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Cuban medical internationalism

Cuban medical internationalism


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In the decades since the Cuban revolutions the country's medical doctors famously served on many semi-official missions abroad. For instance, it has been reported that Venezuela under Hugo Chavez provided cheap oil to the island, while the Castros sent their doctors (as well as sports instructors) in return. Cuban physicians effectively became an important export article.

Was this special national ability the result of deliberate planning or tradition on the island (an earlier versions of some emerging countries' current efforts on providing offshore medical services or an upscale version of nurses from the Philippines, perhaps) or did it just emerge as a by-product of a socialist state's common tendency to put relatively much effort on basic services such as medical care? The Wikipedia article on Cuban medical internationalism goes into many details, but is relatively light on the phenomenon's early history and ultimate causes.

So I am looking for sources more reliable than Michael Moore and I would be esp. interested in any memoirs that may exist from Cuban doctors having served in African countries during the Cold War period: Che Guevara, M.D. does not count :)


Castro make the cuban medical system the showcase of socialist success. He prepared the educational system to make more medical. See chart at the end source.

In fact the export of cuban medical is a one of the big business Castro made. For example in the case of Angola and Venezuela where you can find a big amount of cuban medical the gov of these country are paying for this service now days around of $2,500 usd/month by each doctor to the cuban government and this medical just receive around $100 usd by moth, then you can see the profit generated by this "internationalism".

The same apply to other fields like education and sport training.

From my experience when I lived in La Havana, was very common go to the hospital and the specialist was in mission(how it's called in Cuba when a medical go to other country sent by the gov), and I had to return to my home without medical atention

Recent News: Cuban doctor in Brazil triggers diplomatic tiff

Cuba has a population around the 11,2 million(2012)


USSR trained a lot of foreign students - going so far as creating a special university for that. Education for citizens of client states was free - this was one of the forms of support, like, e.g., selling oil below market prices (which Cuba re-exported at a handsome profit) or buying their products (like Cuban sugar) above market prices.

Castro made the Cuban medical system the showcase of socialist success (like classical ballet and the space program in the USSR) - getting free medical education in the USSR and "re-exporting" it as "medical internationalism".


FACT SHEET ON CUBAN MEDICAL INTERNATIONALISM

The performance of the Cuban state and government in combating the COVID-19 pandemic inside Cuba is in stunning contrast to the disastrous performance by governmental authorities in the United States, particularly at the Federal level in Washington DC. Gross negligence by US authorities – within an already broken and grotesquely unequal health-care system – has led to wholly unnecessary rises in disease, death, infection, and spread. US pandemic deaths are at 140,000 and rising.

Florida, with a large Cuban-American population, is now a world epicenter of toxic COVID-19 contagion. Other US states and regions show mounting crises in hospital and ICU overflows supplies in equipment and PPE overwhelmed hospital staff and so on.

The pandemic is also particularly acute across the Americas where Brazil, Ecuador, Mexico, and Peru, highlight the unfolding horror shows in Latin America and Central America.

The facts presented below are clear and irrefutable. Cuba stands out for its performance, leadership, and results.


Washington Escalates Anti-Cuba Aggression

Despite this reality, the Trump White House, with bipartisan support or acquiescence, has escalated its economic and political war against Cuba, aimed at asphyxiating the legacy and living example of the Cuban Revolution. This flies in the face of near-universal opposition from the overwhelming majority of the peoples and sovereign governments of the world.

The irrefutable facts on Cuba’s domestic example and inspiring medical internationalism in this pandemic are the crushing refutation of the attempt by the Trump Administration to discredit and slander Cuba. We should always remember that Cuba’s impressive figures occur under the conditions of the cruel and brutal US economic aggression and sanctions that have actually deepened since the pandemic exploded.


Cuba’s medical internationalism

Since 1960, socialist Cuba has sent 400,000 doctors and nurses to more than 164 countries to share their medical expertise. Internationalism has been a part of the Cuban Revolution since its earliest days. As far back as 1960, Cuba sent doctors to Valdivia in Chile after an earthquake killed thousands of people.

Cuba’s health system is world-famous for its efficiency. Cuba has more doctors per head of population than any other country in the world, and ranks higher than most “developed” countries on life expectancy and infant mortality. Cuba’s health system concentrates on preventive care, with doctors and nurses living among their patients.

Literally from cradle to grave, Cubans do not pay a cent for health services. This has meant that Cuba’s biggest export, ahead of tourism, is now its thriving biotechnology industry, which has developed lung cancer vaccines and eliminated mother-child HIV transmission. This is all despite the illegal blockade against Cuba.

Cuba has always taken the approach that it is willing to provide assistance to the people of any country, regardless of its relations with their government. Whether it was the right-wing Somoza dictatorship in Nicaragua after the 1972 earthquake or the socialist government in Angola, Cuba has always been prepared to help the people of any country, even when their governments do not reciprocate. After Hurricane Katrina, Cuba even offered assistance to the US government. (It was refused.)

It would take far too long to list every example of Cuba’s internationalist missions. An important example was the mission in Angola, where the MPLA were fighting for liberation against Western-backed mercenaries and apartheid South Africa. Cuba provided not just medical volunteers, teachers and construction workers but also internationalist combatants, more than 2,000 of whom would be killed.

After the Chernobyl incident Cuba took in 26,000 people, the great majority of them children, and gave them free health services, education, and shelter, even after the end of the Soviet Union.

The Latin American School of Medicine trains medical personnel from all over the world, the majority from poor backgrounds, including black Americans, who would not be able to get a medical education in their own country. All the state asks in return is that the qualified doctors go back to their own communities and provide medical care for those who need it, as opposed to who can pay the most.

When Hugo Chávez became president of Venezuela, 70 per cent of the people lacked regular medical care. As part of the health policies of the Bolivarian Revolution, tens of thousands of Cuban health workers poured into the poor barrios of Venezuela. They were nicknamed the “army of white coats.” Of note was Operation Miracle, which allowed blind Venezuelans to travel to Cuba for surgery.

The Cuban medical brigade is named the Henry Reeve Contingent, after an American who fought in Cuba’s first War of Independence against Spain. Their expertise is in working in disaster zones and areas affected by serious epidemics. Since its founding in 2005 they have served in Guatemala, Pakistan, Bolivia, Ecuador, East Timor, Brazil, and other countries, as well as Haïti after the disastrous earthquake in 2010.

Fidel Castro said after the Haïtian earthquake that “we send doctors, not soldiers.” Incidents have since come to light involving disgraceful conduct by American and other UN soldiers sent to Haïti.

Just as it did after the Ebola outbreak in 2014, when it was the first to respond to the World Health Organization’s appeal for medical aid, Cuba has responded to the covid-19 pandemic with absolute selflessness. The image of Cuban medics arriving in Rome will prove more powerful than any propaganda from the United States. The potential of Cuba’s Interferon-2B drug in treating patients only goes to show the inhumanity of the blockade on the world, not just on Cuba.

Cuba’s medical internationalism is the direct product of its Revolution and its socialist ethos. During the Revolution the guerillas built support among the peasants by establishing medical clinics and schools. This has been expanded to the point where Cuba is now in a position to share its resources with the oppressed of the world and now one in every ten Cubans has served in an internationalist mission. This is an achievement not just for Cuba but for every Marxist-Leninist, an example of what we can achieve when we put our ideology into practice.

The insight of Dr Ernesto Che Guevara, that the most important quality for a revolutionary to possess is the love of humanity, could not be better exemplified than by the Henry Reeve Contingent. It is a reminder that there is a better world, an alternative to the misery and poison of capitalism. Cuban medical graduates swear an oath “to serve the revolution unconditionally wherever we are needed, with the premise that true medicine is not that which cures but that which prevents, whether in an isolated community on our island or in any sister country in the world, where we will always be the standard-bearers of solidarity and internationalism.”


Cuba’s strong tradition of medical internationalism looks set to continue despite upheaval in the Americas

After Castro’s death and with profound political and economic change across the Americas, Gail Hurley asks, what future for Cuba’s medical internationalism?

The recent death of Fidel Castro at age 90 prompted a flurry of commentary simultaneously proclaiming the former Cuban leader a hero or a tyrant. Biographers and commentators will no doubt pore over his tenure and legacy for years to come but few will challenge the view that Castro transformed his country and reshaped global political relations during his lifetime. In so doing, the small island nation of just over 11 million people punched well above its weight in the international arena.

One way in which Cuba has consistently ‘punched above its weight’ is its extraordinary global medical record. John Kirk, a Canadian Professor and authority on Latin America, describes Cuba’s medical internationalism as ‘the world’s best kept secret.’ He puts the number of Cuban medical personnel at over 38,000 in over 60 countries around the world with over 20 per cent of Cuba’s doctors working overseas. To put this in context, Cuba (population 11.4 million) has more medical personnel working abroad than the World Health Organization and the G7 countries combined. In addition, Cuba has the largest medical school in the world – the Latin America School of Medicine (ELAM) founded in 1999 – which has over 8,000 students enrolled, the vast majority from developing nations. The school also operates positive discrimination towards families with limited means and towards disadvantaged communities such as the black and indigenous communities of Central and South America.

