Cuban medical internationalism

From Wikipedia, the free encyclopedia

Cuban medical internationalism is the Cuban programme, since the 1959 Cuban Revolution, of
sending Cuban medical personnel overseas, particularly to Latin America, Africa and, more
recently, Oceania,[1] and of bringing medical students and patients to Cuba. In 2007, "Cuba has
42,000 workers in international collaborations in 103 different countries, of whom more than
30,000 are health personnel, including no fewer than 19,000 physicians."[2] Cuba provides more
medical personnel to the developing world than all the G8 countries combined,[2] although this
comparison does not take into account G8 development aid spent on developing world
healthcare. The Cuban missions have had substantial positive local impact on the populations
served.[3] It is widely believed that medical workers are Cuba's most important export
commodity.[4]

Contents
1 Missions abroad
1.1 Anti-colonialism
1.2 Humanitarianism
1.3 Venezuela
1.4 Other countries
1.4.1 Oceania
1.5 2010 Haiti earthquake
1.6 Principles
2 Internationalism at home
3 Effects on Cuba
3.1 Benefits
3.2 Costs
3.2.1 Defection
4 Will lifting the embargo destroy "Castrocare"?
5 Sources
6 References
7 External links

Missions abroad
In 2007, one academic study on Cuban internationalism surveyed the history of the programme,
noting its broad sweep: "Since the early 1960s, 28,422 Cuban health workers have worked in 37
Latin American countries, 31,181 in 33 African countries, and 7,986 in 24 Asian countries.
Throughout a period of four decades, Cuba sent 67,000 health workers to structural cooperation
programs, usually for at least two years, in 94 countries ... an average of 3,350 health workers
working abroad every year between 1960 and 2000."[5]

Anti-colonialism
The programme was initiated in 1963 as part of Cuba's foreign policy of supporting anti-colonial
struggles. It began when Cuba sent a small medical brigade to Algeria, which suffered from the
mass withdrawal of French medical personnel during the independence war; some wounded
soldiers and war orphans were also transported back to Cuba for treatment.[6][7] Cuba did this at
a time when, following the Cuban revolution, "half of the country’s 6,000 doctors fled".[2] Between
1966 and 1974, Cuban doctors worked alongside Cuban artillery in Guinea-Bissau during its
liberation struggle against Portugal.[2] Cuba's largest foreign campaign was in Angola: within two
years of the campaign, by 1977, "only one Angolan province out of sixteen was without Cuban
health technicians."[8] After 1979, Cuba developed a strong relationship with Nicaragua.[9]

Humanitarianism

However, alongside internationalism driven by foreign policy objectives, humanitarian objectives

also played a role, with medical teams despatched to countries governed by ideological foes. For
example in 1960, 1972 and 1990 it dispatched emergency assistance teams to Chile and
Nicaragua, and Iran following earthquakes.[2] Similarly, Venezuela's Mission Barrio Adentro
programme grew out of the emergency assistance provided by Cuban doctors in the wake of the
December 1999 mudslides in Vargas state, which killed 20,000 people.[10]

Cuban medical missions were sent to Honduras, Guatemala and Haiti following 1998's Hurricane
Mitch and Hurricane Georges, and remained there semi-permanently.[6] This has been part of a
dramatic expansion of Cuba’s international cooperation in health since 1998.[11] The number of
Cuban doctors working abroad jumped from about 5000 in 2003 to more than 25,000 in 2005.[11]

In Honduras the medical personnel had a substantial impact: "In the areas they served, infant
mortality rates were reduced from 30.8 to 10.1 per 1,000 live births and maternal mortality rates
from 48.1 to 22.4 per 1,000 live births between 1998 and 2003."[2] However, as one academic
paper notes, "The idea of a nation saving lives and improving the human condition is alien to
traditional statecraft and is therefore discounted as a rationale for the Cuban approach."[2] In
2004 the 1700 medical personnel in Guatemala received the Order of the Quetzal, the country's
highest state honour.[2] A 2005 attempt by Honduras to expel the Cuban mission on the basis
that it was threatening Honduran jobs was successfully resisted by trade unions and community
organisations.[6]

