Cuba Health Promoter Sowing Life

Dariela Aquique 

Yoire Ferrer

HAVANA TIMES, Sept. 20 — Perseverance in saving human lives is one of humanity’s noblest acts, and the Cuban public health care system is distinguished for its precepts in this sense.

Despite its having to negotiate shortages of resources and personnel, which on occasion have to do more with political ideology than with its social mission properly speaking, the decisions and work put into practice in this field are praiseworthy nonetheless.

Among those who stand out in this are health promoters, positions created to conduct prevention work among the public mainly related to issues of sexuality.

Yoire Ferrer is one of these individuals who has been raising consciousness about responsibility among people.  In this interview she shares some of the details of her work.

HT: Basically, what is a “health promoter”? 

Yoire Ferrer: A health promoter is a person with capacity and judgment who receives training related to various types of illnesses, epidemics or specific events so that they’re enabled to promote, prevent and investigate the problems of health in a given community or in a certain population.  In this, the promoter develops certain communication skills in terms of public health and abilities to relate to the population.

Health Promoters in Santiago de Cuba

HT: This is an initiative practiced in many parts of the world.  However in the case of Cuba, it must have distinctive shades.  Can you speak about this?  

YF: In the case of Cuba, health promoters have the peculiarity of their not receiving any wages for the work they carry out.  They are people who participate voluntarily or who want to collaborate so as to share their knowledge and experience in informing the public about health care services and self-care approaches, as well as how to generally improve the quality of people’s lives.

HT:  Why is it precisely the LGTB community, and especially within it the group of MSMs (Men who have sex with men), to which greater attention is given in the field of prevention? 

YF:  Men who have sex with other men is the group that is most affected by the HIV epidemic.  Because of this, efforts toward prevention and the promotion of self-care have been directed basically at this group.  Also, risks are increasing among these individuals because there are greater vulnerabilities among them (biological, social, epidemiological and psychological risks), and this plays a preponderant role in the spread of HIV/SIDA.

The social exclusion that this group has endured for such a long period has worked to influence it, compelling them to carry out sexual acts in settings that are non-conducive to health, sometimes in clandestine conditions so to speak, and this makes them tend not to insist on using condoms, for example.

Poster from the campaign directed to men who have sex with men.

HT:  Are health promoters well received by the public or has there been a lack of work in this area to raise their awareness?  

YF:  In the more than 20 years of the AIDS epidemic, work by the volunteer promoters in Cuba has been increasing in numbers every year.  These are grouped in work areas that consist of the following:

1 – Teenagers and children in the prevention of HIV/SIDA

2 – Men who have sex with other men (MSM)

3 – Women in the prevention of HIV/SIDA

4 – People who practice transactional sex or prostitution, or people connected to prostitution.

5 – People who live with HIV

I should add that promoters see to the social marketing of condoms.  In addition to the existence of a much more integral and refined profile in terms of prevention, there are various forms of communication (telephone, postcards, face to face and anonymous contact).  These of course allow the voluntary promoters to feel much closer to their population group.

As for education we approach this between pairs, or as equals (a methodology introduced in this country more than a decade ago after having being drawn from experiences in the United States).

We have been introducing these techniques gradually, and they’ve generally had a good reception on the part of the public.

HT: What do the statistics look like right now regarding sexually transmitted illnesses and HIV in the country, and especially in Santiago de Cuba, the municipality with the greatest population on the island? 

YF: The rhythm of the epidemic here is not so different from what is occurring right now in the great majority of countries, although the situation in Cuba is not comparable with other situations given the benefits and treatment that people who are sick here receive, both in sanatoriums and as out-patients.  This makes the number of cases much smaller in relation to other countries.   

HIV AIDS test results.

However, I can verify that the epidemic is growing, and every year the number of diagnosed cases is larger because the active search is very refined – despite the prioritized attention and effort made by the Cuban government.  I can’t say anything more about this, the statistics are not public.

