Cuban medical internationalism
Encyclopedia
Cuban medical internationalism is the Cuba
n programme, since the 1959 Cuban Revolution
, of sending Cuban medical personnel overseas, particularly to Latin America
, Africa
and, more recently, Oceania, 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." Cuba provides more medical personnel to the developing world than all the G8
countries combined, 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. It is widely believed that medical workers are Cuba's most important export commodity.
, which suffered from the mass withdrawal of French medical personnel during the independence war; some wounded soldiers and children were also transported back to Cuba for treatment. Cuba did this at a time when, following the Cuban revolution, "half of the country’s 6,000 doctors fled". Between 1966 and 1974, Cuban doctors worked alongside Cuban artillery
in Guinea-Bissau
during its liberation struggle against Portugal. 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." After 1979, Cuba developed a strong relationship with Nicaragua
.
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.
Cuban medical missions were sent to Honduras
, Guatemala
and Haiti
following 1998's Hurricane Mitch
and Hurricane Georges
, and remained there semi-permanently. This has been part of a dramatic expansion of Cuba’s international cooperation in health since 1998. The number of Cuban doctors working abroad jumped from about 5000 in 2003 to more than 25,000 in 2005.
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." 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." In 2004 the 1700 medical personnel in Guatemala
received the Order of the Quetzal
, the country's highest state honour. 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.
Following the 2004 Asian tsunami
, Cuba sent medical assistance to Banda Aceh
and Sri Lanka
. 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.
. 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, Castro's 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.
) and South Africa, the latter in particular after a post-apartheid brain drain
of white doctors. Drawing on Cuba's relationship with the African National Congress
, over 450 Cuban doctors have practiced in South Africa, and 250 South African students trained in Cuba. 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.
"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."
There are currently sixteen doctors providing specialised medical care in Kiribati
, with sixteen more scheduled to join them. Cubans have also offered training to I-Kiribati doctors. 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%, 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.
In 2008, Cuba was due to send doctors to the Solomon Islands, Vanuatu
, Tuvalu
, Nauru
and Papua New Guinea, while seventeen medical students from Vanuatu would study in Cuba. It was reported that it might also provide training for Fiji doctors.
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". Among those sixty-four students were twenty-five Solomon Islanders, twenty I-Kiribati, two Nauruans and seventeen ni-Vanuatu. Pacific Islanders have been studying in Cuba since 2006.
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".
. 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.
Cuban doctors are abroad, they continue to receive their salaries as well as a stipend in foreign currency." Pay for Cuban doctors abroad, while much higher than at home ($23 per month) is still low by international standards ($183 per month). 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.
disaster, "offering treatment for hair loss, skin disorders, cancer, leukemia, and other illnesses attributed to radioactivity."
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. 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."
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."
. 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"; Guatemala reestablished diplomatic relations with Cuba in 1998.
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.
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). 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. 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. Cuba's co-operation with Venezuela provides Cuba with cheap oil in exchange for its medical support to Mission Barrio Adentro.
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.
In August 2006 the United States
under George W. Bush
created the Cuban Medical Professional Parole program, specifically targeting Cuban medical personnel and encouraging them to defect when they are working in a country outside of Cuba. 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
. 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.
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. In February 2007, at least 38 doctors were requesting asylum in the US embassy in Bogotá after asylum was denied by the Colombian government. Cuban doctors working abroad are reported to be monitored by "minders" and subject to curfew.
Two defected Cuban doctors working in Venezuela have asserted that they were told their job was to keep Chavez in power, by asking patients to vote for Chávez in the 2004 recall referendum. Opposition supporters in Venezuela have called Cuban doctors "Fidel's ambassadors" and refused to go to their clinics.
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".
Cuba
The Republic of Cuba is an island nation in the Caribbean. The nation of Cuba consists of the main island of Cuba, the Isla de la Juventud, and several archipelagos. Havana is the largest city in Cuba and the country's capital. Santiago de Cuba is the second largest city...
n programme, since the 1959 Cuban Revolution
Cuban Revolution
The Cuban Revolution was an armed revolt by Fidel Castro's 26th of July Movement against the regime of Cuban dictator Fulgencio Batista between 1953 and 1959. Batista was finally ousted on 1 January 1959, and was replaced by a revolutionary government led by Castro...
