Topic: COMMUNITY INTEREST
- Respect … the person you are dancing with
- Respect … the culture & heritage of Tango
- Respect … the music & the band
- Respect … the people around you
Rutgers Professor Combats Cancer Health Disparities in Incarcerated and Formerly Incarcerated Populations
For Pamela Valera, public health is very personal.
Her youngest sister, Irene, died at age 25 from a rare disease after struggling to get necessary care. At age 23, Irene was diagnosed with idiopathic pulmonary hypertension, which elevates pulmonary artery pressure. With this pre-existing condition, she found it difficult to secure health coverage. “By the time we were able to seriously address the disease, Irene was at a stage where the doctors gave her six months to live,” Valera says.
Her sister graduated from college and was applying to graduate schools to study public health when she died. “The Affordable Care Act passed less than two years later; her disease could have been managed better if it was available,” Valera says. “We just celebrated her birthday; she would have been 32 years old.”
Irene’s death was a defining moment for Valera, who, at the time, was a postdoctoral researcher at the HIV Center for Clinical and Behavioral Studies at Columbia University, studying HIV prevention and human sexuality. “I was fascinated by my sister, this young woman who, in spite of her condition, still did the best she could. I wanted to take on her passion for social justice, both personally and professionally,” she says. “I decided to commit my life to addressing health disparities among those unable to advocate for themselves. Access to screening, prevention and treatment should be available to everyone.”
Valera has long been interested in issues that affect vulnerable populations, especially those involving health disparities. While doing her postdoctoral research, she worked with investigators in the field of criminal justice and correctional health in the New York State Department of Corrections and Community Supervision – an experience that sparked her interest in studying cancer health disparities among those affected by incarceration.
She focused on developing health education programs, studying cancer prevention and smoking cessation among incarcerated men and giving a voice to people in the criminal justice system and after their release.
In 2009, Valera became involved with Bronx Community Solutions, which provides judges with more sentencing options for non-violent offenses, and wrote a proposal to address tobacco dependence resumption among inmates returning to society from tobacco-free facilities. Her work became more pressing in 2011 when New York State began closing prisons, spurring a surge of new releases without adequate resources to address the issues surrounding the population’s reintegration.
She also co-founded the Bronx Reentry Working Group, a coalition promoting community reintegration of formerly incarcerated individuals. “If you have been incarcerated for decades – especially if you entered the system in your 20s – you return to a foreign environment,” she explains. “Technology and how you get services has changed dramatically.”
A major challenge for former inmates is using cell phones, the internet and social media for resources. “You don’t get pamphlets about services anymore, so you need to know how to link to resources,” she says. “The Affordable Care Act has really helped people returning to society get health care.”
Valera says she was drawn to Rutgers School of Public Health because of its focus on urbanism. “Dean Perry Halkitis’ motto of keeping the ‘public’ in public health speaks volumes to me,” she says. “I am excited to be at an institution that advocates for diversity, inclusion, health and social justice.”
Patti Verbanas 2017
Even if they belonged to higher social classes, most women throughout history have been enslaved by men. Until recent times, women throughout Europe, the Middle East and Asia were unable to have any influence over the political, religious or cultural lives of their societies. They couldn’t own property or inherit land and wealth, and were frequently treated as mere property themselves. In some countries they could be confiscated by money lenders or tax collectors to help settle debts; in ancient Assyria, the punishment for rape was the handing over of the rapist’s wife to the husband of his victim, to use as he desired. Most gruesomely of all, some cultures practised what anthropologists have called ritual widow murder (or ritual widow suicide), when women would be killed (or kill themselves) shortly after the deaths of their husbands. This was common throughout India and China until the twentieth century, and there are still occasional cases nowadays.
Even in the so-called 'enlightened' society of ancient Greece — where the concept of democracy supposedly originated — women had no property or political rights, and were forbidden to leave their homes after dark. Similarly, in ancient Rome women unable to take part in social events (except as employed 'escort girls') and were only allowed to leave their homes with their husband or a male relative.
In Europe and America (and some other countries) the status of women has risen significantly over the last few decades, but in many parts of the world male domination and oppression continues. In many Middle Eastern countries, for example, women effectively live as prisoners, unable to leave the house except under the guardianship of a male guardian. (There are many Saudi Arabian women who have only left their houses a handful of times in their whole lives.) And when — or if — they do go outside, they are obliged to cover themselves from head to toe in black, leaving them in danger of vitamin deficiency and dehydration. They have no role at all in determining their own lives; they are seen as nothing more than a commodity, property of the males of the family, and as owners, the men have the right to make decisions for them. Their male owners have the right to have sex with them on demand too. In Egypt, surveys have shown that the vast majority of men and women believe it is acceptable for a man to beat his wife if she refuses sex.
There have been attempts to explain the oppression of women in biological terms. For example, the sociologist Stephen Goldberg suggested that men are naturally more competitive than women because of their high level of testosterone. This makes them aggressive and power-hungry, so that they inevitably take over the high status positions in a society, leaving women to the more subordinate roles. This is hogwash. Women are and can be more competitive than men. Testosterone should not be used as an acceptable excuse for bad behavior.
However, in my view the maltreatment of women has more deep-rooted psychological causes. Most human beings suffer from an underlying psychological disorder, which is called ‘humania.' The oppression of women is a symptom of this disorder. It’s one thing to take over the positions of power in a society, but another to seemingly despise women, and inflict so much brutality and degradation on them. What sane species would treat half of its members — and the very half which gives birth to the whole species — with such contempt and injustice? Despite their high level of testosterone, the men of many ancient and indigenous cultures revered women for their life-giving and nurturing role, so why don’t we?
The oppression of women stems largely from men’s desire for power and control. The same need which, throughout history, has driven men to try to conquer and subjugate other groups or nations, and to oppress other classes or groups in their own society, drives them to dominate and oppress women. Since men feel the need to gain as much power and control as they can, they steal away power and control from women. They deny women the right to make decisions so that they can make them for them, leave women unable to direct their own lives so that they can direct their lives for them. Ultimately, they’re trying to increase their sense of significance and status, in an effort to offset the discontent and sense of lack created by humania.
No one wins when men continually do this to women in business.
