Cuba » A groundbreaking dental educational exchange goes to Cuba.

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In March of this year, Dr. Loren Taple of Saint Paul took a group of University of Minnesota School of Dentistry staff and students on a first-ever dental educational exchange to Cuba. This unique opportunity to shed some light on such a closed environment casts a long shadow. As anyone who has ever sought to discover a new world will tell you, you never can tell what shore the ripples will reach. The Editors < features home

NWD: Our readers are fairly familiar with the School of Dentistry's outreach program called the Jamaica Dental Mission, but at its last reporting we were surprised to discover the addition of a mission to Cuba. This has been in the works for how long? How did it even appear on the U's radar screen?

Dr. Taple: Four years [laughs] „ and it wasnÍt on the UÍs radar screen at all. Back in 1999, my wife, who likes to travel to exotic areas, showed me a newspaper article on Americans who had been able to travel to Cuba. And I said, ñItÍs illegal to go to Cuba. Are you crazy?î Famous last wordsƒ

Until just recently, the U.S. Treasury Department would issue a travel license to travel legally to Cuba for one of three reasons: humanitarian, educational or religious. I was able to obtain my own travel license through the Treasury Department for my first trip, and since that time we have used the license issued to the University of Minnesota. It was perhaps two weeks after we came back this March that the Bush Administration dropped educational exchange as a reason to go. Regardless of the new ruling, however, the University did get its license renewed, so the mission will be able to go on.

I started with the Jamaica Dental Mission in 1989 as a student. I joined the UÍs Operative Clinic as a part-time instructor in 1994, and was asked to join the Jamaica Mission faculty in 1995. I have done that every year but one since. I thought perhaps we can work a dental mission to Cuba in there. Based on that, the Treasury Department issued me a license!

My first trip to Cuba was in 1999. My wife and I knew no one, had no contacts, spoke no Spanish. I researched it on the Internet. IÍm Jewish, so I started there. Since the PopeÍs visit in 1998, things have opened a little, but most churches are museums or government buildings. However, and for reasons no one knows, Castro has allowed the Jewish community to continue to operate in one form or another. There are between 1,500 and 2,000 Jews in the entire country. Even during the last 44 years, Havana has maintained a kosher butcher shop and a couple of synagogues. The Internet provided one in our area.

Our first day in Havana my wife and I walked into the Patronado Synagogue. Like virtually every other building in Cuba, its physical infrastructure was falling apart, birds flying around inside, the whole deal. We were directed downstairs, where we spoke with the president of the congregation, Jose Miller, an old gentleman sitting in the hall. He gave us a 90-minute dissertation on the Jews in Cuba, which included the fact that he was a retired doctor „ in fact, an oral surgeon. This man was connected „ through his synogogue, his profession and being a good Communist Party member. He had met Castro and was a friend of the man in the Cuban Health Ministry in charge of all the dentists in Cuba. It took a couple of years, but Dr. Dan Rose and I set up a meeting with Drs. Armando Mojaiber, the National Director of Stomatology, and Sergio Sardina AlayÍou, an official of the Cuban Health Ministry, back in Cuba.

There are 10,000 dentists in Cuba. They do not have an access problem: They tell their dentists where to work. Graduates are required to supply a certain amount of service to outlying areas after they finish training. After that they may move around, though they are ñplaced according to population.î There is one dentist per approximately 1,500 patients, and you go to the dentist in the area where you live.

Our Cuban colleagues were very interested in any outside information they could bring in, and we put together a loose agreement between the U, the University of Havana and the Health Department in Cuba. Dan went back in September 2002 to finalize it. I went in February 2003 to establish the structure of the upcoming trip with the students and work on the itinerary.

The first group of students went to Cuba in March. I took four senior dental students who had been on the Jamaica Mission just prior to this. Travel license or not, you still have to travel through a third country „ Canada, Jamaica, Mexico „ because there are no direct flights.

NWD: How would you compare your objectives for Cuba to those of the Jamaica Mission?

