Cuba
By: Bianca Carreira
Location of the Island and the most important political
influencers: Fidel Castro and Che Guevara
Migration
While Cubans steadily immigrate to America, four distinct waves of migration have occurred
since the 1960s: Post-Revolution (1959-1962), Freedom Flights (1963-1975), Mariel Boatlifts
(1980s), and Balseros (1991).

Large-scale migration of Cubans to America began during the 1959 revolution when Fidel
Castro overthrew the existing government and installed a communist regime.

From 1965 to 1973, over 300,000 Cubans were flown to Miami as part of a governmentsponsored program, mostly wealthy supporters of the former government and businessmen.

Discontent with Castro regime, the poor economy, political persecution, and the lax stance on
immigration in America led to boat migrations of hundreds of thousands of poor Cubans during
the 1980s.

Cubans are treated with special status by the US government, which offers permanent
residency to any Cuban living in the USA for one year.

As of 2013, 1.1 million Cubans reside in America representing 2.8% of the US immigrant
population. The vast majority of Cuban-Americans live in Florida, mostly in the Miami area.

Currently, with Cuba-America relations going very well, many Cubans are flocking to America
for fear that the longstanding lax immigration policy may get stricter in near future.

Cuban Heritage

Before colonization Cuba was occupied by natives Indians, primarily
fishermen and hunters (Giger, 2013, p. 648).

Cubans are multi-ethic nation.

Colonized by Spain, from 1492 to 1898.

During the early sixteen century the first slaves from Africa arrived in the
island. Slavery was only abolished in 1886.

Chinese workers were brought to the island to work in the sugarcane fields
(Giger, 2013, p. 648).
Religious Practice and Rituals



Cuba is considered a Catholic country and has Our Lady of Charity as their patron.
Santeria - Afro-Cuban religion which is a combination of Catholicism and African native
religions. Practiced even by Catholics.
The atheist population is growing, especially among the young adults.
Santeria


Beliefs each person is born under a guardian that should be worshiped during life.
Santeros and Babalawos (head of the practice) specialize divination to predict the future and
interpret significant omens in the consultant's life (Godoy & Martinez, 1995).
Language and Communication
Spanish is the official language, quite a different dialect than in Spain.
Difference ethnic groups have influenced speech pattern but English is widely
spoken in Cuba.
 Accents and expressions varies according to region.
 Gesture and facial expressions are commonly used.
 Tend to be in a close range when conversing, one foot apart.
 Bluntness and directness of low-context communication styles can seem
insulting or aggressive. The meaning of everything said in high-context
communication has to be interpreted in the context of the social relationship
between the individuals (Williams, n.d.).
 Upon arrival hand shake and kiss on the cheek as a greeting.
 During health care visit if patient speaks Spanish only, Cuban translator is
preferred due to their dialect.


Customs and Traditions
Cuban customs and traditions have been shaped by its melting pot of Spanish, African, French, and
Native heritages, religions, and influences.

Much of family and cultural history is handed down to younger generations through storytelling and
song, not written.


Music, dance, and art are extremely important parts of Cuban culture.
Cuban cuisine is a creative, unique fusion of the cultures (mostly Spanish and African) represented in
the population and its tropical location but is based mostly off of rice and beans.

Carnival, marking the commencement of Lent, brings with it many days of celebration and festivals.
Complete with parades, costumes, dance, music, food, and rum, Carnival is the ultimate in artistic and
cultural expression in Cuba.

Many religious holidays and rituals are celebrated throughout the year for followers of Catholicism or
Yoruba, like the May Pilgrimage to the Cross, the Day of the Dead, and the Feast of St. Lazarus.


Most Cubans engage in the playing of Dominos on the streets and smoke the island’s famous cigars.
Gender Role

Cuban laws grant gender equality raising children, in the household, in school
and pursuing career.

Women still have the expectation to perform all the domestic chores.

Women cover about 70% of health care workers, including doctors but are
under-represented in the military and government.

Girls that are in the age of dating are chaperoned by a family member, but not
boys.

Women are the emotional provider and mediator (Culpepper, Currier, & Diaz,
2004).
Family values and head of households

The man is considered the head of household.

Women have “maternal obligations” such taking kids to doctor’s appointments,
parent’s meeting, and kid’s hygiene.

Kids are raised and cared for by parents and grandparents.

Older children help with the care of younger siblings.

The community is considered part of extended family and also reinforce kids’
education.

Often grandparents live with their children and grandchildren.