In Guinea-Bissau, 1974 (Roel Coutinho, CC BY-SA 4.0)

The tradition of providing medical assistance dates back to the first years following Cuba’s 1959 revolution. The island’s new government soon began to provide emergency medical assistance to countries affected by disasters or armed conflicts. In 1962, just a few years after the revolution and when health professionals were sorely needed at home, Cuba sent 56 doctors to Algeria to support the newly independent nation with its medical needs.

Since then, Cuba’s international medical assistance programme has mushroomed. The medical relief operations after Hurricane Mitch struck Central America in 1998 were pivotal. Since 2013, over 11,000 health professionals have served in Brazil under the country’s ‘Mais Medicos’ programme which provides health services to underserved regions and communities. Cuba also has a longstanding health programme in Haiti and over 15,000 Haitians have benefited from Cuban health training initiatives. Indeed, a hallmark of Cuban medical cooperation is that doctors are there for the long-run they do not engage in so-called ‘medical tourism’. Most recently, Cuba deployed over 250 doctors and nurses to West Africa to join the international effort to fight the Ebola disease outbreak in Guinea, Liberia and Sierra Leone. Cuban doctors have carried out over 3 million eye operations in 33 countries, mostly in Latin America and the Caribbean, funded in part by Cuba’s close ally Venezuela.

But like all international cooperation activities, they cannot be considered in isolation from other political and economic forces at play. Cuba’s international health assistance programme must be viewed as one strategy that has aimed to break the United States’ attempts to isolate the country internationally. Medical internationalism is in this context a tool of ‘soft diplomacy’. Cuba’s provision of medical personnel to many socialist states around the world over the years is also no accident. The recent Cuban-Venezuelan collaboration meanwhile has both political and economic dimensions the relationship is a means to tackle the United States’ dominance in Latin America while the ‘Oil for Doctors’ programme provides for deeply subsidised oil exports from Venezuela in return for doctors, teachers and military advisers from Cuba. Additionally, Cuba reportedly earns some U$8 billion a year in revenues from professional services carried out by its doctors and nurses overseas since the authorities collect a portion of the incomes earned by Cuban workers abroad. Cuba’s international medical assistance programme is therefore one of the island’s largest exports.

But as I’ve said elsewhere, political, economic, security and moral objectives are at play with any donor’s international aid activities, and indeed some, such as the UK (among others), have recently reasserted the role that development aid can play in leveraging and negotiating trade deals.

A joint Cuban-Haitian medical brigade at work in Port-au-Prince (United Nations Photo, CC BY-NC-ND 2.0)

There has been much academic discussion over recent years about the rise of so-called ‘South-South Cooperation’ and the role that ‘emerging donors’ (especially China) are increasingly playing in the international development arena. In these discussions, the contribution of Cuba is often overlooked. Over the past 50+ years, Cuba has consistently used the export of its medical personnel as a powerful and far-reaching tool of health diplomacy. The island nation has built good will and improved its standing with countries around the world during its years of isolation. Its national health system is the envy of many countries in the developing world and the interventions of its health professionals have saved (and continue to save) millions of lives worldwide. Kirk describes Cuba’s medical internationalism as a ‘flag-bearer of Cuba’s commitment to accessible and sustainable healthcare, free to all (especially the marginalized).’ For such a small country in difficult economic conditions of its own, it is an extraordinary humanitarian record.

Looking forward, what future for Cuba’s medical internationalism? The international development cooperation arena is increasingly crowded and some of Cuba’s key partners, such as Venezuela and Brazil, are experiencing profound political, economic and social instability. This is combined with a Trump Presidency in the US that has threatened to ‘close doors’ on already very tentative ties with Havana.

Cubans will probably tell you they have weathered far more severe storms over the last fifty years. Cuba has also very much carved out a niche for itself in international development cooperation Cuban medical professionals continue to inspire and serve in some of the world’s most remote and undeserved places in the world. There is no indication that Cuba’s commitment to social equality and internationalism will wane any time soon.


What’s So New About Cuba’s Medical Internationalism?

Fidel Castro, 88-year-old revolutionary hero and anti-imperialist icon, recently published in the Cuban daily Granma that his island nation would readily cooperate with the US to wrestle Ebola. This is not the first gesture of goodwill that Cuba has made toward the US regarding cooperation, either rather, it is one of many invitations to solidarity that happen to echo across an icy political tundra spanning years of embargo. Perhaps the newest aspect of Cuba’s long-lived medical internationalism is that, in 2014, it yet defies decades of imperial embargo. Cuba’s international medical mission yet survives Yankee economic terrorism, and does so with an outstretched hand for partnership! Other than Cuba’s remarkable magnanimity that persists well into the 21st century, there is little new about Cuba’s maverick ethos of serving the Third World and its public health.

Despite unimaginable economic hardship, Cuba has had no qualms with proffering (and actually sending) America its vital resource: human capital. Facts amassed within the last few years are worth revisiting, especially given that the size of the Cuban population is a decimal of US numbers, and that Cuba’s financial capability does not compare with America’s. Consider the following:

  1. For more than 40 years, Cuban doctors have worked abroad, and Cuban hospitals have received patients from around the world.
  2. Cuba has had more than 30,000 health care personnel (19,000 physicians) in over 100 countries.
  3. Cuba has sent medical teams to Chile, Nicaragua, and Iran, responding to devastating death tolls and destruction caused by earthquakes.
  4. An emergency medical team of almost 2,500 Cubans treated 1.7 million people affected by the 2005 Pakistan earthquake alone.
  5. Cuba has sent medical personnel to El Salvador to assuage the outbreak of dengue fever, donating more than 1,000,000 doses of meningitis vaccinations to Uruguay after an outbreak there.
  6. Cuba sent medical task forces to Iraq during the Gulf War (which remained there after international relief organizations left) it sent medical crews to the beleaguered peoples of Kosovo, too.
  7. Cuban medical personnel went to Guyana in 2005, to aid in flooding, and also to Paraguay so as to work with infectious diseases and epidemiology.
  8. Nearly 100 Cuban doctors worked in Botswana in 2005, combating the HIV/AIDS pandemic.
  9. Cuba has also offered thousands in medical staff to work with HIV/AIDS in sub-Saharan Africa.

The foregoing list in no way exhausts Cuba’s extensive history of medical internationalism. Again, it goes without saying that Cuba’s medical endeavors are decades old. It has been an enduring, if unofficial, pillar of the Cuban Revolution.

During times of war, Cuba sent medical contingents at no cost to Algeria (in the early 1960s), and to Guinea-Bissau and Angola in order to work with denizens of those countries and to train them. In 1987, journalists confirmed the importance of Cuba’s presence—medical and otherwise—in the newly-independent Angola. Numerous victims of land mine violence (by government estimates, some 20,000) comprised a large contingency of amputees. Additionally, about 90 percent of Angola’s white population fled the country at the dawn of independence. Cuban teachers, construction workers, and doctors (roughly 9,000 in all), assuaged the ensuing paucity of skilled assistance.

Reporters also told of Cuba’s generosity to Children from Chernobyl in the early 1990s. More than 2,600 children from the worst-affected areas of Byelorussia, the Ukraine, and Russia received treatment in Cuba. The impoverished island nation provided the larges convalescent program for affected children. Teachers accompanied patients while translators and health workers assisted with family members in severe cases. Fidel Castro backed Cuban spending for the sake of the children, providing a 355 pediatric hospital and special equipment. Cuba invited 30,000 children to come from the Soviet Union, promising to pay local costs.

Cuba’s Latin American School of Medicine not only continues to send doctors abroad, but it also provides students from rural and marginalized areas in Africa, Asia, and Latin America—and the United States—with a six-year medical education, gratis. In an article entitled “Cuban Medical Internationalism and the Development of the Latin American School of Medicine,” Robert Huish and John M. Kirk discuss Cuba’s response to 1998’s Hurricane Mitch, which claimed over 30,000 lives. “Cuba,” the authors note, “sent medical brigades to the affected region and constructed the Latin American School of Medicine just outside Havana.” As for the US, Cuba also responded to the devastation wrought by Hurricane Katrina, disastrous storm whose wrath continues to affect poor Americans. Huish and Kirk note that Cuba offered “at no cost, some 1,586 medical personnel and 36 tons of emergency medical supplies to help the affected communities,” though the Bush regime tragically, and intractably, rejected Cuba’s generosity.

Already, Cuba has already sent some 550 medical personnel (doctors, nurses, etc.) to West Africa, plus additional medical supplies. For whatever it is worth, US Secretary of State, John Kerry, lauded the effort. The US committed as many as four thousand military to establish clinics and train health care workers, along with the troops will go officials from the Centers for Disease Control. Graciously, Fidel Castro wrote in the Cuban daily Granma, that, “With pleasure we will cooperate with US personnel,” not to establish peace between the two countries, but “for the peace of the world.”

