Friday, March 10, 2017

Cuba Beyond the Cusp of Change (Day 3): Reflections on a Week Long Penn State Graduate Course in Cuba

(Pix © Larry Catá Backer 2015)

It is my great privilege to have been encouraged to design and hold a week long embedded course program through Pennsylvania State University. My thanks to the office of the Penn State Office of the Vice Provost for Global Prgrams, Michael Adewumi and Kate Manni, Assistant Director for Embedded Programs, for making this possible.  Thanks as well to  Scott Gartner, the Director, Penn State School of International Affairs, and special thanks to Claudia Prieto (SIA Academic Adviser and Student Services Coordinator) and Rachel Arnold (Assistant to the Financial Officer, Penn State Law/SIA), without whose help and encouragement this program would not have happened. Great thanks as well to our hosts in Cuba, the Centro de Estudios Martianos that went out of its way to enrich the course and the experiences of our students.

This is the first of a series of posts that will develop reflections both on the teaching of embedded programs in Cuba, generally, but more specifically as a way of documenting the way my students and see see Cuba today.  For many years Cuba and its political order was said to be on the "cusp of change" (e.g., here).  Since the start of normalization of relations with the United States, it is quite evident that Cuba has now moved beyond the "cusp" and into the realities of integration within a global system to which it has had both privileged access and been excluded over the last half century.  The re-adjustments in both respects will mark the trajectory of Cuban life for the next generation (compare here, with here).

I started with the embedded course syllabus (INTAF 597C Penn State SIA) and then will post reflections for each day of the journey through the course materials and within Cuba.  The hope is that this provides some food for thought respecting the necessary evolution of political and economic systems, and the constraints within which systems change or expend great energy to stay the same.

Links for full contents HERE.

This post considers our activities on Day 3--Cuban Health Sectors, Cuban cemeteries, and Cuban Social Structures From a National and Regional Trade Perspective.

March 7:   

09:30            Colón Cemetary-Cementerio Chino and introduction to the architecture of Cuba
11:15            Lecture—Results of Medical Research in Cuba  . Dr. Manuel Raices
12:00           Almuerzo
14:30            Lecture—Regional Commerce: ALBA, Martí, Bolívar y Fidel  Dr. Larry Backer

This proved to be an interesting day of contrasts and connections. It interlaced the geographies of status and politics that plays out among the dead in the physical space of the cemetery and among the living in the social and economic organization of medical technology, especially pharma related. Politics and social organization appear as strongly connected to the way n which societies arrange the patterns of eternal rest for their dead as it plays into the performance of competition among economic models that is performed on the bodies of those living human beings who are its objects.

We started at the most important necropolis in Havana—the ColónCemetery. The arrangement of the cemetery represents the physical manifestation of the social and political structures of the society at the time of the burials of the dead, and thus also of its evolution over the centuries. The Colón evidences in death the eternal organization of status based colonial society, and of the even more rigid status arrangements of post colonial states that retain a dependent status within global power structures.  And within these one sees peaking out the manifestations of the new order, which in its own ways substitutes but does not eliminates the ranking and orderings of the dead. A number of observations stuck in my memory of the visit:

1. Cemeteries exclude and welcome in ways that reflect the inclusions and exclusions of the society of the living form which they draw their residents.  As a Catholic cemetery, now more open under the sensibilities of the current political organization of the state, it welcomes its own.  Jews and Chinese had to find their own spaces.  Thus the cemetery, like the society around it, seeks to normalize a majority while in the marginalization of tolerated  (or even embraced subsidiary) elements physical differentiation is meant to underline the space between the “normal” or the “baseline” and everyone else. This is prejudice, to be sure (at least as understood today).  But it is more an imperative of a society the basis of which is itself dependent on the maintenance of the divisions.

2.  Even within the normalized spaces reserved for the eternal ordering of social space the internal divisions of social hierarchy were respected.  The rich, famous, and societal hero’s were accorded pride of place along the main avenue into the cemetery and leading to the Church that forms the center of the necropolis. This is space that is used to show off the wealth and status of the upper levels of social and political hierarchy, and also a space reserved to honor those individuals who gave their lives in the service of this hierarchy and the maintenance of its good order and safety.  Among the most prominent of which were the many firefighters who died in the early part of the last century to save the city from a massive fire.