The elderly are respected and consulted for family decisions.
Healthcare practices and rituals

Mind, body, and spirit are connected.

Illness may be caused by supernatural forces or an imbalance of mind, body
and spirit. Santeros can give herbal medicine or offeringss can be made to the
patient’s guardian in exchange for a cure.

Health care in Cuba is considered a human right for all citizens, with emphasis
in prevention and primary care (Iatridis, 1990).

Homeopathic medicine using food, plants, and herbs to treat patients is often
prescribed by physicians. Ex: mixture of banana leaves and eucalyptus for
asthma, Belladonna plant for fever, and passion fruit for hypertension.
Pharmacies carry all the herbal medication.

Acupuncture is highly used in hospitals for pain management and stress relief.
Health Traditions

Religion plays a big role such as ornaments used as necklace and bracelets to
maintain body and spirit health.

Older generations are consulted how to treat an illness and minimize an
undesired side effect.

Vaccination is free, and polio, TB, diphtheria, measles, and mumps are
eradicated.

Macrobiotic diet is commonly use among people with autoimmune disorders.

Bach therapy uses florals and plants extract to maintain body homeostasis.

Pelotherapy is the use of “healing clays” to detox and improve immune
system.
Health risk factors specific to cultural background

Cardiovascular disease (CAD) and diabetes are the leading cause of deaths
among Cubans, followed by cancer and non-communicable diseases such as
immune disorders, congenital abnormalities etc. (World Health Organization,
2015).

Poor dietary patterns, tobacco smoking, and physical inactivity contributes to
the higher incidents of CAD, obesity, hypertension, and diabetes.

The top five leading causes of disability are are major depressive disorder, low
back pain, iron-deficiency anemia, adverse effects of medical treatment, and
diabetes mellitus (GBD Profile, 2010).

Higher rates of Alzheimer’s diseases.
Fertility practices and childbearing practices; views of pregnancy

Contraceptives are widely available for any women of majority age (16 years old).

Sexual education, family planning and pre-natal care have a big place in Cuban’s health care
system.

Abortion is legal and free.

Pregnancy among teenager has increased due to liberation of sexuality.
Birth related rituals (Spector, 2013, p. 143):

Avoid loud noises and looking at deformed people when pregnant

Stay home for 41 days

BCG at birth

Babies are weaning from the breast to bottle and introduce to solid foods at an early age
(Giger, 2013, p. 652).
Responses to aging

Cubans have great respect for the older generations in their society.

Approximately 90% of elderly people live with other family members (Gondar & Negrín, 2000).

Over 33% of Cuban families have at least one member who is over 60.
Family is the foundation of the support system of the elderly, and are not just there as
caregivers.


Nursing homes are used if family is unable to provide care (Giger, 2013, p.652).

Community and neighbors often take part in educational and recreation activities for the elderly.

Rich tradition oral histories is centered on the elderly who are revered in this sense.
Children of older Cubans often reconnect or reestablish close relationships even if they haven’t
spoken in decades as a sign of respect as their life comes to an end.

Death rituals
In Cuba wakes are usually held at a funeral home within 24-hours of death as there is no
refrigeration and embalming is uncommon.

Most are buried in an unassuming wooden casket. Those of wealthier or political status usually
have a casket adorned with the Cuban flag and more showy decoration (Härkönen, 2011).

The entire family attends the services. Sons and daughters who may have had little contact with
parents always attend as it is feared the spirit of the dead will haunt them in dreams.

Burials take on more of a religious tone despite the fact that Cuba is socialist, usually provided
by the Catholic Church, but this does not bother those of other religions. Cubans in general believe
any religious ceremony bears with it blessings (Härkönen, 2011).

Cubans are buried in vaults above ground. The family must remove the body from the vault after
three years.

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Many believe in reincarnation and post-mortem contact with deceased through a medium.
Visits to cemetery on certain days offer the chance to “speak” with the dead and ask for specific
miracles to be performed.

Responses to death and grief
Do everything possible to keep patient alive, DNR suggests giving up hope or
abandonment.
 Hospital care is valued over dying at home (Giger, 2013, p. 656)
 Post mortem priest or santero is highly involved in the funeral plans.
 Public expression of grief is natural among women, and men are more likely to
hold back.
 Kids are buried in white coffins.
 It is expected that everyone who knows the deceased to participate in the
funeral service before burial.


A Catholic Mass is celebrated 9 days after death.
Cultural responses to health care and Illness

Blood transfusion – 1 in 20 Cubans donate blood in a regular basis, and blood
transfusion is well accepted when in need.

