A non-partisan journal of the left.

Cuba's Healthcare Policy Shows the True Meaning of Humanitarianism and Internationalism

Fri 10th Oct 2008

‘At the risk of seeming ridiculous, let me say that the true revolutionary is guided by a great feeling of love. It is impossible to think of a genuine revolutionary lacking this quality.’ These words were written by Argentine doctor and revolutionary Che Guevara, back in 1965.

Actions, of course, speak much louder than words, and it is through the deeds of Cuban doctors and other health professionals that Che’s words have become a reality.

Although it is far from strong economically, and has for half a century been the target of both military and economic aggression from the United States, Cuba has managed to create a health system that rivals many first world countries. Since 1959, health has been a top priority of the Cuban government. Cuba now has a higher proportion of doctors per population than any other country in the world - the World Health Organisation (WHO) cites a figure of 1 doctor for every 170 individuals. A further glance at WHO statistics would reveal that Cuba also has one of the lowest infant mortality rates in the world (5.3 deaths for every 1000 live birth in children under the age of 1). In contrast, the world’s most developed nations together average an infant mortality rate of around 8 per 1000.

The prevalence of HIV amongst Cuban adults is lower than any other country in the Americas. In stark contrast with many other developing countries, UNICEF figures from 2006 show that no Cuban child under the age of five in Cuba is severely underweight. Diseases such as malaria, dengue and diphtheria, common in many parts of the developing world, are not seen in Cuba. Cuba was the first country in the Americas to eradicate both polio (1962) and measles (1996), by means of nationwide vaccination campaigns. Earlier this year, it emerged that, per population, Cuba has among the highest proportion of centenarians in the world.

Astonishingly, these achievements have transpired despite Cuba’s health budget being only a fraction of what some of the world’s most affluent countries spend on healthcare. WHO data indicates that in 2005 the Cuban government spent the equivalent of $333 per person on healthcare, while that same year the US spent $6,347 per individual. Despite a 19-fold difference in expenditure, life expectancy between the two countries is comparable and Cuba has the lower infant mortality rate.

The Cuban health system is by no means perfect. Shortages of certain medication abound in Cuba - in large part a feature of the trade embargo restricting the sales of medicines to Cuba. The salaries of Cuban doctors are also low, in comparison with other professions. However, despite its short-comings, Cuba has a health system of which it can be proud. The country has in fact taken matters a step further, by sharing the benefits of its healthcare system with those in need.

Over 32,000 Cuban doctors, nurses and other medical personnel are currently working abroad in 70 developing countries*. In the last 45 years, medically qualified Cubans have worked in more than 100 countries. The first post-revolutionary beneficiary of Cuban medical aid was Chile, which received a medical team following the massive Valdivia earthquake in 1960, that had measured 9.5 on the Richter scale and is to date the most powerful earthquake ever recorded.

Nations that maintain reasonable diplomatic relationships with Cuba are not the only ones to have had a helping hand extended to them. In early September 2005 Cuba offered to send 1,500 doctors and other medical personnel to provide much needed assistance to the citizens of New Orleans, following the damage inflicted by Hurricane Katrina. Failing to observe the distinction between foreign policy and humanitarianism, the US declined the Cuban offer of aid.

Very shortly afterwards, on 19th September 2005, Fidel Castro announced the creation of a special medical brigade whose task it would be to travel to areas of the globe affected by catastrophes, natural or otherwise, and provide medical attention to the people affected. The full name of this voluntary rapid response medical contingent is the Henry Reeve International Contingent of Doctors Specializing in Disaster Situations and Serious Epidemics. The contingent is named after a 19th century American who fought and died in Cuba’s ‘Ten Years War’ against Spain.

Shortly after its inception, the brigade was dispatched on its first mission - to provide medical assistance to people living in remote areas of Pakistan, following the October 2005 Kashmir earthquake.

