Castro's legacy: Cuban doctors still go abroad, but it's no longer driven by international solidarity

Stéphanie Panichelli-Batalla, Aston University

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.

Cuban doctors gather in Havana. Alejander Ernesto/EPA

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.

Stéphanie Panichelli-Batalla, Lecturer in Spanish and Latin American Studies, Aston University

This article was originally published on The Conversation. Read the original article.

Cuba’s doctors are emigrating and quitting for lack of incentives.

CUBA’S DOCTOR DILEMMA

By Katarina Hall.*

Cuba boasts that it has one of the world’s best healthcare systems and that it provides some of the best doctors out there. But this hasn’t stopped the island’s doctors from leaving the country in droves and abandoning their careers for better livelihoods in other fields. What gives?

The main reason that Cuba’s doctors are emigrating and quitting is simple: a lack of incentives. They work very demanding jobs for low wages and are subject to a whole set of regulations created especially for them—they are not allowed to leave the country without special permits and they have to attend to anyone who seeks their help, on penalty of jail time.

After the Revolution of 1959, the Cuban Communist Party banned private enterprise and established centrally-determined prices and salaries for nearly everything on the island. They also took over the country’s healthcare system, making all doctors state employees.

Doctors’ salaries of about $40-50 a month are actually $10-20 dollars per month more than the average Cuban’s. But the long hours and stressful conditions make up for it. Anyway, with Cuba’s rising prices, $40-$50 a month isn’t enough for a comfortable life. That’s why most doctors have picked up a second job or left medicine altogether, usually for a job in the growing private sector or in the black market. Being a doctor is prestigious, but paying the bills is more important. In Havana you can meet countless taxi drivers, cooks, and street vendors who were once doctors.

Take for example Clara, the caretaker of my neighbor’s elderly mother. A cheery woman in her late 50s, Clara told me that she had been a dentist for many years but that the bad pay had led her to quit and take up her current job. Clara provides for her mother, who has been diagnosed with senile dementia. Her dentist’s salary couldn’t put food on the table for one, let alone for two. While taking care of another elderly person is not the best-paying job out there, it provides Clara with the money and the flexible schedule she needs to take care of her own mother.

For a doctor to take up another profession is normal, she told me. “There are a lot of doctors who have ended up baking and selling cakes. And they bake because there is nothing better to do. You can sell a cake for 10 or 15 pesos. So if you make two cakes per day, you make some money and you don’t have to deal with a nine-to-five job where you are pressured and where you can’t earn a living.”

The flexibility of Cuba’s growing private sector has allowed many to quit their jobs with the Cuban state and move to jobs that pay in Cuban Convertible Pesos (CUC)—the convertible currency that’s worth about one US dollar. Unfortunately, only a limited number of private sector jobs are permitted: driving a taxi, renting out a house, running a restaurant and hairdressing, for example.

One person who has benefitted from such a move is Rosy, one of my neighbors. Rosy was a doctor for 24 years, but now she rents her apartment to tourists. Rosy explained to me that she had quit mainly because her wages, which were paid in Cuban Pesos (CUP), were just too low. “You get paid six CUP for each shift you take. Six CUP. Do you know how much six CUP is? Twenty-five cents of an American dollar. That is just enough for your day’s lunch.” By renting her apartment, Rosy makes an average of $20-$30 a night.

Rosy finally decided to quit her job after being sent on a year-long medical mission in Angola. Cuba is known for sending doctors to developing countries to do social work, usually to other socialist-friendly countries such as Venezuela, Bolivia, Ecuador, and Nicaragua. “In just one year in Angola, I made more than I had in 24 years,” she said. What disappointed her most was that she didn’t even get paid all the money she earned: “In the whole year there, I made up to a quarter of a million dollars. I know that because I had to register every procedure I did because I got paid depending on what I did and how many times I did it. But I didn’t receive the amount of money corresponding to my work. I only received ten percent of every procedure. From that quarter of a million, I only got $450 a month.” Seeing how much she could make in a year and how much of her money the Communist Party of Cuba kept, she decided to quit.

Rosy also told me that Cuban doctors are expected to be Good Samaritans—or else. “If a neighbor tells you to please check their sick kid you can’t charge them anything. It has to be free. And if you don’t check them, then they are able to turn you in to the authorities and say that you denied them your attention and service.”

Manuel, the taxi driver I’ve mentioned in previous posts, told me that his daughter was a doctor. He was sad that someone as smart and dedicated as his daughter would never have a decent life. “With her doctor’s title and $40 she can’t feed herself. I have to give her food and clothing, because if not, she can’t live. And she’s a doctor! Doctors can’t live here. Where would they live? What can they buy with that amount of money? What are they going to eat? They can’t survive.”

 *Katarina Hall is a Research Associate for Victims of Communism Memorial Foundation. She is a graduate of Universidad Francisco Marroquin in Guatemala, where she studied economic history.

Source: Dissident

¿Why hoarding in Cuban Public Health System?

By Dr. Eduardo Herrera.*

Most state workers in Cuba have the need, in a personal capacity, getting the tools, material and to determine the places where they work. Public health has not escaped this phenomenon.

