In view of the warm acceptance bestowed upon the Memoir of our hospital, published in 1969, which comprised general data on the different activities carried out between 1966 and 1968 by our hospital, aside from the activity displayed by our Outpatients Dept., and due to the deep changes we have made in medical care of in and outpatients, we believed it advisable to bring forth this new Memoir, which covers our work between 1966 and 1970, giving a clear insight of the changes made, and, at the same time, outlining our future plans on psychiatric assistance.
The past eleven years have witnessed our never-ending battle to give adequate care and comfort to the hidden, forgotten and despised mass formed by the chronic cases of the mentally diseased; from the view point of professional care, they are, throughout the world, the most discriminated. Cuba was no exception; we could, even more, add, that perhaps it was the only country where the chronic cases of the mentally ill had to suffer maltreatment.
The revolutionary process has given us the opportunity to test new methods that have revolutionized the established procedures in the handling of chronic cases; we have strived to make them regain their self-respect by respecting them, to give them back self-esteem by appreciating them; we have given the chronically ill a job, or occupational therapy, which makes them feel useful because of their ability to create, and we have also succeeded in our effort to return them to community life in the best possible condition, even more so when the use of psychotropic-drugs allows them to lead a life free from mental symptoms. The creation of various rehabilitation centers, within the hospital proper and away from it, has been the key in reducing to a minimum the impairment caused by mental disease, and has also paved the way for the return of many patients to their communities; in other words, we have successfully developed the so-called tertiary prevention.
From the criteria which classify psychiatric assistance as primary, secondary and tertiary prevention, we can say that as far as tertiary prevention is concerned, our institution wholly fulfills the set standards, based on the rehabilitation, moral support and follow-up of the mentally ill.
We can, furthermore, ascertain that the work activity displayed by our Outpatients Psychiatric Assistance Commission, has thoroughly touched all points outlined from primary prevention; in unison with work and educational centers, and political organizations, it has been making countless efforts along this line, aside from the work, already underway, on mother-child and students hygiene.
On secondary prevention our Outpatients Psychiatric Assistance Commission has done a good job. Our Outpatients Department enables us an early diagnosis and treatment of the mentally diseased; the work of our teams at the "policlinicos" (emergency hospitals) and zone hospitals covers the community needs on psychiatric assistance, preventing, whenever possible, the patient's hospitalization; we do not wait for the patient to come for help, but rather, through this work we attempt to make early detections which allow early treatment.
The creation of monstrous-sized institutions at the country's capital is one of the worst items among our inheritance from the past so-called republican period; at these places, far from their hometowns, the patients were soon forgotten by their relatives and remained in a state of complete oblivion. At present, the Ministry of Public Health has engaged in a policy of zone-wise psychiatric assistance, which, in simple words, just means bringing teams into the different country areas.
As stated in our previous Memoir, if a country's cultural advancement can be measured by the professional assistance to its mentally ill, our Revolution has then brought our country to a high position by dispensing the proper medical and psychiatric care among its people.
Havana Psychiatric Hospital Havana, Cuba, 1971.
HISTORICAL REVIEW
At the presentation of this Memoir of the Havana Psychiatric Hospital (Mazorra) we must take a retrospective view of the Mazorra of yesterday, in the colonial period, under the rule of Spain, as well as in the so-called republican period, under capitalism, to compare it with the Mazorra of today. We attempt to show the whole world what it means to rescue and change for the better something so opprobrious and tragic and transform it into a pride of our socialist fatherland.
THE HOSPITAL IN THE COLONIAL PERIOD
If a visitor to our hospital steps in front of the administration building, he can read a marble plaque at the top of the main entrance that states the hospital was founded in 1857, built by order of the then Captain General Jose Gutierrez de la Concha, Governor of the Island. Before that time, in 1826, the insane persons were interned in the St. Francis of Paula Hospital, through the intervention of Bishop Espada, and also in the old St. Lazarus. Hospital for the lepers, where isolated departments were fitted for the mentally ill.
This proves that ever since then the principle of hospitalization for the mentally ill was established, even though the places were not suitable for these cases.