3.  But this division is not a simpleminded application of Marxist notions of class struggle physically manifested.  The aggregation that was colonial and post colonial Cuba are also represented.  The cemetery fractures along the ethnic lines of the largest elements of immigration—sections for Gallegos and for Catalans, for example.  And of course, Afro-Cubans were relegated to the farthest points from the center of the cemetery—with the notable exception of a mulatto man who had the good fortune to marry one of the wealthiest white women of her generation and whose remains line the main street of the dead.

4. Death can be monetized. The value of the Colón for the living is the extent to which the dead can serve as a source of income.  The visits of relatives are nice but tourists are better. And even better the ability to guide the living through the interpretive journey to the land of death.  Like other aspects of social life, the cemetery can serve as a social space for the articulation of the principles on which the current social order is based.  And where foreigners especially can be charged for the privilege, all the better. This is not an indictment of the Cubans.  Heavens knows the Europeans have a thing or two yet to teach Cuba on that score.  But the use of dead spaces for socialization and embedding of current ideological bases of political organization can be profoundly important ot a spate sitting within site of a giant.
5.   Money does tend to produce revolutions and family status does tend to move even the most rigid social norms.   Placed directly across form the most prominent monument within the 5th Avenue of the Necropolis was the grave of one of the wealthiest, best connected, and scandalous women in Cuba in the first half of the 20th century.  This tomb raised a large middle finger in death that reflected he position of her finger in life as it was pointed at Cuban society, the state and the Church.  She was married into the most prominent family in Cuba, with children, and from one of the most prominent families herself.  Their social, political and economic position put her and her husband at the apex of the social order.  From this apex she  appeared to fall--she began a life long, torrid and very public affair with another member of society, one that eventually saw her banished from Cuba--to Paris. Eventually connecitons and money allowed her an annulment--but with a heavy price--separation from her children; a price she accepted. She eventually moved back to Cuba and died on one of her frequent trips to Paris. Her lover played only a small and supporting role in this drama.  And the fruit of all of this drama: a divorce law for Cuba. And as for that nose thumbing in death--she outwitted the rules that prohibited the building of a tomb monument taller than that dedicated to fallen firefighters--a tomb that sits directly across d¡from hers--by building a fairly squat building fronted by two magnificent palms that now soar above the monuments in the cemetery. And that, perhaps, provides the key metaphor for Cuban social culture emerging through the centuries.
6. People make their own saints and invest them with such power as may give comfort to the living.  Such was the case with one of the most popular tombs of the cemetery--that of "La Milagrosa", a woman who died in childbirth along with the infant.  When buried her child was placed at her feet, in accordance with the burial customs of the times. But it was said that when the tomb was opened the child had moved up to be near her mother. Thereafter many people come to the tomb to seek interventions for health, pregnancy  and child protection. The Church has never recognized these events nor do they take a position with respect to the miracle.  But people have.  This disjunciton between popular culture and mores existing below but in sight of the rigid and powerful official culture and customs also marks a grounding feature of Cuban culture--social, political, economic, and religious.  Perhaps it marks, as well, in its own contextually distinct ways, many societies cleaved by hierarchy.    

Those divisions and fractures manifested within what appeared to be the singular space reserved for the dead was especially manifested in the space that separated the much visited Colón cemetery and the cemetery once reserved for the Chinese community.  Where the state goes to great lengths to preserve the Colón, it expenses little effort to preserve the space for the Chinese dead.  The disrepair of the Chinese cemetery speaks volumes for the gulf that always separates the majority and those at the margins of social organization, even within structures of equality and solidarity. Tourist do not visit the Chinese cemetery for the most part.  There are no fees to visit.  And the caretaker was surprised to see a group interested enough in the social status of death to come over.  The state of disrepair is significant enough to require the removal of the remains of the dead to a bunker underground slightly to preserve their dignity and protect their remains from grave robbers and others bent on desecration. What makes this somewhat remarkable is that, when one talks the time to see the dead one notes at once the central role played by the Chinese community is the struggle for revolutionary victory—from the perspective of the current state order.  And yet though the remains of heroes of the revolution reside in this cemetery, the neglect reminds us of the distance between the ideals of that revolutionary moment so long ago and its realization today.  One can only hope that this contrast is addressed to align ideology and practice.  Perhaps the Chinese state might be persuaded to aid in the rehabilitation of this cemetery in the name of solidarity. And yet there is something of an equivalence.  It is just that that practices of moving remains in the Chinese cemetery is open; that at the Colón is less so.  See, e.g., here.

