Why Cuba Is Exporting Health Care to the U.S.

Bill Quigley

11 Jun 2007

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.

reserved.

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