Havana's Medics Work Around The
Cuba Exports Health
by Hernando Calvo Ospina, Le Monde
www.zmag.org, August 16, 2006
When Hurricane Katrina ripped through
the southern United States in August 2005, the authorities were
overwhelmed and the governor of Louisiana, Kathleen Babineaux
Blanco, appealed to the international community for emergency
medical aid. The Cuban government immediately offered assistance
to New Orleans and to the states of Mississippi and Alabama, also
affected by the storm, and promised that within 48 hours 1,600
doctors, trained to deal with such catastrophes, would arrive
with all the necessary equipment plus 36 tonnes of medical supplies.
This offer, and another made directly to President George Bush,
went unanswered. In the catastrophe at least 1,800 people, most
of them poor, died for lack of aid and treatment.
In October 2005, the Kashmir region of
Pakistan experienced one of the most violent earthquakes in its
history, with terrible consequences in the poorest and most isolated
areas to the north. On 15 October an advance party of 200 emergency
doctors arrived from Cuba with several tonnes of equipment. A
few days later, Havana sent the necessary materials to erect and
equip 30 field hospitals in mountain areas, most of which had
never been previously visited by a doctor. Local people learned
of Cuba's existence for the first time.
To avoid causing offence in this predominantly
Muslim country, the women on the Cuban team, who represented 44%
of some 3,000 medical staff sent to Pakistan in the next six months,
dressed appropriately and wore headscarves._Good will was quickly
established; many Pakistanis even allowed their wives and daughters
to be treated by male doctors.
By the end of April 2006, shortly before
their departure, the Cubans had treated 1.5 million patients,
mostly women, and performed 13,000 surgical operations. Only a
few severely injured patients had to be flown to Havana._Pakistan's
President Pervez Musharraf, an important ally of the US and friend
of Bush, officially thanked the Cuban authorities and acknowledged
that this small nation in the Caribbean had sent more disaster
aid than any other country.
First medical brigade
Cuba set up its first international medical
brigade in 1963 and dispatched its 58 doctors and health workers
to newly independent Algeria. In 1998 the Cuban government began
to create the machinery to send large-scale medical assistance
to poor populations affected by natural disasters. After hurricanes
George and Mitch blew through Central America and the Caribbean,
it offered its medical personnel as part of an integrated health
programme._The Dominican Republic, Honduras, Guatemala, Nicaragua,
Haiti and Belize all accepted this aid.
Cuba offered massive medical assistance
to Haiti, where healthcare was chronically inadequate. In 1998
Cuba even approached France, Haiti's former colonial power, with
a proposal to establish a humanitarian association to help the
people of Haiti. The French government did not respond (although,
finally, in 2004, it sent troops). Since 1998 Cuba has sent 2,500
doctors and as much medicine as its fragile economy permits.
This free aid - the Cuban government funds
the personnel - has been effective. The willingness of the new
barefoot doctors (1) to intervene in areas where their local equivalents
refuse to go, because of the poverty of the clientele or the danger
or difficulty of access, has persuaded other countries, especially
in Africa, to apply for assistance.
Between 1963 and 2005 more than 100,000
doctors and health workers intervened in 97 countries, mostly
in Africa and Latin America (2) By March 2006, 25,000 Cuban professionals
were working in 68 nations. This is more than even the World Health
Organisation can deploy, while Médecins Sans Frontières
sent only 2,040 doctors and nurses abroad in 2003, and 2,290 in
The most seriously ill patients are often
brought to Cuba for treatment. Over the decades these have included
Vietnamese Kim Phuc, the little girl shown in the famous war photograph
running naked along a road, her skin burned by US napalm. Cuba
also took in some 19,000 adults and children from the three Soviet
republics most affected by the Chernobyl nuclear accident of 1986.
In June 2001 the United Nations General
Assembly met in special session to discuss Aids. Cuba, with an
HIV infection rate of 0.09% compared with 0.6% in the US, made
an offer of "doctors, teachers, psychologists, and other
specialists needed to assess and collaborate with the campaigns
to prevent Aids and other illnesses; diagnostic equipment and
kits necessary for the basic prevention programmes and retrovirus
treatment for 30,000 patients".
If this offer had been accepted, "all
it would take is for the international community to provide the
raw materials for the medicines, the equipment and material resources
for these products and services. Cuba will not charge and will
pay the salaries in its national currency" (4).
