On the verge EXPLORING SUSTAINABILITY, HEALTH CARE, AND ENTREPRENEURSHIP ACROSS CUBA TODAY

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1 On the verge EXPLORING SUSTAINABILITY, HEALTH CARE, AND ENTREPRENEURSHIP ACROSS CUBA TODAY by Elizabeth Friary, Clara Herrero, Sarah Higgins, Robin Roberson, and Louise Sécordel 18 Photography by Bing Peng and Louise Sécordel

2 Since President Obama s announcement in 2015 of the re-establishment of diplomatic relations between the United States and Cuba, both businesses and tourists have shown a renewed interest in the isolated island nation. The slow re-opening of Cuba we are witnessing today brings to light the challenges and changes Cuba has undergone since its 1959 revolution. To be able to observe Cuba s current economic state first-hand is a rare opportunity. In March 2016, a group of 20 students, both graduate and undergraduate, from Simmons School of Management traveled to Cuba for a once-in-a-lifetime experience. Accompanied by Professor Indra Guertler, Professor Paula Gutlove, and Visiting Professor Gordon Thompson from Clark University, we studied the policies, trends, and opportunities related to sustainability, health care, and entrepreneurship. As part of our course, affectionately named S.H.E. in Cuba, we spoke with experts on the subjects of sustainable agriculture, the universal health care system, and the rapidly growing private business sector. Many of the changes in Cuba over the past decades emerged from necessity. A sustainable farming movement arose as the result of the food shortages felt during the economic crisis Cuba endured in the 1990s. The revamping of the health care system began after approximately 6000 doctors left the country when Fidel Castro seized control in The pressures of providing subsidies across all sectors of society on stressed state coffers have caused the government to open up to tourism and begin to allow limited private business ownership, and Cubans are seizing the opportunities that come with entrepreneurship and tourism. Policy changes pushed by tourism are fueled by foreign dollars, and American business people are The agroecological farm El Paraiso, overlooking the valley of Viñales. scouring the landscape for new opportunities. What we witnessed gives us hope for the future of the Cuban people, but also highlights many of the challenges and obstacles that remain in place before Cuba will be ready to fully engage with the world. Sustainability For many of us, when we think about Cuba we think of the first half of the 20th century the old cars, Ernest Hemingway, and a romanticized time when the Hollywood elite called Havana their playground. So it may come as a surprise to learn that the World Wildlife Fund in 2006 recognized Cuba as the only country in the world to achieve sustainable development. This status is mostly attributed to Cuba s agroecology, in particular to its reduction of use in chemical fertilizers and pesticides in the country s farming practices. How this came about is rooted in history and it was not necessarily a choice that Cuba made conscientiously. Driving 23 miles outside of Havana, we visited Finca Marta farm in Caimito. We spent the afternoon with Fernando Funes Monzote, a Cuban agroecologist who now operates and manages the 20-acre farm. Funes Monzote explained that in the 19th century the Spanish introduced Cuba to the idea of monoculture growing one single crop in one specific area over and over again. In the early 20th century, under the influence of the United States, Cuba developed an industrial agriculture infrastructure that transformed much of the countryside and fueled its export markets in sugar, tobacco, and coffee. After the revolution in 1959, Cuba relied on the Soviet Union for the machinery, fertilizers, and pesticides required to sustain its industrial agriculture. With the collapse of the Soviet Union in 1991, Soviet support dried up and Cuba was forced to (Left) Standing in front of the well that he and his partner spent several months digging, Fernando Funes Monzote introduces his agroecological farm Finca Marta. (Middle) Touring the farm, Funes Monzote praises the hard work of his farmers. (Right) SOM Professor Paula Gutlove presents Funes Monzote with donations of reusable bags along with ibuprofen, bandages, and flash drives collected from the Simmons community. Donations of similar items, along with medical supplies donated by Boston Children s Hospital, were requested by and given to the various NGOs, schools, clinics, and community organizations the group visited. 19

