Why Cuba Is Exporting Health Care to the U.S.
by Sarah van
Gelder
"About 90
young people from poor parts of the
United
States have joined the ranks of international
students
studying medicine in Cuba."
This article was originally published in YES! Magazine.
Cubans say they offer health care to the world's poor
because they have big hearts. But what do they get in
return?
They live longer than almost anyone in Latin America.
Far fewer babies die. Almost everyone has been
vaccinated, and such scourges of the poor as parasites,
TB, malaria, even HIV/AIDS are rare or non-existent.
Anyone can see a doctor, at low cost, right in the
neighborhood.
The Cuban health care system is producing a population
that is as healthy as those of the world's wealthiest
countries at a fraction of the cost. And now Cuba has
begun exporting its system to under-served communities
around the world - including the United States.
The story of Cuba's health care ambitions is largely
hidden from the people of the United States, where
politics left over from the Cold War maintain an
embargo on information and understanding. But it is
increasingly well-known in the poorest communities of
Latin America, the Caribbean, and parts of Africa where
Cuban and Cuban-trained doctors are practicing.
In the words of Dr. Paul Farmer, Cuba is showing that
"you can introduce the notion of a right to health care
and wipe out the diseases of poverty."
Health Care for All Cubans
Many elements of the health care system Cuba is
exporting around the world are common-sense practices.
Everyone has access to doctors, nurses, specialists,
and medications. There is a doctor and nurse team in
every neighborhood, although somewhat fewer now, with
29,000 medical professionals serving out of the country -
a fact that is causing some complaints. If someone
doesn't like their neighborhood doctor, they can choose
another one.
"The Cuban medical
system can spend a
little on
prevention rather than a lot later on to cure
diseases."
House calls are routine, in part because it's the
responsibility of the doctor and nurse team to
understand you and your health issues in the context of
your family, home, and neighborhood. This is key to the
system. By catching diseases and health hazards before
they get big, the Cuban medical system can spend a
little on prevention rather than a lot later on to cure
diseases, stop outbreaks, or cope with long-term
disabilities. When a health hazard like dengue fever or
malaria is identified, there is a coordinated
nationwide effort to eradicate it. Cubans no longer
suffer from diphtheria, rubella, polio, or measles and
they have the lowest AIDS rate in the Americas, and the
highest rate of treatment and control of hypertension.
For health issues beyond the capacity of the
neighborhood doctor, polyclinics provide specialists,
outpatient operations, physical therapy,
rehabilitation, and labs. Those who need inpatient
treatment can go to hospitals; at the end of their
stay, their neighborhood medical team helps make the
transition home. Doctors at all levels are trained to
administer acupuncture, herbal cures, or other
complementary practices that Cuban labs have found
effective. And Cuban researchers develop their own
vaccinations and treatments when medications aren't
available due to the blockade, or when they don't
exist.
Exporting Health Care
For decades, Cuba has sent doctors abroad and trained
international students at its medical schools. But
things ramped up beginning in 1998 when Hurricanes
George and Mitch hammered Central America and the
Caribbean. As they had often done, Cuban doctors rushed
to the disaster zone to help those suffering the
aftermath. But when it was time to go home, it was
clear to the Cuban teams that the medical needs
extended far beyond emergency care. So Cuba made a
commitment to post doctors in several of these
countries and to train local people in medicine so they
could pick up where the Cuban doctors left off. ELAM,
the Havana-based Latin American School of Medicine, was
born, and with it the offer of 10,000 scholarships for
free medical training.
Today the program has grown to 22,000 students from
Latin America, the Caribbean, Africa, Asia, and the
United States who attend ELAM and 28 other medical
schools across Cuba. The students represent dozens of
ethnic groups, 51 percent are women, and they come from
more than 30 countries. What they have in common is
that they would otherwise be unable to get a medical
education. When a slum dweller in Port au Prince, a
young indigenous person from Bolivia, the son or
daughter of a farmer in Honduras, or a street vendor in
the Gambia wants to become a doctor, they turn to Cuba.
In some cases, Venezuela pays the bill. But most of the
time, Cuba covers tuition, living expenses, books, and
medical care. In return, the students agree that, upon
completion of their studies, they will return to their
own under-served communities to practice medicine.
The curriculum at ELAM begins, for most students, with
up to a year of "bridging" courses, allowing them
to
catch up on basic math, science, and Spanish skills.
The students are treated for the ailments many bring
with them.
"Cuba
trains doctors in an ethic of serving the
poor."
At the end of their training, which can take up to
eight years, most students return home for residencies.
Although they all make a verbal commitment to serve the
poor, a few students quietly admit that they don't see
this as a permanent commitment.
One challenge of the Cuban approach is making sure
their investment in medical education benefits those
who need it most. Doctors from poor areas routinely
move to wealthier areas or out of the country
altogether. Cuba trains doctors in an ethic of serving
the poor. They learn to see medical care as a right,
not as a commodity, and to see their own role as one of
service. Stories of Cuban doctors who practice abroad
suggest these lessons stick. They are known for taking
money out of their own pockets to buy medicine for
patients who can't afford to fill a prescription, and
for touching and even embracing patients.
Cuba plans with the help of Venezuela to take their
medical training to a massive scale and graduate
100,000 doctors over the next 15 years, according to
Dr. Juan Ceballos, advisor to the vice minister of
public health. To do so, Cuba has been building new
medical schools around the country and abroad, at a
rapid clip.
