It used to be one of Fidel Castro’s flagship methods of spreading international communist solidarity to the rest of the world: sending doctors abroad. But in recent years, it also became a way for the US to tempt doctors to defect.
In early 2016, the Obama administration indicated it might put an end to a programme that offers Cuban doctors on international missions an American visa if they want to defect. Since it was set up by the Bush administration in 2006, 7,117 visa applications have been approved by the US Cuban Medical Parole Programme.
For some Cuban doctors I have spoken to as part of my ongoing research, the possibility of a US visa was the sole incentive for them to apply for a mission abroad. As one doctor I interviewed in Miami said to me, the only reason she solicited a mission in Eritrea was because it offered her an opportunity to escape from Cuba and start a new life in the US.
While the indications that this programme could stop came as part of the rapprochement between Cuba and the US, there is renewed uncertainty about the future of Cuba-US relations with the election of Donald Trump.
Soft medical power
But the history of Cuban doctors spending time on a mission abroad goes back much longer – and did not start with the goal of a new life in America.
The programme started shortly after the US embargo was implemented and Cuba was expelled from the Organisation of American States in 1962. Sending international missions abroad was a way of establishing new international relations, helping Cuba out of this forced isolation. In 1963, the Caribbean island initiated its first long-term international solidarity programme by sending a group of doctors to Algeria for 14 months.
Since then, Cuban health care professionals have offered their services all over the world – from Africa and South America to Portugal. Official numbers published by the Cuban newspaper Granma in 2014 reported that 131,933 Cuban doctors have participated since the early years of the revolution in missions to more than 107 countries. These international solidarity missions offer disaster relief, help when epidemics, such as the ebola outbreak in West Africa, arise, and provide health care provision in remote areas where patients have never had access to a doctor.
Motivations have changed
Through my ongoing oral history research, interviewing Cuban health care professionals both living in Cuba and abroad, I have seen a clear shift in the motivations for why people take part in missions overseas. While 50 years ago they were motivated by humanitarian passion and revolutionary conviction, economic interests and a chance to escape Cuba now drive their desire to work abroad.
Sergio (not his real name), is a retired doctor I interviewed in Cuba in July 2016. He first went on a mission in 1974 to Equatorial Guinea, then again to Haiti in 2002 and to Botswana in 2014. In the 1970s, participating in a mission was an honour as it was a way to help other countries in need, as well as to support the Cuban Revolution. As Sergio explained:
I saw many needs. I identified a lot with the programme of the revolution. Why was the Cuban internationalism necessary? Everything we did, we did it with love, with affection. The little we had, we gave it.
Although there were some economic incentives, such as the opportunity to buy a car, the main reason they took part at that time was a revolutionary passion, a humanitarian conviction, and possible career development upon their return. It wasn’t easy – and participation often meant 11 months away from their families with limited contact possibilities. Yet they were proud to provide support to the revolutionary process and health care to those in need. As Sergio said of his first mission:
From a personal point of view, it was very unpleasant, but I came back very happy, with my internationalist card of the mission accomplished.
Although the 1980s were a good economic period for Cuba, the fall of the Soviet Union changed everything. Two of the doctors I interviewed who were on a mission in Africa between 1989 and 1991 said that when they returned to Cuba, they were confronted with a country that wasn’t the one they had left two years earlier.
The economic consequences for Cuba were devastating. During what has been called the “special period in time of peace”, food became scarce, apagones (power cuts) were common, and Cuban people had to come up with ways to survive. This readjustment to the new economic circumstances, known as la lucha (the struggle), changed Cubans’ mindsets.
Many health care professionals opted to apply for missions at that time out of financial necessity. Sergio explained to me that he decided to go to Haiti “because I needed to eat. My salary here wasn’t enough”. Although not high, the salary paid to the internationalists is still much better than the one they receive in Cuba.
The 21st century has been marked by mass missions in South America. Thousands of Cuban health care professionals were working in Venezuela under the government of Hugo Chavez, and many of them are still sent there on a regular basis to work with the Mais Medicos programme in Brazil.
There is no doubt that participating in these missions has improved the financial situation of those who have taken part and their families. Some have saved to renovate their houses, others to purchase goods they would never have been able to afford in other circumstances. But this money never lasts very long because, as Sergio explains, everything is very expensive in Cuba, despite the country’s economic situation.
Impact on Cuban society
One of the common criticisms of sending Cuban doctors abroad is that it is a form of “selective humanitarianism” that diminishes the number of doctors in Cuba. Many of the people I talked to in Cuba during my research said they had to go to another health clinic, known as a consultorio, because their doctor was working on a mission abroad.
Cuban families have also suffered due to the prolonged separations linked to the missions. There are no official numbers about divorces linked to the international solidarity programme, but many of the participants involved explained to me that many couples separated – some of whom had defected to the US.
Being part of the international solidarity programme has been a very enriching and eye opening experience for many health care professionals, both from a professional and a personal perspective. But it has a complicated legacy and may not have always resulted in the best for the Cubans left behind.