Following the 2004 Asian tsunami, Cuba sent medical assistance to Banda Aceh and Sri Lanka.[5]
In response to Hurricane Katrina, Cuba prepared to send 1500 doctors to the New Orleans; the
offer was refused. Several months later the mission was dispatched to Pakistan following the
2005 Kashmir earthquake there. Ultimately Cuba sent "more than 2,500 disaster response
experts, surgeons, family doctors, and other health personnel", who stayed through the winter for
more than 6 months.[5][12]

Venezuela

Main article: Mission Barrio Adentro

Cuba's largest and most extensive medical aid effort is with Venezuela. The program grew out of
the emergency assistance provided by Cuban doctors in the wake of the December 1999
mudslides in Vargas state, which killed 20,000 people. Under this bilateral effort, also known as
the "oil for doctors" program, Cuba provides Venezuela with 31,000 Cuban doctors and dentists
and provides training for 40,000 Venezuelan medical personnel. In exchange, Venezuela provides
Cuba with 100,000 barrels of oil per day. Based on February 2010 prices, the oil is worth $7.5
million per day, or nearly $3 billion per year.[13]

Other countries
Cuba has also sent notable missions to Bolivia (particularly since the 2005 election of Evo
Morales) and South Africa, the latter in particular after a post-apartheid brain drain of white
doctors.[14] Since 1995, a co-operation agreement with South Africa has seen hundreds of Cuban
doctors practice in South Africa, while South Africa sends medical students to Cuba to study.[15]
In 2012, the two governments signed another deal, increasing numbers on both sides. South
African can now send 1 000 students to Cuba for training which, South Africa believes, will help
train the doctors it so desperately needs for the implementation of its National Health Insurance
Scheme.[16] After the 1999 violence in East Timor, the country of a million people was left with
only 35 physicians and 75% of its population displaced. The number later increased to 79
physicians by 2004, and Cuba sent an additional 182 physicians and technicians.[17]

"From 1963 to 2004, Cuba was involved in the creation of nine medical faculties in Yemen,
Guyana, Ethiopia, Guinea-Bissau, Uganda, Ghana, Gambia, Equatorial Guinea, and Haiti."[5]

Oceania

In the 2000s, Cuba began establishing or strengthening relations with Pacific Island countries,
and providing medical aid to those countries. Cuba's medical aid to Pacific countries has been
two-pronged, consisting in sending doctors to Oceania, and in providing scholarships for Pacific
students to study medicine in Cuba at Cuba's expense.

There are currently sixteen doctors providing specialised medical care in Kiribati, with sixteen
more scheduled to join them.[18] Cubans have also offered training to I-Kiribati doctors.[19] Cuban
doctors have reportedly provided a dramatic improvement to the field of medical care in Kiribati,
reducing the child mortality rate in that country by 80%,[20] and winning the proverbial hearts and
minds in the Pacific. In response, the Solomon Islands began recruiting Cuban doctors in July
2007, while Papua New Guinea and Fiji considered following suit.[20]

In 2008, Cuba was due to send doctors to the Solomon Islands, Vanuatu, Tuvalu, Nauru and
Papua New Guinea,[1] while seventeen medical students from Vanuatu would study in Cuba.[21] It
was reported that it might also provide training for Fiji doctors.[22]

As of September 2008, fifteen Cuban doctors were serving in Kiribati, sixty-four Pacific students
were studying medicine in Cuba, and Cuban authorities were offering "up to 400 scholarships to
young people of that region".[23] Among those sixty-four students were twenty-five Solomon
Islanders, twenty I-Kiribati, two Nauruans and seventeen ni-Vanuatu.[24] Pacific Islanders have
been studying in Cuba since 2006.[25]

In June 2009, Prensa Latina reported that Cuban doctors had "inaugurated a series of new health
services in Tuvalu". One Cuban doctor had been serving in Tuvalu since October 2008, and two
more since February 2009. They had reportedly "attended 3,496 patients, and saved 53 lives",
having "opened ultrasound and abortion services, as well as specialized consultations on
hypertension, diabetes, and chronic diseases in children". They had visited all the country's
islands, and were training local staff in "primary health care, and how to deal with seriously ill
patients, among other subjects".[26]

