Reflections on a Surgical Elective in Cuba: Clinical, Cultural, and Personal Insights

Different and enriching

When first thinking about organising my elective, I knew that I wanted an experience that would be both clinically different from my usual training and culturally enriching. 

A further personal challenge I set for myself was to do my elective entirely in Spanish, having studied the language to A Level and travelled in South and Central America after leaving CLC. 

After extensive research, several unsuccessful attempts, and over 100 hopeful emails, I finally heard back from the Universidad de Ciencias Médicas de la Habana offering me a four-week surgical placement in Havana.

relaxed, calm, and less formal

Cuban healthcare is a publicly funded system, much like the NHS/HSCNI. However, rather than housing multiple specialties, each hospital in Havana focuses exclusively on one specialty. 

Despite patients having their care split across several hospital sites, doctor–patient relationships were incredibly warm and familial. Language in Cuba is much more informal and affectionate, with doctors and patients often addressing each other as “darling,” “my life,” “dear,” or similar terms. These terms of endearment, also common in everyday Cuban culture, created a more relaxed, calm, and less formal hospital atmosphere.

For me, this gave the impression that patients wholly trusted their doctors and sought support from them readily.

This was reinforced by the almost complete absence of patient complaints that I observed. In the UK, patients may frequently feel dissatisfied with waiting times or the lack of information provided. In Cuba, by contrast, patients seemed to take the standpoint that their doctors were doing their utmost within constraints.

At follow-up clinics, many even brought gifts to show gratitude. Given that luxuries are scarce and the average Cuban salary barely covers essentials, these offerings (often food or homemade goods) carried great symbolic weight, with effort and thought valued above monetary cost.

Possibly one of the greatest challenges the hospital faced while I was there was the breakdown of the lifts, which meant major surgery could not be performed. Patients either had to wait or be transferred to another hospital, with the surgical team travelling to operate. This highlighted how even basic infrastructure challenges, compounded at times by electricity shortages, could disrupt surgical care.

knowledge sharing

My contribution to the placement involved a wide range of tasks, such as helping with surgical clerk-ins and writing post-operative patient notes.

I also had the opportunity to scrub into operations and assist or help with instruments (Cuban surgical teams do not have scrub nurses, this role typically falls to the most junior team member) as well as helping the registrar close at the end of the operation.

Talking to Cuban medical students, I realised that although they were at a similar stage of training to me, they did not always have the same opportunities or exposure. On several occasions, I explained parts of surgeries and demonstrated how to scrub in, which felt like a valuable way of sharing knowledge.

Several themes emerged from my elective. Firstly, the clinical cases highlighted how healthcare delivery is shaped by context. The contrast between resource-limited and resource-rich settings challenged my assumptions about “gold standard” practice and reminded me of the primacy of clinical reasoning.

Secondly, cultural differences in hierarchy and patient relationships illustrated the diversity of healthcare models and the importance of adaptability. Thirdly, the personal challenges of language and cultural adjustment deepened my appreciation of resilience, humility, and communication as core professional skills.

Critically, the elective underscored that such placements are not simply about personal gain, but about mutual exchange. While I learnt a great deal, I also had a responsibility to contribute integrity, respect, and professionalism to my host institution.