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Selected Examples of Cuban Medical Diplomacy

Perhaps as a portent of things to come, even during the 1970s and 1980s Cuba implemented a disproportionately larger civilian aid program (particularly medical diplomacy) than its more developed trade partners: the Soviet Union, the Eastern European countries and China. This quickly generated considerable symbolic capital for Cuba, which translated into political backing in the United Nations as well as material benefits in the case of Angola, Iraq and other countries that could afford to pay fees for professional services rendered, although the charges were considerably below market rates.

Early success with medical diplomacy and the accumulation of symbolic capital as well as the ability to convert it into material capital, led Fidel to announce in 1984 that Cuba would train 10,000 new doctors specifically to increase the volume of international medical aid. No country other than Cuba has developed doctors as an export commodity. This has paid off handsomely both for the government of Cuba and for the individual doctors involved, as they usually earn considerably more money abroad than in Cuba.

The Cuba-Venezuela-Bolivia Connection

It is, indeed, ironic that in 1959 Fidel unsuccessfully sought financial support and oil from Venezuelan president Rómulo Betancourt. It would take forty years and many economic difficulties before another Venezuelan president, Hugo Chávez, would provide the preferential trade, credit, aid and investment the Cuban economy desperately needed. This partnership is part of the Bolivarian Alternative [to the US] for the Americas (ALBA) to unite and integrate Latin America in a social justice-oriented trade and aid block under Venezuela?s lead. It also has created an opportunity to expand Cuba?s medical diplomacy reach well beyond anything previously imaginable despite Fidel?s three-decade-long obsession with making Cuba into a world medical power; an obsession which was analyzed and documented in my 1993 book, Healing the Masses: Cuban Health Politics at Home and Abroad.

By far the largest Cuban medical cooperation program ever attempted is the present one with Venezuela under Hugo Chávez. The symbolic and material payoffs for Cuba are clearly demonstrated, for example, by the oil-for-doctors trade agreements between the two countries. The accords allow for preferential pricing for Cuba?s exportation of professional services vis-à-vis a steady supply of Venezuelan oil, joint investments in strategically important sectors for both countries, and the provision of credit. In exchange, Cuba not only provides medical services to unserved and underserved communities within Venezuela (30,000 medical professionals, 600 comprehensive health clinics, 600 rehabilitation and physical therapy centers, 35 high technology diagnostic centers, 100,000 ophthalmologic surgeries, etc.), but also provides similar medical services in Bolivia on a smaller scale at Venezuela?s expense. And to contribute to the sustainability of these health programs, Cuba will train 40,000 doctors and 5,000 healthcare workers in Venezuela and provide full medical scholarships to Cuban medical schools for 10,000 Venezuelan medical and nursing students. An additional recent agreement includes the expansion of the Latin American and Caribbean region-wide ophthalmologic surgery program (Operation Miracle) to perform 600,000 eye operations over ten years.

The main medical aid programs are the provision of comprehensive health services throughout Venezuela through the Barrio Adentro programs (Barrio Adentro I and II). As of March 25, 2006, there were a total of 31,390 medical personnel (mostly doctors) providing services through Barrio Adentro I, the primary health care program. Of that number, 23,382 were Cubans and the 8008 were Venezuelan. These Cuban ?medical diplomats? had conducted 171.7 million medical consultations, of which 67.9 million were carried out in the communities (schools, workplaces, and homes). They visited 24.1 million families at home, something previously unheard of on that scale and in those locales. Moreover, these personnel provided 103.1 million health educational activities as well.

During the same period, under Barrio Adentro II, which provides medical diagnostics and physical therapy and rehabilitation, 10,856 histological exams were conducted, 84.4 million clinical laboratory exams were done, 808,153 CAT scans and 47,454 nuclear magnetic resonance exams were performed, among others. The newly established Comprehensive Diagnostic Centers handled 886,609 emergency room visits and performed 7.2 million diagnostic exams; and the Comprehensive Rehabilitation Wards also established under Barrio Adentro II handled 520,401 rehabilitation consultations and applied 1.6 million rehab treatments.

The second largest medical cooperation program is with Bolivia, where in June 2006, 1,100 Cuban doctors were providing free health care, particularly in rural areas, in 188 municipalities, mainly in the departments of La Paz, Santa Cruz, Cochabamba and Chuquisaca. Cuba already has provided the National Ophthalmologic Institute in La Paz with modern equipment and specialized personnel who, along with Bolivian doctors and recent graduates from the Latin American Medical School (ELAM), have treated over 1,500 patients free of charge. New accords stipulate the opening of two additional ophthalmologic centers, one in Cochabamba and another in Santa Cruz. They each will be able to treat 50 patients a day and the La Paz center will allow doctors to attend to 100 patients a day. As a result, Bolivia will have the capacity to perform ophthalmologic operations on a minimum of 50,000 patients annually.

Cuban sources indicate that by the end of July their medical team had attended one million Bolivians free of charge (to the patient) and had performed 23,000 ophthalmologic operations. Additionally, Cuba offered 5,000 more full scholarships to educate doctors and specialists as well as other health personnel at ELAM in Havana. At present, there are some 500 young Bolivians studying at the school and another 2,000 have started the pre-med course there. The six-year medical school program is provided free for low-income students who commit to practice medicine in underserved communities in their home countries upon graduation.

During the ELAM?S first graduation last August, Venezuelan President Hugo Chávez announced that his country will establish a second Latin American Medical School, so that jointly with Cuba, the two countries will be able to provide free medical training to at least 100,000 physicians for developing countries over the next 10 years. The humanitarian benefits are enormous, but so are the symbolic ones. Moreover, the political benefits could be reaped for years to come as students trained by Cuba and Venezuela become health officials and opinion leaders in their own countries. Today, medical students whom Cuba trained as doctors in the 1970s, are now in positions of authority and increasing responsibility.