2010 Haiti earthquake

Cuba is helping with the medical crisis in Haiti due to the 2010 Haiti earthquake.[27] All 152 Cuban
medical and educational personnel in the Haitian capital Port-au-Prince at the time of the
earthquake were reported to be safe, with two suffering minor injuries.[28]

Principles

Missions abroad are intended to provide services at low cost to the host country. "Patients are
not charged for services, and the recipient countries are expected to cover only the cost of
collective housing, air fare, and limited food and supplies not exceeding $200 a month. While
Cuban doctors are abroad, they continue to receive their salaries as well as a stipend in foreign
currency."[2] Pay for Cuban doctors abroad, while much higher than at home ($23 per month) is
still low by international standards ($183 per month).[14] However due to the socialist ideal of their
country this monetary discrepancy is merely circumstantial to the practitioners themselves as it is
the development and preservation of internationalist humanitarian aid that defines their cause.

Internationalism at home
Since 1990, Cuba has provided long-term care for 18,000 victims of the Chernobyl disaster,
"offering treatment for hair loss, skin disorders, cancer, leukemia, and other illnesses attributed to
radioactivity."[2]

In response to the 1998 Hurricane Mitch, Cuba set up the "Escuela Latinoamericana de
Medicina" ("Latin American School of Medicine"; ELAM) outside Havana, converted from a former
naval base. It accepts around 1500 students per year.[2] ELAM forms part of a range of medical
education and training initiatives; "Cubans, with the help of Venezuela, are currently educating
more doctors, about 70,000 in all, than all the medical schools in the United States, which
typically have somewhere between 64,000 to 68,000 students enrolled in their programs."[6]

Following the development of cooperation with Venezuela through Mission Barrio Adentro,
Mission Milagro / Operación Milagro was set up to provide ophthalmology services to Cuban,
Venezuelan and Latin American patients, both in Cuba and in other countries. "As of August
2007, Cuba had performed over 750,000 eye surgeries, at no cost, including 113,000 surgeries
for its own citizens."[2]

Effects on Cuba
Benefits

Although humanitarian principles figure, ideological factors were prominent in Cuba's "doctor
diplomacy", particularly during the Cold War. Subsequently, its continuation has been seen as a
vital means to promote Cuba's image abroad and prevent international isolation. For Cuba's re-
establishment of diplomatic relations with Honduras in 2002, Cuba's health missions in that
country were "undoubtedly a deciding factor";[2] Guatemala reestablished diplomatic relations
with Cuba in 1998.[5]

At the 2009 5th Summit of the Americas, US President Barack Obama commented that at the
summit he had heard much about the impact of Cuban "soft diplomacy" in the form of its medical
internationalism. He said this might be a reminder to the United States that limiting its interactions
with Latin American countries to military and drug interdiction might be limiting its influence.[29]

It has also been suggested that Cuban medical internationalism promotes exports of Cuban
medical technology, and may be a source of hard currency (although the targeting of poor
countries reduces the hard currency potential of missions abroad).[2] In 2006 Cuba's earnings
from medical services (including export of doctors) amounted to US$2,312m - 28% of total
export receipts and net capital payments. This exceeded earnings from both nickel and cobalt
exports and from tourism.[14] These earnings are achieved despite the fact that a substantial part
of Cuba's medical internationalism since 1998 has been organised within the framework of the
"Integrated Health Program" (Programa Integral de Salud, PIS); this cooperation program is free
for the receiving country.[5] Cuba's co-operation with Venezuela provides Cuba with cheap oil in
exchange for its medical support to Mission Barrio Adentro.[5]

It has also been argued that the programme has, particularly in the 1980s and 1990s,
"perform[ed] a critical function in consolidating socialist consciousness" within Cuba.[30]