Organ donation is accepted and promoted in the Cuban culture. They face a
challenge in case of brain death, as many Cubans believe a miracle can happen,
and donating organs from a patient with a beating heart can be considered
giving up.

The majority of Cubans are in favor of organ transplant and believe everything
has to be done to avoid death.

Kidney transplant is the most required organ and common practice in Cuba
when a family donor is a match, but Cubans that migrate to America can
encounter some difficulty to receive organ transplants. Usually their families are
back in Cuba, and due to political relations, medical files cannot be exchanged.
Cultural responses to health care and Illness


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Santeria practices or magic rituals are often used to resolve conflicts both
within and between persons. Herbs, roots, and flowers are used for
rituals. Animals can be sacrificed in rituals where the practitioner is
cleansed-the evil supposedly passing from the victim to the animal
(Godoy & Martinez, 1995).
Family stays with the sick family patient until recovery, taking turns with
their community if necessary. Patient needs emotional support for
successful recovery.
Diseases related to homosexuality are not spoken about among family
and friends.
Responses to health care providers

Cubans have a strong family nucleus. Family is involved in doctors
appointments and nursing teaching. Patient’s privacy from family is not
required and can be considered disrespectful to the family, except with
issues involving sexuality or terminal prognosis.

Often patients requested the health care providers’ opinion about the
treatment course. “What would you do if it was your mother?” They
also consult with family members, and even the Santero, if they
practice that religion.

During a nursing assessment eye contact has to be maintained as a sign
of respect. The lack of eye contact is considered poor care for their
well being.

The proximity during the first encounter it is also important and is
viewed as interest about what they have to say.
Responses to health care providers

Cubans respond well to therapeutic touch and view physical
contact with health care providers as a special bond, meaning
care is exceptional.

Cubans do not discriminate between health care gender, as the
majority of health care professional in Cuba are females.
Concept of time

Cubans have a linear view about time and are commonly late for appointments.

Cubans that became more acculturated to the United States have a better
adherence to scheduled appointments (Giger, 2013, p. 654).

Nurses should assess the Cubans’ level of acculturation and altered the care
based on patients’ orientation to time.

They are more likely to have prescription medication and less likely to visit an
emergency room than other Hispanic group (Giger, 2013, p. 658)

Cubans value the use of holistic medication which can delay health care, and can
lead to a late diagnosis.
Nursing assessment of Cubans

Nurses should assess patient level of acculturation.

Provide interpreter if necessary.

Be personal, maintain eye contact, use their first name, and
avoid big distance during assessment.

Ask about cultural practice, such as the use of herbs, plants, or
any other holistic treatment.

Accommodate patients cultural needs, such as the use of
religious objects.

Teach patient about the importance of follow up care.

Personal questions related to sex should be asked in private.
References
Cuba: WHO statistical profile. (2015). Retrieved April 11, 2015, from
http://www.who.int/gho/countries/cub.pdf?ua=1
Culpepper, L., Currier, B., & Diaz, M. (2004). The Cuban American with depression in primary care.
Journal of Clinical Psychiatry, 6(5), 213-216.
GBD PROFILE: CUBA. (2010). Retrieved April 11, 2015, from
http://www.healthdata.org/sites/default/files/files/country_profiles/GBD/ihme_gbd_country_repor
t_cuba.pdf
Giger, J. (2013). Cuban American. In Transcultural nursing: Assessment & intervention (6th ed., p. 648658). St. Louis, Missouri: Mosby.
Godoy, A., & Martinez, R. (1995, March 1). SANTERIA RELIGION Afro-Caribbean Religion Specifically
Cuba. Retrieved April 11, 2015, from http://cuban-exile.com/doc_326-350/doc0337.html
Gondar, A., & Negrín, E. (2000). Aging in Cuba: Realities and challenges. Retrieved April 13, 2015, from
http://www.medicc.org/publications/medicc_review/I/aging/html/aging_in_cuba___.html
Härkönen, H. (2011, July 26). Funerals in Socialist Cuba. Retrieved April 13, 2015, from
http://www.academia.edu/3077440/Funerals_in_Socialist_Cuba
Iatridis, D. S. (1990). Cuba's Health Care Policy: Prevention and Active Community Participation. Social
Work, 35(1), 29.
Williams, S. (n.d.). Appreciating Cultural Diversity. Retrieved April 11, 2015, from
http://www.wright.edu/~scott.williams/skills/culture.htm