meal option for tourists in Trinidad and Tobago. After preparing our proposal for the class, Andrew and I had a number of conversations about the lionfish while on the study tour in T&T.

At an informal lime with a panel of business men and women in Trinidad, Andrew and I had the opportunity to meet with the executive sous chef at the Hyatt Trinidad. In our conversation, we discussed some of the opportunities and obstacles of our class proposal - employing behavioral science nudges to protect the environment from the invasive lionfish. The insights that we received from him on the perceptions of the fish and the preparation techniques were incredibly helpful as we think about the feasibility of developing a market for lionfish. 

During another panel, we had the opportunity to speak with the Nirad Tewarie (CEO,American Chamber of T&T) and Brian Frontin (CEO,Trinidad Hotels, Restaurants, andTourism Association), who were both receptive to the idea of using behavioral science to nudge tourists to consume lionfish while visiting Trinidad and Tobago.

Lastly, we also had the pleasure of speaking with a marine biologist, who is extremely educated on the topic of marine sustainability and reef preservation, and he has written a number of reports on the status of lionfish in Trinidad and Tobago. He helped dispel many of the myths and incorrect information that is floating on the web, and he described the locals perceptions of lionfish and those barriers to consumption.

I’ve mentioned our proposal for a behavioral science experiment to combat drunk driving in Trinidad a few times now, but to provide a little detail: “SafeLime” would be a smartphone app that would allow users to hail transport (much like uber) to and from bars, rather than using their personal cars. Along with a host of other social features, the app would allow users who successfully completed full bar trips through the app to earn points for redemption at partnered bars and restaurants – hopefully “nudging” them away from drunk driving.

Our suggestion was that the app leverage Trinidad’s existing maxitaxi network as the transport for this program. Maxitaxis are small buses that we had heard are used heavily by commuters in the country, but not traditionally for bar transport. Our hope was to partner with maxitaxi drivers to become SafeLime drivers, adding a level of familiarity to the program (which might drive further use), and hopefully benefitting maxitaxi drivers with increased business as well.