, of sending Cuban medical personnel overseas, particularly to Latin America
Latin America
Latin America is a region of the Americas where Romance languages – particularly Spanish and Portuguese, and variably French – are primarily spoken. Latin America has an area of approximately 21,069,500 km² , almost 3.9% of the Earth's surface or 14.1% of its land surface area...
, Africa
Africa
Africa is the world's second largest and second most populous continent, after Asia. At about 30.2 million km² including adjacent islands, it covers 6% of the Earth's total surface area and 20.4% of the total land area...
and, more recently, Oceania, 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." Cuba provides more medical personnel to the developing world than all the G8
G8
The Group of Eight is a forum, created by France in 1975, for the governments of seven major economies: Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States. In 1997, the group added Russia, thus becoming the G8...
countries combined, although this comparison does not take into account G8 development aid
Development aid
Development aid or development cooperation is aid given by governments and other agencies to support the economic, environmental, social and political development of developing countries.It is distinguished...
spent on developing world healthcare. The Cuban missions have had substantial positive local impact on the populations served. It is widely believed that medical workers are Cuba's most important export commodity.
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."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 AlgeriaAlgeria
Algeria , officially the People's Democratic Republic of Algeria , also formally referred to as the Democratic and Popular Republic of Algeria, is a country in the Maghreb region of Northwest Africa with Algiers as its capital.In terms of land area, it is the largest country in Africa and the Arab...
, which suffered from the mass withdrawal of French medical personnel during the independence war; some wounded soldiers and children were also transported back to Cuba for treatment. Cuba did this at a time when, following the Cuban revolution, "half of the country’s 6,000 doctors fled". Between 1966 and 1974, Cuban doctors worked alongside Cuban artillery
Artillery
Originally applied to any group of infantry primarily armed with projectile weapons, artillery has over time become limited in meaning to refer only to those engines of war that operate by projection of munitions far beyond the range of effect of personal weapons...
in Guinea-Bissau
Guinea-Bissau
The Republic of Guinea-Bissau is a country in West Africa. It is bordered by Senegal to the north, and Guinea to the south and east, with the Atlantic Ocean to its west....
during its liberation struggle against Portugal. Cuba's largest foreign campaign was in Angola
Angola
Angola, officially the Republic of Angola , is a country in south-central Africa bordered by Namibia on the south, the Democratic Republic of the Congo on the north, and Zambia on the east; its west coast is on the Atlantic Ocean with Luanda as its capital city...
: within two years of the campaign, by 1977, "only one Angolan province out of sixteen was without Cuban health technicians." After 1979, Cuba developed a strong relationship with Nicaragua
Nicaragua
Nicaragua is the largest country in the Central American American isthmus, bordered by Honduras to the north and Costa Rica to the south. The country is situated between 11 and 14 degrees north of the Equator in the Northern Hemisphere, which places it entirely within the tropics. The Pacific Ocean...
.
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. Similarly, Venezuela's Mission Barrio AdentroMission Barrio Adentro
Mission Barrio Adentro is a Bolivarian national social welfare program established under current Venezuelan president Hugo Chávez. The program seeks to provide comprehensive publicly-funded health care, dental care, and sports training to poor and marginalized communities in Venezuela...
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.
Cuban medical missions were sent to Honduras
Honduras
Honduras is a republic in Central America. It was previously known as Spanish Honduras to differentiate it from British Honduras, which became the modern-day state of Belize...
, Guatemala
Guatemala
Guatemala is a country in Central America bordered by Mexico to the north and west, the Pacific Ocean to the southwest, Belize to the northeast, the Caribbean to the east, and Honduras and El Salvador to the southeast...
and Haiti
Haiti
Haiti , officially the Republic of Haiti , is a Caribbean country. It occupies the western, smaller portion of the island of Hispaniola, in the Greater Antillean archipelago, which it shares with the Dominican Republic. Ayiti was the indigenous Taíno or Amerindian name for the island...
following 1998's Hurricane Mitch
Hurricane Mitch
Hurricane Mitch was the most powerful hurricane and the most destructive of the 1998 Atlantic hurricane season, with maximum sustained winds of 180 mph . The storm was the thirteenth tropical storm, ninth hurricane, and third major hurricane of the season. Along with Hurricane Georges, Mitch...
and Hurricane Georges
Hurricane Georges
Hurricane Georges was a very destructive, powerful and long-lived Cape Verde-type Category 4 hurricane. Georges was the seventh tropical storm, fourth hurricane, and second major hurricane of the 1998 Atlantic hurricane season...