Current President, Raúl Castro, averred that Cuba believes politicizing efforts is unadvisable doing so, he warns, “diverts us from the fundamental objective, which is the help to face this epidemic in Africa and prevention in other regions.” In accordance with United Nations advice from early September, Cuba has instructed its representatives (participating in World Health Organization and the United Nations events) to assert that Cuba will work side-by-side with even the US to approach Ebola, which has already killed thousands in West Africa, and more than 230 health workers.

In all, Cuba continues to do what it has always done to treat and heal the world. Doing so despite the embargo only further proves its undying commitment neighborliness to the world’s marginalized. But proffering world-class medical capabilities for the greater good is ultimately nothing new.

This article was posted on Tuesday, October 21st, 2014 at 5:57pm and is filed under Cuba, Health/Medical.


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Review

“This is an important and much-needed book. Cuba, a small island of 11 million souls, has some 36,000 medical personnel providing assistance to other countries, many of them too poor to pay for the service. It also has the largest medical school in the world with an enrollment of over 8,000 students from Third World countries. Their only commitment when they graduate is that they return to their home countries and provide medical services to those who can least afford it. In sum, Cuba is credited with saving more lives in the developing countries than all the G-8 countries together. How has it done this? Erisman and Kirk begin to tell us how.”--Wayne S. Smith, Senior Fellow and Director of the Cuba Program at the Center for International Policy in Washington, D.C.

“John Kirk and Michael Erisman have produced a path-breaking study that has no equal in elaborating the extent and significance of Cuba’s international medical programs. These are a key aspect of Cuba’s foreign policy, as the authors deftly demonstrate by relating medical internationalism to Cuba's political goals and relations with the Third World.”--Philip Brenner, Professor of International Relations, American University co-author of Sad and Luminous Days: Cuba's Struggle with the Superpowers after the Missile Crisis.

About the Author

H. Michael Erisman is Professor of Political Science at Indiana State University. He is the author of Cuba’s International Relations: The Anatomy of a Nationalistic Foreign Policy (1985), South-South Relations in the Caribbean (1992), and Cuba’s Foreign Relations in a Post-Soviet World (2000). He co-edited (with John M. Kirk) Cuban Foreign Policy Confronts a New International Order (1991), and Redefining Cuban Foreign Policy: The Impact of the ‘Special Period’ (2006). He is a member of the editorial boards of the “Journal of Latin American Society and Politics” and “Cuban Studies.”

John M. Kirk is Professor of Latin American Studies at Dalhousie University in Canada. He is the author of José Martí: Mentor of the Cuban Nation (1985), and Between God and the Party: Religion and Politics in Revolutionary Cuba (1989). He is the co-author of Sesenta años de relaciones bilaterales: Cuba y Canadá (2007), and the co-editor of Cuba : Twenty-Five Years of Revolution: 1959-1984 (1985), Culture and the Cuban Revolution: Conversations in Havana (2001), A Contemporary Cuba Reader: Reinventing the Revolution (2008), and Competing Voices from Revolutionary Cuba (forthcoming). He is a member of the editorial boards of the journal of the International Institute for the Study of Cuba, and “Cuban Studies”. He is also the editor of the “Contemporary Cuba” series with the University Press of Florida.


Medical Internationalism in Cuba

“What is the secret of our approach? It lies in the fact that human capital can achieve far more than financial capital. Human capital implies not only knowledge but also-crucially important- political awarenes,. ethics, a sense of solidarity, truly human feelings, a spirit of sacrifice, heroism and the capacity to do a lot with very little”

Fidel Castro Ruz, at the first graduation of ELAM students, August 2005

The often-repeated quotation, allegedly from Máximo Gómez that “los cubanos, o no llegan, o se pasan” certainly applies to the programme of Cuban medical internationalism. 1 Cuba certainly “se ha pasado” in terms of this policy: as of April 2012 there were 38,868 Cuban medical professionals working in 66 countries–of whom 15,407 were doctors (approximately 20% of Cuba’s 75,000 physicians). 2 In Africa some 3,000 Cuban medical personnel are currently working in 35 of the continent’s 54 countries, while in Venezuela alone there are approximately 30,000. 3 But that is only part of the story, since there are many other significant facets to Cuban medical internationalism. In all cases it can be argued that “human capital” is the most important common denominator.

This article, based upon seven years of research and some 70 interviews with Cuban medical personnel, both in Cuba and abroad, seeks to provide a broad overview of the importance of Cuban medical internationalism. There are several, very different, programmes of medical cooperation that have been employed, and this article offers basic data on their evolution and impact, as well as providing some analysis of the rationale for their development.

Medical internationalism is not a recent phenomenon, and in fact can be traced back to 1960–when Cuba’s first medical delegation flew to Chile following a major earthquake there. The assistance was significant because Cuba had strained diplomatic relations with the right-wing Alessandri government at that time, emphasizing clearly the humanitarian nature of the mission. A larger medical delegation was sent in 1963, when Cuban medical personnel helped to establish the public health system of Algeria, following its independence from France. Again, the historical context is worth noting, since approximately one half of Cuba’s 6,000 physicians had left the country, mainly heading for Miami. In addition France, under President Charles de Gaulle, was one of Cuba’s few remaining allies at that time—highlighting Cuba’s commitment to humanitarianism rather than political gain. The significance of the Cuban contribution at the time was well emphasized by the Cuban Minister of Health, Dr. José Ramón Machado Ventura: “Era como un mendigo ofreciendo ayuda, pero sabíamos que el pueblo argelino la necesitaba incluso más que nosotros, y que la merecía”. 4 Human capital, as defined by Fidel Castro, was even at this formative stage of the revolutionary process once again the fundamental basis for the decision to provide medical support.

The record of medical collaboration has continued, particularly in developing and underdeveloped countries, and to date almost 135,000 health workers have participated in overseas missions. To put this in context, Cuba currently has more medical personnel working abroad on medical cooperation missions than all of the G-8 nations combined, an astonishing record.

There are three basic stages in medical internationalism employed by Cuba–the early years of the revolutionary process (best typified by the sending of missions to Chile in 1960 and Algeria in 1963) the mid-1970s (when Cuba, supported by the former Soviet Union and socialist countries of Europe, developed a particularly strong programme of collaboration in sub-Saharan Africa) and finally the period beginning in 1990 after the nuclear meltdown in Chernobyl. This was followed by a major increase in medical cooperation in the late 1990s, especially in Latin America and the Caribbean, following the havoc caused by Hurricanes George in Haiti and Mitch in Central America. This most recent stage has resulted in numerous international health initiatives, ranging from integrated health programmes (used in dozens of Third World countries) and providing basic access to healthcare to millions of people who often had never received any attention to the extremely successful “Henry Reeve” Emergency Medicine Contingents which have been employed in natural disasters.

While the record of medical internationalism is a long and honourable one, the vast majority of Cuba’s contributions have been since the late-1980s, the focus of this essay. One example is the support given to victims of the Chernobyl nuclear reactor meltdown in 1986. In all some 26,000 victims (mainly children) have been treated at the Tarará facilities since the first children arrived in March of 1990 (when they were received by President Fidel Castro, emphasizing the importance given the initiative by the government). All medical treatment for patients was provided at no cost to the patients, as was their accommodation and food. This major humanitarian gesture is particularly noteworthy since it was initiated just as the Soviet Union was imploding, resulting in the loss of some 80% of Cuba’s trade, a decline in GDP of some 30%–and the onset of the “Special Period” and its many difficulties. From the Cuban perspective, the timing could not have been worse. For many nations faced with such a profound crisis, it would not have been surprising if the government had swiftly terminated such a broad (and expensive) programme. Yet Cuba did not, again displaying its human capital–and the commitment made to the children of Chernobyl was respected.

From several visits to the facility and meetings with the patients and Cuban medical staff it is clear that the attention given to the children was excellent, and the facility–ably managed by Dr. Julio Medina–has done an extraordinary job in difficult circumstances. At its height some 350 people worked at the Tarará facility, which has a small hospital, hundreds of buildings to house the patients, as well as offering educational and recreational programmes for patients. The children were first examined by Cuban medical personnel in their home country, and usually stayed for 45-day periods, although children with more serious ailments were treated by medical staff in various specialized hospitals in Cuba. The objective was, quite simply, to offer high quality medical and humanitarian support to children whose lives had been badly affected by the impact of the nuclear meltdown. In all 21,874 children and 4,240 adults were treated in Cuba, of whom 19,497 were younger than 14, and the most common ailments were related to skin, endocrinological and digestive problems. 5 (At the time of writing Ukrainian President Victor Yankovich had agreed in late 2011 to start paying for those costs, but to date has not initiated payment, and sadly the programme has been placed on hold).

