Our colleague Ms. Joyce Wong is planning to return to Cuba later this year to continue her research on elderly Chinese men living in El Barrio Chino de la Habana en Calle Zanja (See SMP 2/9/2011). She is preparing a book on this community in collaboration with Professor Eric Tang, University of Texas.Ms. Wong’s work grew out of semi-structured interviews done in Havana in 2007 and 2008.
Some of her work was published in the book Community Health Care in Cuba (Lyceum Books, 2010). Through her interviews Ms. Wong explores the difficulties faced by a group of (now elderly) Chinese immigrants as they sought “to preserve their physical and mental health, maintain their sense of self, and find a place in the context of the Cuban health-care system and Cuban society.”
Readers of the Portal may be interested in a talk this Friday (9/2/2011) at the CUNY Graduate School. Steve Brouwer, author of the blog Venezuela Notes, will be speaking about his new book, Revolutionary Doctors published by Monthly Review Press. He will be accompanied by the Honorable Jorge Valero Briceño, Permanent Representative of the Bolivarian Republic of Venezuela to the United Nations. The talk will take place at 7PM at the Elebash Recital Hall, The Graduate Center, CUNY, 365 Fifth Avenue, New York, NY 10016. Click here for a flyer.
Brouwer’s book begins with a discussion about the Cuban medical system and its programs of medical internationalism (either providing medical care directly overseas or training foreign doctors). It goes on to consider how Cuba assisted Venezuela to create a new public health care system, known as Barrio Adentro. Finally, Brouwer looks at the backlash against the Cuban model on the part of the US as well as the development of revolutionary medicine as part of the creation of a socialist society. It is always mind opening to read about serious attempts to construct socialist societies; there are real alternatives to our current social structure.
Brouwer notes that medicina integral (comprehensive or whole medicine) is built on Che Guevara’s idea that “individuals can liberate and develop themselves more fully when they are devoted to the full and revolutionary development of their communities and societies…” This conception of human development stands in stark contrast to current US political discourse where we are told that individuals develop most fully when they are disconnect from the broader social good and pursue their own selfish ends.
The talk is presented by Monthly Review Press; Bolivarian Circle Alberto Lovera; Cuba Solidarity New York; TheIndypendent; July 26 Coalition; Casa de las Americas; The Center for the Humanities at The Graduate Center, CUNY; IFCO-Pastors for Peace; The Center for Place, Culture and Politics, CUNY; and others.
Our colleagues at MEDICC, Medical Education Cooperation with Cuba, have been very busy over the past several months and it seemed time for an update about their activities:
Nineteen US students graduate from ELAM (The Latin American School of Medicine)
This year is the 7th in which US students have graduated from ELAM; Dr. Cedric Edwards was the first US graduate in 2005. Readers who would like to know more about ELAM should consult Don Fitz’s article published in the March Monthly Review entitled The Latin American School of Medicine Today. This article goes over both the strengths and challenges of study in Cuba.
MEDICC support for US students studying at ELAM
The process of picking US students for scholarships is managed by IFCo/Pastors for Peace. MEDICC, through its MD Pipeline to Community Service program has been playing a key role in helping these students make their transition back to clinical practice in the US. This has involved financial assistance in the form of form of MNISI fellowships that allow students to prepare for and take their US licensing board examinations. The fellowships are vital to make sure that ELAM graduates get positions in US residency programs and do well in those positions. But MEDICC has also developed a mentorship program to give ELAM students practice working in US clinical settings.
If you would be interested in donating, $100 will defray the costs of US exam fees and prep courses; $250 will allow students to prepare for their US board exams with 1,000 online practice questions; and $750 will pay the full cost of one US Medical Licensing Exam.
Would you like to become a mentor?
MEDICC is looking for US health care professionals who would be willing to mentor ELAM students. I personally have mentored several and found them to be a bright and highly motivated group anxious to demonstrate their history and physical examination skills (in fluent Spanish). MEDICC’s Rachel True is responsible for the mentorship program and writes: ”As the cohort of US ELAM students continues to grow, so does our need for mentors all over the country. We are currently looking for more mentors in the following areas of the country: Atlanta, Washington, D.C., Texas, Southern states (AL, MS, LA), Chicago, Los Angeles, and the Midwest (MN, ND, MI). If you have any colleagues or friends who might be interested, please let them know about our program and put them in touch with me. If you would like me to provide you with a brief description of the program, I would be happy to do so.”