Encouraged by Bishop Espada's work, the inhabitants of Havana gave donations for the building of a house to shelter the mentally ill; this building was located on the grounds between the Espada Cemetery and St. Lazarus Hospital; it was named St. Dionisio Hospital. The mental patients remained there until 1829, when they were transferred to the Foundlings' Home, but this place was also inadequate for them.
It can be said that, since then, as a result of the, solution given to their situation, the most dreadful tragedy for the mentally ill began. On October 1851, the Director of the Foundlings' Home pointed out the need of selecting a better place for the hospitalization of the mentally ill; and, in 1854, the board appointed to that effect bought what was called "Potrero Ferro", a piece of land owned by Don Jose Mazorra, close to the city of Havana and present site of our hospital.
Since that date until the end of the colonial period the characteristics of the afore-mentioned insane asylum were not exactly those of a hospital for patients, but those of a corrective house, since vagrants and individuals with very bad records were also sent there, thus establishing a horrible promiscuity in spite of the protests of the scarce physicians. To summarize, we transcribe the following paragraphs from Dr. Domingo Mendez Capote:
"It is a typical case in which, in a concrete way, all the facts that began creating the Cuban conscience to the point of declaring a complete and absolute incompatibility between the Spanish administration and the welfare of the country can be studied, thus placing, in an irreconcilable way, the weapons in its children's hands.
"We cannot say it is an asylum or a house of cure, it is no more than a Spanish jail, with all the horrors and all the attacks to nature, to morals, to hygiene, and to life. The poor insane, in his horrible promiscuity, lacks everything: cleanliness and food.
"There he lives, if that can be called living, surrounded by his own excretions; just to receive as food boiled rice and chick peas, cooked once a day to save fuel."
THE HOSPITAL IN THE REPUBLICAN PERIOD
If horrible was the way the patients were treated during the colonial period, it was worse in the wrongly called republican period, and even more so under the infrahuman conditions during the period of the Batista dictatorship (when even the more elemental human principles disappeared), and only for a few exceptional, and always short. periods. were those conditions somewhat bettered in times of the Republic. Mazorra became a sinecure where politicians without scruples stole the people's money without taking care of the most elementary needs of the patients.
As could be expected, during this period luxurious and comfortable private hospitals, for those that could afford their high prices, began to appear; because the ruling class had solved even this aspect of its problem, while the humble, the poor and the miserable only had for their daughters, wives or mothers the sad destiny of sending them to Ma• zorra.
The patients, herded up in insalubrious wards, naked and hungry, lacking hygiene and the necessary food, consututed and allegation to the famous system of "Representative Democracy": Mortality rates reached never-expected levels; in only one day 86 deaths were registered; the hospital was still managed just like a jail, and among the unhappy patients swarmed convicts that through political influence obtained their transfer to the hospital, making the defenseless mass of patients victim of their most beastly instincts. But, happily for our nation all that horrible nightmare ended with the triumph of the Revolution.
THE HOSPITAL IN SOCIALIST CUBA
Man is the most- precious treasure in socialism. This maxim, chief guide of our revolution, becomes a beautiful reality in our hospital. The jail system, and the enmity between men were left behind, and at present our hospital represents one of the many achievements of our revolution that explain for themselves the deep need for this change, from an opprobrious system of privileges, to one in which the human being, by the simple fact of being one, deserves the most complete and total aid.
Our patients, under a scientific discipline, freely deambulate through the hospital, go daily, and voluntarily, to their respective and varied occupations, all of these controlled by the Occupational Therapy Department, as stated in chapter VI, always supervised by the medical staff and the nurses, with all the necessary elements for their recovery (clothing, food, medicines, etc.) satisfied.
They also enjoy trips, movies, TV, and sports. In other words, we can say that the psychiatric-medical treatment is applied to a population of bodily healthy patients; leaves of absence, for limited visits to their homes, are granted to the patients, according to psychiatrist directions; all patients are taken to their place of origin free of charge.
Our hospital is located about 17 km from the city of Havana and covers an area a little over 65 hectares, enjoying a yearly average temperature of 24.2°C, with a maximum of 28.1°C, and a minimum of 20.2° C yearly averages; it is surrounded by vast gardens and well-kept lawns, with trees and shrubbery, that offer patients the peace and restful atmosphere they need. The wards built by the Revolutionary Government are ' models in their class, their windows are all glass, with not a single accident up to now; the privacy of the patient is respected by the convenient separation of the beds, the same privacy existing in the bathrooms.
