Cuban Medical Internationlism

| December 12, 2020 | 0 Comments

When Cuba appears in United States media today, it is frequently in connection with some change the U.S. government has made in the regulations governing what kind of business can be conducted with Cuba or who can travel there. In America, Cuba seems to be chiefly known for being one of the few remaining socialist states in the world. It’s from Cuba that people come to Florida in rubber rafts. Oh yeah, and that’s where Guantanamo Bay is too. This article presents a lesser-known Cuban story, but one that has impacted the world for decades: a medical diplomacy program that surpasses anything else like it in the world. For decades, Cuba has sent more medical workers to developing countries than the Group of 8 (United States, Canada, Russia, Italy, United Kingdom, Germany, France, and Italy) combined. The income from these medical missions is thought to be a significant part of the Cuban economy. The country is home to the world’s largest medical school where students from over 100 countries study. How is it that a small, comparatively poor country like Cuba has played such a disproportionate role in the world’s healthcare?

How it started

Cuba’s international medical program was initiated in 1963 as part of the country’s practice of aiding anti-colonial struggles in Africa. Following the Cuban Revolution in 1959, Fidel Castro and his followers wanted to support other fledgling governments in their fight against foreign interference. In 1963, the Algerian War for Independence led to the mass withdrawal of French medical personnel, which, in turn, led to a healthcare crisis in Algeria. Cuba responded by sending a medical brigade to Algeria and transporting wounded Algerian soldiers and war orphans back to Cuba for treatment. From 1966 to 1974, Cuban medical personnel worked alongside Cuban soldiers in Guinea-Bissau during that country’s struggle for independence from Portugal.

But it wasn’t just foreign war policy that fueled Cuban medical internationalism; the country also responded to humanitarian needs across the globe. Cuba dispatched emergency assistance teams to Chile, Nicaragua, and Iran in the wake of major earthquakes in those countries. Following Hurricane Mitch and Hurricane Georges in 1998, Cuba dispatched medical teams to Honduras, Guatemala, and Haiti. And from 1998 onward, Cuba’s medical internationalism expanded dramatically. The medical missions that responded to the 1998 hurricanes stayed abroad semi-permanently, while Cuba continued to engage medically with more and more countries.

After the 2004 tsunami in southeast Asia, Cuba sent medical teams to Indonesia and Sri Lanka. Approximately 2,500 Cuban medical personnel responded to the 2005 Kashmir earthquake. When Hurricane Katrina devastated New Orleans in ’05, the Cuban government offered to send a brigade of 1,500 doctors to help out, but the U.S. government refused. Cuban medical workers helped in the recovery work after the 2010 Haiti earthquake. In 2014, Cuba sent 165 doctors and nurses to help fight the Ebola epidemic in West Africa, the largest contribution from any one country. In April of this year, Cuba dispatched hundreds of doctors to at least fifteen different countries to help battle the initial wave of the COVID-19 pandemic.

I have included very few numbers with the missions described above, but just how many medical workers has Cuba been exporting? The number has fluctuated quite a bit over the years. Prior to 1998 (the year the program began its growth spurt), it was never more than several thousand. In 2003, the number was approximately 5,000. By 2007, that number had exploded to over 30,000 with Cuban missions active in over 100 countries. In 2015, Granma, the Cuban state newspaper, reported 50,000 active medical personnel abroad at the time. In 2020, the reported number is 28,000 in over 60 different countries.

Notable programs

While Cuba obviously has had medical programs in a lot of countries, there are a few that stand out. One of these is with Venezuela. In 2003, then-Venezuelan president Hugo Chavez initiated a program called Mission Barrio Adentro. The plan was to build 8,500 medical centers in poor and marginalized Venezuelan neighborhoods which would provide them with publicly funded health and dental care. Venezuela did not have the doctors to staff all these medical centers, so they turned to Cuba. By 2014, there were approximately 30,000 Cuban medical workers serving in Venezuela, a whopping 60% of the Cuban health workers abroad at the time. Venezuela was paying Cuba billions of dollars a year for the services rendered by these doctors and nurses. Additionally, Cuba was providing care for tens of thousands of Venezuelans in Cuba itself and hosting thousands of Venezuelan university students, many of them medical students. As part of the deal with Cuba, Venezuela helped pay for the medical assistance by providing Cuba with 100,000 barrels of cheap oil per day. This way, both countries got something from the other that they were badly in need of. In 2015, Venezuela began to default on its payments to Cuba for the medical services, and, in response, Cuban doctors began returning home. By the end of 2016, the majority of Cuban medical workers serving in Venezuela had returned home.

In the early 1990s, apartheid (institutionalized racial segregation) was abolished in South Africa. This led to a medical brain drain, with droves of white doctors leaving the country. Desperate for trained medical workers, South Africa turned to Cuba. In 1995, a cooperation agreement between the two countries sent hundreds of Cuban doctors to South Africa while South African medical students were allowed to study in Cuba. In 2012, a new deal signed by Cuba and South Africa increased numbers on both sides.

In 1986, a nuclear reactor at the Chernobyl Nuclear Power Plant exploded, spreading radioactive contamination across large swaths of Eastern Europe. Millions of people were exposed to damaging amounts of radiation. Since 1990, Cuba has been providing long-term care for around 18,000 of these Chernobyl victims, providing treatment for hair loss, skin disorders, cancer, leukemia, and other illnesses resulting from exposure to radioactivity.