As Cuban revolutions go, it was an entirely peaceable uprising – but its impact could not have been more profound. On the release of the Buena Vista Social Club™ album in 1997, few outside the specialist world music audience initially took much notice of the record’s elegantly sculpted tunes and warm, acoustic rhythms. Then something extraordinary occurred. The album was spectacularly reviewed by a few discerning critics, but although their words of praise did Buena Vista’s cause no harm, they cannot explain what subsequently happened. Good reviews create an early surge in sales, but unless it’s a big pop release sustained by an expensive TV advertising campaign, the established pattern is that interest then slowly tails off. Instead, Buena Vista’s sales figures kept steadily rising week by week, building almost entirely by word-of-mouth until it achieved critical mass: all who heard the record not only fell in love with Buena Vista’s irresistible magic, but were then inspired to play or recommend the album to everyone they knew. It was one of those rare records that transcended the vagaries of fad and fashion to sound timeless but utterly fresh. Once you heard it, you had to have a heart of stone not to be swept away by the music’s romantic impulses and uninhibited exuberance.
That its impact had made waves, far beyond the specialist world music audience was soon self-evident. Buena Vista went on to win a Grammy and its crossover success persuaded the cclaimed director Wim Wenders to make an award-winning feature film about the phenomenon.s Nick Gold, whose World Circuit label released the record, put it :
“Buena Vista was a once-in-a-lifetime thing. We knew we’d made a special record but nobody could have imagined how it would take off.”
The record’s success launched what can only be described as Cuba-mania, helping to inspire a thousand salsa dance classes and Cuban-themed bars on every high street. At its peak, it seemed that you couldn’t move without hearing Buena Vista’s potent, captivating soundtrack : in coffee shops and mojito bars and even department stores and elevators songs such as Chan Chan, Dos Gardenias and Candela came to accompany our daily existence. Suddenly, Buena Vista was not so much a record as a brand, albeit one based on musical quality rather than marketing hype. Even Salman Rushdie, in his New York novel Fury, paid tribute to its all-pervasive power, describing the long, hot days of 1998 as “that Buena Vista summer”.
On the album’s release, Nick Gold had hoped that, given a fair wind, Buena Vista might ¬-Today the album’s global sales stand at over eight million, making it the biggest-selling Cuban album in history. As one critic put it, Buena Vista has become “world music’s equivalent of The Dark Side of the Moon
Yet few could have predicted this iconic success when the veteran musicians who recorded Buena Vista assembled in the run-down Egrem studio in Havana in 1996. They weren’t even a formal group, but a loose collective, spanning several generations and assembled more-or-less spontaneously for the occasion. Indeed, the group that came together was in essence an accident: the original intention had been to make an experimental hybrid record bringing together African and Cuban musicians, but the African musicians failed to turn up because of visa problems. In fact the original idea had been to record not one but two albums. The first was Juan de Marcos González’ dream project – an album celebrating the continued vitality of Cuban music’s golden age – the 1940’s and 1950’s. He hand-picked and recruited a multi-generational big band which he called the Afro Cuban All Stars and in a week they had recorded their brilliant debut album ‘A Toda Cuba le Gusta’ (‘All Of Cuba Likes It’). The following day recording of the Mali – Cuba collaboration album was due to start, but as the Africans were unavailable World Circuit’s Nick Gold, American Producer Ry Cooder and band leader Juan de Marcos were forced to improvise.
The veteran pianist Rubén González, who didn’t own a piano at the time had been persuaded out of retirement by Juan de Marcos for the All Stars album. Not that it took much coaxing: despite his years of inactivity, his playing was on fire and so eager was he to get to the piano that every morning when the janitor turned up to unlock the studio doors, he was already waiting outside. The singer Ibrahim Ferrer, who was scraping a living shining shoes and selling lottery tickets, was also rescued from obscurity – and proceeded to sing his heart out. Eliades Ochoa the great guitarist and singer provided the rural roots from Santiago. Omara Portuondo was recruited as the company’s leading lady and the rich, resonant voice of the 89 year-old Compay Segundo provided a link with Cuba’s deepest musical past. “He knew the best songs and how to do them because he’d been doing it since World War One,” as Ry Cooder noted.
Yet this stellar line-up of singers was only part of the story. Behind them were some of the finest musicians Cuba had to offer, including the bassist Orlando ‘Cachaíto’ López, who provided the heartbeart, trumpet player Manuel ‘Guajiro’ Mirabal, who added the flair, and Barbarito Torres the virtuoso laoud player. In the space of two weeks World Circuit’s Havana recording blitz produced not only the Afro Cuban All Stars and the Buena Vista Social Club™ albums but also the debut solo album by Rubén González.
When they had finished recording, Ry Cooder knew that he had been privileged to be part of a unique musical experience. “This is the best thing I was ever involved in,” he said prior to Buena Vista’s release in June 1997. “It’s the peak, a music that takes care of you and nurtures you. I felt that I had trained all my life for this experience and it was a blessed thing.”
In Cuba, he noted, he had found the kind of deeply rooted musical context that he had been searching for all his life. “These are the greatest musicians alive on the planet today,” he enthused. “In my experience Cuban musicians are unique. The organisation of the musical group is perfectly understood. There is no ego, no jockeying for position so they have evolved the perfect ensemble concept.”
Following the recordings, the musicians hit the road and extensive tours were undertaken by Rubén González, Ibrahim Ferrer, the Afro Cuban All Stars, Eliades Ochoa, Omara Portuondo and Compay Segundo. The original line up of the Buena Vista Social Club made three triumphant concert appearances; two at Amsterdam’s Carré Theatre and the final legendary show at New York’s Carnegie Hall. The latter was filmed by Wim Wenders as the climax of his successful documentary also named “Buena Vista Social Club™”, and the concert recording was released ten years later as “Buena Vista Social Club® at Carnegie Hall”. Over the years World Circuit has continued to travel to Havana recording acclaimed albums by Ibrahim Ferrer, Omara Portuondo, Rubén González, Cachaíto López, Guajiro Mirabal and Angá Díaz, who had been an integral part of the Afro Cuban All Stars.
Sadly, several of the group’s aging stars, including Compay Segundo, Rubén González and Ibrahim Ferrer are no longer with us. But the timeless, magical music that created the Buena Vista legend lives on. Omara Portuondo has been extremely busy having recorded two albums, one with Brazilian star Maria Bethania and a solo album due for release in autumn 2008; her tours continue to sell out concert halls around the world. Juan de Marcos González is ever active: working on musical productions in Mexico and forming a new edition of the Afro Cuban All Stars. Eliades Ochoa embarks on a new European tour in the autumn of 2008 and has been working on material for a new solo album. Cachaíto López, Guajiro Mirabal, Aguaje Ramos, Manuel Galbán, Amadito Valdés and Barbarito Torres are touring the world to great acclaim as part of the Orquesta Buena Vista Social Club.
