"Context," the word, is not at risk of vanishing just yet, but "context," the concept, could soon go the way of "critical thinking," or "racism," wherein parties that seemingly know little about these terms have the power, through the act of thoughtless appropriation, to destroy their impact.
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Cuba has autism too. Lots of it. But do they have a similar prevalence rate as the US, or other richer countries? Actually, the guesswork says no. But none of this is as yet proven. The resources needed for prevalence studies have just not been available, again, due to the blockade.
Historically, though, there really wasn’t a great, visible need for the Cubans (in particular, their overseeing entity, the Ministry of Health) to implement large resources into autism programming; until 2010-2012, when they started hearing reports of larger numbers from their schools and pediatric offices (the first group of children they started working with is now 16).
Operating out of Havana’s Borras Marfán hospital, Dr. Yoysy Rondon Acosta is the National Coordinator for Autism and other Neurodevelopmental Disorders. Working alongside Dr. Tania Adriana Péon, who heads the National Group of Child Psychiatry. they have been charged with coming up with national plans that can withstand the challenges of both the prevalence rise and the embargo/blockade. Every municipality in the country has its own health center that operates under the Ministry’s guidelines. And the result has been a framework that’s more than a little different…
For starters, they don’t categorize a “big three” of medical, psychological, and neurological influence the way we often do to.
“
For us, autism is ‘neurobiological,’” Dr. Acosta stated.
Going further, she explained that they don’t obscure medical involvement in their thinking, but unlike our
medical model of disability, “(their)
thinking of ‘medical’ is much more of a mix of traditional and natural medicines.”
Going
more further, their approach is intentionally multi-disciplinary. Psychiatrists don’t just reach out to Occupational Therapists on an as-need basis. They are all tied together at the hip as a day-to-day practice. Acosta explained: “
We have seven disciplines that we make work together. Child Psychiatry, Psychology, Neurology, Genetics, Speech Therapy, Physiatry (a combination of Physical and Occupational Therapy)
, and the natural and traditional medicine.“
...
The grandmother reported the lack of speech as the most concerning issue to her. For others, drawing more interest was the child’s clear lack of recognition of the other people in the room. He was also sorting toys by shape and color rather than engaging in “imaginative play.” At first glance he seemed an obvious diagnosis, though he was trusting, not anxious, and his fine motor skills were maybe even advanced.
But the team began asking questions about home life. There was a new baby brother who gets seemingly most of the attention. Dad has left. Mom lets grandma do perhaps far more of the mothering share, even though grandma does not live with them (but she picks the boy up every day to take him to her house for a few hours). Grandma reported that when he eats at his home that the boy is often placed in front of the TV or a computer. That perked the team’s ears up.
One team member told Neuwirth, that “
This is important because in Cuba we don’t encourage children to see screens until they’re 4 years old.“
Because of this and the questions about home life, the team would not diagnose him yet. They could see the likelihood of an autism diagnosis down the road, but for now the team assigned a second meeting, and this time it was mandated that the mother attend with the child.