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Cuba: If it's such a health superpower, why have thousands of doctors fled?

A total of 1,278 Cuban medics fled to make use of a US parole programme for doctors in 2013 alone.

PastedImage-51596 Dr Adberrahman Mohamed

“I LIVED IN Spain for 18 years but knew due to the economic crisis, I couldn’t continue my studies there. If I wanted to become a doctor, there was only one country I could turn to and that was Cuba,” says Abderrahman Mohamed Sidi from the disputed territory of Western Sahara, which borders Algeria, Morocco and Mauritania.

The 26-year-old medical student was born into a refugee camp like the majority of his compatriots due to the ongoing dispute over control of Western Sahara. At a young age, he moved to Spain to pursue his medical studies but couldn’t continue due to financial circumstances.

Instead, he applied and received a scholarship to study for free in Cuba at the Latin American School of Medicine (ELAM as per the Spanish acronym).

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“In my class, there are 15 students from 15 different nations including Palestine, Chad, Tanzania and the United States,” says Sidi who is in his second year of six at the medical school.

ELAM hosts nearly 10,000 foreign medical students from 86 different nations, the majority of whom are from poor backgrounds and developing nations, almost all at the cost of the Cuban state.

It was set up in 1998 at the behest of then-leader Fidel Castro in response to the devastation caused by Hurricane Mitch which tore through many nations in Central America that lacked sufficient medical expertise to treat those affected.

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Health superpower

The medical school is one part of Cuba’s international health efforts, which has earned the Caribbean nation the title as a health superpower.

“When Ban Ki-Moon [Secretary General of the United Nations] called for international help during the Ebola crisis in West Africa, he especially communicated with four nations; United States, Britain and France for their economic resources, and Cuba for its human resources,” says Dr Jorge Delgado who led a medical brigade of 165 Cuban doctors and nurses to fight the Ebola outbreak in Sierra Leone.

PastedImage-20000 Dr Jorge Delgado

The Socialist state sent more doctors to West Africa to fight Ebola than any other nation, a fact which was also the case after the earthquake in Haiti in 2010 and following many other humanitarian disasters worldwide.

It has also initiated health projects like Operation Miracle in which Cuban doctors have performed over 600,000 eye operations worldwide to treat cataracts and glaucoma.

In addition to training thousands of foreign students at home, Cuba sends over 50,000 health workers abroad annually, a third of whom are physicians, to work in developing countries mainly across Latin America and Africa.

Almost 30,000 alone are in Venezuela as a result of the Oil-for-Doctors agreement between the two Socialist states which sees Cuba receive 90,000 barrels of oil a day at cut-down prices.

PastedImage-55830 The refinery where Venezuelan oil is processed in Cuba

Benefits

Cuba’s international health efforts are seen as diplomatically advantageous.

Political observers noted that in Latin America especially, where many states are dependent on Cuban medical professionals for services, nations were reluctant to criticise Cuba, which served to isolate the United States’ hardline stance against its Caribbean neighbour and, thus, facilitate the improvement in relations recently.

Cuban health officials though maintain any diplomatic benefits are secondary and insist this misses the point of Cuba’s health endeavours.

“When we sent hundreds of medics to Pakistan in response to the humanitarian crisis caused by the earthquake there, we didn’t do it because we wanted a vote at the UN,” says Delgado, referring to a 2015 vote on the US embargo at the United Nations where all but two nations (USA and Israel) voted to condemn the blockade.

We did it because we Cubans believe that he who plants love, receives love, he who seeks solidarity, gets solidarity.

At home, Cuba’s health record internationally is a source of great pride. Many billboards, used as propaganda rather than for advertisements in the Caribbean nation, celebrate health missions going back to the first to Angola in the early 1960s.

“It’s something in the soul of a Cuban to want to do,” says Lucia Morales Ruiz, a former Microbiologist from Havana, referring to travelling across the world on medical missions.

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Due to the low wages given to health professionals, the mother was forced to leave her job and now works as a minder.

“I would have loved to travel and help people from across the world, but I never got the chance,” she says.

The collaboration of Cuba sending doctors to other countries has, nevertheless, been an extremely important source of hard currency for the state which has struggled economically  because of the blockade, especially since the breakup of the Soviet Union, which meant the loss of billions of dollars in subsidies.

Estimates put the amount of income derived at around $5 billion annually, eclipsing all other industries for the Cuban economy.

Exploitation

This has led to criticisms, though, that the Cuban state is misusing its doctors for economic gain. It’s not made known how much states pay Cuba for sending its doctors, but it’s believed the medical personnel only pocket a small percentage.

In Angola, for example, a Cuban medic earns about US$125 monthly, while reports suggest the Cuban state is paid US$5,000 dollars per month per doctor.

Conversely, as a Cuban medic receives so little at home (average wages are around €40) and with limited possibilities to travel abroad – historically few Cuban doctors are granted visas to leave the Caribbean state – missions are much sought after by health workers as it gives them a chance to earn money that’s impossible to earn at home.

Dr Jorge Iglesias, a now retired primary care physician, travelled on a two-year mission to Ghana in 1996.

PastedImage-25417 Dr Jorge Iglesias

He admits his primary motive to travel was economic.

“I earned $100 per month in Ghana, as well as my own salary back home, so I could save money as a result,” he says.

It was difficult being away from my family but the higher wages were a driver to travel.

The pensioner, now living in Havana, was forced into retirement due to a tumour in his knee which he was born with but was exacerbated by a car accident in the African nation.

His state pension is only US$10 a month which he says means he struggles to satisfy even basic needs.

Due to the temptations of better wages abroad, thousands of Cuban doctors have deserted while on international missions with many heading to the United States where a special programme called the ‘Cuban Medical Professional Parole Programme’ offers Cuban doctors asylum in return for deserting.

A total of 1,278 Cuban medics fled to make use of the programme in 2013 alone.

The health missions, while generally welcomed in most developing nations, have been met with criticism and protests in Venezuela and Brazil particularly, the latter has over 11,000 medical workers from Cuba, where local doctors feel pushed out by cheaper imported Cuban labour.

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Delgado dismisses the criticism though.

“The issue isn’t the Cuban doctors. If a Venezuelan doctor emigrates to Ireland, for example, to look for work, he’s not going because he can’t get a job in his country, he leaves because he wants a better salary,” the 66-year-old explains.

“A Cuban medic is motivated by helping people, not the remuneration.”

Whether that motivation would still be as strong if doctors found themselves with greater freedom of movement and higher salaries at home remains uncertain.

This journalism was supported by the Simon Cumbers Media Fund.

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More: Barack Obama becomes first US president to visit Cuba in nearly 90 years

Read: Cuba has one of the best healthcare systems in the world… but it pays doctors €46 a month

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About the author:

Fergal Browne

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