Costs

Although Cuba's large-scale medical training programmes and high-doctor-patient ratios give it
much latitude, the expansion of doctor diplomacy since 2004, particularly with the Barrio Adentro
programme, has been dramatic: the number of Cuban doctors working abroad jumped from
about 5000 in 2003 to more than 25,000 in 2005.[11] This has had some impact on the domestic
health system, for example with increased waiting times, particularly with regard to family
doctors.[14] The number of patients per doctor rose from 139 to 179.[17] In March 2008 Cuba
announced a reorganisation of its domestic family doctor programme for greater efficiency.[14]

Defection

In 2000, two Cuban doctors working in Zimbabwe attempted to defect to Canada.[31] They were
prevented from doing so by two Zimbabwean soldiers, who handed them over to Cuban
officials.[32] United Nations officials said Zimbabwe appeared to have violated national and
international laws.[32]

In August 2006 the United States under George W. Bush created the Cuban Medical Professional
Parole program,[33] specifically targeting Cuban medical personnel and encouraging them to
defect when they are working in a country outside of Cuba.[6] Of an estimated 40,000 eligible
medical personnel, over 1000 had entered the United States under the program by October 2007,
according to the chief of staff for U.S. Rep. Lincoln Diaz-Balart.[34] However the promised fast-
track visa is not always forthcoming, and some applicants are trapped in limbo, unable to enter
the US and unable to return to Cuba.[35]
According to a 2007 paper published in The Lancet medical journal, "growing numbers of Cuban
doctors sent overseas to work are defecting to the USA", some via Colombia, where they have
sought temporary asylum.[36] In February 2007, at least 38 doctors were requesting asylum in the
US embassy in Bogotá after asylum was denied by the Colombian government.[37] Cuban
doctors working abroad are reported to be monitored by "minders" and subject to curfew.[36]

Two defected Cuban doctors working in Venezuela have asserted that they were told their job
was to keep Chavez in power,[38] by asking patients to vote for Chávez in the 2004 recall
referendum.[38] Opposition supporters in Venezuela have called Cuban doctors "Fidel's
ambassadors" and refused to go to their clinics.[38]

According to Luis Zuñiga, director of human rights for the Cuban American National Foundation,
Cuban doctors are "slave workers" who labor for meager wages while bolstering Cuba's image as
a donor nation and "the Cuban government exports these doctors as merchandise".[32]

Will lifting the embargo destroy "Castrocare"?

An article by Laurie Garrett in Foreign Affairs warns that lifting of the United States trade and
travel restrictions on Cuba could have dire consequence's for Cuba's healthcare system, leading
to an exodus of thousands of well-trained Cuban healthcare professionals. US companies could
also transform the remaining healthcare system into a destination for medical tourism. Garrett
concludes that if politicians do not take great care, lifting of the restrictions would rob Cuba of its
greatest triumph.[39]

Sources
Robert Huish and John M. Kirk (2007), "Cuban Medical Internationalism and the
Development of the Latin American School of Medicine", Latin American Perspectives, 34;
77
C Muntaner, RM Guerra-Salazar, J Benach and F Armada, Venezuela's barrio adentro: an
alternative to neoliberalism in health care, Int J Health Services 36 (2006), pp. 803–811.
Cooper R.S., Kennelly J.F., Ordunez-Garcia P., (2006) "Health in Cuba", International
Journal of Epidemiology, 35 (4), pp. 817–824.
De Vos et al. (2007), "Cuba's International Cooperation in Health: an Overview",
International Journal of Health Services, Volume 37, Number 4, Pages 761–776
John M. Kirk and H. Michael Erisman (2009), Cuban Medical Internationalism: Origins,
Evolution, and Goals, Palgrave Macmillan

