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HCC program director participates in Cuban exchange by Cindy Abole Public Relations Last December, Hollings Cancer Center's Colleen Corish accepted an invitation of a lifetime—the opportunity to spend time in a place where few Americans have had a chance to travel.  The new clinical services director of Oncology and Medical/Surgical Services was among 10 American health care professionals invited to visit Cuba as part of an ongoing cultural and educational program. The exchange was organized by the Oncology Nursing Society and People to People International's (PTPI) Ambassador Program, a program first created in 1956 by President Dwight D. Eisenhower. Colleen Corish, left, and a Cuban nurse at one of the country's concultorios (clinics). Corish and others joined an oncology specialty delegation organized to enhance international understanding through education, humanitarian and cultural exchange. For 45 years, the PTPI Ambassador Program has matched officials, representatives and counterparts with delegates from many countries to inspire professional growth, networking and other key experiences.  Participants had to raise more than $4,000 to cover travel and program expenses. Corish received some support through educational grants from the Hollings Cancer Center, MUSC/UMA,  Ortho Biotech, Novartis and Amgen. Delegates were asked to document their eight-day trip and later recorded their daily activities online. “This trip was a great opportunity to observe and learn more about Cuban health care practices, especially oncology nursing, under a still closed society,” said Corish, R.N. Cuba is considered a third-world communist country and had undergone a tumultuous political history and struggle which climaxed with the country's Communist Revolution in 1959. The following year, President John F. Kennedy banned U.S. travel to Cuba. More than a few decades later, Corish and a growing number of other American policy makers and business people have traveled to the Caribbean nation, just 80-miles beyond Florida's southernmost coast.  This group was composed of people with diverse origins, talents and knowledge. Together, the team accounted for more than 25 years of oncology, medicine and other health care experiences. One Cuban-born team member was returning to her birth country for the first time. Several delegates shared their fluency in Spanish and were a great asset to the team in helping others relate and interact with their Cuban counterparts. The delegation met with government and community health care leaders, plus physicians and nurses. Guided by both government and travel escorts, the team traveled the flat and rolling terrain of four of the country's 14 provinces to observe and evaluate medical care and the entire nursing process for a country of 11 million people. Corish and several PTPI Ambassador Program delegates visit a pediatric ward at the Hospital Ortopedico in Cuba. Visits included stops at the Institute of Radium, the country's national cancer center; the Clinical Research Center, an orthopedic hospital, plus numerous consultorios or community clinics and specialized polyclinics. The Cuban health care system is organized in the shape of a pyramid. At the base are the consultorios, which are clinics staffed by a physician and nurse team who provide primary and preventive care within specific communities. Patients can visit the consultorio during morning hours, while afternoons are usually reserved for patient home visits. Typically, a consultorio team can provide health care for 500 to 700 people. For testing and specific medical needs, a patient is referred to a polyclinic and often accompanied by the community physician. A polyclinic can host patients from as many as 30 or more consultorios, thus providing care to about 20,000 people. The team also visited the National Institute of Oncology and Radiation, an organization that maintains a national cancer registry, helps to establish standards for cancer care in Cuba and directs investigations to new treatments and therapies. For Cuban males, the most common cancers included prostate, lung and bladder, according to one entry submitted in the group's Cuban delegation Journal. For women, breast and cervical are most common. Cancer screening guidelines were unconfirmed. However, women are taught to conduct a monthly self-breast exams. For women past age 40, physicians conduct a risk factor assessment to determine if a patient needs early mammography or an ultrasound evaluation. Mammograms are conducted every three years for women between the ages of 50 to 65. Within one specific polyclinic area, the incidence of breast cancer is 64/20,000 women. “The affection and respect that the members of the health care team had for each other were obvious in the way they interacted,” Corish said. “It appeared to us that they enjoyed their work and truly cared for the welfare of their patients. They believe strongly that communication with the patient and family members is a key component to holistic health care.” In Cuba, cancer treatment is basic. Nurses usually administer chemotherapy in the hospital. Often in early stages of the disease, the team may visit the patient and family at home to discuss a patient's diagnosis and prognosis. Terminal patients may choose to receive chemotherapy or other treatments at home or at the cancer center. Another journal entry focused on the credibility of health care as a career choice. By all accounts, physicians and nurses are occupations very respected by the Cuban people. Education for nurses is free, as long as they commit to work two years in an underserved area of the country. In great contrast to their American peers, Cuban physicians and residents earn an average of 325 Cuban pesos per month (about US $40-60), although specialists may earn more through bonuses. Nurses are paid about the same salary as physicians. But in a communist regime, these health care professionals pay no taxes, utility bills or housing. But this experience was not all hard work. Inescapable were the lively sounds and dances, spicy smells and savory tastes of a passionate Latin culture. The group toured other historic places like Revolutionary Square, Old Havana, the Castillo de la Real Fuera and the famous Tropicanna Nightclub. They dined on a variety of native and Caribbean cuisines that helped to influence their Cuban experience. “I feel so fortunate that I was able to participate in such an experience,” Corish said. “This opportunity made me feel very grateful for what we have in the U.S...for the freedoms and resources that we enjoy. But it also taught me to respect a culture that demonstrates the ability to do so much with so few resources and money. This experience had a major impact on me both personally and professionally.”