Achieving Universal Health Care: A New Issue of MEDICC/Review
MEDICC Review, the International Journal of Cuban Health and Medicine, published its most recent issue in July; the issue is entitled Achieving Universal Health Care and contains articles from Colombia, Brazil, Ecuador, Cuba, Vietnam, Ethiopia, and Nigeria. The full table of contents is given below. I was particularly interested in an update on medical schools who were seeking to be socially accountable (i.e. to train graduates who met the health needs of their countries, Roundtable: Revisiting Innovative Leaders in Medical Education) and a brief description of changes to the Ecuadorean health system (Sumak Kawsay: Ecuador Builds a New Health Paradigm). Following a new 2008 constitution health in Ecuador has been declared a right and discussion is underway about how build a care system built on sumak kawsay, a Quecha phrase translated as collective well-being. This idea has been related to the concept of sustainable development as well as the Brazilian formulation of collective health (the Brazilian form of social medicine).
Finally, some collective well-being captured on the streets of Havana
For those of you who don’t speak Spanish, these are the “rappers of the third age”, i.e. geriatric rappers. The lead singer informs us that she has” five children, 11 grandchildren, five great-grandchildren and nothing stops me from singing and dancing.”
Marazul Charters, in consultation with MEDICC (Medical Education Cooperation with Cuba) is pleased to advise you of an exciting research opportunity in Cuba, focusing on Healthy Aging.The week-long research program is scheduled for the week of May 1 – 8, 2011. We are sending this announcement to health professionals and policy-makers dedicated to preserving and optimizing the health of older adults. Participants will be drawn from university centers for healthy aging, gerontology departments and associations, national organizations on aging; and senior councils on active aging.
The graying of the global population is occurring rapidly, most significantly in developing countries. According to the United Nations Population Fund, Cuba will head the list of Latin American and Caribbean countries with the most elderly population by 2025. Citizens of Cuba are not only living healthier and longer, but they have a higher level of education than 40 years ago. Addressing the needs of a highly educated aging population presents new challenges, requiring innovative programs. In response, Cuba has developed a comprehensive national program for older adults – unique in the developing world. This research experience will offer US participants the chance to observe first-hand Cuba’s low-cost working models and determine if these models have relevance in their own work settings. Research objectives will include the following:
1. To examine Cuba’s national programs aimed at healthy aging, including the Comprehensive Care Program for Cuban Elders, the Research Center on Longevity, Aging and Health, and the Cuban Society of Geriatrics and Gerontology. Family doctor-nurse teams serve every community, and all policlinics have a multidisciplinary Gerontology Care Team comprised of a doctor, social worker, nurse, and psychologist.
2. To examine Cuba’s community programs, including “Grandparents’ Circles” which engage elders in social events, Tai Chi in parks and sports activities.
3. To examine Cuba’s Seniors University, an innovative program in which older adults play an active role in defining the aging process, and in proposing solutions to the challenges of aging.
Full time health professionals conducting research in Cuba are allowed to do so under the US Treasury Department’s general license for professional research. Participants make arrangements directly with Marazul Charters, as we are an agency licensed to make all program and travel arrangements to/from and within Cuba (marazulhealth@gmail.com or 1 800 223-5334, ext 16.) The cost for a one-week program including roundtrip air from Miami to Havana, Cuban visa, accommodations, meals and full research program in Cuba averages $2,200. This is in addition to the cost of a domestic flight to Miami. MEDICC (www.medicc.org) serves as a program consultant to Marazul, and in some cases may be able to provide partial fellowships.
If you think you may be interested in participating in this opportunity, the first step is to please email marazulhealth@gmail.com by Friday, February 11, 2011, and we will send further information. We look forward to hearing from you.
Sincerely,
Bob Guild
Vice President
Marazul Charters, Inc.- In consultation with MEDICC
For 20 years Joyce Wong, a friend and colleague, has worked as a licensed clinical social worker with the Cambodian and Vietnamese refugee community in the Bronx. We wanted to share with readers of the Portal some of her recent work examining immigrant health care both in the Bronx and in Cuba.