References
1. ^ a b "Cuban Physicians to Aid 81 Nations" (http://www.plenglish.com:80/article.asp?
ID=%7B771AA7E5-B9F3-4129-AFF7-208C0DC1D65D%7D)&language=EN), Prensa Latina, March 29,
2008
2. ^ a b c d e f g h i j k l m n Robert Huish and John M. Kirk (2007), "Cuban Medical Internationalism and the
Development of the Latin American School of Medicine", Latin American Perspectives, 34; 77
3. ^ San Sebastián, Miguel, Anna-Kari Hurtig, Jaime Breilh, et al. 2005 “The People’s Health Movement:
health for all now.” Revista Panamericana de Salud Pública/Pan American Journal of Public Health 18:
45–49.
4. ^ Foreign Affairs July/August 2010. page 69
5. ^ a b c d e f g De Vos et al (2007), "Cuba's International Cooperation in Health: an Overview",
International Journal of Health Services, Volume 37, Number 4, Pages 761–776
^ a b c d e Monthly Review, January 2009, The Cuban Revolutionary Doctor: The Ultimate Weapon of
 6. ^ a b c d e Monthly Review, January 2009, The Cuban Revolutionary Doctor: The Ultimate Weapon of
Solidarity (http://www.monthlyreview.org/090112brouwer.php)
7. ^ Gleijeses, Piero (1996). "Cuba's First Venture in Africa: Algeria, 1961-1965". Journal of Latin American
Studies 28 (1): 159–195. JSTOR 157991 (//www.jstor.org/stable/157991). "The Minister of Public Health,
Jose Ramón Machado Ventura, led the group, which included 29 doctors, three dentists, 15 nurses and
eight medical technicians. (There were 45 men and ten women.) . . . With the arrival of this medical
mission in Algeria on 24 May 1963, Cuba's technical assistance abroad began." (Quote is from p. 165).
8. ^ Cohen, Sylvester, 1994 “Cuba and the liberation of Southern Africa.” Monthly Review 46 (September):
17–25.
9. ^ Schwab, T., Sims, H.D. (1985), "Cuba and Nicaragua: a key regional relationship, 1979-1984." Cuban
Studies 15 (2), pp. 73-81
10. ^ Briggs, Charles, and Mantini-Briggs, Clara (2009), American Journal of Public Health, "Confronting
Health Disparities: Latin American Social Medicine in Venezuela", I(3)
11. ^ a b c De Vos et al (2008), "Cuba's health system: Challenges ahead", Health Policy and Planning, 23(4),
pg:288-290
12. ^ Cuban doctors in Pakistan: Why Cuba still inspires; Akhtar, A.S. 2006 Monthly Review 58 (6), pp. 49-55
13. ^ Foreign Affairs, July/August 2010. page 69
14. ^ a b c d e Julie M. Feinsilver (2008), Oil-for-Doctors: Cuban Medical Diplomacy Gets a Little Help From a
Venezuelan Friend (http://www.nuso.org/upload/articulos/3537_2.pdf), Nueva Sociedad 216 July–August
2008
15. ^ Cuba, SA health deal is in good shape (http://www.businessday.co.za/articles/Content.aspx?
id=172709) Business Day (28 May 2012)
16. ^ SA signs deal with Cuba for more doctors (http://www.businessday.co.za/articles/Content.aspx?
id=172709) Business Day (28 May 2012)
17. ^ a b Robert Huish and Jerry Spiegel (2008) "INTEGRATING HEALTH AND HUMAN SECURITY INTO
FOREIGN POLICY: CUBA’S SURPRISING SUCCESS", The International Journal of Cuban Studies
Volume 1 Issue 1 June 2008
18. ^ Pacific Magazine: Six More Cuban Physicians To Serve In Kiribati
(http://www.pacificmagazine.net/news/2007/10/01/six-more-cuban-physicians-to-serve-in-kiribati)
19. ^ Kiribati discusses medical training with Cuba (http://www.rnzi.com/pages/news.php?
op=read&id=26617)
20. ^ a b Cuban doctors reduce Kiribati infant mortality rate by 80 percent
(http://www.rnzi.com/pages/news.php?op=read&id=33793)
21. ^ "Vanuatu to get six doctors from Cuba" (http://www.rnzi.com/pages/news.php?op=read&id=41373),
Radio New Zealand International, August 10, 2008
