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The Cuban Challenge

Taking medical diplomacy a degree further, at the recent MERCOSUR summit in Córdoba, Argentina, Fidel called for a social agenda to globalize solidarity in health and education. He offered Cuba?s experience in health and education to support that agenda. In these remarks, he laid down a gauntlet not only for MERCOSUR, but also for his adversary, the US government. It appears, however, that no one will take him up on it.

Post-Fidel Medical Diplomacy

Fidel transferred power to his slightly younger brother Raúl Castro just days before the Non-Aligned Movement meeting was convened in Havana. Indications are that although Raúl is the heir apparent, something approaching a de facto collective leadership most likely will govern Cuba in the near future. This leadership group probably will include not only Raúl, but also Ricardo Alarcón, who presides over the National Assembly of People?s Power; Carlos Lage, Vice President; and Foreign Minister Felipe Roque Pérez. None of these figures is expected to alter significantly Cuba?s practice of medical diplomacy in the near term. As long as the export of excess Cuban doctors continues to provide both material capital (e.g., oil-for-doctors) and symbolic capital (e.g., support in international forums), it is likely to be maintained. However, the scale of this program depends more on Hugo Chávez?s largesse than on Cuba?s willingness to continue it.

The temporary export of Cuban doctors also provides a safety valve for disgruntled medical professionals who earn much less at home than less skilled workers in the tourism sector. Their earning opportunities abroad are significant both within the confines of medical diplomacy and even more so, beyond it. This has led to a number of defections, allegedly around six hundred, although some say this figure is too high. This figure could grow if Cuban-American activist groups carry out their threats to assist these doctors serving in foreign lands if they defect. Should this number increase dramatically in this period of political change, the Cuban government may decide that the cost is too great to bear. In an effort to break the oil-for-doctors bond that supports the Cuban economy and create a medical brain-drain, the Bush Administration announced (on August 7) a possible change in its Cuba policy to ease immigration for Cuban doctors who participate in Cuba?s medical programs abroad. This is in sharp contrast to its tightening of policy regarding immigration of Cubans who enter the U.S. illegally. The lure of vastly increased earnings, easy access to high technology, and a much better material quality of life may lead doctors born, raised and trained at great expense in revolutionary socialist Cuba to cease helping those in need in developing countries and depart en masse. If they do, this is unlikely to break the ties that currently bind Cuba and Venezuela. But, this will raise questions about the consistency of US immigration policy. The fact that the Bush administration is trying to destroy Cuba?s medical diplomacy program indicates that the program works. Rather than attempt to destroy it, the Bush administration should emulate it.

The following are countries to which Cuba provides aid regarding health issues:

The Americas

Antigua and Barbuda, Argentina, Aruba, Bahamas, Belize, Bolivia, Brazil, Colombia, Costa Rica, Dominica, Ecuador, Grenada, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Panama, Paraguay, Peru, Venezuela, Dominican Republic, St. Kitts and Nevis, St. Vincent and the Grenadines, St. Lucia, Suriname, Trinidad and Tobago

Africa

South Africa, Angola, Botswana, Burkina Faso, Burundi, Cape Verde, Congo, Djibouti, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Equatorial Guinea, Guinea-Bissau, Guinea, Lesotho, Mali, Mozambique, Namibia, Niger, Rwanda, Sao Tome and Principe, Seychelles, Sierra Leone, Swaziland, Chad, Uganda, Zimbabwe, RASD, Algeria

Asia

Qatar, Yemen, Laos, Pakistan, East Timor, Indonesia

Europe

Italy, Switzerland, Ukraine

Source: Cuban Health Department 2005

Julie M. Feinsilver is the author of ?Healing the Masses: Cuban Health Politics at Home and Abroad? (Berkeley: University of California Press, 1993). Dr. Feinsilver is a Senior Research Fellow at the Council on Hemispheric Affairs in Washington, DC, and an international civil servant. The views expressed herein are solely her own and do not necessarily reflect those of any institution with which she is affiliated.

As an addenda to Dr. Feinsilver?s article on Cuba?s Medical Diplomacy, please note that the Bush administration has stepped up to its leaks that the U.S is about to announce a program that, in effect, would lure some of the 15 to 20 thousands Cuban doctors, now mainly serving in Venezuela and Bolivia as health service volunteers. Starting in August, the Bush administration began to indicate that it would consider changing its immigration legislation in order to make it easier for Cuban doctors participating in the Island?s medical program abroad to gain refugee status in the U.S. In her report, COHA Senior Research Fellow Julie Feinsilver analyzes the multiple aspects of Cuban medical diplomacy. A version of this article originally appeared in Foreign Affairs en Español Vol. 6 No. 4 (Octubre-Diciembre 2006), pp. 81-94.