Throughout the years she has been involved in training medical residents and students on refugee mental health in addition to organizing with the Committee Against Anti-Asian Violence (now called Organizing Asian Communities) in the area of language rights for the Southeast Asian community. She contributed a chapter, on the mental health and resiliency of elderly Chinese men in Cuba, to the book Community Health Care in Cuba. She is a native New Yorker who grew up in Washington Heights to parents from Puerto Rico and China.
Accessing Health Care: From the Bronx to Cuba
In 2010, Ms. Wong was interviewed for Asia-Pacific Forum, a program on New York radio station WBAI. The interview (available at this link) examined barriers to health care access for two different Asian immigrant communities. The first was the Southeast Asian refugee community in the Bronx who have faced challenges to obtaining language access and quality health/mental health care. (See our prior posts on the Justice is Healing campaign). She then turned to Cuba where she shared her research on health access for the Chinese-Cuban elderly male population in Havana.
La Magia de Cuba
During her visits to Cuba for the book chapter, Ms. Wong produced a short photo-video documentary entitled La Magia de Cuba, for a course on global mental health at the Harvard Program in Refugee Trauma on healing environments. It needs no commentary or introduction. Enjoy:
Ms. Wong is planning to return to Cuba this year to expand her research on elderly Chinese men with a plan to publish a book with Professor Eric Tang, University of Texas. A fundraising event will take place later this spring and we will keep readers informed. She can be reached via email.
I requested a year off from school to go to Haiti and work with the Cuban doctors after completing my 2nd semester of 3rd year at ELAM (the Latin American School of Medicine). I am one of 120 American citizens studying medicine in Cuba free of charge, with plans to practice medicine upon graduation in underserved communities of the United States and around the world.
When I arrived, I found several international ELAM graduates (http://elamedicosinternacionalistas.wordpress.com), including 7 United States graduates (http://www.michaelmoore.com/words/mike-friends-blog/cuban-trained-us-docs-complete-haiti-mission), and a number of Haitian medical students working alongside the Cuban doctors. We were stationed at a field hospital set up by the Henry Reeve Brigade of Cuban doctors on January 28th in a small central park of Croix des Bouquet, just outside Puerto Prince. Together we served displaced earthquake victims and patients suffering from inadequate health care services.
In the first six months the hospital was established, we addressed the needs of more than 70,312 patients; 53,588 at the hospital and 16,723 in the field. We performed a total of 2,506 operations on-site, with 786 major surgeries; including emergency caesarean sections, ectopic pregnancies, thyroidectomy, hernias, hydroceles, hysterectomies of uterine fibroids, orthopedic surgeries and more. We assisted 116 natural births. We diagnosed 3,533 patients with our on-site laboratory and diagnostics center. We saw 3,192 patients for x-rays and ultrasounds. We treated 8,778 patients with physical therapy, and we hospitalized 2,053 patients on-site (Information provided by the Henry Reeve Brigade of Croix des Bouquet Statistical Report, June 2010).
When you stepped out of the hospitals and into the streets the only question that came to mind had to be, “where is the aid?” It was obvious, even six months after the earthquake that little progress had been made, with little to no evidence of monetary support. Hundreds of thousands of people were still living displaced in make-shift tent cities. The city still resembled a disaster zone with buildings teetering above cracked foundations, while corpses remain beneath the rubble. The doctors seemed to be the only relief effort making a difference.
The Cuban doctors were accomplishing more than what the international community was willing to recognize. Croix des Bouquet was just one of several field hospitals established by the Henry Reeve Brigade to serve communities in and around Puerto Prince free of charge. CNN even had to apologize after interviewing one of the Cuban doctors and crediting him as Spaniard. Fortunately, Cuban doctors aren’t looking for recognition; they are out to save lives and continue to do so all over the world.
The Henry Reeve Brigade has since moved on to other emergencies, like the fires plaguing Russia. Other Cuban doctors have replaced them to continue serving the Haitian community free of charge. Brazil and Cuba have signed a trilateral accord with the Haitian Health Minister to establish three hospitals staffed by Cuban doctors located in communities surrounding Puerto Prince where health services are limited to non-existent. Cuba has been dedicated to sending doctors to Haiti for 11 years. Amidst the unfortunate circumstances of the earthquake, they continue to fulfill their commitment to the Haitian community by sending doctors. With the success of the students working alongside the doctors, they now have plans to send more students in the years to come.