According to Bruno Rodriguez, the head of the Cuban medical mission in Pakistan, the Henry Reeve contingent treated around 1.74 million people (73% of all those affected), carrying out 14,506 surgical operations during their time in Pakistan. While many Western based NGOs left the region after a few months, the Cuban contingent stayed for seven months, from October 2005 to May 2006, enduring the harsh winter in the mountains regions in the North of Pakistan. Although Pakistan’s President Musharraf was under pressure from the US to refuse Cuba’s offer of aid, he did not capitulate to the whim of the US. As the last group of volunteers of the Henry Reeve brigade were preparing to leave the area, President Musharaff’s words to Bruno Rodriguez, Cuba’s first deputy foreign minister, were ‘‘Your example will live on in the Pakistani people´s heart, and I bid a sad farewell.’’

When the Cuban medical team departed, they left behind the 32 field hospitals and equipment that they had brought with them.

Help has also been given to those closer to home. For example, in July 2004, Cuba established an ambitious project know as ‘Operation Miracle’ whose aim is to perform free sight restoring operations on individuals living in Latin America and the Caribbean who are too poor to afford the surgery. The project aims to restore sight to six million individuals. As of January this year, one million people from 28 countries had benefitted. Cuban doctors and nurses also work throughout Latin America helping to extend healthcare provision to the most marginalised community. In some cases the support that Cuba offers is not unilateral. For example, in return for having sent 30,000 Cuban doctors, dentists and other healthcare workers to Venezuela, President Hugo Chavez provides Cuba with cut price oil.

Most recently, 35 surgeons and other medical personnel were dispatched to China following the powerful Sichuan earthquake that struck in May of this year.

Detractors have pointed to Cuban doctors working in Latin America who have taken advantage of their placements abroad to defect, using these cases as a way of pouring scorn on Cuba, its healthcare system and its human rights record. In order to encourage such defections, US laws permit Cubans to enter America without the need of a passport, this ‘privilege’ is reserved solely for Cuban citizens. However, despite the efforts of the US and despite the words of critics, only around 2% of Cuban doctors working abroad choose to abscond.

For those wishing to see a film about Cuban humanitarianism, I recommend watching the DVD ‘Made in Cuba’. The DVD contains two short films; one tells the story of ‘Operation Miracle’, the other depicts Cuba’s humanitarian response to the Pakistan earthquake.

In line with the adage that ‘if you give a man a fish he eats for a day, but teach him how to fish and he'll eat forever’, Cuba has helped to establish medical and nursing schools in South America and Africa by way of providing medical educators and learning resources. Since 1976, with Cuban assistance, medical schools have been founded in Yemen, Guyana, Ethiopia, Uganda, Ghana, Haiti as well as in other developing countries, with Cuban assistance.

On the 22nd September of this year, in a speech at the UN headquarters in New-York, Jose Machado Ventura, Head of the Cuban delegation, pointed out that Africa’s problems will not be resolved by ‘condolences, lamentations and limited charitable aid’, adding that the ‘need is for new relations of solidarity and full cooperation with our African brothers.’ He later gave an example of what such solidarity means in practical terms by revealing that in 2007 alone, nearly 2000 Cuban medical staff carried out almost 200,000 surgical procedures and helped to deliver around 100,000 babies whilst working in 35 African nations.

If a single relatively poor country can achieve so much, we can only imagine what could be accomplished by the world’s most affluent countries, were they to follow Cuba’s example. The Cuban ideal of international solidarity that works to foster goodwill between nations, is in contrast to actions perpetrated by some countries who use their wealth and workforce to invade and occupy. Dispatching a medical brigade rather than a military one and saving lives rather than taking them, is much more likely to eliminate mistrust between nations and to create a better world. There are those in the developed world who talk about eliminating poverty and deprivation but do not follow through with their actions. Sometimes they even give with one hand while taking twice as much with the other. To quote Che Guevara again, ‘words that do not match deeds are unimportant.’

* A full list of these countries, as of February 2007, can be seen on the website http://www.medicc.org/ns/index.php?s=47&p=12
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