How Cuba eases minds

DEPENDING on where you are coming from, there is a satisfactory degree of rough justice in the idea that a country which is so poor that it cannot afford to give its population orthodox Western medicine may well be getting it right through adaptations of traditional medicine and the use of its own culture to interpret the latest therapies.

Such a country, in the eyes of Margaret Hills, is Cuba. Hills is a lecturer in psychiatric art therapy at Queen Margaret University College in Edinburgh. Cuba, where she will carry out research for her PhD over the next year, is an island off the coast of the US which for a certain generation will always be linked with the word ''crisis'', while much younger people see it as a new holiday destination where a pound sterling goes a long way.

An uncomfortably close neighbour of the most powerful First World country in the world, Cuba is classed as Third World.

It has been

the communist thorn in the fleshy side of capitalist America and quarantined as such. There are few cliches more trite than the one which allies poverty with happiness, but Hills's preliminary investigations have exposed a society poor in resources but rich in ingenuity, mutual respect, and commitment to health and education.

She will be taking up a placement through the university in Havana at a children and family centre called COAP in Vedado, and at the Hospital Psiciatrico de La Habana. She will work closely with Dr Aurora Garcia, whose particular approach to understanding children's art is at the heart of Hills' desire to work in Cuba, and hopes to develop her own interest in the issues of identity by working with adolescents under

Dr Garcia's supervision. She believes that she can bring back to University College, which is already a leading provider of degree courses in a wide range of health therapies, a new slant on art therapy,

and a valuable insight into inter-

cultural co-operation.

Hills leaves for Havana on August 25 with 16-year-old son Alexander, who will study there. She has developed a deep interest in Cuba, inspired by its health and education system. ''They have a quality of access across the board for everybody and they put an enormous amount of resources and energy into providing a comprehensive system. Although they are short of material resources, they are quite extraordinary in their commitment to providing health and education to all of the population.'' That Cuba is a symbol of hope and courage in the face of adversity is what captured her imagination. That it is surviving as the last socialist country has its appeal, too.

Hills' background includes a training in adult psychiatry at Guys Hospital in London. She wanted to work with adults with mental-health problems using clinical art therapy. Returning home to Edinburgh in 1987, she worked with the renowned Well Springs organisation, then in social work with adults with mental handicap and their families, and with adolescents in care. Six years ago she began teaching at

University College, securing placements for students to pursue the practical side of their training. Art therapy has been used within the NHS since the 1970s, but hasn't been used extensively in Scotland until the past decade. It was Joyce Laing, perhaps most famously associated with the Special Unit at Barlinnie, who introduced art therapy to Scotland. ''Art has always been concerned with the psyche and the soul and emotions, so it is quite an obvious relationship,'' Hills says. ''Art allows people to express hitherto unexpressed emotions, feelings and thoughts, and the very act of making an image about something can help you conceptualise, to give words to a feeling, a desire or memory. But that doesn't happen in isolation. It requires the supportive presence of an art therapist, trained in art so that they are sentitive to the production, to what it means to make something, but also sensitive

to the relationship and to understand that we are not always conscious of what motivates us.''

Until the course was developed at University College, art therapy in Scotland remained slow to take off. Now it is blossoming and University College has some 200 student placements around the country. Clinical art therapy is now used in prisons, psychiatric hospitals, children and family centres, working with the elderly, with women's aid, and with physical illnesses such as cancer and stroke patients.

When Hills goes to Cuba, she says she has no agenda but will remain focused on COAP, where the psychologist Garcia has developed a new method of understanding children's art. Children who have problems such as bedwetting, anxiety, or lack of concentration at school are referred to Garcia. She asks them to do just two pictures, one of themselves at home with their families, the other of a subject of their choice.

She has already witnessed families undergoing this type of therapy. Having sent one anxious little boy on an errand, Garcia said she knew the parents were to be divorced. ''It became clear that they hadn't told the child, but his anxiety seemed related to his fears about his parents.'' His behaviour was ritualistic and his drawings clearly showed him outside the family in different ways. Garcia based her decisions on therapy on her conversations with the child about the drawings.

Hills, who has been raising money for the Cuban project (colleagues, friends and customers in the Edinburgh night club Cuba Norte have been very generous but

donations will be welcomed by Hills at the Queen Margaret University College campus in Duke Street, Leith) and has been reassured that she should not worry about getting all the art materials because the

people there see themselves as ''muy creativos,'' or very resourceful.

Hills says: ''That about sums it up. They don't have access to Ritalin to curb hyperactive children, but they are always thinking of other ways of doing things.'' Although there may not be enough pens and paper to go round pupils, every school has a psychiatrist. This means being able to tackle childrens' problems on a day-to-day basis rather than waiting until a child has a major problem which needs clinical intervention.

There is, Hills says, an amazing amount of trust between doctor and patient: respect in Cuba does not elevate the professional but treats him or her as an equal who can help the family. When Hills wanted to see the hospital director, who had fought along with Che Gevara, she had to wait in a queue with the patients. Professionals are not seen as judgmental, as Hills has experienced in Scotland.

Hills says there is a lack of anti-psychotic medicine at the Havana psychiatric hospital. When international restrictions prevented the importation of drugs to Cuba, professionals feared it would be to the severe detriment of mental-health patients. As an alternative, they involved patients in the life of the hospital, in art and music, and in the community. Asked why this system was so successful, a nurse told Hills: ''We are like a big family. It is the spirit of community and the commitment of those who work with the patients.'' Every morning, musicians from the community come to the hospital bandstand and play music.

Isolation is often detrimental to those with mental health problems, the elderly, or children and adolescents with problems. The

conscious involvement of the community in Cuba is something which has been worked at. ''It is a socialist ideal that you are responsible for each other. That you have a debt society and are not just an isolated individual with an 'I'm all right jack' attitude,'' Hills says. She found that Cuba's brand of socialism was quite unique and certainly not just an importation of the Soviet regime. She says Scots are proud of their socialism, but feels they have to work at it to match Cuba's.

The use of ''green'' medicine in Cuba owes its presence to a combination of tradition and deprivation. Just as in psychiatry, drugs have been in short supply. The

creative (and successful) response has been to take up old recipes for local remedies.

Hills says: ''My work is not just about art therapy and Cuba. There are all sorts of other themes, such as creativity and courage and identity.'' She hopes to return, therefore, with not only an academic body of work but a book for a wider readership. One of the aspects she will try to fathom is the Cubans' high morale in the face of adversity, although she is aware that transferring working practices from one culture to another is not simple. Why, she wonders, should one nation become depressed and downtrodden by its health and social problems, while another fights back and rises above them?

During the Cold War, psychologists in Britain went down the Pavlovan road of ''locking people in rooms and getting them to do the right thing,'' Hills says. Because of the lack of resources, the Soviets got really interested in learning theory and what heightens people's potential to be creative. Some of this is reflected in the Cuban attitude and is what Hills finds so positive and so worthwhile trying to import

to Scotland.