The House That Castro Built
During a recent trip to Cuba I stayed at a home that was owned by Fidel Castro. It was a beautiful home. The current owner has acquired a license to rent some of the rooms of his home out, as part of private enterprise initiatives in Cuba. He had to sign a 5-year contract. Each room he rents out he must pay the government 35 CUC a month. ($35 USD) He has relationships with 5 agencies. These agencies work to do the logistics for Americans, Europeans and other to travel to Cuba. These agencies pay the home owners a nondisclosed amount. They are their guarantee to have the rooms filled. Any profit the homeowner makes, they must pay 10% to the government as well. Recently, President Trump has created some very tough restrictions for Cuba. This same homeowner’s business is now in jeopardy. There were 20 Americans who were slated to stay at his home. They cannot get Visas to come. He is stuck. He is still required to pay the 35 CUC per room/month to the government, where there are people there or not. He has four more years to his contract. The government will not give him a break. They depend on the USA for their visits.
In order for this homeowner to leave Cuba to visit the USA, it’s not easy for him either. He has to go to the immigration office for a meeting to try to get a Visa. The meeting costs $160 CUC. This cost may not get him a Visa. In the event, he has to return to try again, it’s another $160. So, the Cubans are now trying to go through Columbia to get Visa’s to come to America. This creates enormous expense for them.
Their success is evidence of a growing Cuban middle class with disposable income. With the increase of private enterprise, President Obama’s relaxation of restrictions on US travellers and the introduction of Airbnb to Cuba in 2015, more tourist money has been going directly into the hands of the people instead of into government-owned hotels and restaurants. Private business owners are making incomes that far exceed anything they could earn working for the state.
Their success is evidence of a growing Cuban middle class with disposable income. With the increase of private enterprise, President Obama’s relaxation of restrictions on US travellers and the introduction of Airbnb to Cuba in 2015, more tourist money has been going directly into the hands of the people instead of into government-owned hotels and restaurants. Private business owners are making incomes that far exceed anything they could earn working for the state.
After years of stagnation, Cuban entrepreneurship has changed and grown dramatically. Regulations governing entrepreneurship were liberalized significantly in October 2010, notably allowing the hiring of employees. Official attitudes about it changed from indifference to encouragement. The number of Cubans employed in this sector increased 145 percent, from 157,371 in October 2010 to 385,775 today, representing about one in 13 workers.
Most important, the purpose has changed. In the past, when no thought was being given to changing the socialist model, entrepreneurship seemed to be viewed as a necessary evil, of marginal importance to the economy. It is now viewed as a strategic necessity for a government that is determined to cut costs and boost economic output by reducing government payrolls and expanding the private sector. For every new person employed as an entrepreneur, the government counts one more job created, one more stream of tax revenue, one more household with higher income, and one less household in need of the universal food subsidies that it aims to eliminate.
Entrepreneurship, in Cuba called trabajo por cuenta propia, or self-employment, is the most visible manifestation of economic reforms undertaken by President Raul Castro since he took office in 2008. The entrepreneurs, called cuentapropistas, are operating their new businesses on the streets of every city and town. State media are covering this sector amply and, in a new twist, favorably.
But the new entrepreneurs are only part of the reform plan, which is being developed and implemented according to a blueprint approved by the Communist Party in 2011. To reach major economic objectives involving job growth, productivity increases, improved government finances, and reduced incentives for young Cubans to emigrate, a larger “non-state” sector of the economy has to develop, one that will need to include larger and more complex businesses than those that today’s entrepreneurs are creating.
The situation was similar at labor ministry offices in the provincial capital of Sancti Spiritus, where an official said that 720 licenses had been issued in the first two weeks of the new policy.
Public response to the new policies was strong because of the government’s new disposition to issue new licenses again, and because they in fact expanded opportunities for entrepreneurship:
• Licenses are now available in 181 lines of work.
• To bring entrepreneurs in from the black market, licenses may be granted to those without a vinculo laboral, i.e. those with no current workplace.
• Previously, only restaurants and small food-service operations such as sandwich stands were permitted to employ assistants. The new regulations permitted employees to be hired in 83 lines of work, and later they were changed to allow employees to be hired in any line of work.
• In private restaurants, the seating limit was increased from 12 to 20 and later to 50. Prohibitions on serving beef and shellfish were ended.
• “Housing, rooms, and spaces” may be rented to entrepreneurs for use as places of business.
• Entrepreneurs may now have licenses for more than one line of work.
• Unlike before, entrepreneurs may work anywhere, not just in the municipality in which they were licensed.
• Instead of being restricted to selling to individuals, they may now sell goods and services to state entities, foreign companies, and cooperatives.
• A June 2012 article in Granma discussed the ways in which government entities in Artemisa are contracting “brigades” of carpenters, painters, bricklayers, and other construction workers to fix a stadium, cafeterias, and other public buildings. A local official praised the “speed and quality” of their work.
• Entrepreneurs must pay income tax. The first 10,000 pesos of income, an amount that equals approximately twice the average salary paid in the state sector, is tax-exempt. The top marginal rate is 50 percent. Expenses totaling up to 40 percent of gross income may be deducted from taxable income (the previous limit on deductions was 10 percent). In addition, there is a sales tax, a public service tax, and a tax per employee hired, all deductible from income tax. The tax on hired labor is explained as necessary “to avoid concentrations of wealth.”
Finally, there is a contribution to social security, which entitles entrepreneurs to disability and maternity benefits and monthly payments upon retirement. Taxpayers can vary the amount they contribute, and benefits will depend on the amount contributed.
• In May 2011, these policies were eased to favor job creation over tax collection. The tax per employee was suspended for businesses with fewer than six employees, taxes were reduced and deductions increased in some occupations, and businesses were allowed to close for repairs more easily and for longer periods, suspending their licenses and their tax obligations.
Beyond the new regulatory treatment, other government actions evidence a change in attitude toward entrepreneurs and a desire to see the sector grow rather than simply subsist.
With the new policies governing entrepreneurship, a retiree in rural Pinar del Rio province said, “The only people not working are those that don’t want to.” That’s an exaggeration, but an easy one to make given the appearance of so many new businesses across Cuba.
