The Paternalism Test

Maria Matienzo

I’m not going to write about a man and a woman who after one night of passion and nine months of waiting are about to have an unwanted child.  My intention is not to go into the insecurity of a father who wants to know whether it’s his child or not.

Nor am I writing about other parents who overprotect their kids so much that they end up controlling their children’s experiences and, by extension, their lives.

Well, perhaps this story does deal with overprotection, or the low awareness people have of other people’s “bubble,” which is to say their boundaries and the respect we should have for the decisions of others.

This is why I must comment on the scope of Cuban medicine, given its status.

When the family doctor program first began it was set up so that everyone had a kind of a nearby doctor who they could turn to for any ailment.

In each province there were thousands of them, in each municipality hundreds, and in every neighborhood (depending on it size) there could also be a hundred doctors.  Within a manzana (a four-square-block neighborhood) you could wind up having four or five, and one or two physicians on a single block. (*)

Houses were built in which there lived and worked a doctor and a nurse, and where a specialist would visit once a week on rotation.

At the beginning it worked marvels.

However with the country’s fever for internationalism and solidarity, we were slowly finding ourselves left without doctors.  They were no longer so common in the neighborhoods, and even less so at the block level.  One can now find the old “doctor’s houses” (as they’re commonly called) closed or boarded up.

Nevertheless, the obligations of physicians did not decline.  They continued being the highest authorities in terms of hospital referrals, keeping up on all deaths in a neighborhood or how many pregnant woman were on the block, as well as everything from cases of HIV to breast cancer.

Let me explain.

One doesn’t just go to a clinic and that’s it.  No.  You have to first go to your “family doctor” to be able to move up to the next rung of Cuban medicine (well, unless you have a good friend; a good friend who can get you special treatment).

It even occurs this way with a vaginal smear test.

Smear tests consist of extracting fluid samples from the neck of the uterus in an effort to prevent uterine cancer.  This will involve medical personnel alerting you of any infection that’s contracted through water or simply by sitting down in the wrong place.  These exams should be performed biannually starting at age 25.

With that brief clinical and social explanation, I believe I can begin my story.

It turns out that the last time I went to the doctor for those necessary procedures, I experienced a mystery.  I had to lay down in a small room with three doors: one leading to the doctor’s office, one to a medicine supply room and another one that led to the patient’s waiting room.  Everything would have been fine except that none of the three doors had locks.

So, with my nerves on end, I undressed and waited for the nurse to appear (they’re the ones typically responsible for conducting the test).  With little pieces of paper, she jammed the doors shut and as I got set for the procedure she blurted out, “Let’s hope nobody comes in! Later the nurse accidently threw away the sample and then literally picked it up out of the garbage.

But the main character in my story is not me, it’s the person who I’ll describe using the initial “P.

P didn’t want to take the test because she’d already experienced her own terror-filled incident.  What happened was that when she refused to take the test, they had threatened to take her to the police or to fine her or to put her in jail for the equivalent of the fine (meaning that if she were fined three hundred pesos, for example, then she’d be jailed for three hundred days).

When P told me this, I roared with laughter, especially concerning the pressure that people were exercising on her because they were convinced that the authorities were going to apply the nonexistent law against her.

The story seems absurd, right?  But it’s also true.  Of course nothing happened in the end.  P signed a waiver affirming that under her own recognizance she would not take the test, and everything was settled.  But what was astounding was that the threat of fines and jail time came from the mouth of the same nurse, who —being familiar with some of Cubans fears of— used them agains)t P.

(* Cuban political organization is geographically distributed by provinces, municipalities, neighborhoods and blocks.