, and remained there semi-permanently. This has been part of a dramatic expansion of Cuba’s international cooperation in health since 1998. The number of Cuban doctors working abroad jumped from about 5000 in 2003 to more than 25,000 in 2005.
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." 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." In 2004 the 1700 medical personnel in Guatemala
Guatemala
Guatemala is a country in Central America bordered by Mexico to the north and west, the Pacific Ocean to the southwest, Belize to the northeast, the Caribbean to the east, and Honduras and El Salvador to the southeast...
received the Order of the Quetzal
Order of the Quetzal
The Order of the Quetzal is Guatemala’s highest honor. Established in 1973, it is bestowed by the Government of Guatemala. The award acknowledges officials of nations, organizations and other entities whose artistic, civic, humanitarian, or scientific works merit special recognition....
, the country's highest state honour. 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.
Following the 2004 Asian tsunami
2004 Indian Ocean earthquake
The 2004 Indian Ocean earthquake was an undersea megathrust earthquake that occurred at 00:58:53 UTC on Sunday, December 26, 2004, with an epicentre off the west coast of Sumatra, Indonesia. The quake itself is known by the scientific community as the Sumatra-Andaman earthquake...
, Cuba sent medical assistance to Banda Aceh
Banda Aceh
Banda Aceh is the provincial capital and largest city in the province of Aceh, Indonesia, located on the island of Sumatra, with an elevation of 35 meters. The city regency covers an area of 64 square kilometres and according to the 2000 census had a population of 219,070 people...
and Sri Lanka
Sri Lanka
Sri Lanka, officially the Democratic Socialist Republic of Sri Lanka is a country off the southern coast of the Indian subcontinent. Known until 1972 as Ceylon , Sri Lanka is an island surrounded by the Indian Ocean, the Gulf of Mannar and the Palk Strait, and lies in the vicinity of India and the...
. In response to Hurricane Katrina
Hurricane Katrina
Hurricane Katrina of the 2005 Atlantic hurricane season was a powerful Atlantic hurricane. It is the costliest natural disaster, as well as one of the five deadliest hurricanes, in the history of the United States. Among recorded Atlantic hurricanes, it was the sixth strongest overall...
, Cuba prepared to send 1500 doctors to the New Orleans; the offer was refused. Several months later the mission was dispatched to Pakistan
Pakistan
Pakistan , officially the Islamic Republic of Pakistan is a sovereign state in South Asia. It has a coastline along the Arabian Sea and the Gulf of Oman in the south and is bordered by Afghanistan and Iran in the west, India in the east and China in the far northeast. In the north, Tajikistan...
following the 2005 Kashmir earthquake
2005 Kashmir earthquake
The 2005 Kashmir earthquake was a major earthquake centered in Pakistan-administered Kashmir known as Azad Kashmir, near the city of Muzaffarabad, affecting Gilgit-Baltistan and Khyber Pakhtunkhwa province of Pakistan. It occurred at 08:52:37 Pakistan Standard Time on 8 October 2005...
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.
Venezuela
Cuba's largest and most extensivle medical aid effort is with VenezuelaVenezuela
Venezuela , officially called the Bolivarian Republic of Venezuela , is a tropical country on the northern coast of South America. It borders Colombia to the west, Guyana to the east, and Brazil to the south...
. The program
Mission Barrio Adentro
Mission Barrio Adentro is a Bolivarian national social welfare program established under current Venezuelan president Hugo Chávez. The program seeks to provide comprehensive publicly-funded health care, dental care, and sports training to poor and marginalized communities in Venezuela...
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, Castro's 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.
Other countries
Cuba has also sent notable missions to Bolivia (particularly since the 2005 election of Evo MoralesEvo Morales
Juan Evo Morales Ayma , popularly known as Evo , is a Bolivian politician and activist, currently serving as the 80th President of Bolivia, a position that he has held since 2006. He is also the leader of both the Movement for Socialism party and the cocalero trade union...
) and South Africa, the latter in particular after a post-apartheid brain drain
Brain drain
Human capital flight, more commonly referred to as "brain drain", is the large-scale emigration of a large group of individuals with technical skills or knowledge. The reasons usually include two aspects which respectively come from countries and individuals...
of white doctors. Drawing on Cuba's relationship with the African National Congress
African National Congress
The African National Congress is South Africa's governing Africanist political party, supported by its tripartite alliance with the Congress of South African Trade Unions and the South African Communist Party , since the establishment of non-racial democracy in April 1994. It defines itself as a...