The block of Havana’s Neptuno Street between Aguiar and Amistad Streets is a good example. It is near areas frequented by tourists, but it is not a tourist spot and its businesses cater to Cubans. Many new businesses were in operation during a June 2011 visit.
A retired house painter sold herbs for medicinal, religious, and culinary uses from his front step, paying 150 pesos per month tax and earning, he said, a modest supplement to his pension. He was fixing up a bedroom upstairs to rent to foreigners, but he was waiting for the “right moment” to start that business. The room rental, he believed, would be “the only way to get my head above water. When I marry again it has to be to a foreigner too.”
Nearby, a babalawo (Santeria priest) ran the Ile Ogdara religious articles shop, with a cafeteria alongside. He pays 2,000 pesos per month to rent the space, and one month into the business he expected to do well. Next door to him, a shop sold religious clothing.
A few doors away, a woman took advantage of the new regulations to take out two licenses, so she could sell party supplies and music CDs in the same premises. With a combined monthly tax bill of 450 pesos, she was clearing between 1,000 and 1,500 pesos per month.
Across the street, the Gran Via store is a place where the government rents space to 15 individual entrepreneurs for 30 pesos daily. Businesses included jewelry and watch repair, sales and repair of shoes and sandals, sale of wickerlike patio furniture made by the vendor’s husband, and more. “Much of this was hidden before,” one repairman said, “and now people are coming out in the open.”
For the barber in Santa Maria del Rosario, the change came in May 2011; he lost his state salary and his life became both more complicated and more lucrative. He pays 993 pesos per month to the state to cover rent, utilities, and taxes. That works out to about 40 pesos per workday, so he has developed the habit of setting aside that amount each day – and on a typical day, he says, that leaves about 80 pesos for himself. He acquires supplies completely on his own without difficulty, he says, including the electric clippers that friends bring him from the United States. His prices: ten pesos for a regular haircut, 20 for a “styled” cut, ten for a shave, all to the sound of reggaetón played through an I-pod blaring through two small computer speakers on the windowsill.
A similar change is taking place in state taxi companies. A Cuba taxi driver explained that in 2010 his company stopped paying his salary and started renting him his taxi for a flat $42 per day. He keeps the taxi at his home, pays for gas and repairs, charges in convertible pesos, and keeps his profit. Interviewed in June 2011, he was not yet sold on the new system because his earnings vary so much between high and low tourism seasons.
What does the experience of converting the smallest barber and beauty shops into private entities tell about the government’s task ahead? First, the pilot projects and limited scope indicate the slow, cautious pace of the reform process. Second, these are examples of reductions in state sector payrolls that do not involve layoffs, but rather the conversion of state jobs to private jobs on the spot. The move to create private non-farm cooperatives will likely repeat these traits.
A local official said the number of entrepreneurs renting rooms in their homes had jumped from 200 to more than 400. The local tourist hotel on a hillside just out of town has only 78 rooms.
A recent economics graduate had just opened a gallery on the main street to sell art and photography. She does business in a sheltered porch and interior room that she rents from a retiree.
On the main street: room rentals, several cafeterias, ice cream stands, vendors of imported trinkets and housewares, pizza makers, and new private restaurants. Several taxi drivers had started business in recent months; one also rents a room in his home and is fortunate enough to be listed in Lonely Planet.
New restauranteurs worried about competition and many employ promoters who approach visitors to drive business their way. The owner of one new restaurant on the main street, El Colonial, said about 15 new private restaurants had opened in the past six months. Subsequent visits showed that some restaurants off the main street had closed.
But entrepreneurs alone are not likely to generate one million new private sector jobs under current rules. Those jobs, combined with further reductions in the public-sector workforce, can potentially eliminate a fiscal deficit that has already declined from 6.9 percent of gross domestic product in 2008 to 3.8 percent last year.
In Cuban discussions of economic policy – in academic journals, public debates, Catholic church magazines, and state media – there is no shortage of ideas for policies to spur the expansion of the private sector.
When it comes to entrepreneurship, the most common suggestion is to treat the sector as an “infant industry” by reducing taxes to promote growth until the sector matures. Other suggestions are to do away with the list of 181 permitted lines of work and instead to allow entrepreneurial ventures in any line of work except those that the state may reserve to itself, and to allow professionals to work as entrepreneurs in the field for which they were trained.
However, the potential for far more substantial job growth lies in the creation of private non-farm cooperatives. In this area, policies have yet to be defined except in general terms.
The economic policy blueprint adopted in 2011 by the Communist Party stated that private cooperatives will be formed “as a socialist form of collective property in different sectors…integrated by persons who join together contributing goods or labor….and assume all their expenses with their income.” A briefing document circulated as layoffs were beginning in 2010 noted dozens of potential business lines for cooperatives, including services to municipal governments, and singled out five general areas: agriculture, construction, construction materials, transportation, and food production.
The lack of entrepreneurial opportunities for Cubans with advanced professional and technical skills means that Cuba is failing to take full advantage of the investment made in their education and foregoing their potential contribution to economic development: innovation, competitiveness, export growth, job growth, and reduced incentives for young Cubans to emigrate. Many of the new entrepreneurs, such as those re-selling housewares brought to them from relatives abroad or selling copied music and movies on disc, have created jobs and pay taxes but otherwise contribute little to development.
The Cuban people are surviving in a situation where they are supposed to die. What are the sanctions supposed to do? Why is an embargo being done? Somebody wants to make an example of them.
What are we doing to Iraq or Gaza? These situations weren't put on against socialism, they were all put on because the proper model is the poor making the powerful richer, so the poor can have trickle down. The main way we can help Cuba is to stop keeping them in isolation. For example, let people from here go visit without all this rigmarole.
CUBA's Health System, The Real Story
I just spent a week in Cuba where I was given access to unique individuals. These individuals are residents of Cuba who shared their stories. They allowed me to attend their medical appointments to enter the hospitals. There are few modern myths that have been debunked as frequently yet have been accepted as incredulously as the idea that Cuba has a superior (or even adequate) health care system. Articles have been written since the 1960s debunking the nonsensical claims about health care in Cuba and yet it is invariably the issue that is trotted out to show how socialism can actually be effective. These appointments I attended were heartbreaking.
