Cuban Medical Diplomacy

Twenty-four years ago this week, the first Executive President of Guyana Mr. Linden Forbes Sampson Burnham died on the operating table at the Georgetown Public Hospital.
The doctors in charge of the surgical procedure on his throat were all Cubans. The gradual destruction of the infrastructure of the country following the collapse of the economy in the seventies had not left the medical sector unaffected.

To fill the gap created by the widespread emigration of doctors to the developed countries, the government by 1972 had eagerly accepted the offer of Cuba to send some replacements.
Just four years after the Cuban Revolution of 1959, Castro had embarked on a programme of assigning Cuban doctors to Third World countries (initially “revolutionary” ones were favoured) in dire need, even though there had been an exodus immediately after his victory.
The contribution was so well received and generated so much goodwill, that the programme was institutionalised as Cuba focused on free universal health care for its citizens and created the institutions for sustaining the latter.
The new medical schools created by the communist state were soon churning out so many doctors that by 2007, more than 67,000 health workers had served in 94 countries spread across the globe. Guyana is one of those countries.
Obviously, these countries could not all be ‘revolutionary” and in fact, several of them were actually opposed to the Marxist philosophy of Castro. Especially in national emergencies such as earthquakes (Iran) and mudslides (Venezuela) the help was invaluable.

From an ideological perspective Castro was able to dull much criticisms of the nature of his regime when he contrasted the behaviour of the “developed” countries that castigated the “political” control over his citizens yet pulled away the health professionals from underdeveloped countries – leaving them even deeper in the hole.
The Cubans did not just send out health professionals – they actually started sending individuals stricken with various ailments of the eye from several Caribbean nations to Cuba where they were operated on and returned to their country of origin.
It has been claimed that every day in Cuba, some 1500 eye operations are conducted – most of them for free, on foreigners. Over the last half-decade almost 4,000 Guyanese have benefited from this programme.

While there has been some criticism of the Cuban health aid – primarily stemming from the difficulties in doctor-patient communication and the alleged low-level training of the Cuban medical personnel – most Guyanese are not looking at a gift horse in the mouth. The bottom line for them is that until the overall economic situation in Guyana – as with most developing countries – improves dramatically, the endemic shortage of doctors will not end and Cuban doctors will be a boon.
The Cuban experiment to provide “real” freedom by taking care of social needs such as education and health care while restricting the rights of citizens to choose their government has been severely criticised – especially by the US.
However, the 2006 programme by President George Bush to undercut the medical diplomacy by facilitating Cuban doctors serving abroad to defect to the US has backfired since most beneficiary countries saw it as mean spirited.
The way to go would be for the developed world to follow Cuba and accept health care as a human right that should be available to all. Let medical diplomacy be broadened.

The Cuban Threat: Medical Diplomacy

Living in a hostile neighborhood led Fidel to look for allies elsewhere. Part of this process has included the conduct of medical diplomacy, which is the collaboration between countries to improve relations and simultaneously produce health benefits. Medical diplomacy has been a cornerstone of Cuban foreign policy and its foreign aid strategy since shortly after the triumph of the 1959 revolution. Despite Cuba’s own economic difficulties and the exodus of half of its doctors, Cuba began conducting medical diplomacy in 1960 by sending a medical team to Chile to provide disaster relief aid after an earthquake. Three years later, and with the US embargo in place, Cuba began its first long-term medical diplomacy initiative by sending a group of fifty-six doctors and other health workers to provide aid in Algeria on a fourteen-month assignment. Since then, Cuba has provided medical assistance to scores of developing countries throughout the world both on a long-term basis and for short-term emergencies.

And now, with help from his friend, Hugo Chávez, who is awash in oil wealth, Fidel is threatening to provide massive amounts of medical aid to improve the health of poor Latin Americans. Rather than a fifth column promoting socialist ideology, these doctors provide a serious threat to the status quo by their example of serving the poor in areas in which no local doctor wouldwork, by making house calls a routine part of their medical practice and by being available free of charge 24/7, thus changing the nature of doctor-patient relations. As a result, they have forced the re-examination of societal values and the structure and functioning of the health systems and the medical profession within the countries to which they were sent and where they continue to practice. This is the current Cuban threat.

Over the past forty-five years, Cuba’s conduct of medical diplomacy has improved the health of the less privileged in developing countries while improving relations with their governments. By the close of 2005, Cuban medical personnel were collaborating in 68 countries across the globe. Consequently, Cuban medical aid has affected the lives of millions of people in developing countries each year. And to make this effort more sustainable, over the years, thousands of developing country medical personnel have received free education and training either in Cuba or by Cuban specialists engaged in on-the-job training courses and/or medical schools in their own countries. Today, over 10,000 developing country scholarship students are studying in Cuban medical schools. Furthermore, Cuba has not missed a single opportunity to offer and supply disaster relief assistance irrespective of whether or not Cuba had good relations with that government. This includes an offer to send over 1000 doctors as well as medical supplies to the United States in the immediate aftermath of Hurricane Katrina. Although the Bush administration chose not to accept the offer, the symbolism of this offer of help by a small, developing country that has suffered forty-five years of US hostilities, including an economic embargo, is quite important.
Guyana, South America
Washington, D.C. U.S.A.

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