3 (Left) SOM students with American students from the Escuela Latinoamericana de Medicina, a medical school in Havana (Middle) A dental opertory in the dental clinic in the Polyclínico Dr. Tomás Romay in Havana (Right) SOM students listen as a nurse health educator shares stories about her outreach work. make due with less. The country redesigned its agricultural system to one that required fewer resources, and developed a competency in organic and sustainable agriculture. During the country s organic farming revolution, Funes Monzote notes, Cuba became one of the most prolific per capita food producers in Latin America and the Caribbean. Although the World Food Program reports the country imports up to 80 percent of its population s food, Funes Monzote says that Cuba produces about 50 percent of the country s domestic needs and believes it could sustainably grow enough food to cover the population s needs if 50 percent of the land was farmed. Large North American agricultural entities are eager to do business in Cuba. For Funes Monzote, history has taught him the importance of learning how to build an enterprise that is sensitive to social, environmental, and ecological issues. He believes that sustainable agriculture is at the core of improving people s lives economically, socially, physically, mentally. The main challenge facing him and other farmers across the nation is whether their organic farming movement can change the mindsets of those governing Cuba s agricultural sector, to ensure both largescale and long-lasting change. Health care The emigration of Cuban doctors that occurred at the time of the Cuban Revolution turned into an opportunity to rethink the health care system. The system that emerged focused on comprehensive primary care and prevention services, and emphasized access to all. Cuba is widely recognized for its effective public health system and is also known for its medical internationalism. For a nation with limited resources, its low infant mortality and high vaccination rates, coupled with high life expectancy, are testaments to Cuba s devotion to community-based care. During our visit, we realized that health care industry was difficult to translate into Spanish, mainly because health care is not viewed as an industry, but as a fundamental human right. This value is reflected in the way the health care system is structured (not to mention that all care is given free of charge to patients). All Cubans have easy access to neighborhood consultorios or family doctor practices where physicians and nurses typically live in the same neighborhood as their patients. Patients can schedule appointments or drop in during morning hours; and in the afternoons, providers typically make home visits. For more extensive primary or secondary care, patients are referred to the nearest polyclínico, or polyclinic facilities similar to small hospitals outpatient clinics, which provide services such as maternal health, family planning, mental health, eye and dental care, and rehabilitation. The polyclinics also work closely with both consultorios and the Ministry of Public Health to track population health indicators and outcomes. For tertiary-level care, patients are referred to hospitals. Claudia, a nurse health educator at Polyclínico Dr. Tomás Romay in Old Havana, told us about the facility s role in providing comprehensive care to all patients within the community. In her role as educator, Claudia visits schools and community centers to teach people about health and wellness, covering topics as diverse as healthy eating, exercise, and sexual education. Cubans have a close relationship with their consultorio and polyclínico teams, and the nation is proud to guarantee at least one annual medical visit to all of its citizens. Claudia and other medical professionals are hopeful that the opening economic landscape will bring higher-quality diagnostic tools and up-to-date medical equipment for them to provide less invasive and more effective services to their patients. 20

4 Entrepreneurship The burgeoning openness in Cuba is making entrepreneurship one of the fastest growing industries. This is particularly visible in the hospitality sector with its growing number of casa particulares (rooms for rent in private homes), classic car taxi companies, and paladares (privately owned restaurants, often operating out of a family s home). During the trip we encountered entrepreneurs in each area. A casa particulare is similar to AirBnB in the United States, where individuals rent rooms in their homes or their whole apartment to tourists. Our hospitable hosts during our stays in both Havana and Viñales provided home-cooked meals for breakfast and the occasional dinner. Due to limited hotel accommodations in Viñales and other smaller cities and towns across Cuba, casas particulares lodge the majority of tourists visiting the island. However, limitations in consistent access to modern-day supports, such as the internet and online booking services, inhibit promotion of these accommodations and pose challenges for the owners. As US and Cuban relations begin to normalize, there is both a need and an opportunity to increase marketing and advertising, both nationally and internationally, for the individual casas. Improvements in infrastructure and a loosening of communication restraints are two factors that could help catapult this nascent industry. Restaurants in Cuba are also a staple to the tourist industry and the economy. Entrepreneurship in the restaurant business, while growing, doesn t happen without state support and heavy taxation. The Cuban government grants individuals permission to open a paladar and also retains the power to shut the restaurant down in a moment s notice. This instability in permitting combined with a lack of business experience by the owners means many paladares open and close both quickly and frequently. We spoke with Ivan, an employee in a paladar who told us about how their restaurant, while bustling, was forced to close after the experienced manager whose name the permit was under decided to move on. Ivan wanted to continue the operation and rebrand. He and his team slowly made changes to the space doing it all themselves to save costs and he took the time to attend business management courses. Now ready to open, he has so far been unable to secure the necessary permits. His story is a typical illustration of the roadblocks and delays entrepreneurs face in Cuba today. Opportunities Cuba is in the preliminary stage of a significant economic and cultural shift. Our 12-day visit allowed us to observe how a country that was forced to stop in time has made changes in order to sustain itself and its people. We were given opportunities to observe how governmental changes have affected these industries thus far, and we ve caught a glimpse into what the future may hold. We hope to see the strengthening of Cuba s efforts in sustainability, health care, and entrepreneurship in ways that preserve the nation s culture and honor the Cuban identity. On April 11, 2015, President Barack Obama and Cuban President Raul Castro openly met at the Summit of the Americas in Panama. This was the first public meeting of the countries heads of states since the 1960s. The hope sparked by this meeting and the restoration of diplomatic relations has led to speculations regarding an improved economic and social status for the Cuban people. The Cuban people are relentless in their optimism. The changes unfolding could mean that the next generation of Cubans may have a better economic standing than their parents for the first time in over 55 years. Cuban small business entrepreneurs are everywhere: (from left) an open artist market in Havana; a taxi repair man; and an ice cream vendor. For more photos from Cuba see page

5 Simmons goes to Cuba We loved the photos taken by Bing Peng and Louise Sécordel so much that we re taking a page to share even more with you. We hope you enjoy the sights of this special, evolving place. Management Magazine l Fall 2015 The 12-day trip to Cuba is just one of many travel courses and study abroad programs available to Simmons students, both undergraduate and graduate. Whether you re interested in studying, volunteering or getting an internship abroad, Simmons Center for Global Education can help you find the right fit. For more information, visit simmons.edu/cge/study-abroad. 32