If you get sick on a cruise ship or are an American in Cuba, who gets sick, your health care experience is distinct. These are hospitals that the regular Cuban citizens are not permitted to go to, only foreigners can. For foreigners, who can pay with hard currency. In Havana can receive pretty decent healthcare. However, if you need any advanced imaging you will have to take a flight to Mexico to do so. Many medical device manufactures have donated MRI, CT and other devices to the hospitals. However, they are boat anchors now. There is no money to service them so they sit rotting in their suites. A primary selling point of socialism is that everyone is treated equally regardless of class or ability to pay. But in reality, socialism keeps the inequality of capitalist systems and merely spreads the misery to more people. Outside of Havana, the hospital conditions are inhuman.
In America doctors are well compensated for their years of training and experience. Although the pay varies based on such factors as specialty and region of the country, the average physician in the US earns $472,000 a year. In most countries, of course, doctors are not paid nearly as well. In Hungary doctors earn an annual income of $12,000, while in many regions of China the salary is half that amount, about $5,000 a year.
But, Cuba is near the bottom of the least when it comes to compensating health care professionals. Doctors in Cuba earn somewhere between $30 and $50 a month ($360 to $600 a year). At the high end, doctors with two specialties can earn as much as $67 per month.
These salaries do not match the cost of living in Cuba. It’s quite expensive to live in Cuba. A young doctor would have to work for more than a week just to afford a gallon of milk (average cost is $7). If he doesn’t have such expensive taste he can go forgo the dairy for cheaper fare: a pound of potatoes only cost about one day’s wage (90 cents). Physicians have a territory, like a paperboy. They are assigned a neighborhood to knock on doors to go and see families. They go in and give vaccines (Cuba is ahead of many countries as it pertains to vaccines), give prescriptions and assess the overall health of the community, proactively.
In Cuba, medication for hospitalized patients is free, but all outpatient medications have to be paid for out-of-pocket. And all medications (even aspirin) require a prescription. There are also no private pharmacies (except on the black market) so you have to get your Tylenol at a state-run pharmacy. That is, if you can find one. With a population of 11 million, and more than 2 million in Havana, there are only 2pharmacies presumably located on the island.
The first was situated in a residential neighborhood in Havana. It was large yet incredibility rundown, just like its surrounding area. The narrow shelves lining the pharmacy were bare bones, giving the impression that the store was going out of business. The space focused strictly on pharmaceuticals; there were no cosmetic, greeting card, health and wellness, or candy aisles.
In comparison, the second farmacia we visited near the Ciengage de Zapata Biosphere Reserve—a 3-hour bus ride from Havana—was no larger than a backyard storage shed. Dressed in a white lab jacket, a female pharmacist manned the Dutch-door prescription window, counseling a patient who stood on the sidewalk. Her female assistant sat at a card table with a cardboard box containing filled prescriptions.
Not surprisingly, the shortages allow health care workers to supplement their income on the black market. Some doctors, nurses and cleaning staff smuggle the medicine out of the hospitals in a bid to make extra cash.
The doctors are underpaid, the system is unequal, and the hospitals are horrific. But at least they can take credit for having a low infant mortality rate, right? Actually, there’s more to be said for that statistic.
You might suspect a story behind this respectability — and you are right. The regime is very keen on keeping infant mortality down, knowing that the world looks to this statistic as an indicator of the general health of a country. Cuban doctors are instructed to pay particular attention to prenatal and infant care. A woman’s pregnancy is closely monitored. There are numerous maternity only hospitals all over the country. They are significantly run down and close to inhuman conditions. The regime manages to make the necessary equipment available. And if there is any sign of abnormality, any reason for concern — the pregnancy is “interrupted.” That is the going euphemism for abortion. The abortion rate in Cuba is sky-high, perversely keeping the infant-mortality rate down. Cuba's annual induced abortion rate persistently ranks among the highest in the world, and abortion plays a prominent role in Cuban fertility regulation despite widespread contraceptive prevalence and state promotion of modern.
There is one aspect of Cuba’s health care system that seems to produce results: preventive care. The foundation of Cuba’s preventative health care model is for family doctors to oversee the health of those in their neighborhoods. But there’s a catch.
In Cuba when you hear “The doctor will see you now” it often means in your own home. And you don’t have a choice about it.
Imagine your doctor knocking at your door to give, not just you, but your whole family an annual health check-up. As well as taking blood pressure, checking hearts and asking all sorts of questions about your job and your lifestyle, this doctor is also taking careful note of the state of your home, assessing anything which could be affecting the health of you and your family. These doctors are assigned a territory in the town, like a paper route.
Chances are the doctor is not just checking to see if you’re hiding Twinkies in the pantry, but will be reporting other findings to the local magistrates.
Cuba has a thriving Black market in medicine. Friendships are carefully maintained with several doctors so a seller will have no problems obtaining enough prescriptions to support their business.
People will sell medications at vastly inflated prices, but shortages in state-run pharmacies mean that many people have no choice but to turn to black market entrepreneurs. Massive corruption throughout the Cuban health system means that this double-tier system is common across the country.
Although medicines are officially sold only through government pharmacies, prescriptions are routinely siphoned off to obtain remedies that are then resold on the streets for far higher prices.
As doctors are only paid up to 1,600 Cuban pesos (65 US dollars) each month - barely a living wage - most need to find some way to subsidise their income. All Cubans know that doctors have thousands of needs and life challenges corrupt even the most honest. You may even find your physician driving a rickshaw or cab to make ends meet.
The best selling medicines on the street are salbutamol inhalers for treating asthma, the tranquiliser meprobamate, the painkiller ibuprofen and vitamin C in tablet form.
Topical treatments such as the anti-bacterial ointment gentamicin, skin cream triamcinolone and antifungal lotion clotrimazole are also in high demand.
Products such as these officially cost 0.65 Cuban pesos but are sold for ten pesos on the black market.
Beta-blockers such as atenolol and the anti-inflammatory analgesic dipyrone were in particularly high demand on the black market. A strip of dipyrone is sold in a pharmacy for 0.70 Cuban pesos; on the street it costs five Cuban pesos.
This year 60 medicines were affected by problems with raw materials and the withdrawal of some suppliers. Other medicines are sourced from far away, leading to production delays.
Of the 857 medicines that make up the state’s basic medicine supplies, 269 are imported from different countries, primarily from very distant markets like China, India and some European countries, and have a supply procurement cycle of between 60 and 90 days.