It was to those notions of solidarity within the structures of Cuban Marxist Leninism that I devoted my lecture, Regional Commerce: ALBA, Martí, Bolívar y Fidel.  It served as a bridge between the visit of the cemeteries and the discussion of Cuban efforts in the Pharma sector that took the class through the afternoon. The Alternativa Bolivariana para los Pueblos de Nuestra América (ALBA), the command economy alternative to the free trade model of globalization, is one of the greatest and least understood contributions of Cuba to the current conversation about globalization and economic harmonization. Originally conceived as a means for forging a unified front against the United States by Cuba and Venezuela, the organization now includes Nicaragua, Honduras, Dominica, and Bolivia. ALBA is grounded in the notion that globalization cannot be left to the private sector but must be overseen by the state in order to maximize the welfare of its citizens. The purpose of this paper is to carefully examine ALBA as both a system of free trade and as a nexus point for legal and political resistance to economic globalization and legal internationalism sponsored by developed states.

The paper on which the presentation was based starts with an examination of ALBA’s ideology and institutionalization. It then examines ALBA as both trade organization and as political vehicle for confronting the power of developed states in the trade context within which it operates. ALBA remains embedded in a large web of trade arrangements among its member states that bind them in different ways under different arrangements. That context highlights differences, especially in relation to MERCOSUR (the Latin American intergovernmental trading bloc) and the abandoned FTAA. It also produces both cooperation and challenge. This is most acutely felt in ALBA’s relationships with CARICOM (the Caribbean Common Market) and in the rising network of bilateral investment treaties among regional states. Taken together, for the moment, at least, ALBA’s greatest contribution might well be its ideology. Its mere existence serves as a basis for challenging assumptions in the creation and implementation of methods of integration. It provides a base through which this distinctive ideological voice can be leveraged by its state parties in Hemispheric integration debates. It seeks to balance the tensions between post colonial nationalism, internationalism and state sector dominance by substituting for private markets and private actors, state actors and tightly controlled markets. It is no longer focused on eliminating borders for the production and management of private capital; instead it is focused on using borders as a site for the assertion of public authority to control all aspects of social, political, cultural, and economic activity. Understood as an ideological joint venture among its participants, ALBA represents a space within which a consensus on alternatives to the existing preeminent economic model of globalization might be constructed. As such, it may represent one of Cuba’s greatest triumphs and also its greatest challenge to the normative tenets of the current framework of economic globalization. Thus contextualized, ALBA serves as a nexus for six great points of tension and connection within both modern trade theory practice and the construction of state system frameworks in Latin America. ALBA implicates tensions between integration and nationalism; between public and private models of integration; and between internal and external regional trade norms. It also highlights connections between the current form of trade frameworks and the construction of alternative forms of trade arrangements; between anti-Americanism and integration; and between conventional frameworks of Latin American trade and it challengers. These are summarized in the conclusion.

The paper on which this was based may be accessed HERE:

The PowerPoint slides that are helpful may be accessed HERE:

Our afternoon lecture provided a brilliant contrast and parallel to the morning visit. But in this case the bodies that are the object of ordering are the living, and the space within which that ordering is undertaken is defined by the sector of medical research and the delivery of medical advances to targeted populations. To that end we heard a marvelous presentation, “The Organization of the Cuban Biotechnology Business Opportunities,” from Dr. Manuel Raices, Researcher, Scientific secretary  of the International Congress Controlling Diabetes  and its main complications.

Slide 1
35 years ago Cuban state sought to start its own bio tech sector.
Effort to commercialize products in ways that reflect well on the state and its economic decision making
Program has been very successful.
Sector built around a research center in the West of Habana. National Center for Scientific research. Used for basic research and science.
Will talk about the work of the Cuban Bio tech sector.

Slide 2
Cuba produced
            33 products against infectious diseases
33 Oncological products
18 Cardiovascular products
              7 products to control diabetes and other pathologies

They are working on a number of additional applications in every field  but especially those in which people mostly die of: Cancer related conditions, cardiovascular, diabetes and infectious diseases, and autoimmune diseases.
He then spoke to the mechanics of medical research and its connection with moving products developed to markets—focusing on the regulatory and financial constraints on the marketing of such products.  That produces tremendous transactions costs.
Projects are developing in light of the globalization of once regional diseases, e.g., Ebola now becomes global issue in the face of easy transport.

Slide 3
Cuba is well situated especially for tropical diseases and heart disease, diabetes and cardiovascular diseases.
He then spoke to the origins of the biotech industry.  Started with a visit by a US researcher  to speak about interferon.  (Now a $17 billion market).  At the end of the lecture he received a request to speak with Fidel who became enthusiastic about it and persuaded the US researcher to start sharing research around interferon in Cuba.

