John M. Kirk

The Cuban Health Care System

As documentary-maker Michael Moore explains, “Cuba is a very poor country, our embargo has made it very difficult for them, and yet in spite of that they are able to put together a health care system that guarantees they have a better life span than we do, a better infant mortality rate and more doctors per capita.”1 A very different picture is offered by Jorge Salazar-Carrillo, a professor of economics at Florida International University: “After many years of disrepair, the Cuban health system is now in crisis.”2 Similarly, Dr. Julio Cesar Alfonso describes the Cuban medical system as “a disaster”—where doctors reuse needles to draw blood from patients, have a sharpening stone for the needles and use X-ray machines that haven’t been replaced since 1959.3 Empirical evidence gathered by the World Health Organization (WHO), UNICEF and the Pan American Health Organization (PAHO) reveals a radically different picture. For instance, statistics show that the HIV prevalence for adults in Cuba is one-tenth the corresponding figure for the United States, a life expectancy that is comparable to U.S. rates, and better infant mortality rates, illustrating successful Cuban approaches to public health in at least some areas.

Contemporary Cuban Medical Aid Programs: Latin America and the Caribbean

The implosion of the Soviet Union led to a series of major reforms in Cuba starting in the early 1990s. Policies that would have been inconceivable just a few years before were now reluctantly accepted by the revolutionary leadership as being essential for the survival of the Cuban revolution. As a result, starting with the legalization of hard currency in 1993, a number of economic innovations were introduced—some 200,000 Cubans became self-employed, foreign investment was successfully courted and hundreds of joint ventures were soon in place, state farms were reorganized as collectives with greater autonomy, tourism (which for decades had been studiously neglected) became the locomotive dragging the economy in its wake—and the numbers of tourists increased eightfold between the early 1990s and 2007. Cubans living abroad who returned after an absence of several years hardly recognized the country.

Toward an Understanding of Cuban Medical Internationalism

The facts are clear and speak for themselves. Indeed, any one of the following highlights of Cuban medical internationalism could be seen as being a truly exceptional example of international solidarity: 23,000 children, victims of the Chernobyl nuclear meltdown, have been and continue to be treated in the Tarara beach resort outside Havana; 1.5 million people in Latin America, Africa, and the Caribbean have had their eyesight restored through Operation Miracle; tens of thousands of victims of natural disasters have been treated by extensive emergency medical missions—from Pakistan to Peru; some 9,000 students from the developing world are studying (at no cost) to become doctors at the Escuela Latinoamericana de Medicina, and 50,000 other medical students are currently being trained in Cuba through an alternative medical curriculum; medical schools with Cuban cooperation have been established in Yemen (1976), Guyana (1984), Ethiopia (1984), Uganda (1986), Ghana (1991), Gambia (2000), Equatorial Guinea (2000), Haiti (2001) Guinea Bissau (2004), and East Timor (2005); and finally tens of thousands of Cuban doctors have saved countless lives in dozens of countries since 1960. Indeed, by 2008, Cuban medical staffwere caring for over 70 million people in the world and in some countries— such as in Haiti—practically the entire population. This multifaceted

Cuba’s Cold War Medical Aid Programs

Cuba is certainly unusual and some might even say unique among less developed countries in terms of the fascinating odyssey that it pursued through the tangled web of Cold War and post-Cold War politics. Indeed, one of the very few things that both the proponents and the detractors of the Revolution can agree upon is that Havana has consistently cast a much longer shadow over the international stage than one might have expected given its small size (approximately 11 million inhabitants) and relatively meager natural resources. This was true even in pre-Castro days, for a special aura always seemed to have surrounded Cuba. The Spanish, for instance, called the island the Pearl of the Antilles in recognition of its status as the crown jewel of their Caribbean empire. Later it would gain added notoriety when various writers, Ernest Hemingway being perhaps the best example, and even Academy Award-winning filmmakers such as Francis Ford Coppola (in Godfather II) would use it as the backdrop for some of their most popular works. Undoubtedly, however, it has been Fidel Castro and the Revolution that he unleashed that have thrust the country most prominently (and most controversially) into the public limelight.