Also particularly noteworthy is Cuba’s role in training tens of thousands of doctors from all corners of the developing and underdeveloped world, both in Cuba and abroad. In the wake of the horrendous damage caused in Central America by Hurricane Mitch in 1998, the foundation of the Escuela Latinoamericana de Medicina (the largest medical university in the world with an annual intake of over 1,500 students and with over 9,000 enrolled in the six-year programme) has proved to be an extremely successful vehicle for providing medical care for people who otherwise would have none. To date approximately 10,000 physicians have graduated from ELAM. Over 20,000 foreign medical students are also being trained through the Nuevo Programa de Formación de Médicos Latinoamericanos–although this hands-on method is also being used in a variety of countries, where training is adapted to local conditions and specific needs. Cuban medical professors are teaching in fifteen countries–and are especially numerous in Venezuela. In addition, since the 1970s Cuba has assisted in the founding of medical schools in several countries, including Yemen (1976), Guyana (1984), Ethiopia (1984), Uganda (1986), Ghana (1991), Gambia (2000), Equatorial Guinea (200), Haiti (2001), Guinea Bissau (2004), and East Timor (2005). The role of Cuban medical professors is particularly important in Venezuela, as noted later.

Hurricane Mitch (1998) in many ways was the catalyst for a significant development in Cuba’s vastly increased approach to medical internationalism. Some 30,000 people died in that natural disaster, and the Central American leaders appealed to the international community for assistance. Significantly, Cuba did not even have diplomatic relations with the countries affected (several of which had traditionally maintained a policy of hostility to the revolution), yet within days sent 424 personnel to assist the affected areas. This would increase to a maximum of 2,000, before settling at approximately 900 in the region.

What was particularly different about the mission in Central America, however, was the decision to help the countries affected to help themselves. Thus was born the central idea of ELAM, according to which students from the region would be trained as doctors in Cuba so that they could return and assist their own people. Cuban medical personnel remained (and still remain), but have gradually seen their numbers decrease as they are replaced by local medical graduates who have been trained in Cuba. In November 1999 the Escuela Latinoamericana de Ciencias Médicas (whose name was later changed to the Escuela Latinoamericana de Medicina) opened its doors to the first students, mainly from the affected region. Most of the students came from poor backgrounds, and approximately one-half were women.

The Cuban approach to training foreign students at ELAM is based essentially upon a commitment to train students who could not otherwise attend medical school. The belief is that, since they are not from privileged sectors, they are more likely to return to their communities to work upon graduation, and help their people. In this way it is hoped that the traditional “brain drain” (as graduates from Third World medical schools head to First World countries where the salaries are higher) would be reversed, and that a “brain gain” would result. It is also noticeable how graduates from ELAM who, for a variety of reasons cannot work in their own countries, have also volunteered to work in other countries where there are underserved populations. The best example is Haiti, where students from many Latin American countries are currently working. The lessons of human capital in their six years of training in Cuba have clearly been passed on to thousands of these graduates.

In many ways representative of the Cuban level of collaboration throughout the Third World is the broad outreach of Operation Miracle, initiated in 2004. The origins of this wide-ranging ophthalmological programme can be found in the challenges encountered in Cuba’s outstanding literacy plan employed in several countries, 6 when it was discovered that many people were unable to read mainly because of existing medical conditions–mainly cataracts and glaucoma (both easily treated with relatively minor surgery). They were unable to participate in the literacy programme because of deficient eyesight. As a result the revolutionary leadership decided to develop a programme that would allow people to see again, and in particular this approach has spread throughout Latin America. To take one example, in Bolivia alone since 2006 more than 600,000 surgical operations have taken place, mainly for Bolivians but also for citizens of other South American nations bordering that country. Significantly, among the Bolivians treated was Mario Terán, the soldier who executed Ernesto Che Guevara in October 1967.

The success of this programme can be gauged by reading some of the articles found in the “Oftalmología” part of the Infomed website. 7 In the section “Más sobre Operación Milagro” there are dozens of articles illustrating the enormity of this programme. To take just a few examples: 15,000 Paraguayans have had their sight restored, 400,000 Haitians have benefited from the programme, 90,000 operations have been carried out in Nicaragua, with almost 200,000 operations in Venezuela… By October 2011 it was estimated by Dr. Reinaldo Ríos, medical director of the Ramón Pando Ferrer ophthalmology hospital in Havana, that the programme had treated over 2 million people in 34 countries of Latin America, the Caribbean and Africa. 8 These operations, carried out by Cuban physicians with Venezuelan support, have been provided at no cost to the patient–the vast majority of whom would otherwise have been unable to pay for these operations.

Another extremely important component of Cuban medical internationalism in recent years is the role of the “Henry Reeve” Emergency Contingent. The medical brigade (named after an American participant in Cuba’s first war for independence) dealing with natural disasters and serious epidemics was founded in September 2005 shortly after massive flooding hit New Orleans as a result of Hurricane Katrina. The Cuban government had offered to send 1,586 medical personnel and 36 tons of medical supplies to assist the people of the region, only to have President George W. Bush reject the humanitarian gesture. Within two weeks the “Henry Reeve” International Contingent had been formed, with its goals outlined by Fidel Castro in his speech of September 19, 2005 at the graduation of medical students: “This will take the place of the Medical Force formed to help the people of the United States when Katrina hit the south of the country with all its brutal force. Its aim will not just be to help a certain nation, but to give immediate assistance, with its specially trained staff, to any country that suffers a catastrophe, particularly those that are hit by hurricanes, floods or other natural phenomena of this severity”.

The “Henry Reeve” contingent has been involved in 12 missions in countries facing natural disasters, most recently in Chile following an earthquake there. These have all taken place within the space of a few years, a remarkable feat. The largest was to Pakistan (with some 2,250 members), although in many ways the most memorable has been that to Haiti.

Cuba has played (and continues to play) an enormously important role in Haiti, both after the earthquake in January 2010 which killed 250,000 and in controlling the cholera epidemic which broke out nine months later. Within two months of the onset of the epidemic almost 150,000 cases had been confirmed, with 3,333 deaths reported. 9 In both cases Cuban personnel assumed the leading role in supporting the Haitian people, and their efforts dwarfed those of the international community. In fact Cuba had been providing a major medical presence since 1998, when Hurricane George devastated the country. Some 500 Cuban medical personnel had arrived at that time, and when the earthquake struck twelve years later there were still 340 Cubans working in the public health sector.

In terms of the cholera outbreak, the Cuban-led medical team was bolstered by the arrival of ELAM graduates and upper level students. By April 2011 there were 1,117 members of the Cuban medical brigade, including 923 Cubans and 194 foreign graduates from Cuban programmes. Together they had seen 2 million patients, operated on 36,000, and delivered almost 35,000 babies. A further 465,000 Haitians had benefitted from rehabilitation programmes. 10 Again, their humanitarian efforts of the Cuban mission were (and are) greater than those of all of the industrialized nations combined. To date, however, these contributions remain largely ignored by the international media.

Cuba’s role in Haiti has been exemplary. Not only did it provide by far the largest medical contingent at the time of the earthquake, but it also made the greatest contribution to stopping the cholera outbreak, saving thousands of lives. Perhaps most important of all, Cuba is now preparing Haiti for the future by establishing a public health system, financially supported mainly by Venezuela and Brazil. Key to this will be the role of Cuban-trained Haitian doctors, some 625 of whom had graduated from ELAM by early 2011. Of these 430 were already working in Haiti, 11 and later that year another 115 graduated from the Santiago de Cuba campus.

An equally important aspect (and in many ways a microcosm of Cuba’s various medical internationalism programme) can be seen in its role in Timor Leste. Cuban personnel arrived after an official request for support in 2003, since as late as 2002 there were only 47 physicians in the entire country. The initial role of Cuban personnel was to provide badly-needed medical support in a country still recovering from its independence struggle and invasion by Indonesian armed forces. Within the first five years of the arrival of the Cuban brigade more than 2.7 million medical consultations had taken place, with an estimated 11,400 lives saved.

The next phase of Cuban cooperation in the country was to train Timorese youth to become doctors, and take care of their own people. By 2008 “there were some 350 Cuban health workers in the region, with 870 East Timorese and more than 100 Melanesians and Micronesians engaged in medical training”. 12 Most received their basic training in Cuba, and then returned to Timor, although increasingly the objective is to train them in their homeland, where a Faculty of Medicine (staffed by Cuban professors of medicine) was established in 2005. Once again the common theme of providing Cuban medical support initially, and then developing local talent to replace Cuban specialists and assume medical responsibilities, has been successfully employed. Human capital has thus been transplanted to this country, and is in turn being expanded to other small countries in the South Pacific.

Comparable to the efforts in Timor Leste, although on a much larger scale, has been Cuba’s medical cooperation in Venezuela, where at present the largest contingent of Cuban medical personnel is found. The contribution of almost 30,000 Cuban medical personnel in Venezuela started in 1999 following massive flooding in the state of Vargas. Some 15,000 people died or disappeared, and within a week over 450 Cuban medical personnel arrived to support the initiatives of newly elected president Hugo Chávez. Four years later the municipality of Libertadores in Caracas, noting the major public health deficiencies in the area, appealed for medical support from Venezuelan doctors. Most refused, citing concern over their personal security, leading President Chávez to then approach Havana–and as a result in April 2003 Cuba sent 53 family physicians.