Last November, the minister of public health announced new control measures to try and stamp out the illicit sales.
All doctors were limited to issuing 100 prescriptions a day, each identified by a numeric code.
To prescribe a medicine a physician must see the patient and give them a prescription. Now no one can have blank prescriptions that haven’t been filled in which could be taken to a pharmacy falsifying the doctor’s name and the medicine.
In addition, the doctor’s name and signature on the prescription must be legible and accompanied with instructions on how to take the medicine.
But the practice is proving hard to end, considering that the black market involves all levels of health care staff, from pharmacy workers up to doctors. Worst affected are people who rely on these medicines, mostly of whom are elderly people. When we went to see the family doctor and he prescribed a family member a cortisol cream. We went to buy it at the pharmacy and were told that there wasn’t any. This is the normal thing that happens. However, in the corner of the pharmacy there was a man selling it for ten Cuban pesos. The same thing happened when a family took their child to the doctors to have their eyes tested. It was identified that he needed glasses. They were told that no glass was available to male the glasses. However, if they paid them 10 CUC they would meet them on the corner in an hour and would have the eye glasses. I don’t understand why the government doesn’t have enough for people´s needs but there are people selling it outside.
Want some paprika-infused chorizo sausage? How about a bit of buffalo mozzarella? Or maybe you just need more cooking oil this month, or a homemade soft drink you can afford on paltry wages. Perhaps you are looking for something more precious, such as an imported air conditioner or some hand-rolled cigars at a fraction of the official price.
In a Marxist country where virtually, all economic activity is regulated, and where supermarkets and ration shops run out of such basics as sugar, eggs and toilet paper, you can get nearly anything on Cuba’s thriving black market — if you have a “friend,” or the right telephone number.
A raft of economic changes introduced over the past year by President Raul Castro, including the right to work for oneself in 178 approved jobs, has been billed as a wide new opening for entrepreneurship, on an island of 11 million people where the state employs more than four in five workers and controls virtually all means of production.
In reality, many of the new jobs, everything from food vendor to wedding photographer, manicurist to construction worker, have existed for years in the informal economy, and many of those seeking work licenses were already offering the same services under the table.
And while the black market in developed countries might be dominated by drugs, bootleg DVDs and prostitution, in Cuba it literally can cover anything. One man drives his car into Havana each day with links of handmade sausage stuffed under the passenger seat. A woman sells skintight spandex miniskirts and gaudy, patterned blouses from behind a flowery curtain in her ramshackle apartment.
Economists, and Cubans themselves, say nearly everyone on the island is in on it.
“Everyone with a job robs something. The guy who works in the sugar industry steals sugar so he can resell it. The women who work with textiles steal thread so they can make their own clothes.
Some make their living as a “mule,” ferrying clothes from Europe to Havana for sale at three underground stores. These people end up in jail for his activities.
Merchandise flows into the informal market from overseas, but also from the river of goods that disappear in pockets, backpacks, even trucks from state-owned warehouses, factories, supermarkets and offices.
There are no official government statistics on how much is stolen each year, though petty thievery is routinely denounced in the official press. On June 21, Communist party newspaper Granma reported that efforts to stop theft at state-run enterprises in the capital had “taken a step back” in recent months. It blamed managers for lax oversight after an initial surge of compliance with Castro’s exhortations to stop the pilfering.
Criminal and corrupt acts have gone up because of a lack of internal control. An extensive study by Canadian economist Archibald Ritter in 2005 examined the myriad ways Cubans augment salaries of just $20 a month through illegal trade — everything from a woman selling stolen spaghetti door-to-door, to a bartender at a tourist hot spot replacing high-quality rum with his own moonshine, to a bicycle repairman selling spare parts out the back door. He and several others who study the Cuban economy said it was impossible to estimate the dollar value of the black market.
One could probably say that 95 percent or more of the population participates in the underground economy in one way or another. It’s tremendously widespread. Stealing from the state, for Cubans, is like taking firewood from the forest, or picking blueberries in the wild. It’s considered public property that wouldn’t otherwise be used productively, so one helps oneself.
Cubans even have a term for obtaining the things they need, legally or illegally: “resolver,” which loosely translates as solving a problem. Over the decades it has lost its negative connotations and is now taken as a necessity of survival.
Turning to the black market and informal sector for nearly everything is so common that it has become the norm, with little or no thought of legality or morality. When legal options are limited or nonexistent, then everyone breaks the law, and when everyone breaks the law, the law loses its legitimacy and essentially ceases to exist.
There is evidence, however, that Castro is persuading at least some black market operators to play by the rules and pay taxes. In the last seven months, more than 220,000 Cubans have received licenses to work for themselves, joining about 100,000 who have legally worked independently since the 1990s. Of those, some 68 percent were officially “unemployed” when they took out their license, 16 percent had a state job and another 16 percent were listed as “retired,” according to statistics on the government Web site Cubadebate.
Many of these jobless and nominally retired people were likely making ends meet by working in the informal market, and even the former government workers were probably connected in one way or another.
You have to find a way to survive. A Cuban residents monthly government ration card plus their meager salaries only covered two weeks’ worth of food. They often sit in the pa and think, ‘What can I do?’”
Some will even begin bicycling around town on Sundays, renting out bootleg DVDs of the latest Hollywood films, which others had downloaded from the Internet. They defend their decisions to turn to the black market to put food on the table.
Physicians are required to stay in their roles for a minimum of two years. IT is only then that they can migrate to another higher paying job, such as a cab driver, shoe shiner, etc.
How do we help them?
When Thora Sørensen had an ostomy operation in the 1950s, ostomy care was primitive. Thora was afraid to go out in public, fearing she might experience leakage. Her sister Elise, a nurse, conceived a solution – the world’s first adhesive ostomy bag, one that would prevent leakage and let her sister live a much freer life.
Based on Elise’s idea, civil engineer and plastics manufacturer Aage Louis-Hansen and his wife Johanne created the ostomy bag, leading to the founding of Coloplast in 1957, which, today, is a global leader in intimate healthcare.
“Intimate healthcare is about recognizing the importance of quality of life,” says Oliver Johansen, Senior Vice President of Global R&D at Coloplast. “Of people with stoma, 91% fear leakage, and 76% will have experienced it in the last six months. We want to change that.”
For people living with a stoma (an opening on the surface of the abdomen that has been surgically created to divert the flow of waste) the real issue is not the stoma itself but the fear of leakage, which significantly impacts quality of life and leads to isolation.