Doctors, nurses and many health technicians have to grab some materials to work comfortably and try to avoid complications in patients they serve. Grabbing instruments and medicines needed in their daily work.

Dr Eduardo Herrera. 

"Ensuring sutures, catheters, instruments or any other team gives us work with less stress," pose a group of my surgical colleagues. This would have serious consequences that surprised performing these practices, as they could be expelled from the centers and go to prison.

Notwithstanding the measures taken by the government and not allowed to have materials and instruments in personal lockers for workers, these manage to violate the laws.

Many feel they must ensure their work with patients while some take advantage of gaps to get some gains to alleviate the low wages earned. To at least buy food, clothes and shoes.

The situation is not as simple as it seems, as were the staff, especially doctors myself included. We face problems with patients about the limited possibilities to solve your health problem due to lack of resources. Which we would have to pay in case of a complaint, in a fatal outcome.

The leader in the country, do not present the situation and the shortcomings we suffer, when to punish. The conditions not only work but also of life. They are not taken into account when requiring.

Today we see a surgeon, after taking a crowded bus and traveling for some hours, have to operate a case without taking into account as then finds the stress suffered during the trip. He is considering whether breakfast, because their salary reaches him badly to eat.

The health personnel in Cuba are exposed to these and other difficulties to overcome them are just a way out of mission or collaboration. Reason why the Cuban doctors are always ready to participate in any contingency.

Only then would better working conditions for a while. Earn a little more, have a chance to buy a car or a house, otherwise the government granting it.

As to enjoy their work in other countries, although they supposedly poorest, will provide more opportunities at work and in their lives. 

*Doctor Herrera  is a specialist in General Surgery and works at the University Hospital "Calixto Garcia" in Havana , Cuba where he also resides. Collaborates with the website of Cuban issues ,Hablemos Press.

Estados Unidos u otros países deben seguir el Sistema de Salud pública de Cuba.

Un articulo académico que apareció en la revista Science, en los Estados Unidos , originado en la Facultad de Medicina de la Universidad de Stanford, California, ha producido no pocas reacciones en el mundo académico. Los argumentos y las opiniones contrarias a lo que exponen los académicos Drain y Barry no han cesado. En este articulo tomado del Blog; Francis (th) E mule Science’s News (¡que nombrecito para un Blog de ciencia!) se analiza el articulo de marras y otras respuestas o comentarios al mismo. Aquí incluimos algunas notas y sobre todo al final ponemos todas las referencias en el ánimo de que al asunto sea analizado íntegramente.

Atención, pregunta: ¿Debería EE.UU. copiar el sistema de salud pública de Cuba?

A veces cuando leo algo no sé si va en serio o va en broma. El 30 de abril leí en Science un artículo sobre las excelencias del sistema de salud pública cubana. El artículo proponía que el Presidente Obama debería tomar buena nota e incluso imitar a Cuba en su reforma del sistema sanitario público en EEUU. A mí el artículo me resultó muy curioso. No por las estadísticas que presentaba, todas repletas de datos oficiales del gobierno cubano, que podrían estar adulterados, sino porque una revista tan norteamericana como Science publicara un artículo loando las excelencias de un país que ha sufrido un embargo terrible durante 50 años y sigue.

El artículo en Science dice que la esperanza de vida en Cuba, a pesar del embargo en alimentos, medicinas y suministros médicos, es similar a la de EEUU y superior a la de otras regiones de América Latina.

Los autores del artículo acaban indicando que EE.UU. podría aprender de Cuba lecciones muy valiosas acerca del desarrollo de un sistema de salud universal que hace hincapié en la atención primaria. Los autores recomiendan que el Congreso solicite al NIH (Instituto Nacional de la Salud) un estudio de los éxitos del sistema de salud cubano y cómo se puede emprender una nueva era de cooperación entre los científicos de EE.UU. y los cubanos. Además, de eliminar el embargo para la exportación de medicinas y material sanitario a Cuba.

Foto de la Izquieda: Pacientes que murieron de hambre y frio en un hospital de La Habana que no sabemos en que estadistica fueron incluidos.

En los comentarios destacan:

El que hace Katherine Hirschfeld que dice: lo tiene claro, cuidado con la fuente de los datos y argumenta que los datos presentados en el artículo de Drain y Barry tienen como fuente el gobierno cubano. ¿Confiables?

Cualquier artículo académico que evalúe la situación del Sistema de Salud en Cuba debe discutir la forma en que estos problemas sistémicos falsean la investigación empírica.

Lawrence Bodenstein también expresa con claridad no hay nada gratis; afirma que no se cree que Cuba pueda proporcionar a Estados Unidos el know-how para ofrecer una atención en salud primaria de alta calidad a bajo costo. El sistema de salud de Cuba es específico de un país pequeño centralizado.

Como quiera la polémica es interesante, falta la parte cubana. ¿Se animan?

Informacion relacionada:

• Fifty Years of U.S. Embargo: Cuba’s Health Outcomes and Lessons
• Cuban Health Care: Consider the Source
• Cuban Health Care: Benefits without Costs
• Response—Cuban Health Care