Note: Article written by Joanna Mae Souers. Photograph titled, “Joanna Mae Souers on Wound Care” was taken by Cuban photographer, Juvenal Balán. The other photographs were taken by Joanna Mae Souers.
Yenaivis Fuentes Ascencio, 23, a medical student from Guantánamo, Cuba and Aníbal Ramos Socarrás, 30, a surgery resident from Manzanillo, Cuba are currently on a tour of the US. We understand that they have been in Atlanta, the Twin Cities and Chicago and will be traveling to Washington before arriving in New York City on Saturday. They will be visiting and talking in New York on April 12 (at the Schomberg Center) on April 13th (at Rutgers University) and on April 14th (at Hofstra in the morning and Hunter College in the evening) before leaving for the West Coast on Thursday.
It is not often that we have a chance to have a face-to-face discussion with Cubans from the island in the United States. We understand that US students who have studied at ELAM (the Latin American Medical school) will be speaking at the Schomberg Center event. For more information call: Nellie Bailey 646-812-5188 or Tom Baumann 646-256-0992. A fairly complete list of their engagements can be found at this link.
Anibal Ramos Socarrás
For more posts about health in Cuba, click on our Cuba category in the blog roll. For information about getting a free medical education in Cuba (yes, free), please consult ifco and see some of our posting about the Latin American School of Medicine and its students.
Joanna Mae Souers, an American studying medicine at the Latin American School of Medicine (ELAM) has written several times on the portal (see here). She asked us to post the following thank you note:
David Lundquist, President and CEO of Kingston Hospital, of upstate New York, made efforts to organize supplies to donate to the students of the Latin American School of Medicine in Havana Cuba. Supplies included masks, gloves, scrubs, and several other useful items that the students can use during their time in Cuba. Because of the U.S. embargo against Cuba, supplies are limited and students are expected to bring their own. It is very helpful when hospitals can help students out by donating supplies to alleviate them from these costs.
Kingston is where I grew up, and it is wonderful to get such positive support from local hospitals. Many health care professionals don’t know about the program to study medicine in Cuba, but when they hear about the opportunity, in spite of political propaganda, they think it’s great and they look forward to anything they can do to support the students. Cuba is well renowned for their public health care and international relief efforts, but what is little known is that there are over 100 U.S. students studying medicine in Cuba for free, with one catch, the promise to return to the U.S. upon graduation and practice in underserved communities. Is that really a catch? This is a gift from the Cuban government to the American people.
I want to thank Kingston Hospital for their generous donation and I want to encourage other hospitals to donate what they can. If you would like to make a donation of medical supplies or books to the students of ELAM, please contact IFCO & Pastors for Peace via their website www.ifconews.org.
We have received an appeal from our friends at MEDICC who are providing support to Haitian doctors in Haiti who have been trained in Cuba. This is a particularly important effort since it strengthens the local medical infrastructure; these Haitian doctors will remain in place long after the disaster relief ends. And it also breaks with the mainly paternalistic (and subtly racist) presentation of Haitians as the passive recipients of help provided by outside agents. [A link to be donate, can be found here.]
Cuban Medical Assistance in Haiti
There are currently about 400 Cuban-trained Haitian doctors working in 120 communities around Haiti, including Port-au-Prince. As graduates of the Latin American Medical School in Havana (ELAM) these doctors typically come from the poorest regions of Haiti and have studied medicine to serve Haiti, not to emigrate to the US (where the majority of Haitian-trained doctors work). They are accompanied by a 370-person Cuban medical mission which has been working in Haiti for several years.
The work of the Cubans and Haitians in the past week is described in these video feeds from CNN’s Shasta Darlington and Steve Kastenbaum. To quote from the Kastenbaum report:
“There are so few places where ordinary Haitians can turn to when they are in need of urgent medical care in the center of the city. We came across one: La Paz hospital. It is now being administered by Cuban medical personnel here in Haiti alongside crews from Spain and Latin America. And it is amazing to see. They are giving medical attention—quality medial care—to severely injured people, six to seven hundred patients a day, several dozen surgeries a day. They have three theaters going around the clock, 24-7, and it is one of the only places deep in the city where Haitians can go and be treated and have a reasonable expectation of surviving.
