In a newly released report from ECLAC (the United Nations Economic Commission for Latin America and the Caribbean), Older Persons in Latin America and the Caribbean: Situation and Policies, Cuba is described as among the most rapidly aging of all Latin American and Caribbean nations. In categorizing the relative distribution of a nation’s population for those persons 60 and over, countries are described as Incipient Aging (average 5.5% of persons 60+), Moderate Aging (average 6.9% of persons 60+), Moderate to Advanced Aging (average 8.1% of persons 60+), and Advanced Aging (average 13.7% of persons 60+). For the year 2000, Cuba was firmly in the middle of the group of countries described as Advanced Aging, with 13.7% of the population over age 60. But more importantly, ECLAC population studies predict that the percentage of Cuba’s population over the age of 60 will rise to 25% of the population by the year 2025, and ominously, to 33.6% of the population by the year 2050, at which time Cuba will be perhaps the ‘oldest’ nation in Latin America and the Caribbean. Meeting the challenges of a graying population now and in the future includes issues of economics, health, environment, and policies and programs designed to enable older adults to live out their days with dignity and quality of life.

In 1999, Roberts et al., in a Project Report prepared for USAID, wrote: “At this time, the only legal outlet in Cuba for organized civic activities outside of state control are Churches—the churches are the only civil society entities officially allowed to function, and the only concession made to individual choice on the island.”1 Acknowledging their inability to meet the needs of the island’s elders even at today’s level, the Cuban government has called upon faith-based NGOs to provide health and social services to the island’s older adults. Babún, in a presentation to ASCE in 2001, explained the role of Faith-Based NGOs in distributing humanitarian aid, and delivering social services in the Special Period.2 He told us that Faith-based NGO’s conduct neighborhood humanitarian services, provide transportation, obtain medical supplies, and provide meals. In return, the Cuban government demands that church-affiliated NGOs on the island serve people without regard to their religious beliefs.

Subsequent to his presentation, Dr. Babún and I were awarded support from USAID to assist independent NGOs on the island to develop their service capacity in the provision of social services to older adults. Our work was to be designed to support successful independent initiatives of Cubans and others on the island, and others who seek to provide social services and promote respect for human dignity and human rights. The specific objective of the initiative was to advance positive social and health outcomes for Cuba’s elders by providing the knowledge and expertise necessary to strengthen and expand independent, non-governmental social service agencies.

In order to better understand precisely what knowledge and expertise was most needed by the independent NGOs on the island, we held focus groups with visiting NGO representatives and recent émigrés. (Cuban NGO representatives often visit the United States, Canada, and other democratic nations on funding missions and on invitations from families and Churches and other not-for profit organizations.)

Recent émigrés described a need for education without ideology—and a need for education that will enable Cubans to participate in a free market economy when the time comes. They also told us of the elder situation. For example, Omar told us: “I have nothing to do with medicine or with nursing homes; I am an air conditioning technician. But I have an opinion about the life of the elders in Cuba. For all people, the situation is difficult, but it is worst for the elders. They sell things in the street; in great part they are supported by the aid of relatives in the USA. Some of them are living as indigents unless they have relatives in the United States or children with good positions in Cuba. A high percentage of them suffer, like in the hospitals with free services but without medicines. The fortunate ones receive help of the Church.” When we asked them what would help make NGOs stronger, better able to provide more assistance to more elders, Francisco replied: “To make stronger the NGOs that already exist, there is a need to fortify them, not only with economic aid but also with knowledge.”

NGO representatives, most of whom were leaders of independent congregations, explained the services they provided and where their needs for knowledge and expertise were most imperative. Over and over again, the need for expansion in the provision of support for Cuba’s elders was described:

• Dr. VH told us: “I’ve been a pastor for the past 28 years … I began working with elders in 1994. I run a ‘home’ in an old, semi-destroyed house. We are working to improve it some. There are 18 elders living there. Six are bed ridden. Also, we help 4 elders that live in the community. Doctors and nurses visit us, but we take care of the rest.”
• LP told us: “In 1990 we took on the task of taking in homeless elders. We picked them up and placed them in the ‘home.’ There is a wait now, but we contact elders and make of list of them. Additionally, we have between 8-10 elders who receive groceries; sometimes the food is even prepared for them.”
• JA told us: “I hold a position at the national level, with …. We are planning on providing groceries to elders. We have a special stock for their nutrition. We do not offer other services.”
• ER and FM told us: “It cost us a lot of prayer and hard work to start the nursing home. God has allowed us to find the funding necessary for the completion of the chapel. It’s almost finished. This will increase the space for elders. This has been a dream of ours. We will provide the nursing home with fruits, vegetables, and meat from our farm so they can have the basic nutrition.”
• JP told us: “For 10 years I was the director of the ‘home’ sponsored by …. It was a very interesting experience because the authorities made sure we knew that the elders who were cared for in religious homes had to have better care and a wider scope of service for older adults than government ‘homes.’”
• HS told us: “We are caring for 15-20 elders from the surrounding areas; they can come have lunch and dinner here. There will be 30 persons living there and 15-20 from the community that come for meals.”
• V told us: “We depend on help from the parishioners for food and funding (one peso per church member or whatever is possible). My mission receives a little food from the Convention that is distributed. There is a group of elders who are receiving food. We do not know how to offer other services.”
• And then FM told us this about the work of NGOs: “One must be very discrete and enterprising in the work. What am I doing against the government? In spite of the threats, they aren’t going to stop us. I am understanding that both things, service and education go together. And it is silencing me no longer. I am going to learn and speak and do a great deal…. We must learn how to better serve.”

