Review Karen Wolfswinkel

Karen Wolfswinkel, Child and adolescent psychologist NIP/Cognitive Behavioral Therapist VGCT

Inspiration from Cuban Mental Healthcare, 2019

March 2019 I participated in the course on preventive care and the involvement of the community in health Cuba. A course that has exceeded all my expectations. For me it was impressive and educational to experience how Cuban care is organized.

The course was well organized by Dr. Niubel Díaz Padilla and her sister dr. Belniu Díaz Padilla in cooperation with the ENSAP (Escuela Nacional de Salud Publica and Cuba). The theory lessons were given by the teachers of the ENSAP, and in addition there were lectures on current studies, among others by Dr. Belniu Díaz Padilla. There was also explanation on location by doctors and nurses working in the field. Thanks to the simultaneous translation in English with the help of the interpreter, the lessons were interactive and questions could be asked, so that various aspects were discussed in depth.


The course became extra interesting because the specific interests and professional areas of the students were taken into account as much as possible. Both in the theoretical lessons and in the working visits. The combination of theory and practice in the course gives the opportunity to better understand the organization of Cuban Healthcare. I was able to see that health care starts with the family doctor and the nurse associated with him / her. They work together in their fixed neighborhood. They visit their patients once a year whether or not there is an illness. 

The severity of patients’ care needs is assessed by the family doctor and nurse in four groups: the group that is not (yet) ill, with the aim of investigating how this can be retained in the specific situation of the patient. Patients at risk for specific health problems where  preventive and treatment programs are put in. Sick patients who need more research can be quickly referred to the Polyclinics in which the family doctor works closely and the fourth group is the group of patients who, due to the seriousness of their complaints, must be referred to specialized care. I am struck by the personal care that is provided. Family doctors often live in the same neighborhood as their patients and know people personally. There is a cordial and personal contact where I saw how practitioners are respected and how cared for and at home the patients feel with their practitioners. We, as well as students, were received heartily by both patients and practitioners


The visit to the pediatric policlinic in a Centro Comunitario de Salud Mental was a highlight for me. I was warmly welcomed by the child psychiatrist who had prepared case studies to discuss and shared his method with me. I took back to the Netherlands as inspiration the personal way of working of the child psychiatrist, his patience with patients who sought contact with him if not through the door or through the window.  The cosiness in the Cuban waiting rooms is really nice to see. People know each other and chat while waiting for their appointment.

Also at the Hospital Psiquiátrico de La Habana, Havana we were warmly welcomed and shown around. We have learned about the history and structure of the hospital and have been shown around by various departments, where we have been given an explanation of how the hospital works. We were lucky because we arrived on the day that the hospital celebrated the birthday of older> 80 years. We were allowed to attend a big party where patients and clinicians with party hats on dancing to the music of a salsa band. Unforgettable!

What I bring from Cuba is not only my respect for the expertise, efficiency, knowledge and creativity of my colleagues in Cuba, but also the cordial proximity of the practitioner and patient. For me it is an example to experience how heat and proximity in healthcare can make suffering more portable. That it costs nothing and only makes both the practitioner and the patient richer. In addition, I was inspired by the organization in the community and the emphasis on prevention. I am convinced that in the expensive and ever-changing healthcare field in the Netherlands we can learn a lot from our colleagues in Cuba!

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