We saw so many traumatic injuries there. I can’t even say how many amputations we saw, compound fractures, traumatic flesh wounds. Yet, these overwhelmed medical teams were finding ways to take care of all of them, despite being very low on critical supplies—sutures, oxygen, anesthetics, water—they need all these things. Their supply lines stretch all the way back to Spain, and it’s being sent in. And it is being done in a remarkably orderly fashion.”
[The Portal has provided information about US students studying at ELAM who have also agreed to return to medically disadvantaged areas in the US.]
Providing support through MEDICC & Global Links
MEDICC, the Medical Education Cooperation with Cuba, has paired up with Global Links to organize a recovery and long-term medical assistance program for ELAM-trained Haitian doctors. Both organizations have decades of experience in regional material aid cooperation, and with Cuba and Haiti in particular. They will be working with representatives of the Haitian graduates to identify needs for medicines, medical supplies, and equipment. And they will get these supplies directly to them.
While US law does not allow Cuban doctors in Haiti to receive these essential medical materials–the US embargo is taking its toll post-disaster–MEDICC and Global Links will ensure distribution to the young Haitian physicians working in public hospitals and clinics alongside the Cuban team, seeing hundreds of patients daily.
To quote from MEDICC”s appeal:
We need your help to raise the funds for this joint effort–and to raise the policy bar by replacing hostility towards Cuba with cooperation when it comes to the health of the hemisphere–Haiti deserves nothing less. And Haiti’s young doctors need your support now.
For more information, see www.medicc.org, where you can also donate online to the HAITI EARTHQUAKE APPEAL. Or send your check to: MEDICC, PO Box 361449, Decatur, Georgia, 30036. Note at bottom: HAITI APPEAL.
MEDICC (Medical Education Cooperation with Cuba) is a 501 (c) (3), not-for-profit organization; your donation is tax-deductible.
Much has been made of the disastrous health and social conditions in Haiti. It is important to keep in mind that these conditions did not develop in a vacuum. Paul Farmer, in an April 8, 2004 article published in the New England Journal of Medicine, documented the links between political violence and the public health in Haiti.
This political violence was often the result of outside interference, most prominently by the US. Commondreams.org has published several articles discussing this from which we quote the following (written by Peter Hallward):
The noble “international community” which is currently scrambling to send its “humanitarian aid” to Haiti is largely responsible for the extent of the suffering it now aims to reduce. Ever since the US invaded and occupied the country in 1915, every serious political attempt to allow Haiti’s people to move (in former president Jean-Bertrand Aristide’s phrase) “from absolute misery to a dignified poverty” has been violently and deliberately blocked by the US government and some of its allies.
Aristide’s own government (elected by some 75% of the electorate) was the latest victim of such interference, when it was overthrown by an internationally sponsored coup in 2004 that killed several thousand people and left much of the population smouldering in resentment. The UN has subsequently maintained a large and enormously expensive stabilisation and pacification force in the country.
Haiti is now a country where, according to the best available study, around 75% of the population “lives on less than $2 per day, and 56% – four and a half million people – live on less than $1 per day”. Decades of neoliberal “adjustment” and neo-imperial intervention have robbed its government of any significant capacity to invest in its people or to regulate its economy. Punitive international trade and financial arrangements ensure that such destitution and impotence will remain a structural fact of Haitian life for the foreseeable future.
it should be noted that the 2004 coup was the second overthrow of Aristide by international forces.
Finally, one long-lasting step towards Haitian reconstruction would be cancellation of its foreign debt (click here to sign a petition asking for this). In fact, one of Aristide’s many political sins was calling for the French to return the money that Haiti had been forced to pay the ex-slaveowners in order to gain recognition by France. For another twist on this story, see Bill Quigley’s “Why the US owes Haiti Billions: The Briefest History.”
On September 27th 2009, Dr. Joan Beder, Dr. Susan Mason, and Joyce Wong, CSW spoke at Social Medicine Rounds on Community Health Care in Cuba. Drs. Beder and Mason have recently published a book of the same title which we have reviewed on the Portal (see: New Book on the Cuban Health Care System).
Breast Cancer in Cuba
Dr. Joan Beder began with a discussion of her work with breast cancer patients. Dr. Beder is a professor of social work at the Wurzweiler School of Social Work at Yeshiva University. She has an interest in oncology services and specifically services for women with breast cancer. She began her talk by pointing out some of the contradictory aspects of work in Cuba. Cubans have guaranteed rights to health and education; this something that we did not have in the US. Yet it was clear walking around Havana that Cuba is an impoverished country where food was rationed.