The new wards for women are conveniently separated one from the other, as can be seen in the pictures included in this Memoir.
All these modifications and improvements have been done following the directions of the Revolutionary Government through the Ministry of Public Health, tireless guide in offering our people the best in public welfare services.
We believe this Memoir will serve to make our hospital better known, and that our visitors, national and from abroad, will take with them a pleasant souvenir of it.
It is evident that to provide adequate psychiatric care these resources must be decentralized, that hospitalization must be avoided as much as possible, and that in cases in which it may be absolutely unavoidable, the patient should be kept as close as possible to his family and social circle. Therefore, the Ministry of Public Health began sometime ago the erection of hospitals for the mentally ill at the different provinces. Three of these hospitals, located at Pinar del Rio, Matanzas and Las Villas provinces, are already working in all aspects, extra-hospital care included. At present the Camaguey Psychiatric Hospital is being finished; its construction has been done by patients from the Camaguey Psychiatric Hospital Rehabilitation Center, that, of course, are currently undergoing rehabilitation processes.
This centralization at the capital, to which our Revolutionary Government a putting an end, is part of our sad inheritance from the past.
At the same time, it is the policy of the Cuban Ministry of Public Health, to provide adequate community psychiatric care through the "policlinicos" (emergency hospitals) and zone hospitals, at which early detection and treatment of starting cases is possible.
On the other hand we all know about the existence in most countries, especially in underdeveloped ones, of psychiatric hospitals of monstrous size, of which the former Insane Asylum of Cuba was a magnificent example. But, as previously said, we have faced this reality with great courage and, at present, not only our new patients receive a maximum of care and attention, but we can add that we are working with even greater tenacity with our old patients, as, for the past eleven years we have kept a constant v:utle co help and comfort the hidden and despised mass formed by the chronic cases of the mentally ill.
We are certain
that both the historical and medical, detailed account given in this Memoir will
serve to give guests, national and from abroad, a true picture of today's
psychiatric care in Cuba.
ERGOTHERAPY AND REHABILITATION (PP. 89-92)
INTRODUCTION
Ergotherapy is defined as any activity that can be constructively used in helping patients regain their general abilities, and, through them, their place in society.
In view of the repulsive state in which capitalist society had kept the mentally ill, the Havana Psychiatric Hospital, under the direction of the Ministry of Public Health, undertook the development of ergotherapy, which in our institution has two definite characteristics: ergotherapy and rehabilitation activities diversification, and participation of most of our patients in these activities.
By ergotherapy alone a patient's rehabilitation cannot be accomplished, but, it is absolutely necessary when psychotropic-drugs and psychotherapy are applied. Our ten-years experience has proved this to such an extent that our future projects include a larger use of this method.
All through these years we have made tests, analyses and comparisons to obtain a solid criterium, based on facts, to serve as scientific base to our statement that ergotherapy must be an essential element in handling mental patients of all sorts.
It has never
been our policy to exclude any of our patients from the benefits of ergotherapy,
but time has been responsible for the formation of control groups, that have
permitted us to evaluate ergotherapy treatment, in association with
other resources, among patients that prior to the revolutionary triumph were
kept in inhuman conditions at our institution, and that had never given the
slightest sign of improvement; and among those that, during that same period,
received many short-lived discharges. At present a large number of those same
patients engage in different intra or extra-hospital activities, at a work and
rehabilitation level far above the one they formerly had, in case they had any.