While it was and is obvious that independent NGOs providing social services on the island need every conceivable resource, from food and water to furniture and equipment, the NGO leaders we interviewed agreed that among their most urgent needs were education and training, and to this end we were prepared to develop guides to assist them in the development and implementation of programs addressing the services they defined as most critical. Analyzing our discussions, our Program Team found that among the most important services that were provided or potentially could be provided were Nutritional Programs, Residential Care, Adult Day Care, Home Care, Hospice Care, Record Keeping, and Disaster Planning and Recovery.

• Nutritional Programs: Attainable and cost-effective strategies for operating nutritionally sound, safe, and hygienic feeding programs, including food pantries, hot meal kitchens, and inhome services to bring food and water to those too weak to venture out.
• Home Care: Services to frail elders, including: personal care; homemaker services; shopping; and chores. Assisting with activities of daily living, including bathing and toileting. Techniques for restoring mental and physical skills and abilities after injury or illness.
• Adult Day Care: How to develop effective programs and programming strategies to engage elders and overcome mental and physical barriers to participation; accessibility; staffing requirements.
• Residential Care: The physical environment, scheduling staff and volunteers, health monitoring, routine care, and emergency procedures. Effective programming strategies to engage elders. Obtaining and distributing medications and medical devices.
• Hospice Care: Providing care and comfort to the terminally ill and their families.
• Disaster Preparedness and Recovery: Strategic planning to prepare client populations for disasters and providing recovery services to clients after they occur.
• Record Keeping: Developing and maintaining client histories, treatment plans, and progress reports, incorporated into each of the individual manuals and guidebook. To encourage record keeping, each guide was printed with blank pages, and with wide margins for notes and ideas and work plans.

As the role of NGOs as a vehicle for the establishment of independent social services in Cuba in the 21st Century mimics the role they played in the United States during the 19th Century, in the development of the service program development and implementation guides, we always kept in mind the ultimate outcome objectives of these manuals, to enable NGOs to:

• Train and utilize volunteer staff to their highest potential;
• Promote respect and human dignity;
• Improve the quality of life for Cuba’s elders;
• Provide the best level of service possible with limited resources;
• Provide appropriate services;
• Monitor clients health and changing health and social service needs;
• Better meet the emotional, nutritional, and physical needs of their communities elders;
• Position themselves to provide more services through strategic long range planning; and
• Prepare for emergencies and post-disaster recovery.

We attempted to make the guides completely apolitical to protect the users. Even in our Disaster Planning and Recovery guide, we avoided any allusion to transition or civil unrest. Our guides have not been banned (as of this date) and we have been told that they are among the most requested books on the island—more than 1,500 of them have been distributed.

In closing, I would like to offer this comment about the role of civil society, and the small faith-based NGOs that our work supports, in the creation of democracy. One of the prevailing views asserts that the higher the rate of mobilization in civil society, the greater the movement towards democracy. In his essay The Virtue of Civil Society, Edward Shils discussed the need for civility as an essential social climate for political action, and many scholars consider volunteerism, civic engagement, and the fostering of civic values by associational networks, the pillar of pluralism and democracy. Julieta Valls and Dave Schemeling described the same need when they spoke of the “Third Sector,” the cultural sphere, and the necessity of building social trust as crucial for democratic development. 3 But an evident shortcoming of this theoretical discussion and understanding of civility and civil society is that it does little to answer the question: How would a society with a precarious civic history go about building one?4 I submit that assisting the small independent NGOs in Cuba to provide services to elders, and involve their communities in the provision of care to the frailest members of their communities, is one operationalization of the answer, as it encourages volunteerism and organizational structures while promoting respect for others and human dignity. Assisting these small independent NGOs to serve Cuba’s elders is perhaps what Natsios meant when he discussed the relief to development continuum: that humanitarian aid programs should be designed to encourage long-term development.5

I would like to end with the words of USAID Director Natsios (emphasis added):

At the heart of all humanitarian relief strategies lie two essential imperatives: saving lives and reducing human suffering. …This should not be done primarily through the importing of humanitarian relief commodities … but through the strengthening of the coping mechanisms of the population … (to) yield the greatest and most productive result in making people self-sufficient.6

FOOTNOTES

1. Churchill Roberts, Ernesto Betancourt, Guillermo Grenier, and Richard Shaffer, Measuring Cuban Public Opinion: Project Report, prepared for the U.S. Agency for International Development, contract LAG-G-00-98-00021-01, The University of Florida, 1999.
2. Teo A. Babún, Jr., “Faith-Based NGOs: Their Role in Distributing Humanitarian Aid and Delivering Social Services,” Cuba in Transition—Volume 11 (Washington: Association for the Study of the Cuban Economy, 2001), pp. 418-433.
3. Julieta N. Valls and Dave Schmeling, “The Role of Volunteerism in Capacity Building for Cuban Non-Governmental Organizations,” in this volume.
4. Enrique Pumar, “Structures of Opportunities, Emerging Civil Society, and Transition: The Work of Human Rights Organizations,” Cuba in Transition—Volume 11 (Washington: Association for the Study of the Cuban Economy, 2001), p. 70.
5. Andrew Natsios, “Humanitarian Assistance During a Democratic Transition in Cuba,” Studies in Comparative International Development, 4 (Winter 2000), pp. 23-33.
6. Natsios, p. 26.