Participants of a Havana day program for older adults who live alone enthusiastically greeted U.S. social workers who were learning about Cuba’s health care and child welfare systems.

Despite long-term political differences between the U.S. and Cuba, there is a common interest in services to the young and elderly. This year, NASW led two social work delegations to Havana — one in February and the other in March. The trips were part of NASW’s Social Workers Across Nations initiative.

The first group, co-led by Luisa Lopez, director of NASW’s Human Rights and International Affairs Division, and Stacy Collins, an NASW senior practice associate, traveled to Cuba Feb. 13-18 to learn about health and child welfare there.

On their first full day in Havana, delegates visited the national headquarters of the Federation of Cuban Women, an organization endorsed by the Cuban government for improving the status of women in society. The group was instrumental in improving Cuba’s literacy rate, which the United Nations says stands at 99.8 percent — compared with a rate of 99.0 percent in the U.S.

Other destinations included the National Center for Sexual Education and Research, a community-based center for orientation and diagnosis of learning disabilities, a mental health center and the Center for the Prevention of STIs/HIV/AIDS.

But, it was the delegation’s visit to a home for children without family support (Casa de niños sin amparo filial) that was the highlight of the trip for Lopez. She told NASW News that she found both the setting and the children “remarkable.”

“The children there were engaging in a way that even children of the same age who haven’t suffered serious trauma tend not to be,” Lopez said. “That is a testament to the services they are receiving.”

More generally, Lopez said she was impressed by the enthusiasm that Cubans show for their country: “They are committed to working together to ensure that no one falls through the cracks and are convinced they can overcome their difficulties.”

Those difficulties include years of commercial, financial and economic hardship that’s been worsened by the ongoing U.S. embargo, which began in 1962.

Collins said she was particularly struck by the country’s attitudes toward sexual orientation. “They are decades behind the U.S. in terms of acceptance of gays and lesbians,” she noted. And although the Cuban people appear to be very racially and ethnically integrated, Collins said, they still wrestle with issues of race.

Collins and Lopez were enthused by the Cuban health care system, which provides free access for all. There, social workers are considered an integral part of interdisciplinary care teams.

“Care of pregnant women and children is a clear public health priority,” Collins noted. “Every child has access to a pediatric clinic and developmental screening.” Cuba’s infant mortality rate is lower than the rate in the U.S.

Members of the March NASW delegation pose for a group photo.

The second group, co-led by Joan Levy Zlotnik, director of the NASW Foundation’s Social Work Policy Institute, and Chris Herman, an NASW senior practice associate, traveled March 13-18 to learn about Cuban social services for older adults.

NASW President James J. Kelly, a gerontologist, was part of the second delegation and was recognized for his leadership at each site visit. Kelly, who spent some time in the Soviet Union in the 1980s, said he was impressed to discover that “the more stringent level of Soviet controls did not exist in Cuba.” He said he was saddened, however, by the lack of over-the-counter medicines, such as Tylenol, Advil and vitamins, available to Cubans.

The trip included visits to health and social programs serving older adults, including a primary care office, an adult day program and the “Convento de Belen” special project for senior citizens (funded by UNESCO and other organizations). A meeting with an interdisciplinary gerontological care team and a visit to a polyclinic highlighted the value of social work services.

Zlotnik suggested that Cuba may have advantages as a place to grow old. “I was struck by how many of the older adults we met were engaged and happy,” she said. “I got a real sense that older adults are revered in the Cuban culture and there is a strong emphasis on community responsibility for isolated older adults.”

Despite being a poor country, Cubans’ life expectancy is about the same as Americans’ because they have invested in primary care and community-based delivery of health care services, said Zlotnik. “Their focus is more hands-on than high tech.”

For Debra Turkat, a nursing home social worker in Washington, the trip was both a professional exchange and a pilgrimage — her grandparents emigrated from Cuba to the U.S. after Fidel Castro came to power in 1959.

“The trip changed my life,” she told NASW News. “Social workers are well regarded there — they are respected and are given important jobs to do. This was interdisciplinary training at its best, from what I could see.”

Herman said she was impressed that Cubans are more focused on the social determinants of health, and said Americans could learn from the delivery of primary care in Cuba.

“Social workers are found in every primary care setting,” she observed. “I’d like to see the U.S. head in that direction.”

Both groups met with Odalys Gonzalez (right), president of the Cuban Society of Social Workers in Health Care, a member of the International Federation of Social Workers.

Learn more about Social Workers Across Nations.