22. ^ "Fiji says Cuban help sought as neighbours turn away" (http://www.rnzi.com/pages/news.php?
op=read&id=38964), Radio New Zealand International, April 4, 2008
23. ^ "Cuban Foreign Minister Opens Cuba-Pacific Islands Meeting"
(http://www.cubanews.ain.cu/2008/0916amistadislaspacifico.htm), Cuban News Agency, September 16,
2008
24. ^ "Small Island States and Global Challenges"
(http://www.cubanews.ain.cu/2008/0929especialnusa.htm), Cuban News Agency, September 30, 2008
25. ^ "Cuba-Pacific ministerial meeting underway in Havana"
(http://www.radioaustralia.net.au/news/stories/200809/s2366887.htm?tab=latest), ABC Radio Australia,
September 17, 2008
26. ^ "Cuban doctors have inaugurated a series of new health services in Tuvalu a small island nation in the
Pacific"
(http://www.cubaheadlines.com/2009/06/14/17664/cuban_doctors_have_inaugurated_a_series_new_hea
lth_services_tuvalu_a_small_island_nation_pacific.html), Prensa Latina, June 14, 2009
27. ^ "Cuba grants medical aid to Haitian earthquake victims"
(http://www.portalangop.co.ao/motix/en_us/noticias/saude/2010/0/3/Cuba-grants-medical-aid-Haitian-
earthquake-victims,a1293e93-e022-4af7-ac52-a49bdf9e635b.html). Agencia Angola Press. 18 January
2010. Retrieved 19 January 2010.
28. ^ Robinson, Circles (January 14, 2010). "Cuba Reacts to Haiti Earthquake"
(http://www.havanatimes.org/?p=18130). Havana Times. Retrieved 19 January 2010.
29. ^ Venezuelanalysis, 20 April 2009, Chavez-Obama Meeting at Summit Relaunches US-Venezuela
Relations (http://www.venezuelanalysis.com/news/4376)
 30. ^ Saney, I. 2009, "Homeland of humanity: Internationalism within the cuban revolution", Latin American
Perspectives 36 (1), pp. 111-123
31. ^ Karen DeYoung. Washington Post Staff Writer. " 'Kidnapped' Cuban Defectors Disappear in Africa"
(http://www.cubanet.org/CNews/y00/jun00/07e6.htm).
32. ^ a b c Miami Herald, 6 June 2000, Cuban doctors vanish in Zimbabwe
(http://www.cubanet.org/CNews/y00/jun00/06e4.htm)
33. ^ US State Dept, Cuban Medical Professional Parole Program
(http://www.state.gov/p/wha/rls/fs/2009/115414.htm), accessed 4 April 2009
34. ^ South Florida Sun-Sentinel, 10 October 2007, Hundreds of Cuban medical workers defecting to U.S.
while overseas (http://www.coha.org/2007/10/hundreds-of-cuban-medical-workers-defecting-to-us-
while-overseas/)
35. ^ Mike Ceasar, "Cuban Doctors Abroad Helped to Defect by New U.S. Visa Policy"
(http://www.worldpoliticsreview.com/Article.aspx?id=981), World Politics Review (August 1, 2007).
36. ^ a b Michael Ceaser (2007), The Lancet, "Cuban doctors working abroad defect to the USA", Volume
369, Issue 9569
37. ^ El Universal 3 Feb 2007 (Spanish) "Cubanos desertores atrapados en Bogotá"
(http://buscador.eluniversal.com/2007/02/03/pol_art_166219.shtml).
38. ^ a b c "Cuban doctors defect, speak out - Two Cuban doctors who defected gave an inside account of
the Cuban-Venezuelan health program." (http://www.flacso.org/hemisferio/al-
eeuu/boletines/01/36/rel_07.pdf). The Miami Herald. August 15, 2006.
39. ^ Foreign Affairs July/August 2010. page 63.

External links
Cuba Pushes its 'Medical Diplomacy' (http://news.bbc.co.uk/2/hi/americas/8059287.stm)
by Michael Voss, BBC News, May 20, 2009
Alternatives to Health Insurance: Cuban Doctors
(http://www.palestinechronicle.com/view_article_details.php?id=15109) by Belén
Fernández, The Palestinian Chronicle, May 18, 2009
Chernobyl Kids in Cuba (http://pa.photoshelter.com/c/archivolatino/gallery-
slideshow/G0000EhAWoAPXuYw/) - a slideshow by Edgard Garrido

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