Home »

Other Western Hemisphere Examples

Cuban medical teams had worked in Guyana and Nicaragua in the 1970s, but by 2005 they were implementing their Comprehensive Health Program in Belize, Bolivia, Dominica, Guatemala, Haiti, Honduras, Nicaragua, and Paraguay. Throughout the years, Cuba also has provided free medical care in its hospitals for individuals from all over Latin America and not just for the Latin American left.

Under Haitian President Rene Préval, Cuba began its medical cooperation with Haiti in 1998. Currently, there are approximately 400 Cuban medical professionals working in Haiti on two-year assignments in 110 of the 164 comunes across the island. The program costs the Haitian government approximately US$1.8 million annually, which averages out to cost US$375 per month for each medical professional plus room and board, transportation and exemption for airport departure taxes. Because money is fungible, it is not evident which donor is providing the funding. Although very inexpensive by international standards, this program is relatively costly for the cash-strapped Haitian government and could become even more so if it is expanded as has been discussed recently.

Jamaicans, among others, with little means have been going to Cuba for free eye surgery as part of Operation Miracle. A spokesperson for the Jamaican Health Ministry has indicated that they had received positive feedback on the surgeries that had been administered. The number of patients reported with complications amounted to fewer than three per cent of the 1,854 patients who were treated in Cuba as of 2006.

As previously mentioned, Cuba has offered disaster relief over the years to every country that has experienced an emergency. And most often the offer has been accepted. A recent (2005) example is Guyana, where Cuba sent a team of 40 medical doctors and technicians to provide disaster relief after severe flooding had been recorded in the country.

Because Cuba has been successful in developing health programs at home and has provided medical aid abroad, often under difficult circumstances, some donor countries are willing to provide financial support for Cuban medical assistance in third countries in what is called triangular cooperation. Germany has provided funding for Cuba to develop health programs in Niger and Honduras. France provided some funding to execute a health program in Haiti. Japan provided two million doses of vaccines to vaccinate 800,000 children in Haiti and US$57 million to equip a hospital in Honduras where a Cuban medical brigade works.

Multilateral agencies, such as the World Health Organization (WHO) and the Pan American Health Organization (PAHO) also finance medical services provided by Cuba for third countries. Both organizations provided funding for Cuba?s medical education initiatives. Finally, Cuba?s Comprehensive Health Program, which is being exported to various countries that receive Cuban medical assistance, is supported by 85 NGOs and through triangular cooperation with both governments and NGOs, has received US$2.97 million in support. Although some of the amounts are small, it is clear that donors find that support for Cuba?s medical diplomacy makes professional sense.

Medical Diplomacy Outside of the Western Hemisphere

Cuba dispatched very large civilian aid programs in Africa to complement its military support to Angola and the Horn of Africa in the 1970s and early 1980s. With the withdrawal of troops and the later geopolitical and economic changes of the late 1980s and the 1990s, Cuba?s program was scaled back, but remained. Having suffered a post-apartheid brain drain (white flight), South Africa began importing Cuban doctors in 1996. Already in 1998 there were 400 Cuban doctors practicing medicine in townships and rural areas. By 2004, there were about 1200 Cuban doctors working in African countries, including in Angola, Botswana, Cape Verde, Côte d?Ivoire, Equatorial Guinea, Gambia, Ghana, Guinea, Guinea-Bissau, Mozambique, Namibia, Seychelles, Zambia, Zimbabwe, and areas in the Sahara.

On the African continent, South Africa is the financier of some Cuban medical missions in third countries. This South African-Cuban alliance has been much more limited in scope than the Venezuelan-Cuban deal. Discussions on the extension of Cuban medical aid into the rest of the African continent and a trilateral agreement to deploy over 100 Cuban doctors in Mali with US$1 million in South African financing, were concluded in 2004. Rwanda was to be next in a similar agreement. Cuba also had deployed 400 medical doctors to Gambia. As of December 2005, Cuba was implementing its Comprehensive Health Program in Botswana, Burkina Faso, Burundi, Chad, Eritrea, Gabon, Gambia, Ghana, Guinea-Bissau, Guinea-Conkary, Equatorial Guinea, Mali, Namibia, Niger, Rwanda, Sierra Leone, Swaziland, and Zimbabwe.