Introduction: Cuba as a World Medical Power

Clearly and certainly not surprisingly, the above quotations demonstrate that Che Guevara and Henry Kissinger had very different ideas about the nature of the Cuban Revolution’s potential role on the world stage. Guevara, who had been trained as a physician in Argentina before becoming radicalized and joining Fidel Castro’s guerrillas on an odyssey that would eventually lead him into the realm of legend, is thinking in terms of self-sacrifice and service in the pursuit of basic human needs (e.g., health care) that will earn the Revolution the gratitude and respect of not only the Cuban people but also those in other countries (i.e., “one’s neighbors”) who are fortunate enough to become the beneficiaries of Cuban aid initiatives. Kissinger, on the other hand, reacts with both incredulity and contempt to the notion that Cuba could or should be seen as a major player in international affairs. Admittedly, Kissinger’s outburst was not prompted by Cuba’s commitment to the kind of health care and related aid programs to which Guevara was referring, but instead it was in reaction to the Revolution’s extensive (and successful) military initiatives in Africa in the 1970s (e.g., in Ethiopia and especially Angola). In reality, however, the “global foreign policy” that was creating so much consternation on Kissinger’s part involved more than just the military activities that tended to attract the most attention, especially from Washington and the U.S. mass media. Indeed, there was another key element to these internationalist initiatives that, although more low-profile than Havana’s military campaigns, proved to be much more significant in the long run. This often overlooked dimension entailed Cuba’s extensive developmental aid efforts, at the center of which were its health care programs. Various sources indicate that the number of Cuban developmental aid personnel (mostly medical professionals) working overseas in the late 1970s totaled approximately 14,000 (mostly in sub-Saharan Africa), with the figures rising as high as 46,000 in the late 1980s.1

Contemporary Cuban Medical Aid Programs: The General Third World Arena

Although international affairs often appear to be a quite chaotic enterprise entailing widespread instability, those who track the longterm dynamics of the overall context (or system) within which governments and other players interact note that fundamental structural change therein is actually quite rare. But such reconfigurations do occasionally occur, a few major examples in the Western tradition are as follows: the fall of the Roman Empire and the subsequent development of the medieval feudal system; the consolidation of the modern European nation-states and their colonial empires; and, flowing from World War II, the relatively short-lived Cold War era that included, as mentioned in chapter 3, the emergence of medical diplomacy as a major dimension of Havana’s foreign policy. Then, as the twentieth century drew to a close, the global landscape would once again be radically altered. In the process, the Cuban Revolution (including its medical aid programs) would confront the daunting challenge of surviving the cataclysm and successfully navigating the stormy passage to a post-Cold War order.

Cuba: The Shaping of Revolutionary Consciousness@@@Cuban Foreign Policy Confronts a New International Order

Cuba and the struggle for political space, H. Michael Erisman and John M. Kirk the triangular relationship - Cuba, the Soviet Union and the United States implications of the Gorbachev era for cuban socialism, Rhoda Rabkin economic relations between Cuba and Eastern Eruope - present situation and possible developments, Jose Luis Rodriquez the future of Cuban-US relations - a Cuban view, Rene J. Mujica Cantelar US-Cuban relations - the view from Washington, Wayne S. Smith Cubas relations with the Third World Cuba and Africa - 30 years of solidarity, Armando Entralgo Gonzalez and David Lopez gonzalez Cubaa international relations with Latin America and mediator in international conflicts - formal and informal initiatives, Donna Rich Cuban development aid - south-south diversification and counterdependency politics, H. Michael Erisman exporting the educational revolution - the Cuban project to become a world educational power, Mark Richmond Cubas relations with the countries of the North Atlantic community Western Europe and Cubas development in the 1980s and beyond, Gareth Jenkins Canada-Cuban relations, Richard V. Gorham Cubas Canadian connection - the Northern door opens wider, John M. Kirk. Conclusion confronting the challenge of a new international order, the editors.