The offer was rejected. But eight African
and six Latin American countries did benefit from an educational
HIV/Aids intervention project which broadcast radio and television
programmes, treated more than 200,000 patients and trained more
than half a million health workers.
There are currently some 14,000 Cuban
doctors working in poor areas of Venezuela. The two governments
have also set up Operation Milagro (miracle) which, during the
first 10 months of 2005, gave free treatment to restore the eyesight
of almost 80,000 Venezuelans, transferring those suffering from
cataracts and glaucoma to Cuba for operations (5). More widely,
the project offers help to anyone in Latin America or the Caribbean
affected by blindness or other eye problems. Venezuela provides
the funding; Cuba supplies the specialists, the surgical equipment
and the infrastructure to care for patients during their treatment
So far no other government, private body
or international organisation has managed to put together a global
medical programme on such a scale or to offer such a level of
assistance to those in need of care. Operation Milagro's goal
is to operate on the eyes of a million people every year.
A few hours before he took up office as
president of Bolivia in December 2005, Evo Morales signed his
first international treaty, which was with Cuba, setting up a
joint unit to offer free ophthalmological treatment. As well as
the national institute of ophthalmology in La Paz, recently equipped
by Cuba, there will be medical centres in the cities of Cochabamba
and Santa Cruz. Young Bolivian graduates from the Latin American
School of Medicine_(ELAM) will take part in the programme.
ELAM was founded in 1998, just as Cuba
began to send doctors to the Caribbean and Central America. It
operates from a former naval base in a suburb of Havana and trains
young people of poor families from throughout the Americas, including
the US. There are also hundreds of African, Arab, Asian and European
students. Cuba's 21 medical faculties all participate in training.
In July 2005 the first 1,610 Latin American students graduated._Each
year some 2,000 young people enroll at the school, where they
receive free training, food, accommodation and equipment in return
for a commitment to go back home and treat their compatriots (6).
Ideological considerations have inspired
the medical and ophthalmologic associations of some countries
to launch a campaign against this initiative. The review of the
Argentine council of ophthalmology, for example, questioned whether
the Cuban ophthalmologists really were doctors and announced that
it was taking steps, along with humanitarian NGOs, to fund a similar
There was the same reaction in 1998 in
Nicaragua, where, despite the severity of the catastrophe caused
by hurricane Mitch, President Arnoldo Alemán refused to
admit Cuban doctors. Similar reactions have been seen in Venezuela
since 2002 and now in Bolivia. Conservative doctors, who prefer
to specialise in diseases of the credit-worthy and refuse to enter
shantytowns, accuse Cuba's barefoot doctors of incompetence, illegal
medical practice and unfair competition.
In April 2005 the legal authorities in
the Brazilian state of Tocantins ordered out 96 Cuban doctors
who had been treating the poor. The state governor disagreed,
but could do no more than "recognise the professional bravery
of the doctors who were welcome here and whom we wish to thank".
The medical associations are afraid that
if the Cuban medics bring down prices or even offer some services
free, medical treatment will cease to be a profitable, elitist
service. As each new doctor graduates in Cuba, they intensify
their protests and political pressure.
There is also a threat that diplomas obtained
in Cuba will not be recognised elsewhere. Excessive charges in
Chile have prevented many Cuban-trained doctors from validating
their medical qualifications there. But, as the BBC has pointed
out, if Latin America's medical associations persist in their
opposition they risk losing the support of populations deprived
of access to health services, for whom the project is a glimmer
of light in the darkness (8). In the US, where 45 million people
have no health cover and medical studies cost about $300,000,
a blockade forbids students to study in Cuba, threatening up to
10 years' imprisonment and fines of up to $200,000.
Sceptics see the humanitarian aid offered
by Cuba as a publicity stunt, an investment to secure diplomatic
support in the face of continuing US hostility. They point out
that when the UN Human Rights Council was established in March
2006, Cuba was elected with the support of 96 of the 191 UN member
states, whereas Nicaragua, Peru and Venezuela, where political
opposition is legal, as it is not in Cuba, were rejected.
But a western diplomat was prepared to
recognise that Cuba's policy of exporting doctors was an initiative
which benefited so many people that it should be applauded even
by its political enemies (9).
More about Hernando Calvo Ospina.
Translated by Donald Hounam
Hernando Calvo Ospina is a journalist
and the author of 'Bacardi: the Hidden War' (Pluto Press, London,