It is important to recognize the determination of Chávez to use the nation’s petroleum wealth for the benefit of the country as a whole, and particularly marginalized sectors traditionally excluded from such services. It is also worth emphasizing the level of bilateral cooperation that resulted within just a few years. The original mission to Libertadores was extremely successful, resulting in the decision to expand the programme to the country, and ultimately the various stages of Misión Barrio Adentro. The growth in the number of Cuban medical personnel was extraordinary. According to Chávez, from just 53 doctors in April 2003 this had increased by November 2010 to a situation in which Cuban personnel were staffing 6,172 consultorios médicos populares, as well as working in 3,019 dental positions, 459 ophthalomology posts, 514 Centros de Diagnóstico Integral clinics, 559 Salas de Rehabilitación and 28 Centros de Alta Tecnología. 13

In addition to Cubans treating Venezuelan patients in their own country, over 51,000 Venezuelans have also received specialized medical treatment in Cuba. 14 By April of 2012 it is estimated that Cuban medical personnel had provided over 745 million free medical consultations, with over 1.5 million lives being saved. 15 (This refers to people who, if adequate medical support had not been provided and based upon traditional mortality patterns, would probably have died). Preparing for the future, Venezuela is seeking to emulate Cuba’s ELAM–and, with the support of Cuban medical professors, is training over 30,000 physicians. In February 2012 the first cohort graduated–8,150 specializing in Medicina Integral Comunitaria (MIC) a further 6,300 are soon due to graduate, having completed the 6-year programme. At present, according to Chávez, some 22,604 students are studying MIC in Venezuela, and this will clearly make a significant contribution to the public healthcare system. 16 It is worth noting that none of this could have happened without strong bilateral ties, and extraordinary Cuban cooperation in the national medical system.

At times Cubans complain about their family doctor participating in an internationalist mission, or having to walk further to the local consultorio, because there are so many medical personnel are abroad. It is worth noting, however that, while approximately 20% of Cuban physicians are indeed working abroad, the ratio of doctor to patients in Cuba is still probably the best in the world. A comparison with other countries is pertinent in this analysis. In Canada there were 2.4 physicians per 1,000 population, 17 and 2.4 in the United States in 2009, whereas in Cuba there were 6.7 in 2010, according to World Bank data. 18 Moreover the distribution of medical attention to Cubans is far more equitable than Canada (and indeed most industrialized countries, including the United States), where a number of physicians work in the private sector (making medical care inaccessible for many), and where few physicians work in rural areas. While increased distances to visit a médico de familia and longer waiting times might bother Cuban patients (since so many physicians are in Venezuela), they are still in an enviable situation–far better than any other country in the world in terms of accessibility. As a result, the approximately 100,000 barrels of oil received daily in Cuba (and with preferential prices) in exchange for professional services, make this relationship mutually beneficial–as anybody who remembers the dark days of the “Período Especial” can attest. 19

One of the most recent programmes undertaken by Cuban medical internacionalistas has been the survey of the population of ALBA countries to ascertain the level of physical and mental challenges of their populations, carried out by hundreds of Cuban medical personnel in member countries of ALBA. Cuba had already carried out a similar medical survey within its own territory, arguing that this detailed analysis was needed in order to both have a full understanding of challenges facing individual members, and prioritize the medical needs of these patients. In the case of Venezuela (where in 2008 Cuban medical personnel–including a large pool of geneticists and social psychologists– worked with local health brigadistas) in the Misión José Gregorio Hernández, some 600,000 patients were identified as having special needs–and the government moved to meet those specific concerns. The purpose of these campaigns was thus not just to undertake a detailed survey, but rather to undertake a scientific study to determine the causes of the particular “discapacidad” and to provide the needed assistance to the persons affected.

Since 2009 other countries belonging to ALBA have also benefitted from this detailed project. This was a massive undertaking, with over 71,000 specialists (Cubans together with specialists from each of the countries involved) working on the project, going door-to door, and visiting over 3,800,000 homes in Venezuela, Bolivia, Ecuador, Nicaragua and Saint Vincent and the Grenadines. 20 By July of 2011 a total of 1,017,464 people with special needs had been identified in the ALBA countries where the research had been carried out. In Bolivia this campaign was known as the Misión Moto Méndez (named after a 19 th century guerrilla), involving Cuban, Venezuelan and Bolivian physicians, and as a result of the intensive campaign some 83,000 people with physical and mental challenges were discovered. The Misión Solidaria Manuela Espejo had a similar goal–to undertake a bio-psycho-social scientific study, in order to determine the causes of the problems facing Ecuadorians, and the needs that they faced. In all 229 Cuban medical specialists and 129 Ecuadoreans visited 1,286,331 homes, and listed 294,611 persons with special physical or mental needs. Significantly, by January 2012, a total of 265,515 technical supports had been given to 135,254 of these people. 21

Any one of these various programmes of medical cooperation would be extraordinary for a country of the size and wealth of Cuba. Indeed no industrialized country has ever attempted to undertake any one of such ambitious healthcare initiatives. But to see the combination of so many humanitarian initiatives being enacted is truly extraordinary. Just as important is the recognition that these programmes have been ongoing for five decades. In the case of Africa, to take just one example, while there are currently some 5,500 Cuban professionals working there, almost 40,000 Africans have graduated from Cuban universities, and there are currently 3,000 studying in Cuba. 22 With justification Nelson Mandela summarized well the Cuban contribution in his visit to Havana in 1991: “Venimos aquí con el sentimiento de la gran deuda que hemos contraído con el pueblo de Cuba… ¿Qué otro país tiene una historia de mayor altruismo que la que Cuba puso de manifiesto en sus relaciones con África?”. 23 In the case of Latin America the data are even more surprising, since particularly during the last twenty years Cuba has provided tremendous levels of cooperation with countries of the region. Once again human capital has been employed to the full–saving countless lives in the process.

All of this poses the logical question: why does Cuba continue to provide this far-reaching collaboration? One reason put forward is that Cuba is seeking to exercise what is known in North American academic circles as “soft power,” that is co-opting countries by showering them with positive support and benefits in exchange for future considerations from them. At first glance there would appear to be some validity in this argument. Indeed it is obvious that Cuba’s programme of medical internationalism–even in countries with which it had enjoyed difficult diplomatic relations–has resulted in a clear softening of opposition by those governments, and ultimately to a normalization of relations. After all, how can you not have diplomatic relations with a country whose doctors are saving thousands of your compatriots’ lives?

It is particularly significant that Cuba has not provided medical cooperation solely to countries with similar ideological convictions. Mention was made earlier of the first mission to Alessandri’s Chile in 1961 and, also almost 40 years later, of the extensive Cuban collaboration with Honduras and Guatemala (after Hurricane Mitch), countries which had been strong US allies, and had traditionally condemned Cuba. El Salvador, under a number of military governments, was also a major ideological foe of the Cuban revolution, yet Havana did not hesitate in sending 22 tons of emergency medical supplies following an earthquake there in 1986. Likewise it sent a large medical delegation in 2000 to assist when a major outbreak of dengue occurred. In addition Cuba also provided medical support to Somoza’s Nicaragua after an earthquake devastated the capital in 1972. No other Latin American president had been as opposed to the Cuban revolution as Anastasio Somoza, and indeed in 1961 he had allowed mercenaries to leave from Nicaraguan ports in the abortive invasion of Playa Girón.

As an extension of this approach it is also argued that the Cuban government pursues this policy to obtain votes of support at the United Nations (which in 2011 saw 186 nations condemn the US economic embargo of Cuba). In a May 2007 interview by the author and Michael Erisman with Dr. Yiliam Jiménez, this argument was answered well: “Y si aun aceptamos la perspectiva más cínica–o sea que Cuba manda médicos a países pobres para ganar votos en la ONU, ¿por qué los países industriales no hacen lo mismo? Lo más importante es salvar vidas–y eso es precisamente lo que hace nuestra política”. Her argument is completely correct. So far the lack of similar commitment to “salvar vidas” on the part of the G8 nations is sadly absent, while consistently Cuba has placed humanitarianism before ideology.

It is also abundantly clear that the major driving factor behind these initiatives for decades has been the revolutionary leadership, and in the particular the long-term vision of Fidel Castro, for whom access to public healthcare has always been an extraordinarily important issue–the most basic human right. From interviews with Cuban policy-makers during the course of this research it is obvious that his was the principal initiative in all of these programmes. The political will to undertake these health campaigns, to mobilize human resources and ensure adequate funding, thus came as a result of a political and humanitarian decision taken by the presidency.

For a foreigner examining this complex, multifaceted phenomenon, it is also clear that the development of a finely-tuned conciencia socio-política on a national level is also an extremely important base, allowing acceptance of these far-reaching policies. The successful medical internationalism programme over the years has also supported the sense of national identity, strengthening the profound sense of nationalism and national pride that are extremely noticeable in Cuba. This is supported by the Cuban Constitution itself which notes the commitment to “el internacionalismo proletario, en la amistad fraternal, la ayuda,a la cooperación y la solidaridad de los pueblos del mundo, especialmente los de América Latina y el Caribe”.