Dr. Taple: Even as so-called ñthird world countries,î Jamaica and Cuba are entirely different from each other. In both places people have access to some level of dental care. In Jamaica, we set up a four- to five-chair operatory in a rural area, usually at a school, with portable equipment and supplies we bring. We see mostly school kids, and try to do comprehensive dental care following a World Health Organization model. The oral hygiene instruction alone is priceless in its long-term effect. In Cuba, they have three dental schools; there are none in Jamaica. Cuba has the manpower and clinics. They get their equipment from Shanghai, Yugoslaviaƒ The problem is, the people donÍt have access to what we would consider the standard of care. TheyÍre a good 30 years behind where we are. The main operative clinic in the dental school uses old Ritter stand-up barber-style chairs. They work, but „ theyÍre not practicing four-handed dentistry or using the latest in materials because they donÍt have access to them. Their sterile techniques are somewhat suspect. At the dental school, one instructor wore the same pair of gloves all day, handling papers and wiping his face. So the thrust of the mission is not the same. We go to Jamaica to work. Cuba is an educational exchange: presentations on new and different products, lectures on delivery systems, meeting with student groups, site visits and working in their dental school clinic. We brought them materials such as composite and sealant and gave them a new 3M cordless curing light. We visited the regional Cimeq (Centro de Investigaciones Medico Quirurgicas) Center, a ñhigher techî clinic for oraland maxillorfacial reconstruction. We were the first American group ever to visit this center. We worked in the Dental SchoolÍs clinic, seeing their patients for the day, which our students found frustrating, to put it nicely. They donÍt, for instance, take a good medical history. It was eye-opening. But that was a good thing as far as learning goes.

NWD: LetÍs talk about the people involved. What draws someone to a project like this?

Dr. Taple: Approximately 20 dental and dental hygiene students go to Jamaica; four continued to Cuba. If they speak Spanish, that certainly helps. (I donÍt speak that muchƒ) We look for interest. One of the objectives of this recent mission to Cuba was to see what kind of a role there could be for hygienists in the Cuba part. They donÍt have dental hygienists in Cuba. The dentists, called stomatologists, do everything. Most of the people going into dentistry there are women.

My history mostly you know. In 1990, I went with another organization, the International Health Service, run by Dr. Harold Panuska, to Honduras, right on its border with Nicaragua during Contra time, and that intrigued me too. With Dr. Rose stepping back this past year from his involvement with University, it was me, Dr. Benijala Salihbegovic, Dr. Scott Rake, Dr. Mark Englestad and Melissa Cozart, from the hygiene faculty, who ran this past yearÍs missions to Jamaica and Cuba. Where does it go from here? [laughs] Well, because of state budget cuts at the U, I was just laid off, and other personnel have left. WeÍll see what happens. It is my full intention to see that these missions do not disappear. They are important and beneficial to the students who are able to participate.

What do I get out of it? Well, I get out of my office for a couple of weeks, recharge; give something back, as corny as that sounds; see interesting places. I think itÍs the same for the other faculty and students. For the ones who have never even been out of Minnesota, it is a journey to a whole other world, like stepping into a time machine. But if you could peel back the layers of time and physical deterioration, you could see what an incredible place this was in the 30s and 40s, before Batista and Castro. Inevitably Castro will go, money will flow back in and things will change. The sad part is that with change Cuba will lose some of the true Cuban flavor that has been so hermetically preserved.

For the last few years the group has been senior dental and hygiene students plus two juniors (one for each week) who learn how the mission operates, act as gophers, sterilize instrumentsƒ They are the continuity for the following year. We ask for essays on why they want to go, and that helps us select the students who can go.

NWD: What do the students get from it?

Dr. Taple: In Jamaica, the dental and hygiene students get a lot of clinical experience taking out tons of teeth (without benefit of X-rays), placing fillings, sealants. So itÍs a clinical and cultural exchange.

NWD: What the average person knows about Cuba is basically „ nothing. What is the country like?