Dr. Beder noted that the Cuban system provided essentially the same treatment options – chemotherapy, radiation, and surgery – that were available to patients in the US. But the supply of drugs was quite limited. Breast cancer screening programs had been impacted by the US trade embargo; the Cubans could not obtain the best mammography film and equipment because it was produced in the US. As a consequence higher than necessary doses of radiation were used in mammography.
Dr. Beder was asked by the Cubans to provide some guidance on helping women with the psychosocial consequences of breast cancer. She worked with the Federation of Cuban Women which runs a series of Women’s Centers where breast self-examination and mammography are promoted. Initially they considered setting up a self-help hotline for breast cancer survivors. This turned out to be problematic due to the deficiencies of the Cuban system; people may not always have access to a phone in a private setting. Her work led her to undertake a training program in the special needs of oncology patients for Cuban social workers.
She concluded by pointing out that cancer is now the second leading cause of death in Cuba; cardiovascular disease is number one. Cognizant of this, the Ministry of Health has begun a special national program to train doctors in the prevention and early detection of cancer.
The Cuban approach to mental illness also has been shaped by a context where resources are limited and medications are in short supply; again, this is due – in part – to the effects of the embargo. Psychosocial treatments have been emphasized and mental health is based on three principles: community, prevention, integration. Arts and music programs are valued and accepted as mental health interventions. She described with a mixture of amusement and admiration how official meetings might be interrupted for a short break allowing the participants (“even the Ministers”) a chance to sing and dance. (It was later suggested that this would be a great idea for hospital rounds).
Care for mentally ill patients was often provided by social workers who live in the same community as the patient and make house calls as needed. When patients needed more supervision, family members were paid to stay at home and care for them. When a family member was not available, patients were placed in a foster home. Since family members (or foster families) were paid, patients with mental illness were not typically viewed as an economic burden for their family or community. Dr. Mason shared some pictures of a day program run from a private home. The atmosphere was quite domestic and she remarked: “It feels like you just want to hang out there.”
Did this model work? Dr. Mason expressed frustration that despite the theoretical advantages of this community model for psychiatric care, there was really no hard outcomes data to demonstrate that it was effective.
A Healing Environment
Joyce Wong is a social worker at a Bronx community health center where she works primarily with South East Asian immigrants. She grew up in Washington Heights in a community that was largely Cuban and later traveled to Cuba to visit Havana’s Chinatown. This had once been one of the largest “Chinatowns” in the Western Hemisphere. With emigration, the population has dwindled considerably and now consisted primarily of the elderly.
In Chinatown, she interviewed elderly men to learn how they had managed to survive in Cuba after leaving their homes in China. She found the men relied on ethnic pride and identity, maintaining their language, and consciously suppressing painful memories. She described this not as a form of repression, but rather as a conscious decision to look for happiness and self-healing.
Ms. Wong made a short film about her trips to Cuba, a place she felt was a “healing environment.” La Magia de Cuba (Cuba’s Magic) is a montage of music and photos and is available on Picasa at this link.
The situation of Cuban patients, denied access to the best possible care because of the US trade embargo was denounced by Amnesty International in September. Readers interested in learning about the health impacts of the embargo should consult their report: The US Embargo against Cuba: Its Impact on Economic and Social Rights.
Dr. Joan Beder began with a discussion of her work with breast cancer patients. Dr. Beder is a professor of social work at the Wurzweiler School of Social Work at Yeshiva University. She has an interest in oncology services and specifically services for women with breast cancer. She began her talk by pointing out some of the contradictory aspects of work in Cuba. Cubans have guaranteed rights to health and education; this something that we did not have in the US. Yet it was clear walking around Havana that Cuba is an impoverished country where food was rationed.
Dr. Susan E. Mason is also a professor of social work at Yeshiva University; in addition she is a professor of sociology and the chair of the college departments of sociology and political science. Her area of expertise is schizophrenia and she is the co-author of 
Joyce Wong is a social worker at a Bronx community health center where she works primarily with South East Asian immigrants. She grew up in Washington Heights in a community that was largely Cuban and later traveled to Cuba to visit Havana’s Chinatown. This had once been one of the largest “Chinatowns” in the Western Hemisphere. With emigration, the population has dwindled considerably and now consisted primarily of the elderly.