The profoundly-rooted sense of international solidarity–which was found as early as the struggle for independence in the late 19 th century–is also a key psychological factor. Cuba was assisted in the second half of the 20 th century by other acts of solidarity from foreigners, from the key role of Ernesto Che Guevara to the economic support of the countries of COMECON, and in more recent times from Venezuela. The combination of decades of participating in internationalist missions, or having friends and family members do so, has resulted in a process of profound socialization in respecting such humanitarian initiatives.

It is also true that the exportation of professional goods and services is the largest single source of hard currency for the Cuban economy, far outstripping tourism and nickel. Estimates for the amount of income derived from medical services abroad range from $3 billion to $8 billion annually. The most recent estimate is $5 billion, roughly double the earnings from the successful tourist industry. 24 Whatever the amount, it is still the largest generator of hard currency for the government, and remains as a priority of the Cuban government.

With arguably a surplus of medical personnel (a position often denied by members of the revolutionary leadership, who claim that there is never have an excess of doctors), this use of trained medical cadres is an enormously successful economic policy. The government of Raúl Castro has moved to reduce some of the benefits earlier enjoyed by both internacionalistas (lifelong financial supplements) and beneficiaries (North American students at ELAM no longer study for free, the Ukrainian government is expected to pay for treatment of children affected by the Chernobyl implosion, and foreign students are now expected to pay for further specialization). In addition the government has made it clear that it is interested in expanding the medical tourism operations in Cuba, and to send Cuban personnel to wealthy countries. This is illustrated by the Cuban role in Qatar, where in early 2012 a 75-bed hospital staffed by some 200 Cuban medical personnel was inaugurated in Dukhan. In sum, while Cuba’s medical internationalism for poorer countries remains intact, there is a growing determination to increase profits from the exportation of medical goods (clearly seen in the impressive growth of the biotechnology sector) and services.

On a personal level–that of the internacionalistas themselves–in the course of interviews for my research it has been interesting to see the explanations given by them for their involvement in missions abroad. The majority explain that they participate in medical missions for financial reasons since it allows them the opportunity to earn several times their salary during their Internacionalista experience than they would if they remained in Cuba. While it is extremely difficult to be away from family for long periods of time, most welcome the chance to earn a greater income, which allows them to purchase goods in Cuba that otherwise they could not afford. (Most contracts are for 2-year periods, although members of the mission generally return for a month midway through their stay abroad). Since the start of the Special Period, there is an inverted pyramid in terms of salaries, with those employed in the tourist trade–even in positions where no further education is required–earning far more than professionals with advanced degrees. Internacionalista missions thus allow participants to redress in part at least some of that imbalance.

Others have noted that the medical experience abroad in underdeveloped countries represents an excellent opportunity for them to develop their professional medical skills, since they deal with situations that are often totally new to them. From malnutrition in Gambia to gunshot wounds in Guatemala, the experience allows them to expand their medical knowledge, to become better doctors and nurses. Several others interviewed also refer to this experience as a kind of rite of passage, something that almost all medical staff in Cuba do at some point in their life. In sum, there are many different reasons–ranging from genuine altruism to personal gain, from a decades-long tradition of service to the possibility of income-generation.

Whatever the motives of individuals or the revolutionary government, there is no doubt that these five decades of medical cooperation have made an enormous contribution to the wellbeing of the Third World. Any one of these (many) significant medical contributions would be truly noteworthy, particularly since Cuba is a small country, with severe economic constraints. However, when seen in their entirety, they represent a truly extraordinary contribution to the wellbeing of dozens of countries around the globe. Writing in 2010, Julie Feinsilver offered a succinct summary of the significance of this contribution. She noted how Cuban internacionalistas have “saved more than 1.6 million lives, treated over 85 million patients (of which over 19.5 million were seen on house calls at patients’ homes, schools, jobs, etc.), performed over 2.2 million operations, assisted 768,858 births, and vaccinated with complete dosages more than 9.2 million people”. 25

Whether it be to Alessandri’s Chile in 1960, Somoza’s Nicaragua in 1972, or even George Bush’s United States in 1995 (when an offer of some 1,500 Cuban medical personnel in the wake of Hurricane Katrina was rejected), the same commitment to assist humanity has been consistent. Mention was made earlier of Fidel Castro’s speech at the founding of the “Henry Reeve” Brigade. In it he also referred to the need to respond to natural disasters, regardless of the ideology of the country: “Not once, throughout the selfless history of the Revolution, have our people failed to offer its supportive medical assistance to other nations in need of this aid at times when catastrophes have hit them, regardless of wide ideological and political differences, or the serious insults received from the government of any of these countries”.

In essence Cuba has provided an example for the planet, showing how its successful medical collaboration programmes have been far more successful, and more far-reaching, than anything provided by all of the G-8 countries’ efforts combined. For over fifty years Cuban medical personnel have served the poorest and most neglected areas of the world, going where other doctors refused to go. At present they are looking after the wellbeing of some 70 million people. The root of this contribution is the same “human capital” found in Chile in 1960 and in each of the 66 countries where they are currently working. Indeed their work–overlooked by the media in industrialized nations– puts the “developed” countries of the world to shame…

John M. Kirk is a Professor in the Department of Spanish and Latin American Studies at Dalhousie University, Halifax, Canada.

1.This research project is supported by funding from the Social Science and Research Council of Canada. I would like to thank the Council for financial support. I would also like to recognize the support of Dr. Víctor Manuel Rodríguez, of the International Relations sector of MINSAP, and Dr. Arturo Menéndez Cabezas, currently working in Barcelona, Venezuela. I would also like to thank Emily Kirk, of the University of Nottingham, for her helpful comments.

2.Data provided by Dr. Yiliam Jiménez, director of the Unidad Central de Cooperación Médica of MINSAP, in a Prensa Latina report of April 3, 2012, “Colaboración médica cubana, gratituidad y acceso universal”.

3. “Alrededor de 5,500 profesionales cubanos prestan servicio en África,” Cubadebate , June 5, 2010.

4.Cited in Piero Gleijeses, Misiones en conflicto. La Habana, Washington y África, 1959-1976 (La Habana: Editorial de Ciencias Sociales, 2002), p. 28.

5.Data obtained from report (“Pograma cubano de atención médica integral a niños relacionados con el accidente de Chernobil”), received from Dr. Julio Medina, director of the programme in Tarará, and from an interview with him in December 2011.

6.The literacy programme has been used in 29 countries, teaching basic literacy to 6.5 million people, according to Pedro Rioseco, “Desarrollo exitoso del programa alfabetizador ‘Yo sí puedo,’” Prensa Latina, May 24, 2012.

7.See “Más sobre Operación Milagro,” located at http://www.oftalmologia.sld.cu/mas-sobre-operacion-milagro.

8.See “Misión Milagro ha beneficiado a dos millones de pacientes,” Radio Santa Cruz report, October 8, 2011.

9.Conner Gorry, “Haiti One Year Later: Cuban Medical Team Draws on Experience and Partnerships,” MEDICC Review , vol. 13, no. 1 (Jan 2011), p. 52.

10.See “Bruno Rodríguez en ONU: La reconstrucción de Haiti es tema pendiente,” Cubadebate , April 6, 2011.

12.Tim Anderson, “Cuban Health Cooperation in Timor Leste and the South West Pacific,” The Reality of Aid: Special Report on South-South Cooperation 2010 (Quezon City, Philippines: IBON, 2010), p.77.

13.For further analysis, see John M. Kirk, “Cuban Medical Cooperation within ALBA: The Case of Venezuela,” International Journal of Cuban Studies , vol. 3, nos. 2/3 (Summer/Autumn 2011), p. 231.

14. “Un paso gigante por la vida,” Juventud Rebelde , May 31, 2012

15.René Tamayo, “Una misión de vanguardia,” Juventud Rebelde , April 17, 2012.

16.René Tamayo, “Primera graduación de médicos integrales comunitarios de Venezuela,” Juventud Rebelde , February 16, 2012.

17.Patrick Sullivan, “Canada’s MD/Patient improves but low international ranking continues,” Canadian Medical Association, February 12, 2012 (See http://www.cma.ca/md-patient-rate-improves Accessed May 31, 2012).

18.See “Physicians (per 1,000 people)” at http://data.worldbank.org/indicator/SH.MED.PHYS.ZS Accessed May 31, 2012). The website of the Oficina Nacional de Estadísticas in Cuba notes that in 2010 there were 76,506 physicians in the country, with an average of 1 physician for 147 patients. See http://www.one.cu/aec2010/esp/19_tabla_cuadro.htm.

19.Dr. Jiménez has summarized this relationship well: “We believe in fair trade. If that means that we export a product that we have surplus of–in this case educational goods and services–to a friend at a reduced price, and they export to us at favorable conditions something that they have in abundance–petroleum–what is wrong with that?”. See John M. Kirk and H. Michael Erisman, Cuban Medical Internationalism: Origins, Evolution and Goals (New York: Palgrave Macmillan, 2009), p. 186.