Dr. Taple: Cuba has a 97 percent literacy rate, and probably more museums per capita than any place in the world. There are no advertising billboards, though there are some related to the Revolution. The Revolution continues to this day. The Revolution started 44 years ago; the Revolution continues today „ because if the Revolution was over, Castro would have nothing to say. In every neighborhood they have a meeting area called the CDR, the Committee for the Defense of the Revolution. They all meet once a week at the exact same time throughout the country, and by God you had better be there. ItÍs that committee that decides where you live, the car you drive, the job you get. ItÍs neighbor watching neighbor.

The average dentist gets $160 a year, period. Like everyone else, dentists get ration cards for their pound of beans, rice and pork. There is little if any red meat. They have thriving art and craft markets. One of our students bought a painting for 30 or 40 bucks from a man who quit being a physician because art paid better! The buildings „ here they would be condemned. In Cuba, they have high ceilings, and if your family needs more room, you donÍt move, you build in a half-floor or loft to double your space. There are lots of old American cars. Any new ones are Korean, Russian, German. American cars are pre-1959 „ all still running. ThereÍs no rust down there. The climate is hot and way humid.

Cuba has no formal relationship with the United States. They do have a ñU.S. Interests Office,î which is like an embassy without an ambassador. It is guarded by Cuban guards.

You hardly see any Cuban money in Cuba. Since the Soviet Union fell apart, the Cuban peso has less value than a roll of toilet paper. They run on a three-money economy: the Cuban peso, the convertible peso and dollars. The economy for the most part runs on U.S. dollars. Prices in stores are in dollars, you pay in dollars, you get change in dollars. Everything, even their banks, operates in dollars. The problem is, you canÍt cash a travelerÍs check or use a U.S.-based credit card. You basically have to go there with a wad of cash and hope nobody rips you off, because if they do, you cannot get it back, you canÍt get more and you canÍt have more wired to you. The Cuban people operate with convertible-to-dollars pesos, with an unofficial conversion rate of about 25 to one, so what is worth a buck to me is worth about four cents to them. Castro does allow 200-300 dollars a month to flow in from family members outside Cuba. Without dollars and money from the outside, I believe the whole thing would crumble in a heartbeat. But if you are 50 or younger, with 44 years of embargo, you donÍt know anything different „ and of course it is the people who are getting hurt the most by the U.S. embargo.

NWD: What is the health care delivery system like? Is there a dental community? What is their level of education? Is there private practice dentistry?

Dr. Taple: They do allow dentists to go into private practice „ after the age of 65. [laughter] Of course you have no resources to do it with! So no, it does not exist. There are specialty clinics at the School: operative, perio, pedo, oral surgery, pros, but not much endo. I did visit theirñInternational Clinic,î which is comparable to the Faculty Practice Clinic here at the U. They have an intraoral camera and other high-tech toys. ItÍs for people who can afford it or for those visiting from outside Cuba, though even they have to pay. So even in a Communist society, a little capitalism exists. Otherwise health care and education there is free. With their literacy rate, they are being held back simply by not having the money to implement what they need for up-to-date practice. For example, the Radiology Department at the dental school was one area being ñremodeled,î which is code for the deterioration that isnÍt being fixed. As I said, lack of money prohibits sealants, X-rays prior to fillingsƒ Early detection is not part of their philosophy. [laughs] But they do produce studies that support the way they practice.

The Cubans make do with what they have. They go into dental school right out of high school. Dental education is five years, followed by a required two to three years of service. Is there a dental community? Not exactly. We met with two groups that seemed actually to be the same peopleƒ One was the Federation of Students, and the other was the Union of Young Communists. There is no student dental association or any dental association as far as I know. When they get together it is under the umbrella of what is good for the country or the party. What they wanted to show off was the Regional Oral Maxillofacial Dental Center.