“The key to solving this issue is an appliance that provides a secure fit to the body,” Johansen says. “Because bodies are different and change over time, we design our products with this in mind. Since bringing the world’s first disposable, self-adhesive ostomy pouch to the market six decades ago, we have developed the market’s complete portfolio of ostomy solutions.”
The ostomy bag may have started it all, but today Coloplast’s mission is to help people with a variety of intimate healthcare needs, which has driven an enormous amount of innovation across an everbroadening portfolio of products.
Within continence care, where the fear of having an accident in public can again lead to isolation, Coloplast innovations, such as the SpeediCath, have driven industry change to compact catheters that improve functionality through their small size and design, improving compliance and reducing psychological barriers.
Another area of innovation is in wound and skin care, where Coloplast developed the award-winning Biatain Silicone, a series of wound care dressings that come in all shapes and sizes and that focus on user experience and aesthetics.
“We are continually developing innovative life-changing products that make a real difference to our users,” Johansen says. “Take our latest ostomy bag – clinical evidence shows that we are truly reducing leakage, the number one concern of our users.”
“That said, there are still some fundamental needs unmet, so innovation is paramount for finding solutions that solve obstacles our users face every day. Our ability to listen to our users, understand their needs, and respond with life-changing products and services is what drives us and keeps us a leader in our industry.”
Drone Flight for Food Delivery In Iceland Takes Off
The Icelandic online marketplace has partnered with Flytrex to provide its customers with drone deliveries, following approval from the Icelandic Transport Authority (Icetra).
Food and consumer goods will be picked up from shops and restaurants around Reykjavik and delivered to consumers around the city. Reykjavik is separated by a large bay and the drone deliveries will save energy and resources usually needed to travel around the body of water or over a bridge located in the north east of the city. This will save up to 20 minutes driving time during rush hour.
"We have seen a tremendous increase in our online delivery orders in recent months, and we expect to see this growth continue in the coming months as consumers experience the much faster delivery times Flytrex drone delivery offers," said Maron Kristófersson, CEO of AHA.
"We’ve been monitoring online logistic technologies around the globe, and Flytrex soared above all the others with its swift, smart, safe, and commercially viable solution. The partnership with Flytrex will further propel AHA’s turn-key software, sales and business processes for operating a multi-merchant e-commerce marketplace. We hope to partner with Flytrex not only in Iceland, but also as part of our marketplace solution overseas."
Watch this video to see this amazing new food delivery system.
As the world continues to move online, how we shop for our groceries also is changing.
Already two years ago, online grocery shopping studies found that one-third of primary grocery shoppers had bought groceries online within the past year, and that this trend was extending across all age groups. Brick Meets Click, a retail consultancy, surveyed U.S. consumers and reported that 1 in 5 of these shoppers was now an active user of online grocery services, and that these shoppers spend an average of 16 percent of their weekly grocery dollars online.
Then in 2017, Amazon bought Whole Foods Market, stepping into the brick and mortar side of the grocery business.
It was a clear message to traditional grocers that if they were not already in an online, multichannel environment, they had to find a way to enter that world—because that’s where their shoppers were going.
One of the ways retailers do get people in the doors is flexibility in options. In other words, if an individual wants to order a grocery item online and then pick it up later at a store, they should be able to do that. If they want home delivery, it is nice to know that the option is there. For others, brick and mortar presence still is a major part of their food shopping experience. Together, these consumer wants add up to a need to address grocery sales and services through multiple channels.
“In the way that the smartphone industry took off after a few rough starts, I expect the home grocery delivery and pick up in store market to eventually achieve widespread success,” says Eric Lamphier, senior director of Product Management at Manhattan Associates. “Retail grocers and food companies are trying to adapt to a world where more and more purchases are completed online versus in person. Grocery stores are one of the last retailers to really embrace the e-commerce wave. It’s the remaining shopping necessity that requires people to venture out of their homes.”
Lamphier adds that while the technology to enact grocery delivery already exists in terms of integrated order management, warehouse and transportation, and the ability to provide visibility into inventory and distribution channels, the path to profitable execution is not 100 percent guaranteed.
“Questions remain about whether stores will have enough online orders to justify the investment into delivery vehicles, temperature maintaining vessels and staffing for delivery,” he says, adding, “The bottom line is that brick and mortar grocery stores will need to transform themselves from strictly in-store strategies to omnichannel locations.”
The problem is: grocers aren’t known for having an amazing online and in-app experience, because they haven’t needed it in the past. Instead, they’ve been focused on pristine in-store displays and fully organized and stocked shelves. All of this makes developing infrastructure and strategies to meet the needs of today’s online consumer a challenge.
“A major impact will involve labor considerations, as this transformation increases the need for employees to focus on fulfillment, as well as shifting schedule demands that weren’t part of the equation before omni-channel grocery was an option,” says Lamphier. “Once the grocery store also functions as a warehouse, it has to be able to answers questions like: ‘How do you forecast the demand for shoppers who want the best of both worlds—the luxury of delivery sometimes, as well as the occasional in-store experience?’”
Jim Tompkins agrees that there are challenges ahead for grocers because of the experiential differences between online and in-store shopping for groceries.
“Being able to offer everything online that you offer in a physical store is impossible to do in an industry like groceries,” says Tompkins.
For example, you have different categories of goods, he notes. There are the restockable types, like paper towels, soap or cereal, that can be treated and sold the same online as they are in-store. But then there are the unique pantry items that are not standard and restockable, like a customized birthday cake or a try and buy cheese center, where the salesperson assists customers in matching their cheese with their wine. There also are refrigerated and fresh items. For instance, many customers want to be able to choose their own fresh salmon from the display case; they do not want someone to do it for them.
Tompkins believes that grocers are better off if they think of the task ahead as a “unichannel” instead of an “omnichannel” approach.
“When I think of omnichannel, I’m thinking that omnichannel is something that a retailer does,” he says. “For the grocery industry, I prefer instead to use the term “unichannel,” because what grocers want to do is make all of their channels perform as one in the eyes of their customers. To do that, customers have to have the same experience, whether they order online or visit a physical store.”
Of course, the experience isn't going to be uniform for the consumer in every respect. It’s likely they will still prefer to pick out their fresh salmon personally—but what Tompkins and Lamphier are referring to is the ability of grocers to align as many common business processes to both the online and the in-store shopping experience as possible, so that shoppers experience consistency across both channels.