Slide 4
Cuba begins working on gene splicing building on innovative human research from 1973-75.  Emphasized the difference in research tracks.  In the US from research to Market to health system.  In Cuba in the 1980s from research to distribution through the health system to markets. This both starts and distinguishes the rise of biotechnology in both states. US objectives for bio tech is to make money to grow, hitting the market you then create social impact in the health system.  Because Cuban could not access markets (they were not very good at that). So rather than target markets, they started by creating social impact through use and then approach the market. The object fr the Cubans then was to sell the health system—delivery mechanisms with a product that solves a problem, rather than in the traditional system in which one gets financing form the market that takes a risk on the development of a product that might solve a problem.

Slide 5
Main results of the health care system in Cuba.  Specialization in delivery—prevention and early detection, specialized diagnosis and therapies and then a biotech industry that meets demand. For Cuba then, the markets are irrelevant to the development of an industrial sector—proper management grounded in meeting social needs can be as or more successful than marlets based development.

Slide 6
Goal; design strategies and technologies etc. that focus on early detection and therapies from birth to death, with the object to solve problems rather than to make money (the money coming later in state ot state transactions.

Slide 7
Then he spoke to the organization fo the Pharma sector in Cuba: 31 enterprises, 78 factories, 21 000 workers. Each is organized as an SOE that reports directly to the President.  No direct reporting connection to the ministries.

Slide 8
Looked to commercialization.  In the 1980s only 3 drugs (meningitis vaccine, IFN alpha 2b, Diagnostics). The rate grew substantially in the 12990s and has expanded at a faster rate since the 2000s.  The meningitis vaccine remains viable and important.

Slide 9
Looked to the R&D pipeline.  He noted the difference between the conventional pipeline and the Cuban version. The difference is avoidance of sales stage and go right to national coverage, therapeuric guidelines are created and complex interventions worked through.  Once that is done then health impacts are measures,.

Slide 10
Clinical research continues in areas of diabetes, oncology, infectious diseases and other indications.  Clinical trials are conducted within the Cuban system.

Slide 11
Clinical trials in 30 other countries.  Cubans not paying for these trials.  They go to the country and identify a powerful local company loyal to the home state and willing to “solve problems” rather than just make money.  Barter exclusive license for financing of trials.  If they say yes, you sign and start up.

Slide 12
Intellectual property protection. Cuba has moved aggressively to protect its patent rights all over the world.  Patents are good and bad. Patent protection does not affect aggressive protection of price in certain cases, especially with respect to developing states.  Cuba also reverse engineers and then provides access to states that do not protect patents. Embargo produced perverse results that produced an exception for the biotech sectors.  Now working with Mongolia.

Slide 13
Commercialization of states has been expanding.  Latest focus is on Middle East and Gulf States. US markets are next targeted.

Slide 14
Business Model approved by the state.  A number of distinct models of relationships are now authorized.

Slide 15
Investment proposals for the Mariel Special Zone. State has focused on particular sub sectors of Pharma that are open for foreign investment.

Slide 16
Cuban basic frame of medicines. National production of 569 products.  Object is self-sufficiency in production

Slide 17
Program for newborn screening. 33 diagnosis kit developed for 19 pathologies.  Part of 119 screening procedures for pre-natal care. Object is to ensure live healthy births including genetic screening. Looking for free delivery and avoid fee for service structures. Abortion: state went from fully available to more managed abortion.  The problem was that cheap abortions produced consequences—multiple abortions produces sterility. Abortion has been used in lieu of vigorous birth control. So women turn to abortions.

Slide 18
Cuban program for preventing infectious diseases using preventive vaccines. The problem here is of providing vaccinations where many have to be imported at great expense.  Again object is national self-sufficiency –workarounds and deals.

Slide 19
Example of Hepatitis B and C.  Distribution of vaccine for free to reduce and eliminate Hep B. Example of political will of the state to mobilize resources to solve a social problem, rather than work with markets to produce a fee based solution available to some.

Slide 20
Pix of BioCubaFarma; 1600 people researching

Remainder of slides discuss the scope of areas where cooperation with US would be useful for both sides.

Slide 21 - 23
Agricultural production
Produce anti tick vaccine for cattle used along the rio grande.  Object to turn cow blood into tick poison. 4 million cattle already vaccinated.  Not available in US which is tragic along the Texas border.

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