Why do they want us there? These people for the most part do not get to leave the country, and their Internet service is filtered through the Cuban government server. So any time they can get information from outside, they eat it up. It would be nice to bring the educational exchange full circle and bring them up here, but that isnÍt going to happen in the foreseeable future.

NWD: Orient us politically. It sounds like "after Castro" is the scenario that is just waiting to happen.

Dr. Taple: The politics of the place are out there and in your face wherever you go. Walk around anyplace in the U.S. and you wouldnÍt have an inkling about its politics, but there „ you donÍt even have to look for it. If you can gain the trust of someone there and have him or her open up honestly to you, ñafter Castroî is something that most Cubans are looking forward to. Most Cubans with whom I spoke, when they heard where I was from, said ñU.S. is good!î

NWD: What did you take with you?

Dr. Taple: Anything that would fit in a box: amalgams, needles, sealants, anesthetics, lights, gloves, composites. We werenÍt sure what we would be allowed to bring into the country.

NWD: What are the opportunities for seeing the country and other ñspare timeî occupations?

Dr. Taple: We stayed in a hotel in the historic section of Havana, which was nice. They really are restoring these sections of the city. Our nights were free, and honestly, I felt safer walking around the streets of Havana than in downtown Minneapolis. There are lots of police. They donÍt appear to have a lot of crime, because they know they will suffer severely if they try anything. We went to art markets, to their big baseball stadium to see their main team play „ from front-row box seats right next to the first base dugoutƒ for three bucks. It was a lot of fun.

NWD: Is it still their national passion?

Dr. Taple: Well, three-quarters of the stadium was empty. Three bucks is a lot for the average Cuban. After a couple of innings, we realized the first baseman would leave his glove on the base after his team retired and the opposition first baseman would come in, pick it up and get on with the game. But the Cubans are very passionate about their baseball. If you stroll by the central park in Havana you can usually find groups of men having a heated discussion about the recent game.

NWD: What do they need „ from us, from themselves? What would you most like to do for them as ñthe next best step?î

Dr. Taple: With their delivery and clinic system, the best thing we can do is inform them about what is available outside of Cuba and whet their appetites.

NWD: Is this part of a trend to ñopen Cuba?î

Dr. Taple: I guess if the Cuban government did not want it to happen it wouldnÍt be happening. Is it part of some broader loosening? Maybe. When you go from, say, Canada to Cuba, they will make you buy a Cuban Tourist Card at the airport, which they will stamp. They will not stamp your passport. They want Americans there „ to spend money. The problem is, if you are there illegally and have trouble, thereÍs no place to go for help.

NWD: Who else is down there?

Dr. Taple: Canada. Canada built the Havana airport. Nice airport. Lots of Europeans vacation there. The Spanish - they own, partly, a lot of the hotel chains. IÍm not sure how that works because there is no private property.

NWD: How about a language barrier?

Dr. Taple: They do speak English; theyÍre not that closed off. ItÍs required at the dental school.

NWD: What specific focus would you like our readers to have on this experience?

Dr. Taple: I think it is important to have these programs continue, not let them disappear. The value of the Jamaican Mission has been proven, and as for Cuba, there is simply no other place in the world the students could get this kind of experience. While both of these trips operate under the aegis of the University, they are not funded out of University dollars. The students raise all the money through fundraisers, pizza nights at the School, selling safety glasses their own contributions and those of others, including past participants. These student missions are an approved program of the Minnesota Foundation. Consequently, all donations are tax-deductible. Each year costs rise. We expect next yearÍs mission to Jamaica and Cuba to cost about $31,000. The loss of these endeavors wouldnÍt save a cent, but the loss to the students would be immeasurable, and in terms of opportunity missed, the cost could be inclculable. Therefore, to help ensure these trips continue, I have agreed to continue as director of these missions in an unpaid position.

I have thoroughly enjoyed my involvement in these programs and look forward to continuing to do so. I would urge anyone who has the opportunity to do things such as this to go ahead and do them. The rewards you receive from the people you are helping are priceless.

Copyright 2003. Minnesota Dental Association