20.Data taken from two reports, “Destacan resultados de estudio sobre discapacidad en países del ALBA,” Cubadebate , July 7, 2010 and “Exitoso estudio cubano de discapacidad en países del ALBA,” November 27, 2010, found at nttp://www.tvcamaguey.co/cu/index.php?view=article&catid=43%3Asalud&id=6054%3Ae..

21.Data taken from “Misión solidaria Manuela Espejo,” n.d., issued by the Office of the Vice-President of Ecuador and found at http://www.vicepresidencia.gob.ec/programas/manuelaespejomision.

22. Data taken from comments by Deputy Minister of Foreign Affairs, Marcos Rodríguez in “Alrededor de…,” Cubadebate , June 5, 2012.

24.Fernando Ravsberg, “May Day in Cuba: The Doctors Out in Front,” Havana Times , May 2, 2012.


Doctor's orders?

According to a report by the opposition-linked Cuban Prisoners Defenders, based on direct testimony from 46 doctors with experience of overseas medical missions, plus public-source information from statements by 64 other medics:

  • 89% said they had no prior knowledge of where they would be posted within a particular country
  • 41% said their passport was removed from them by a Cuban official on arrival in the host country
  • 91% said they were watched over by Cuban security officials while on their mission, and the same percentage reported being asked to pass on information about colleagues to security officials
  • 57% said they did not volunteer to join a mission, but felt obliged to do so, while 39% said they felt strongly pressured to serve abroad.

The BBC made repeated requests for a response from the Cuban government but received no reply. However, After the Cuban Prisoners Defenders report was published, Cuban President Miguel Díaz-Canel tweeted: "Once again the empire's lies are trying to discredit Cuba's health cooperation programs with other countries, labelling them as "modern slavery" and "human trafficking" practices. They are upset about #Cuba's solidarity and example."

Last December, he offered his support for "the heroes of Cuban and Latin American medicine" to mark Latin American Medicine Day.

"To those who fight for life, it is all the same in a modest Cuban neighbourhood or a village in the Amazon. More than doctors, they are guardians of human virtue," Cuba's leader tweeted.

While Dayli at least managed to escape becoming a victim of violence in Venezuela, a compatriot and fellow woman medic was less fortunate. The 48-year-old family doctor wishes to be identified by the pseudonym "Julia" to spare her family knowledge of her ordeal.

During her five-year mission in Venezuela, Julia was stationed in Bolívar state. "I was unfortunate in that the mission co-ordinator took a shine to me, and I didn't agree to his repulsive insinuations. He had me sent away to a series of out-of-the-way locations in rural areas."

At one point, along with another Cuban woman doctor, she was posted to a shack with a clear plastic roof. One day when they saw a door had been forced open, they called the co-ordinator - but Julia says he did nothing.

Then, she says, "I woke up one night, with someone holding my mouth shut. The doctor in the other room was screaming. There were two men in balaclavas, armed with guns." Julia says she was raped by both men.

The mission co-ordinator came to take the two women away from this location, but, Julia says, he suffered no apparent consequences or official reprimand for having exposed members of his team to such danger.

Julia was taken to Caracas where she was given anti-HIV medicine and sessions with a Cuban psychologist. "Her treatment was not the best. The focus was basically ɽon't tell anyone this has happened.'"

While on a mission in Bolivia, Julia defected across the border into Chile, and now lives in Spain, where she has asked for asylum and works as a surgeon's assistant.

María (not her real name) is another female Cuban medic who says her gender made her a target. She was a 26-year-old family doctor when she was deployed to Guatemala on her first international mission in 2009.

During her journey into the state of Alta Verapaz, the mission co-ordinator began telling her about a rich man in the area, whom he referred to as an "engineer". Maria says: "He insinuated that he liked Cuban women." She says she was given a mobile phone, on which the "engineer" began calling her every day.

"I didn't answer, and I even changed the number, but still he called," Maria says. "The co-ordinator told me I would be sent home as a punishment if I didn't got to see this man, and I said that was fine with me.

"My principles were on the line. I went with the idea of helping poor people on a mission for my country. It was so frustrating - I felt scared but could not run away." María says that her passport was taken from her by her Cuban minders as soon as she arrived in Guatemala.

After two months of resisting pressure to see the man, María was switched to another mission. Some months later she heard that the "engineer" had been arrested in an army raid, accused of being a drug trafficker. María completed two years in Guatemala, and later absconded from her next mission in Brazil by signing up to a US medical parole program, aimed at persuading Cuban doctors to defect.

Dayli says she and her team in Venezuela had to meet weekly targets set by the Cuban mission leaders related to the number of lives saved, patients admitted and treatments for certain conditions.

She says she rejected what she considered unethical interference in honest medical care principles: "That is where my problems began because I wasn't going to lie. If a patient is ready to go home and take medicine orally, I am not going to have them admitted for five days on a drip. I can't say how many heart attack patients I am going to have in a given week."

According to the Prisoners Defenders report, more than half of 46 doctors with experience of overseas missions who were interviewed reported having to falsify statistics - inventing patients, patient visits and pathologies that did not exist. By exaggerating the missions' efficacy, the Cuban authorities can, the report says, demand greater levels of payment from the host country, or justify the enlargement of the operation.

Dayli says the conflict she had with her senior medical colleagues at El Sombrero over the instructions to boost treatment statistics led to her being posted in lower-level destination in the calmer, more rural town of San José de Guaribe. But the twin pressures of working without sufficient medical equipment and orders to hit artificial or impossible targets remained.

Once a woman arrived mid-labour, Dayli recalls, but the clinic did not have the right set of instruments for delivering a baby. Another time, she says she had to inset a tube into a patient by the light of her phone as there was no fuel for the generator.

She alleges her request to transfer a man with lung cancer to Caracas was denied so he would count towards her clinic's statistics.

"The health of Venezuelans is not important to the mission," she says. "I had an 11-year-old die in my arms when I was trying to put him on a breathing apparatus that was not working."

Carlos Moisés Ávila tells a similar story. The 48-year-old doctor joined one of the first missions in Venezuela in 2004.

"We each had to report a life saved every day, so sometimes I had to grab someone who was healthy and stick them on a drip," Carlos says.

"Medicines arrived from Cuba out of date, so we had to destroy and bury them before including them in the inventory as used so they could be charged for. We would get our pay from soldiers, who were sometimes months late in coming, and would also take medicines from the hospital," recalls Carlos.

Carlos says he signed up for the medical mission to improve his financial situation. Instead of getting around $20 a month in Cuba at that time, he started earning $300 in Brión, in Venezuela's Miranda province, although he says that the Cuban government was paid more than 10 times that amount for each doctor on the Barrio Adentro programme.

Dayli says that all fraternising with Venezuelans outside of work was prohibited. The Cuban doctors lived together and had to respect a 6pm curfew. The mission co-ordinator was a Cuban security service official.

"He would ask you about your roommates in weekly interviews," Dayli says. "He had network of paid local informers who would pass on any information about you in order to detect possible deserters. We weren't allowed to have a drink with a Venezuelan, or go to their house because you saved their life and to see how they're doing. If you fraternised with a dissident, you could have your mission revoked."

Carlos says during the seven years he spent in Venezuela, he saw the way medicine was used as a political tool for propaganda purposes, sometimes at the expense of physicians' ethical code.

"During the 2004 campaign for the recall referendum, we doctors were sent out door to door to give out gifts and medicines to boost support for President [Hugo] Chávez," he says. "We also had lists of patients according to their political tendencies. Chávez regime supporters were put down as having hypertension, while opposition people were listed as diabetics. The former got better treatment, and any information we gathered on locals was passed on to the mission co-ordinator, a Cuban woman who controlled all of our personal relationships and who we were allowed to meet."

A New York Times report in March quoted Cuban doctors stationed in Venezuela describing how they had worked to persuade patients to vote for the country's ruling Socialist Party, including by refusing treatment for opposition supporters and canvassing on doorsteps with gifts of medicine to bribe waverers.

In response, the Cuban government denied the claims, saying that its "honourable" doctors had saved nearly 1.5m lives in Venezuela, as well as citing their participation in the fight against Ebola in Africa and cholera in Haiti, among other examples.

Carlos also made the move from a Brazilian mission to the US, where he is now rebuilding his life in Houston, working as a medical assistant.

He is now unable to visit Cuba for fear of being imprisoned on the island for desertion. In 2018 he applied for a humanitarian visa to visit his mother who had cancer. It was denied, and he could not see her before she died. "That's the way they play it, dangling permissions and gifts in front of you so people play ball. I soon realised our mission was more political than humanitarian."

Dayli eventually came to a similar conclusion.

She returned to Cuba in 2014 where she was posted to a hospital without an intensive care unit - a clear sign, she says, that she was out of favour. Later she was suspended from medical practice for alleged absences from work - an allegation she rejects. She says she began to be treated as a dissident, with a state security agent posted outside her house who followed her everywhere. Her family and friends were harassed. Eventually, she could take it no more and is currently visiting relatives in Spain, where she may decide to try and settle.