Other Cuban health ventures

Cuban medical internationalism consists of more than sending medical personnel abroad. In 1999, Cuba established the Escuela Latinoamericana de Medicina, also known as ELAM. This medical school is the largest in the world by enrollment; in 2013 the school had 19,550 active students from 110 different countries. Only non-Cuban students can enroll in the school, with the majority coming from Latin America. However, many African, Asian, and even North American countries are represented in the school’s student body. ELAM’s mission is to educate competent doctors with an MD degree. The school is officially recognized by the Educational Commission for Foreign Medical Graduates and the World Health Organization. It is fully accredited by the Medical Board of California, which has the strictest standards in the United States. ELAM gives enrollment preference to students who come from the poorest communities and intend to return to those communities upon graduation. In 2000, while on a trip to the United States, Fidel Castro offered several hundred openings at ELAM for students from low-income communities in the U.S. The offer from ELAM was classified as a “cultural exchange program” by the U.S. State Department to avoid the restrictions of the United States embargo on Cuba. In 2004, members of Congress successfully campaigned to have ELAM exempted from tighter travel restrictions enacted by the Bush administration. All classes at ELAM are taught in Spanish. If necessary, Cuba will give incoming students a 12-week intensive course in the Spanish language.

Cuba also attracts significant numbers of health tourists, individuals who travel from around the world to receive medical care in Cuba. An estimated 20,000 health tourists come to Cuba every year, generating approximately $40 million annually for the Cuban economy. The country operates a special division of hospitals to treat these foreigners, offering care for disorders such as multiple sclerosis, Parkinson’s disease, and retinitis pigmentosa, as well as providing cosmetic and eye surgery.

Cuba also boasts a notable biotechnology sector. In the 1980s, the Cuban government invested millions of dollars in vaccine laboratories and a large biotechnology center. The country had its first breakthrough in this area in the late 1980s when Cuban scientists developed and patented a meningitis-B vaccine. Today, the country continues to export large amounts of vaccines to developing countries. Cuba’s scientists have also done extensive research in cancer treatments, and the country opened a joint biotechnology venture with China in 2005 to facilitate the transfer of cancer treatment technology. One Cuba-developed cancer treatment held enough promise that, in 2005, the U.S. government made an exception in the trade embargo so the treatment could be imported to and tested in the United States.

Cuba ranks number one in the world in doctor-to-patient ratios, with approximately 82 physicians for every 10,000 people. By comparison, the United States has 26 physicians for every 10,000 people. Of course, many of Cuba’s doctors work abroad or serve medical tourists, so the Cuban population does not enjoy the full benefit of all these doctors. Still, all the medical knowledge has some positive outcomes for Cuba. The life expectancy for Cubans at birth is 79.2 years, quite high for a developing country. The island has infant and maternal mortality rates that compare with those found in the developed world. That a developing nation like Cuba has health outcomes so similar to developed countries is referred to by analysts as the Cuban Health Paradox.

Some diplomatic concerns

Dozens of other countries have benefitted from Cuba’s medical internationalism, but Cuba benefits as well. Cuba’s export of medical goods and services brings in a significant amount of revenue for the cash-strapped country. Although Cuba is not very open about its trade statistics, it was estimated that a full 28% of the country’s export receipts came from medical services in 2006. This exceeded the proceeds from the country’s other top exports of nickel, cobalt, and tourism. Although Cuba provides medical workers to some developing countries free of charge, other countries pay the Cuban government handsomely for the medical help they receive. The doctors typically receive only a fraction of this money, with the rest going to help to keep the Cuban government solvent.

Ever since 1960, the United States has enforced a trade embargo on Cuban exports. This embargo extends to Cuban medical care, and the U.S. has worked to actively thwart Cuba from exporting medical services. This may seem ridiculous (why would the U.S. keep Cuba from helping the same developing countries that the U.S. is also interested in helping?), but the U.S. government alleges that the Cuban government exploits their doctors by paying them so little of the money that is received for their services in the host countries. Some Cuban doctors support this idea, complaining of poor treatment from the government, while others say they are content with their positions and receive fulfilment from the work that they do.

Ironically, it may be the very trade and travel embargoes that stifle U.S.-Cuba relations that have caused Cuban medical internationalism to thrive. Because of the good education and wealth that is so easily accessible in the United States, many of the most brilliant people from the world’s developing countries end up in the U.S., depriving their countries of origin of their talent. Cuba limits the outflux of its citizens, keeping all its talent close to home. That, coupled with their investment in medical research and education, has allowed its medical programs to thrive. If the relationship between Cuba and the United States were to become friendlier (which is a possibility under a Biden administration)0, many of Cuba’s doctors could be incentivized to leave their country for good. Some hundreds have already done so under a 2006 U.S. program that provides easy entry to the U.S. for Cuban medical professionals who are working abroad under the direction of their government. If Cuba were to drop their travel restrictions in response to the lifting of the U.S. embargo, the resulting medical brain drain could be devastating.

Conclusion

I found this story of Cuban medical internationalism fascinating. It’s not that the facts themselves interest me so much; it’s that I went so long without ever hearing them. I first saw mention of Cuba’s programs in April of this year when Associated Press did an article on Cuban doctors responding to the coronavirus pandemic. How is it that I completed twelve years of grade school and two years of college without ever seeing this mentioned? How is it that I had been scouring multiple news sites on a daily basis for a year (while I was writing the Breaking News posts) without ever seeing as much as a whisper about Cuban doctors? Maybe I am the only ignorant one, but I doubt it. Instead, I believe this to be a result of the human tendency to portray a specific image about a country and then downplay those facts that would be detrimental to this image. In the United States, Cuba is generally portrayed in a negative light. After all, its government is socialistic; how could anything positive happen there! (That was said tongue-in-cheek, in case you didn’t catch that.) I don’t say this to promote anti-U.S. sentiment, nor do I want to imply that life in Cuba is rosy, but it is not fair to publicize only the negative points about any person or government. It makes me wonder what else is out there that would change my view of the world if I only knew it.

~ Leonard Hege

Category: Public

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