Deploying doctors and medicine

WE HEAR a lot these days about the failing medical condition of Cuba’s longstanding leader, Fidel Castro. But very few are aware of the country’s celebrated medical internationalism or vaunted "doctor diplomacy."

Instead of sending food packages, development assistance funds and heavily armed soldiers, the Cuban government deploys critically needed doctors, medical technicians and medicine to a good part of the world. Since it is unable to provide significant amounts of cash and material resources, it dispenses human capital.

For instance, after hurricane Katrina had ripped through New Orleans and the Gulf Coast in August 2006, Cuba offered to send, on its own dime, almost 1,600 medical personnel and over 35 tonnes of emergency medical supplies to the decimated area. Sadly, this generous offer was rejected by the Bush administration.

Historically speaking, though, over 100,000 Cuban health professionals have provided care in 102 different countries since the early 1960s. Today, roughly 40,000 Cuban medical workers are striving to heal the sick and to rebuild shattered lives in 73 countries or overseas territories.

Beginning in Chile, where it sent a medical team after a devastating earthquake in 1960, Cuba’s medical diplomacy has grown to be a key component of its external relations.

After earthquakes hit both Chile and Nicaragua in the early 1970s, Cuba dispatched doctors and a medical team to help with these humanitarian disasters. In war-torn countries like Angola and Guinea-Bissau, Cuba has sent doctors and health technicians to treat the many casualties.

Setting aside major ideological differences, Cuba provided medical personnel to El Salvador in 2000 following a serious outbreak of dengue fever. In the case of Uruguay (which had broken off diplomatic relations with Havana), the Cuban government donated 1.2 million doses of vaccine to deal with its meningitis epidemic in 2001.

Following horrendous floods in Guyana in 2005, a 40-person medical team spent several months there. Moreover, some 22,000 cancer-ridden victims, many of them children, from the 1986 Chernobyl nuclear reactor meltdown have been taken to Cuba for free long-term medical care.

Since 2004, Cuban doctors have implemented "Operation Miracle" to restore sight to 862,000 people in Latin America and the Caribbean, at no charge to the patients.

Cuban doctors are working in Zambia and Botswana to treat the HIV/AIDS pandemic, and low-cost anti-retroviral drugs are being distributed to a number of Caribbean countries. In sub-Saharan Africa, Cuba has promised to send 5,000 medical workers to combat HIV/AIDS, if the West will cover the cost of medications (it has declined thus far).

In addition, a former naval base has been transformed into a top-notch medical facility – the Latin American School of Medicine, the largest medical school in the world. Free of charge, Cuba has agreed to take in students from throughout the region and beyond (from some 89 countries) and train them to be physicians.

Almost 25,000 low-income students from Africa, Asia and Latin America (and even from the U.S. and Puerto Rico), with the assistance of full scholarships, come to Cuba to study medicine. The only provision is they have to return, after completing a six-year program, to their home countries and work in areas where health care is not easily accessible.

Why do the Cubans do it? Is it purely for altruistic reasons? Or, does it have more to do with ideological and philosophical considerations?

In the post-Soviet Union era, Cuba dealt with its massive economic crisis of the 1990s by utilizing its medical diplomacy to cultivate friends and allies throughout the world. Given the continuation of the U.S. economic embargo, these countries have played an important role in allowing Cuba to diversify its trade, investment and commercial relations.

By cashing in its "medical chits," if you will, Havana also hopes to defend itself against the hostile efforts of the U.S. to isolate and punish Cuba – particularly in multilateral forums like the United Nations. To be sure, on Oct. 30, the UN General Assembly voted overwhelmingly in favour (184-4) of a resolution that called upon the U.S. to rescind its economic embargo against revolutionary Cuba.

These so-called "medical diplomats" have also bolstered Cuba’s prestige and image in much of the developing world. It is no wonder, then, that Cuba was asked to lead the 118-nation Non-Aligned Movement for 2006-2009.

It is also good business for Cuba, with the export of medical goods and services bringing in more revenues in 2006 than tourism. Lastly, medical internationalism, and the national pride that it engenders, serves to rally the people around the Cuban government.

Not everyone, of course, is pleased to see Cuban doctors scattered throughout their countries. National and regional medical associations, and some individual physicians in the host countries, are angry about how the visiting Cubans approach medicine. The Cubans reply that they work in underserved areas, where the middle-class doctors simply refuse to treat poor patients.

Cuba’s commitment to improving the health of communities outside its borders is extraordinary. Indeed, as a struggling developing country itself, which lost half of its own doctors after the 1959 revolution, its medical foreign policy can only be seen as a model for richer countries to emulate.

John M. Kirk and Peter McKenna are professors at Dalhousie University and the University of Prince Edward Island respectively, and the authors of the forthcoming book, Fighting Words: Competing Voices Over the Cuban Revolution.

Source:thechronicleherald.ca