"I wanted to be a doctor in Cuba but I have given that up now. I don't want to be a risk to my family. I spoke my mind and this is the consequence. They want soldiers, not doctors."


Assata Shakur and the History of Cuban Internationalism

As the United States re-designates Cuba as a “State Sponsor of Terrorism” for “repeatedly providing support for acts of international terrorism in granting safe harbor to terrorists,” we need to look at the personal history of Assata Shakur (originally named Joanne Chesimard), one of those mentioned by the State Department’s press release.

By looking at Shakur’s individual trajectory, we can understand that the U.S. is not concerned about terrorism it is only concerned about the strength of the Cuban revolution, which proved to the entire world that oppressed peoples can make their own history.

A Popular Black Activist

On November 3, 1979, headlines announced the prison break of Shakur, a former Black Panther and a member of the organization’s clandestine offshoot, the Black Liberation Army, or BLA. Convicted in 1977 by an all-white jury for murdering a New Jersey State trooper, with no physical evidence indicating that she had been the shooter, Shakur’s trial had been widely covered in Black media as a symbol of police and FBI efforts to violently repress radical Black movements.

On hearing the news of the escape, one of New York’s oldest Black newspapers, the New York Amsterdam News, elatedly wrote: “they say three brave brothers and a sister went to fetch Assata Shakur from the cold confines of steel and stone where she had been held fast against her will. Who the four were, I know not. But, every Black person knows them and have met them in the collective unconscious mind of the race.”

Listed at the top of the FBI’s Most Wanted list, Shakur was extremely popular among poor Black communities. Supporters in New York City and Los Angeles pasted notices on the windows of their homes: “Assata Shakur is welcome here.” However, Shakur was not found for the next five years. In an October 1987 report from Cuba, it was revealed that she was living in Havana, where she had been granted political asylum by the government of Fidel Castro.

Cuba: A Haven for Left-Wing Political Refugees

Shakur’s sanctuary in Cuba was in line with earlier episodes in which Black activists had found asylum there. Many had taken refuge on the island since the early 1960s, including members of the National Association for the Advancement of Colored People, NAACP, the Black Panther Party, BPP, and the Republic of New Afrika, RNA.

Speaking at Havana’s Chaplin Theater in October 1965, Fidel contrasted Cuba’s status as a haven for left-wing political refugees with the emigration of rich Cubans to the U.S., who were seeking shelter from the radical changes brought about by the revolution. “Although it is true that certain citizens educated in those ideas of the past and in that system of life of the past prefer to go to the United States,” Fidel argued, “it is also true that this country has become the sanctuary of the revolutionaries of this continent.”

He continued: “The revolutionaries of the continent have a right to consider themselves our brothers, and they are worthy of this right. This includes North American revolutionaries, because some leaders, like Robert Williams [leader of the NAACP chapter in Monroe, North Carolina, who had formed a Black gun club to help local residents defend themselves against violence from the Ku Klux Klan and white vigilantes], fiercely persecuted there, found asylum in this land. Thus, just as he, so can those being persecuted by reactionaries and exploiters find asylum here. It does not matter if they speak English and were born in the United States. This is the fatherland of the revolutionaries of this continent.”

Shakur greatly admired the internationalist spirit of the Cuban revolution, noting that the Caribbean nation had “a long history of supporting victims of political repression … not only of people in the United States, like Huey Newton, Robert Williams, Eldridge Cleaver … but also people who were victims of political repression in other places, like Chile, the apartheid government of South Africa, Namibia. I felt this was a place that held the principle of international[ism] very close to heart.”

Persistence Amid U.S. Pressure

When New Jersey’s governor announced a $100,000 reward for Shakur’s capture in 1998, Cuba’s Foreign Ministry spokesman, citing the country’s right as a sovereign nation to provide political sanctuary to foreigners, countered that she was not a criminal but a “well-known civil rights activist” who had fled from state-sponsored violence. As the FBI indefatigably tried to apprehend her, Shakur characterized herself as “a 20th century escaped slave” and described Cuba as “one of the largest, most resistant and most courageous palenques [communities of formerly enslaved people] that has ever existed on the face of this planet.”

While Fidel has not publicly named Shakur, he once defended Cuba’s provision of political asylum to an unnamed fugitive accused of shooting a New Jersey police officer (undoubtedly Shakur). He characterized the individual as a victim of “the fierce repression against the black movement in the United States” and “a true political prisoner” who had sought protection against persecution. “They wanted to portray her as a terrorist,” Fidel charged, “something that was an injustice, a brutality, an infamous lie.”


¡Salud! tells the story of Cuba's medical internationalism

[This article originally appeared in Seven Oaks Magazine]

Michael Moore’s Sicko, an incendiary expose of the for-profit health care system in the United States, generated some predictable backlash from right-wing pundits. More than anything else in the film, what tended to get them especially enraged was the role of Cuba in the documentary.

After comparing and contrasting the US system with health care in Canada, Britain and France, Moore delivers the coup de grace by taking a number of 9/11 rescue workers to Cuba to get treatment for work-related illnesses that the U.S. system would not cover. These scenes feature friendly Cuban medical professionals providing free, quality care to the sick 9/11 heroes so shamefully neglected by their own government. Contrary to the hysterical claims of Moore’s critics, these acts of generosity were not mere propaganda set-ups in reality, the provision of free treatment for the 9/11 workers only scratches the surface of Cuba’s exemplary medical internationalism.

Director Connie Field’s Salud! picks up from Moore’s Sicko with a documentary that examines Cuba’s long and elaborate history of exporting the gains of socialized medicine. In addition to telling an inspiring story that has received next to no mainstream media coverage in the western world, Salud! also presents an important debate, counterposing two very different philosophies as to what it means to be a physician.

Field’s documentary begins with some of the basic history of the Cuban revolution. The dire state of health care, especially in the countryside, was a factor in bringing about a mass movement and fuelling support for the guerrilla army that toppled Batista in 1959. In the early 1960s, free health care became a right for all Cubans, and a rapid process of training new health professionals was undertaken. Within only a few years, Cuba began to send brigades of medical volunteers to allies and various needy Third World countries. The extent of Cuba’s “doctor diplomacy,” as it has been called, is truly staggering. Over the past five decades, more than 100 000 Cuban medical professionals have served abroad, often in the most remote, isolated and impoverished locations.

Salud! covers a lot of ground for a medium-length documentary, highlighting the accomplishments of Cuba’s doctors in The Gambia, South Africa, Central America, and Venezuela. To its credit, the documentary lets the story unfold primarily through the observations of the doctors and patients themselves, supplemented by some experts in the field, such as the innovative and tireless internationalist Dr. Paul Farmer.

The segments in Africa are particularly poignant. We see experienced Cuban doctors literally reduced to tears by the extreme poverty and suffering of their patients. In The Gambia, the Cubans have helped to build a basic health care system from the ground up, beginning with simple measures to reduce the scourge of malaria. In many cases, following their community health model, Cuban doctors live in small villages that have never before had the benefit of medical attention.

In South Africa, while many of the local doctors and private practitioners live like kings, the country’s health care system is stressed beyond its limits by the AIDS crisis and a lack of personnel and funding. In one scene, we see a Cuban physician who has “defected” from his compatriots’ team in South Africa. Now in private medicine, the born-again capitalist happily shows off his mansion and boasts of his new lifestyle in “a white neighbourhood”. A Cuban medical official explains that only roughly 2% of all of their internationalist physicians have left to pursue this more lucrative type of medicine. South African and other African health officials, for their part, complain of a much higher percentage of “brain drain” with their graduates, as they watch helplessly as doctors are lured by contracts from North America and Europe.

In Venezuela, too, the film demonstrates the clash of medical philosophies between the Cubans and the local physicians. When the government of Hugo Chavez initiated community health clinics in the poorest barrios, Venezuelan doctors refused to sign on, so the government called in thousands of willing Cubans to do the job. Now, for the first time, the barrios around Caracas have doctors living and working in poor communities.

The last segment of Salud! covers the incredibly ambitious efforts of Cuba to offer free medical training to students from throughout Latin America, Africa, and – believe it or not – even the United States. Some of the most delightful interviews in the film are with these young students. In two notable cases – a young man from rural Honduras and a dynamic young woman from a barrio in Caracas – the students tell of being inspired to become doctors after witnessing the selfless efforts of Cuban doctors in their communities.

The thousands of students receiving medical training in Cuba represent a real hope for developing a ‘New Doctor’ for the 21st century, not driven by a desire for money or social status, but instead motivated to serve those in need and live as an equal with those in his or her community.

Salud! is an important documentary, and not just because it deals with one of the great and almost unknown accomplishments of the Cuban revolution. The film also confronts crucial issues about our collective right to health care in a world where so many still die needless, preventable deaths because of the greed or indifference of others.


Watch the video: Why does Cuba have so many doctors? (July 2022).


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