FRFI 217 October/November 2010

• Cuban medical internationalism, origins, evolution and goals

John M Kirk and H Michael Erisman, Palgrave Macmillan 2009, £57

‘The life of a single human being is worth a million times more than all the property of the richest man on earth . . . Far more important than good remuneration is the pride of serving one’s neighbour.’

(Che Guevara, 1960, On Revolutionary Medicine)

The phenomenal achievements of Cuba’s health system are recognised throughout the world, even by critics of the socialist island. What is perhaps less discussed is the impact of Cuba’s health interventions throughout the underdeveloped world. With a population of just 11.3 million, Cuba punches above its weight in the international health arena: it has 40,000 medical staff engaged abroad and the largest international medical school in the world; since 2004, 1.5 million people in Latin America and the Caribbean have had their eyesight restored for free by Cuba. As Wayne Smith, director of the Cuba Program at the Center for International Policy in Washington put it: ‘Cuba is credited with saving more lives in the developing countries than all the G8 countries together. How has it done this?’ It is both the ‘how’ and the ‘why’ that Erisman and Kirk have set out to explore here, bringing together four years of research to begin to provide the answers.

This book brings together data covering the 50 years since the 1959 Revolution to show the extent to which Cuba’s health programmes have resulted in ‘better life and indeed life itself for dispossessed people all over the world’.

Cuba’s health initiatives, they show, outstrip the contribution of the World Health Organisation and Medecins Sans Frontieres (MSF). Cuba’s medical teams are working in 80 countries, caring for approximately 70 million people.

Cuba sent its first international health brigade to Algeria in 1963. Since then, over 124,000 health professionals have worked in 103 countries. As well as Comprehensive Medical Programmes set up at the request of the home country, Cuba continues to send emergency brigades, for example to Honduras after Hurricane Mitch in 1998 and to Haiti after Hurricane George in the same year, despite aid groups saying it was too dangerous.

Haiti is a good example of the impact of Cuban medical intervention. By 2004, Cubans were providing health care to 75% of its 8.3 million people, contributing to a fall in infant mortality from 80 per 1,000 live births to 28; 247 students were studying at a medical school founded by the Cubans. By 2005, 600 Haitian students were studying medicine in Cuba, and the first group of Cuban-trained Haitian doctors had returned to work in Haiti. The president of Guyana, Bharrat Jagdeo, told US president George Bush in 2007 that ‘if Cuba were to withdraw their doctors from Haiti, their health system would collapse’. Since the book’s publication we have of course witnessed the vital role played by Cuban doctors in Haiti in the aftermath of a devastating earthquake in January 2010.

The authors detail the many countries, from Gambia to East Timor, where Cuban health professionals have worked and continue to work, underpinned by many useful tables. But they also examine the rationale for Cuba’s approach, and compare it with what they call the ‘First World’. In the first place, the aid they offer actually arrives, unlike most of the developed countries, which are quick to promise much and slow to deliver anything.

Cuba’s Latin American Medical School (ELAM) provides free education to international students from poor countries, who then return home to practise. Cuba also trains medical staff in the countries where it operates. For example, by 2007, there were 20,000 Venezuelan medical students being trained by Cubans in Venezuela and 2,400 Venezuelan medical students in Cuba. Over the next decade, Cuba and Venezuela intend to train 200,000 doctors. Cuba is contributing to the ‘brain gain’ rather than the brain drain through which developed countries poach doctors trained in oppressed nations.

Kirk and Erisman contrast the overall ethos that underpins Cuba’s attitude with that of, specifically, the United States. While recognising that Cuba’s efforts have ‘brought tremendous diplomatic benefits for the island’, they stress that ‘Cuban medical internationalism is not used solely to score political points abroad’ (p181, authors’ emphasis) and dismiss accusations that Cuba’s approach is selfish or cynically motivated by a wish to promote its pharmaceutical products abroad. They cite instead, the Cuban Constitution’s commitment to ‘proletarian internationalism…cooperation and solidarity with the peoples of this world, especially those of Latin America and the Caribbean’ (p182). Their book, they say, illustrates the application of that ideological framework. By contrast, they mention a 2005 US medical diplomacy effort in Panama which had one simple objective: ‘Challenging the socialist campaigns of Cuba’s Fidel Castro and Venezuela’s Hugo Chavez and winning over people’. ‘“Too little, too late”’ would appear a fitting commentary on the US approach to gaining regional support through medical aid’, they conclude. They condemn, too, the US’s ‘Cuban Medical Professional Parole’ programme, which seeks to persuade health professionals on international missions to defect to the US. However, only some 500 have ever taken up the offer.

Cuba’s ethos of providing help is detailed: training people to do it for themselves, supported by a literacy campaign; involving the community; what they call the Cuban model of ‘doing more with less’. ‘The secret lies in the development of a totally new form of revolutionary physician, ably described by [former] Cuban vice president Carlos Lage (himself a paediatric cardiologist), “A revolutionary physician is a person for whom a sick person is not a client, but a patient…The objective of a revolutionary physician is not to earn money but to save lives”.’

The authors are of course writing as academics rather than Marxists, and fall down a little when trying to label Cuba’s approach to international health. They categorise it as an example of ‘soft power’, popularised by Joseph Nye – the idea that rather than using carrots and sticks to exert power, a country can use the ‘attraction’ of its culture, geography or ideas to influence others. But readers of FRFI can recognise socialism when we see it, and what Kirk and Erisman have produced, overall, is a excellent handbook on the nature of a socialist and revolutionary approach to medical internationalism – get your library to order it now.

Hannah Caller and Cat Wiener