Others, from that same time, have already been discharged, and their follow-up
shows that they are completely cured. It is now five years since a large group
of these patients was discharged, and there has been no need to re-hospitalize
any of them. This gigantic work has developed through several stages. At the
beginning we only had a few activities, put in practice in the wards or in the
outside hall that connects them. In 1963 a sports ground, made up by a stadium
holding 6000 fans, and several buildings for the various ergotherapy activities,
was inaugurated. But even more important than this is the fact that the hospital
itself has turned into a gigantic ergotherapy and rehabilitation workshop. Once
this first stage was over, extra-hospital activities were begun with patients
sufficiently well to participate in them. By these activities we attempted at
placing them in a different environment from that of the hospital. Therefore,
extra-hospital rehabilitation centers, with lodging, were created, their living
conditions being very similar to those of community life. At these centers
patients engage in activities prescribed by the ergotherapy specialist,
receiving, at the same time, medical and psychiatric care. They receive a decent
wage for their labor which they may freely spend in themselves, or use it to
help their families, or save it; patients here are fully free to go out during
their days off and to receive visits from friends or relatives. At present we
have several extra-hospital rehabilitation centers at which 700 of our patients
work. Among these are:Plan Bosque Rehabilitation Center; Barlovento
Rehabilitation Center; Batey Rehabilitation Center. Pamphlets describing the
work being done at these centers have been published. As far as the
rehabilitation of female patients is concerned, the Ergotherapy and
Rehabilitation Department has given them definite tasks in agreement with their
work capacity and their degree of rehabilitation.
Our experience in the follow-up of discharged female patients shows that most of
them remain as housewives, and that those that go out to work make use of the
skills learned during their rehabilitation time. Discharged patients are
systematically followed-up, either through their scheduled visits, and that of
their relatives, to the Outpatients Department where aside from psychiatric care
they receive all the psychotropic-drugs they may need free of charge, or through
the home and place-of-work visits of our teams, in cases of patients that do not
visit our Outpatients Department. The different photographs included in this
memoir show the ergotherapy and rehabilitation activities currently being
carried out at our institution, in both, intra and extra-hospital centers. Let
us once more say that ergotherapy, applied in large groups, and sufficiently
diversified so that each patient may find and practice whichever activity he
considers most suitable and useful, is an essential element in the treatment of
the mentally ill. We shall now give a brief description of those activities:
Nursery: Tending ornamental plants.
Productive gardens: Cultivating flowers of different varieties.
Lawns: Mowing them and taking care of the watering.
General Warehouse, Meat Shop, Kitchen and Dining-room: Helping in all chores.
Laundry, Carpentry Shop, Mechanics Shop, Plumbing Shop, Electricity Shop,
Shoe-Repairs Shop, Ironwork: Many as helpers, but also as masters in each of
these trades. Offices: As porters and messengers. Manufacture of Wooden Toys and
Artificial Flowers, Knitting of all kinds, Machine and Hand Sewing: All these
are developed in buildings especially constructed and with electrical equipment.
Barbershop and Beauty Parlor: Here they take care of their personal appearance,
helping one another. Sports: Baseball, Softball, Volleyball, Basketball, Track
and hurdle races, Discus throwing, Shot put and javelin throw, high jump, long
jump and pole vaulting, track and field, rhythmic exercises. All these
activities can be diurnal and nocturnal and there are free competitions between
teams of patients from the different wards, or with outside teams. At these
competitions patient participation is complete, since those that do not assist
as competitors, do it as spectators.
Each year the All-Sports Games are celebrated, being this an event of great importance at which the best players in each sport are selected. The most important aspect of these games is the previous preparation that patients that consider themselves apt to participate in a given sport undergo, emulating among them, and, thereby, being stimulated to do their utmost to excel. Music: In a modern building, especially constructed to this end, the following activities are conducted: instrumental music, choirs, singing, dancing, recitation, putting on stage of small theatrical pieces, all by patients of both sexes. School learning, Reading and Drawing: In classrooms, and instructed by teachers, many learn to read and write, and others improve their knowledge. Others go to the Reading Room or to Drawing classes. Productive Activities: The manufacture of containers made out of cardboards, and medicine-bottle washing, both of great importance for the Ministry of Public Health, are done within the hospital. The care of the Poultry Farm, located on the hospital proper, and where every nine weeks 70,000 chickens are fattened, is another of our productive activities. Gathering of fruit crops, planting of coffee plants, and participation in the sugar-cane harvest are also among these activities. In these cases the groups of patients are taken to the exact place where they are to work, and live there during all the time that work lasts. Other Activities: Patients also participate in trips to the country, to the beaches, swimming pools, places of recreation, movies and, every so often, TV. Televised programs, from the hospital grounds, are transmitted by remote control to all the country. A great number of these patients, after recovery, become hospital workers, and others go back to their old jobs in their hometowns, thus helping the new society being created in our country.