, over 450 Cuban doctors have practiced in South Africa, and 250 South African students trained in Cuba. After the 1999 violence in East Timor
East Timor
The Democratic Republic of Timor-Leste, commonly known as East Timor , is a state in Southeast Asia. It comprises the eastern half of the island of Timor, the nearby islands of Atauro and Jaco, and Oecusse, an exclave on the northwestern side of the island, within Indonesian West 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.
"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."
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
Kiribati
Kiribati , officially the Republic of Kiribati, is an island nation located in the central tropical Pacific Ocean. The permanent population exceeds just over 100,000 , and is composed of 32 atolls and one raised coral island, dispersed over 3.5 million square kilometres, straddling the...
, with sixteen more scheduled to join them. Cubans have also offered training to I-Kiribati doctors. 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%, and winning the proverbial hearts and minds in the Pacific. In response, the Solomon Islands
Solomon Islands
Solomon Islands is a sovereign state in Oceania, east of Papua New Guinea, consisting of nearly one thousand islands. It covers a land mass of . The capital, Honiara, is located on the island of Guadalcanal...
began recruiting Cuban doctors in July 2007, while Papua New Guinea
Papua New Guinea
Papua New Guinea , officially the Independent State of Papua New Guinea, is a country in Oceania, occupying the eastern half of the island of New Guinea and numerous offshore islands...
and Fiji
Fiji
Fiji , officially the Republic of Fiji , is an island nation in Melanesia in the South Pacific Ocean about northeast of New Zealand's North Island...
considered following suit.
In 2008, Cuba was due to send doctors to the Solomon Islands, Vanuatu
Vanuatu
Vanuatu , officially the Republic of Vanuatu , is an island nation located in the South Pacific Ocean. The archipelago, which is of volcanic origin, is some east of northern Australia, northeast of New Caledonia, west of Fiji, and southeast of the Solomon Islands, near New Guinea.Vanuatu was...
, Tuvalu
Tuvalu
Tuvalu , formerly known as the Ellice Islands, is a Polynesian island nation located in the Pacific Ocean, midway between Hawaii and Australia. Its nearest neighbours are Kiribati, Nauru, Samoa and Fiji. It comprises four reef islands and five true atolls...
, Nauru
Nauru
Nauru , officially the Republic of Nauru and formerly known as Pleasant Island, is an island country in Micronesia in the South Pacific. Its nearest neighbour is Banaba Island in Kiribati, to the east. Nauru is the world's smallest republic, covering just...
and Papua New Guinea, while seventeen medical students from Vanuatu would study in Cuba. It was reported that it might also provide training for Fiji doctors.
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". Among those sixty-four students were twenty-five Solomon Islanders, twenty I-Kiribati, two Nauruans and seventeen ni-Vanuatu. Pacific Islanders have been studying in Cuba since 2006.
In June 2009, Prensa Latina
Prensa Latina
Prensa Latina, legal name Agencia de Noticias Latinoamericana S.A. , is the official state news agency of Cuba, founded in March 1959 shortly after the Cuban Revolution.-Overview:...
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".
2010 Haiti earthquake
Cuba is helping with the medical crisis in Haiti due to the 2010 Haiti earthquake2010 Haiti earthquake
The 2010 Haiti earthquake was a catastrophic magnitude 7.0 Mw earthquake, with an epicentre near the town of Léogâne, approximately west of Port-au-Prince, Haiti's capital. The earthquake occurred at 16:53 local time on Tuesday, 12 January 2010.By 24 January, at least 52 aftershocks...
. All 152 Cuban medical and educational personnel in the Haitian capital Port-au-Prince
Port-au-Prince
Port-au-Prince is the capital and largest city of the Caribbean nation of Haiti. The city's population was 704,776 as of the 2003 census, and was officially estimated to have reached 897,859 in 2009....
at the time of the earthquake were reported to be safe, with two suffering minor injuries.
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. WhileCuban doctors are abroad, they continue to receive their salaries as well as a stipend in foreign currency." Pay for Cuban doctors abroad, while much higher than at home ($23 per month) is still low by international standards ($183 per month). 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 ChernobylChernobyl
Chernobyl or Chornobyl is an abandoned city in northern Ukraine, in Kiev Oblast, near the border with Belarus. The city had been the administrative centre of the Chernobyl Raion since 1932....
disaster, "offering treatment for hair loss, skin disorders, cancer, leukemia, and other illnesses attributed to radioactivity."