“When grocers move to an environment where they must address multiple channels of sales, they have to adapt their business processes and systems to support the strategy,” adds Tompkins. “This is why it is important to identify business processes that are common to each channel. The areas that usually are common include sales, procurement, warehousing and distribution, and the overall workflow of the supply chain.”
In many cases, especially for perishable items, e-commerce grocery will likely still mean fulfillment (pick up) at local grocery stores, but grocers will need to adapt their distribution channels to handle both in-store and online consumption without impacting the in-store experience.
“Omni-channel grocery affects the buying process and strategy for how to replenish and replace products in both distribution centers and stores,” says Lamphier. “If you’re trying to create a model for online orders, adjustments will need to be made to the quantities of items that are anticipated to be purchased online versus in store, as well as to the timing of those purchases.”
Clearly, there is pain involved in getting to this new multichannel approach for traditional grocers, but as online giants like Amazon move into the brick and mortar world, historically brick and mortar operations have to adjust to online sales as well if they are to remain viable.
Nowhere are these growth pains likely to be felt more keenly than in the supply chain.
“There’s work to do, with plenty of opportunity for development and innovation,” says Lamphier. “Retailers are well-positioned to handle the planning aspects through transportation and warehousing, but the biggest hurdles will be around the in-store execution of the order. For example, how do you know that the inventory is there? How do you route it to the right store? How do you pick it, and do you complete the process via pick-up in store or home delivery? We are at a tipping point for adapting existing inventory and supply chain technology to fully capitalize on these market opportunities.”
Although warehouse operations, which already deliver to physical stores, might not change significantly if a grocer decides to use a pick-up in-store model for online orders, there is impact to systems, such as Point of Sale (POS), and other store services. Lamphier explains that one example of this is when the customer comes into the store. How is the store is going to handle that?
“For instance, do they order online and have the purchase delivered straight to their vehicle in the store parking lot? The grocer has to determine how the process works,” he adds.
The challenges of managing perishable foods must also be addressed
“Because we’re talking about perishable food, we know that home delivery is going to be very difficult,” says Lamphier. “The food delivery vehicle needs to be the size of a parcel delivery truck or smaller and include cleanliness and safety inspection. Retailers will need to create the correct temperature zones for the respective types of foods, and implement software optimization for delivery routes and pickup/drop-off. There’s a lot to the process, and until someone really knocks that out of the park, it’s going to be a hurdle for grocers to overcome.”
The catch here is: it may not be as large a challenge for logistics and distribution strongholds like Amazon, which larger grocery chains will find themselves competing against.
“In the end, the challenge for the food supply chain in a multichannel environment is all about velocity,” says Tompkins. “In other words, can the goods be sourced from origin to destination and ultimately to the customer to meet the customer’s expectations? And how can you guarantee the freshness of goods, especially if they are perishable?”
Many large grocery chains have profit margins that average between one and two percent, so there is not much room for error, as grocers work to open multichannel shopping environments.
“Consumers have grown increasingly fickle by having become empowered by social media, online search and other tools that let them compare companies and products and communicate their experiences and opinions to others,” reports Alix Partners, a corporate turnaround consultancy. “The historical model of one-way mass-market communication is giving way to two-way dialogue and relationship building…Because of all of those forces, CP companies, especially the larger ones, have had difficulty in growing their top lines during the past four years. In fact, revenue peaked in 2013.”
This likely means that large grocery chains will need to compete against new forces, like Amazon-Whole Foods, by relying on the knowledge and skills of internal staff, which may not include comprehensive knowledge and skills bases for competing in online environments or for adapting business processes to multichannel engagement with consumers.
“The real issue here is not ‘bricks and clicks,’ but ‘bricks and cliques,’” says Tompkins. “Amazon, an e-commerce presence, now buys Whole Foods so it can give its clique of buyers ‘bricks.’ But if you’re a traditional grocery store chain and must now compete with a large online presence with formidable warehousing and logistic capabilities, you might be asking yourself how you will be able to compete with that mode…In China, Ali Baba grocery stores enable you to choose your fresh lobster, which they will cook for you in the store while you shop. Models like this are what traditional grocers are competing against. Ninety percent of these stores look like they did 35 years ago, and now they find that in addition to adapting to a multichannel approach, they must cut prices as well. It’s a difficult challenge.”
Although the road to multichannel grocery shopping may be difficult, large grocery chains still have their brands, their followings and the good will they have cultivated through the years. It’s a foundation that can be built on.
“The key is to know who you are and to do it really well,” says Tompkins. “Some grocers focus on shiny apples in well-appointed displays. Others want to show a farm-to-shelf approach, with the dirt still on the apples. Grocers need to be asking themselves these questions about identity. Do you want a coffee shop in the store? Do you want to have private level goods? Do you want to offer in-store samples of food? What are the demographics of the customers that you are targeting to serve?”
At the same time, retail grocers need to assess their own ability to deliver on an e-commerce order, and truthfully evaluate how they can best deliver the goods.
“A fundamental question that retail grocers need to be asking themselves is whether they have a website and/or app that allows a customer to place an online order,” adds Lamphier. “Success will depend on whether or not they have a convenient, responsive customer experience that is well connected to their in-store inventory positions. Then, they need to determine how online orders will be routed to the appropriate stores? They also need to assure themselves and their customers of a high level of confidence in store inventory levels.”
Tompkins adds: “In the outbound side of the supply chain, grocers have to run their supply chains based on demand, whether that demand is from online or in-store sales. For example, if you know that you only sell five items of something daily, why keep 24 items stocked on the shelf?”
The Amazon Whole Foods purchase was a wakeup call that shook up traditional grocery chains, because it transformed having a multichannel grocer consumer experience from an option to an absolute competitive requirement.
In pursuing a multichannel strategy, grocers should take away one lesson from Amazon, which filled its brick and mortar “hole” by making the Whole Foods acquisition.
Large grocers with an established brick and mortar presence must do the reverse; they must fill the online shopping gap in their own consumer fulfillment strategies.
“Companies will to have reconfigure their business models in innovative ways, such as by deploying direct-to-consumer distribution and making savvier use of digital channels in their marketing and product distribution strategies,” says Alix Partners. “And they’ll have to make their supply chains more efficient than ever while also—and even more important—becoming nimble enough to satisfy consumers more swiftly and effectively than ever.”
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