Higher Institute of Medical Sciences
Hospital Dr. Salvador Allende
Havana, Cuba

March 2010
The Cuban culture plays an important role in the field of medicine.  It protects the terminally-ill patients by limiting the information that can be revealed to them.  Cubans believe it unnecessary and cruel to reveal the terminally-ill patients that they have little time left because, according to their belief, they die faster and it affects their quality of life.  For this reason the physician speaks to the family first and then the family decides if they want the patient to find out the diagnosis.  In almost all cases the family comes to a decision that it is best for the patient not to know the truth.  
A 68-year old patient was recently sent to our medical center by her family physician because there were some abnormalities in her chest x-ray.  She came to the hospital accompanied by her daughter and brought along her chest x-ray and a note from her physician.  When my classmate and I performed the medical interview and the physical exam, our results agreed with the findings on the chest x-ray.  The patient had lung cancer and was unaware of her condition.  In fact, she had no symptoms other than the typical weight loss characteristic of lung cancer.  She had been a heavy smoker since the age of twelve.  After discussing the case with our professor it was time to tell the family our finding.  We also needed their permission to perform further tests to confirm the diagnosis. 
Minutes before I spoke to the family, I thought, what if I tell the patient the truth?  She deserves to know that she has cancer.  On the other hand, I ought to understand that I am practicing medicine in Cuba and I must assimilate their culture.  Approaching the family with the news is not an easy task.  I usually try to prepare beforehand but one just never knows how the family will respond to the news.  The patient’s daughter was very strong even though a few tears slowly made their way down her cheek.  Immediately after knowing that her mother had cancer, she asked us to please not say anything to her mother.  She did not want her mother to suffer anymore than she was already suffering.  The patient remained at the hospital for about a week until we ran a number of tests to confirm the diagnosis.  Indeed, the results showed that the patient had lung cancer.  She was discharged from the hospital the day of her birthday.
The day after the 68-year old patient was discharged from the hospital, a 79-year old patient occupied her bed.  The same story was true for this patient.  She had been diagnosed with lung cancer a few months prior to being admitted at out center, but she was unaware of her pathology.  Once again, the family made the decision to keep the truth away from their loved one. 
It has been difficult for me to assimilate this part of the Cuban culture.  Nonetheless, the terminally-ill patients appear to be not interested in the truth.  They usually never ask the physician questions regarding their diagnosis.   It is as if they are not prepared for the truth. 
Sincerely,

Alejandro Bernal
Website: www.pnhpwesternwashington.org
Email: alex238209@yahoo.com