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Alfonso is a typical young man with schizophrenia. Alfonso hears voices all night long. He lives at home with mother and father. His mother was on the verge of a nervous breakdown. She couldn't sleep because Alfonso couldn't sleep. He was up all night hearing voices and talking to himself, the voices, the mother, the neighbors.

Until Risperdal. Now, he is beginning to get some sleep on some nights. Naomi Pinson and I met with Alfonso in the small Habana port town of Regla. We talked to his family. We were able to do our Peer Educator Project class with him. The day was spent learning about what is mental illness and how to live with it. Also, the family has agreed to be part of the first NAMI family to family training in Cuba in the future.

We talked about Alfonso's lack of sleep and the weird waking cycle every couple of hours. This insomnia-like erratic sleep pattern filled with anxiety was the mental illness. This sleep pattern was probably coming from the brain being overactive. Many people with mental illness cannot sleep through the night. A sleep routine is critical. Risperdal is one of the best medications for constant and consistent sleep.

We talked about getting a sleep routine that was important. Medicine is an aid to sleep at night. However, the person who takes the medicine will still have to learn to sleep at night. And, if Alfonso cannot sleep during the first few weeks, he should stay in bed and learn how to rest. If he cannot sleep then he can at least get some rest. He should keep taking the Risperdal. Not taking it, then taking it has also made him erratic. He might also feel so good that he thinks that he is no longer mentally ill or needs the medication. The rehabilitation period toward stability from major mental illness is years. He should set aside the next two years to get stable on the medication and stay involved in his mental health programs of care. This is what we covered with the Peer Educator Project class with Alfonso.

The whole time we were involved with Alfonso and teaching him how to live with a psychiatric condition, his parents were involved with us. There is not a big separation of families and patients in Cuba. Also, his psychiatrist was there. Dr. More is his psychiatrist in Cuba. He participated in the group. Psychiatrists in Cuba go to the home and walk through life with the patients. For instance, he takes the bus and walks through the town of Regla with Alfonso. He is a side-by-side companion to help keep him stable and find the medication level which is best for Alfonso. There are no artificial boundaries and barriers which separate patient from doctor.

The Cuban mental health system has done a great job of teaching Alfonso about diet and exercise. He still remains thin and fit. Cuba doesn't just have classes. They have whole training sessions where people walk and exercise in groups as part of their day programs. Alfonso has also decided that he enjoys walking very much. He walks all over Habana. He enjoys his time looking at Habana and walking through the streets. He has cut back on going to his day program. We encouraged him to return to his program involvement.

We talked about how we have to fight for funding for our programs in the United States. We talked about how we have waiting lists for mental health services. Everyone in Cuba has open and unlimited access to mental health programs. Mental health is part of the national healthcare. Alfonso began to see that he had real opportunity. Cuba also has vocational rehabilitation as part of the mental health system. There is NO separate state agency for vocational rehabilitation. Everybody is working together as part of the mental health system.

There is a team approach to each person who is receiving mental health services. Cuba has staffed the mental health system with many workers so that the staff is not tired, disillusioned and discouraged like in our mental health system. The workers in Cuban mental health stay on the job. They see working in mental health as a lifetime career. The mental health workers spend a lot of time with the patients because they have the time and energy.

We talked to Alfonso about the concepts of the Peer Educator Project. We explained to him that he could learn more about his own coping skills and teach others. We talked about how the future of mental health would be more people with psychiatric conditions working in mental health. There will be more and more classes by people with mental illnesses about what we have and how to live with mental illness. He is a great candidate to become a Peer Educator. We talked about returning and setting him teaching the Recovery Workbook to start a Peer Educator Project in Cuba.

We talked about our history as mental patients. We talked about the history of the mental health system. We talked about our experience in living with mental illness. Alfonso said that he did know other people with mental illness in Habana. He also talked about how someday he might work in mental health. The years that he spent in the system could be seen as on-the-job training. He could be learning from the inside out. We encouraged him to attend the programs and pay attention. He might be working in those same programs some day.

He then told me the big problem. That he could not get Risperdal all the time. A lot of his discouragement has come because of his inability to have a guaranteed source of medication. The blockade against Cuba had been a blockade against medication. There have been times that he had to stop taking the medication because he could not get medication shipped to him. His brother in Miami is working two jobs just to support paying for his medicine to get sent to Cuba. He would be more content and more compliant if he thought that he had a steady supply of medicine. Sometimes he just thinks, "what is the use? I will never get well. I will never have the supply of medicine that I need."

He has stopped taking medication out of discouragement. He said that the mental illness made him think negative thoughts. The idea of being without medication made him think even more negatively about his life. He was also almost crying and looked so sad. Naomi and I promised that we would try to resolve his erratic access to medication.

We left and we reminded him that he was going to have to remember that he was going to have to learn a sleep routine. If he can't sleep then he has to learn to stay in bed and rest. He also had to see that he is an educational resource. Pay attention to his symptoms. See how he gets through the day. Also, learn coping skills from others with a psychiatric condition. Teach others. The motto of the Peer Educator Project is "Reach One Teach One."

Alfonso was a dock worker. He unloaded ships in the harbor of Habana. He still lives in the port town of Regla across the harbor from Habana. He isn't a dock worker anymore. He does have an important life which he can share with others. He can help himself. He can be of help to others.

Thank you Alfonso for spending time with us. Thank you Dr. More for introducing us to Alfonso.