HT:  The cases of HIV in Cuba are running in high figures.  However to counteract this, the Cuban government and of course its health care system has prioritized the creation of an entire mechanism for extenuating this malady.  Could you discuss some of the elements that exemplify this?  

YF: The Cuban government allocates considerable resources in educational programming and in prevention – like, for example, the purchase and subsidy of condoms as well as supplying all those with HIV who need anti-retroviral medicines (which are extremely expensive).  The Cuban government gives these away for free in very public campaigns directed at vulnerable groups.

Multi-sectorial work is one of the priorities and directives of the government for prevention work on the job or as a multi-sectorial response to the epidemic.  What prevails is the concept that public health is a social product and therefore the public should assist with this situation.

HT:  Do you think that the campaign against homophobia being waged by the Center for Sexual Education (CENSEX) is geared to dealing with individuals with AIDS and HIV in the country, as this is the community most inclined to infection and the transmission of these illnesses? 

YF:  CENESEX, as the center for educational work around the acceptance of sexual diversity, is also addresses the issue of AIDS prevention since this is a fundamental aspect of the work education concerning sexuality.  In this way it serves to reduce the levels of stigma and discrimination against the LGBT community.

Transvestites at a cultural gala against homophobia.

HT: Your work hasn’t limited you to solely being a health promoter; you’ve delved into teaching, research and even the world of art to ensure that the message and healthy advice concerning sexual education gets out to everyone.  Does this have to do with your personal experience?  

YF: Personally, I do this job with much love.  I especially want to transmit things from my personal experiences to other people.

HT: Viviendo al limite (Living to the limit), is a feature film of short testimonials that was realized in Cuba under the artistic baton of director Belkis Vega.  Its art direction appealed to a quite novel resource known as the technique of “Playback Theater” or spontaneous theater.  This was brought here by one of the instructors of her international network, a US citizen named Susan Metz.  In this movie you played a leading role.  Tell us about that experience?    

YF:  In the beginning, when the whole process of the documentation and organization of the movie was beginning, I recognized that I didn’t feel confident or sure that this project would be successful, because I always thought that far from exhibiting the experiences lived by a person with HIV, in the way represented through the technique employed — Play back — it seemed like something very crude and that it could in a certain way promote compassion but that it would be far from engendering understanding.

But after getting involved in the project I understood that “Living to the Limit” was the ideal approach for putting discrimination to an end for once and for all, and that it would also open new horizons in relation to understanding those who live with HIV.

Despite this being a bitter and dark tract in these people’s lives, they also learn how to take care of others, they have dreams and they don’t lose the capacity to love, to feel, and to be a part of this social world.

HT:  As a consequence of the work that you carried out, you’ve had the opportunity to travel to other countries.  Have you been able to verify if Cuba truly ranks among the nations that exhibit high indices of quality public health care? 

YF:  The Cuban situation around public health is different from the rest of the world in the most positive sense we can establish.  I’ve had the opportunity to visit other places and I assure you that the situation of Cuban public health care is very positive, even when it’s compared to countries that also have free health care.

HT: You’re a graduate in the English language; however you have now gone many years without exercising it, dedicated entirely to this aim of health and disease prevention.  Do you feel satisfied?  

YF: I’ve had to force myself to learn many things about health.  Yet in the end I’ve been able to enter this world, but I have to admit that now I don’t know if I’m qualified to work in anything else.  Still, I also have to admit that my interest in languages has not slackened, and in a certain way when I have the opportunity to develop my knowledge in that field, I do.  Today I have a master’s in health promotion.  This was difficult to achieve, but it has provided me with essential knowledge for the work I carry out.

The reality is that this country experiences an eternal dichotomy.  On one hand it aims to put into practice an efficient health care system, one which it brags so much about.  But on the other hand there is the marked tendency for circumspection, which is evidenced for example in the fact that the interviewee can’t give figures concerning the rate of growth in the numbers of those people who are sick from HIV.    

Still, this man puts his own professional interests aside because he considers this work his mission.  He struggles daily to preserve lives and teach others how to do it; and in this way continues… sowing life.