Cuban medical teams also have worked in East Timor since 2004 to create a sustainable health system. Currently, 182 medical professionals are providing a variety of services in Cuba?s Comprehensive Health Program. At the same time, Cuba offered full medical school scholarships for 800 East Timorese students to begin work on the sustainability of their program.

Recent Cuban disaster relief medical missions are still providing assistance in post-tsunami Indonesia and post-earthquake Pakistan. Shortly after the tsunami, Cuba sent a medical team and equipment to provide disaster relief. At the time, the team was handling over 150 consultations daily in a military field hospital and a polyclinic. They also were providing some preventive as well as curative care on their visits to refugee camps. Less than a week after the devastating October 2005 earthquake in Pakistan, Cuba sent a team of highly experienced disaster relief specialists comprised of 2300 doctors, nurses and medical technicians. Part of the team worked in refugee camps and Pakistani hospitals. The rest worked in 30 field hospitals located across the earthquake-stricken zone. The team brought everything they would need to establish, equip, and run those hospitals. The cost to Cuba was not insignificant. Two of the hospitals alone cost half a million dollars each. Only recently (May 2006), Cuba sent 54 emergency electrical generators as well.

In the past Cuba has also provided aid to Armenia, Iran, Turkey, Russia, as well as to most Latin American countries that have suffered either natural or man-made disasters. This type of medical diplomacy in the affected country?s time of need has garnered considerable bilateral and multilateral symbolic capital for Cuba, particularly when the aid is sent to countries considered more developed.

In Search of Sustainability: Provision of Medical Education and Training in Cuba and Abroad

In an effort to have a more sustainable impact on the health of the aid recipient countries? populations as well as a multiplier effect on the immediate aid given, medical education always has been an important part of Cuba?s medical diplomacy. Education and training consist of on-the-job training, seminars, courses and full medical education. As early as the 1970s, Cuban medical professors either established medical schools or taught in medical faculties in Angola, Ethiopia, Guinea-Bissau, Nicaragua, and Yemen. This has been a continuing process ever since.

Cuba has long provided total scholarships for students from other developing countries to study anywhere from secondary school (medical technicians) through post-graduate studies. From 1961 to 2001, almost 40,000 foreign scholarship students had graduated in various medical disciplines from Cuban schools. Of those, 16,472 graduated from institutions of higher education. These numbers peaked in the 1980s before the fall of the Soviet Union. Now, with an oil-for-services agreement with Venezuela, Cuba is vastly increasing its scholarship offerings.

The Latin American Medical School (ELAM) was established in 1998 specifically to train students from poor communities in Latin American and African countries. In exchange for full scholarships, these students must be willing to return to their countries and practice medicine in poor communities for at least five years. After meeting with members of the US Congressional Black Caucus a few years ago, Fidel announced a symbolically significant plan for medical diplomacy with the United States: 500 full scholarships to Cuba?s ELAM for US minority students. Half of the scholarships would be for African Americans and the other half divided between Hispanics and American Indians. So far only a few Americans have accepted the offer.

There were a total of 10,661 foreign medical students from 27 countries studying in Cuba at the ELAM during the 2005-2006 academic year. Of this total, 10,084 were enrolled in medicine, 67 in stomatology (dentistry), 134 in nursing, and 376 in health technology. This is triple the number of medical students enrolled in 2002. To train French-speaking Africans and Haitians, the Cuban Government established the Facultad Caribeña de Medicina (Caribbean Medical School) in Santiago de Cuba, where 254 Haitians and 51 Malian students were studying in 2002.

Graduates from these medical schools take the National Final Cuban Examinations (NFCE) at the end of their program and then do an internship in their home countries. After that, they must take their home country?s qualifying exam just as all other medical students must do to be licensed to practice medicine. Reports from Chile, which has one of the most highly developed health systems in Latin America and a rigorous university system and medical licensing requirements, indicate that the first seven Chilean medical students who have graduated from ELAM and returned to Chile have had their degrees validated by the University of Chile as required and have entered successfully into Chile?s public health system. This suggests that the quality of education provided at the ELAM is high. The fact that Cuban doctors who have found work in Chile on an individual basis have had their credentials validated by the University of Chile in what one Chilean official said was a complicated and demanding process, attests to the overall quality of Cuban medical education.