In response to the 1998 Hurricane Mitch
Hurricane Mitch
Hurricane Mitch was the most powerful hurricane and the most destructive of the 1998 Atlantic hurricane season, with maximum sustained winds of 180 mph . The storm was the thirteenth tropical storm, ninth hurricane, and third major hurricane of the season. Along with Hurricane Georges, 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. 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."
Following the development of cooperation with Venezuela through Mission Barrio Adentro, Mission Milagro / Operación Milagro was set up to provide ophthalmology
Ophthalmology
Ophthalmology is the branch of medicine that deals with the anatomy, physiology and diseases of the eye. An ophthalmologist is a specialist in medical and surgical eye problems...
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."
Benefits
Although humanitarian principles figure, ideological factors were prominent in Cuba's "doctor diplomacy", particularly during the Cold WarCold War
The Cold War was the continuing state from roughly 1946 to 1991 of political conflict, military tension, proxy wars, and economic competition between the Communist World—primarily the Soviet Union and its satellite states and allies—and the powers of the Western world, primarily the United States...
. 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"; Guatemala reestablished diplomatic relations with Cuba in 1998.
At the 2009 5th Summit of the Americas
5th Summit of the Americas
The Fifth Summit of the Americas was held at Port of Spain in Trinidad and Tobagofrom April 17 to 19, 2009.Organizers planned for the Fifth Summit to focus on a wide-ranging theme: "Securing Our Citizens' Future by Promoting Human Prosperity, Energy Security and Environmental...
, US President Barack Obama
Barack Obama
Barack Hussein Obama II is the 44th and current President of the United States. He is the first African American to hold the office. Obama previously served as a United States Senator from Illinois, from January 2005 until he resigned following his victory in the 2008 presidential election.Born in...
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
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
that limiting its interactions with Latin American countries to military and drug interdiction might be limiting its influence.
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). 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. 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. Cuba's co-operation with Venezuela provides Cuba with cheap oil in exchange for its medical support to Mission Barrio Adentro.
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.
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. This has had some impact on the domestic health system, for example with increased waiting times, particularly with regard to family doctors. The number of patients per doctor rose from 139 to 179. In March 2008 Cuba announced a reorganisation of its domestic family doctor programme for greater efficiency.Defection
In 2000, two Cuban doctors working in Zimbabwe attempted to defect to Canada. They were prevented from doing so by two Zimbabwean soldiers, who handed them over to Cuban officials. United Nations officials said Zimbabwe appeared to have violated national and international laws.In August 2006 the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
under George W. Bush
George W. Bush
George Walker Bush is an American politician who served as the 43rd President of the United States, from 2001 to 2009. Before that, he was the 46th Governor of Texas, having served from 1995 to 2000....
created the Cuban Medical Professional Parole program, specifically targeting Cuban medical personnel and encouraging them to defect when they are working in a country outside of Cuba. 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
Lincoln Diaz-Balart
Lincoln Rafael Díaz-Balart was the U.S. Representative for from 1993 to 2011. He is a member of the Republican Party. He previously served in the Florida House of Representatives and the Florida Senate...
. 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.
According to a 2007 paper published in The Lancet
The Lancet
The Lancet is a weekly peer-reviewed general medical journal. It is one of the world's best known, oldest, and most respected general medical journals...
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. In February 2007, at least 38 doctors were requesting asylum in the US embassy in Bogotá after asylum was denied by the Colombian government. Cuban doctors working abroad are reported to be monitored by "minders" and subject to curfew.
Two defected Cuban doctors working in Venezuela have asserted that they were told their job was to keep Chavez in power, by asking patients to vote for Chávez in the 2004 recall referendum. Opposition supporters in Venezuela have called Cuban doctors "Fidel's ambassadors" and refused to go to their clinics.
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".
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.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
External links
- Cuba Pushes its 'Medical Diplomacy' by Michael Voss, BBC News, May 20, 2009
- Alternatives to Health Insurance: Cuban Doctors by Belén Fernández, The Palestinian Chronicle, May 18, 2009
- Chernobyl Kids in Cuba - a slideshow by Edgard Garrido