But the scale of the effort required to address current
and projected needs for doctors requires breaking out
of the box. The new approach is medical schools without
walls. Students meet their teachers in clinics and
hospitals, in Cuba and abroad, practicing alongside
their mentors. Videotaped lectures and training
software mean students can study anywhere there are
Cuban doctors. The lower training costs make possible a
scale of medical education that could end the scarcity
of doctors.
U.S. Students in Cuba
Recently, Cuba extended the offer of free medical
training to students from the United States. It started
when Representative Bennie Thompson of Mississippi got
curious after he and other members of the Congressional
Black Caucus repeatedly encountered Cuban or Cuban-
trained doctors in poor communities around the world.
They visited Cuba in May 2000, and during a
conversation with Fidel Castro, Thompson brought up the
lack of medical access for his poor, rural
constituents. "He [Castro] was very familiar with the
unemployment rates, health conditions, and infant
mortality rates in my district, and that surprised me,"
Thompson said. Castro offered scholarships for low-
income Americans under the same terms as the other
international students - they have to agree to go back
and serve their communities.
Today, about 90 young people from poor parts of the
United States have joined the ranks of international
students studying medicine in Cuba.
The offer of medical training is just one way Cuba has
reached out to the United States. Immediately after
Hurricanes Katrina and Rita, 1,500 Cuban doctors
volunteered to come to the Gulf Coast. They waited with
packed bags and medical supplies, and a ship ready to
provide backup support. Permission from the U.S.
government never arrived.
"Immediately
after Hurricanes Katrina and Rita,
1,500 Cuban
doctors volunteered to come to the
Gulf
Coast."
"Our government played politics with the lives of
people when they needed help the most," said
Representative Thompson. "And that's unfortunate."
When an earthquake struck Pakistan shortly afterwards,
though, that country's government warmly welcomed the
Cuban medical professionals. And 2,300 came, bringing
32 field hospitals to remote, frigid regions of the
Himalayas. There, they set broken bones, treated
ailments, and performed operations for a total of 1.7
million patients.
The disaster assistance is part of Cuba's medical aid
mission that has extended from Peru to Indonesia, and
even included caring for 17,000 children sickened by
the 1986 accident at the Chernobyl nuclear plant in the
Ukraine.
It isn't only in times of disaster that Cuban health
care workers get involved. Some 29,000 Cuban health
professionals are now practicing in 69 countries - mostly
in Latin America, the Caribbean, and Africa. In
Venezuela, about 20,000 of them have enabled President
Hugo Chavez to make good on his promise to provide
health care to the poor. In the shantytowns around
Caracas and the banks of the Amazon, those who organize
themselves and find a place for a doctor to practice
and live can request a Cuban doctor.
As in Cuba, these doctors and nurses live where they
serve, and become part of the community. They are
available for emergencies, and they introduce
preventative health practices.
Some are tempted to use their time abroad as an
opportunity to leave Cuba. In August, the U.S.
Department of Homeland Security announced a new policy
that makes it easier for Cuban medical professionals to
come to the U.S. But the vast majority remain on the
job and eventually return to Cuba.
Investing in Peace
How do the Cuban people feel about using their
country's resources for international medical missions?
Those I asked responded with some version of this: We
Cubans have big hearts. We are proud that we can share
what we have with the world's poor.
Nearly everyone in Cuba knows someone who has served on
a medical mission. These doctors encounter maladies
that have been eradicated from Cuba. They expand their
understanding of medicine and of the suffering
associated with poverty and powerlessness, and they
bring home the pride that goes with making a difference.
And pride is a potent antidote to the dissatisfaction
that can result from the economic hardships that
continue 50 years into Cuba's revolution.
"ALBA, an
alternative to the Free Trade Area of the
Americas, puts human needs ahead of economic
growth."
From the government's perspective, their investment in
medical internationalism is covered, in part, by ALBA,
the new trade agreement among Venezuela, Bolivia,
Nicaragua and Cuba. ALBA, an alternative to the Free
Trade Area of the Americas, puts human needs ahead of
economic growth, so it isn't surprising that Cuba's
health care offerings fall within the agreement, as
does Venezuelan oil, Bolivian natural gas, and so on.
But Cuba also offers help to countries outside of ALBA.
"All we ask for in return is solidarity," Dr. Ceballos
says.
"Solidarity" has real-world implications. Before
Cuba
sent doctors to Pakistan, relations between the two
countries were not great, Ceballos says. But now the
relationship is "magnificent." The same is true of
Guatemala and El Salvador. "Although they are
conservative governments, they have become more
flexible in their relationship with Cuba," he says.
Those investments in health care missions "are
resources that prevent confrontation with other
nations," Ceballos explains. "The solidarity with
Cuba
has restrained aggressions of all kinds." And in a
statement that acknowledges Cuba's vulnerabilities on
the global stage, Ceballos puts it this way: "It's
infinitely better to invest in peace than to invest in
war."
Imagine, then, that this idea took hold. Even more
revolutionary than the right to health care for all is
the idea that an investment in health - or in clean
water, adequate food or housing - could be more
powerful, more effective at building security than
bombers and aircraft carriers.
Reprinted from "Democracy, Latin America Leaps
Ahead,"
the Summer 2007 YES! Magazine,
PO Box 10818, Bainbridge Island, WA 98110.
Subscriptions: 800/937-4451 Web: www.yesmagazine.org.
Sarah van Gelder is executive editor of YES!
Magaxine. She
was in
Cuba (legally) in December 2006 visiting medical
schools, clinics, and hospitals. Her travel
was
supported by The Atlantic Philanthropies, and
MEDICC
provided program consulting.
© 2007 Independent Media Institute. All rights
reserved.
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