Cuban Medical Cooperation Faces Challenges beyond COVID-19

By Luis Brizuela (IPS-Cuba)

Doctors participaing in a send off ceremony for those professionals heading for St. Kitts and Nevis. Photo: Jorge Luis Baños/IPS

HAVANA TIMES – Cuban medical cooperation faces many challenges today: to prove the prestige of its national health system, consolidate itself as a source of economic income and revive solidarity efforts which some governments have insulted and called human trafficking.

Governments in 15 countries – mostly in Latin America and the Caribbean, as well as Italy, France and Andorra in Europe – have already asked the Cuban government to send them health professionals to help them fight the Coronavirus outbreak, which is already present in 195 countries and taken over 47,000 lives, according to the World Health Organization (WHO).

Some 600 members (over half of which are women) make up the 14 brigades of the country’s Henry Reeve International Team of Medical Specialists in Disasters & Epidemics, who are working to help and contain the pandemic.

“Those of us who go on a medical mission abroad do so voluntarily, nobody is forcing us. They ask for us because our staff are highly trained and we work in solidarity,” said Yaquelin Guerra, a Nursing graduate who has provided services in Venezuela and Bolivia.

A member of the brigade that left for Saint Kitts and Nevis in the Caribbean on March 28th, Guerra explained to IPS that “sick people are dying for no reason. People shouldn’t be dying when there are trained professionals to fight for their health.”

This medical contingent was created by former president Fidel Castro (1926-2016) in September 2005, to provide assistance to victims of Hurricane Katrina which swept through the US South, aid which the US government rejected at the time.

It is named after US citizen Henry Mike Reeve (1850-1876), who enlisted as a volunteer in the first of Cuba’s three independence wars (1868-1878) against the Spanish Crown, and who went on to become a Brigadier General of the Liberation Army.

Cuban medical cooperation missions date back to 1963, when the first brigade was sent to Algeria. Ever since then, some 407,000 health professionals, technicians and staff have provided assistance in 154 countries, according to official figures.

Since 2011, the Caribbean country with a socialist government reorganized its health services, in tune with the process of updating its economic and social system, among other strategic sectors, to stimulate the development of medical and health services and to increase markets for exporting these.

The Medical Cooperation Program was also restructured into three categories. In the first, Cuba covers expenses when its brigade is offering services in very poor countries; in the second, expenses are shared with the receiving country of its cooperant aid workers, and in the third, the Caribbean island is paid for these services.

A doctor gives a prescription to one of her elderly patients in Havana at a time when fear of the spread of the Coronavirus among Cubans. Foto: Jorge Luis Baños/IPS

However, reports about all of these different forms of cooperation highlight the principle of solidarity, as Cuban health professionals are normally sent to places where doctors in recipient countries don’t normally go, whether that’s because they are faraway, hard-to-reach or because of health risks.

According to Cuba’s Ministry of Public Health, over 50,000 of its doctors were working in 67 countries in 2019, as part of one of these established categories.

The island currently has nine doctors per 1000 inhabitants, for a local population 11.2 million.

In the case of the Henry Reeve International Medical Brigade, 28 brigades with almost 8000 professionals have been deployed in 22 countries, to deal with the aftermath of flooding, hurricanes, earthquakes and epidemics.

The three brigades sent to Sierra Leone, Guinea and Liberia to help fight the Ebola outbreak (2014-2015) particularly stand out, which then UN General Secretary Ban Ki-moon and then WHO Director-General, Margaret Chan, requested from former president Raul Castro (2008-2018).

Since March 11th – the day that Cuba announced its first three confirmed cases of COVID-19, and the WHO declared Coronavirus a global pandemic -, the number of people infected with the virus has gone up to a total of 212 people, 6 of whom have died, according to government figures published on April 1st.

Vladimir Palacios, living in the town of Bejucal in south Havana, told IPS that he was worried about “more and more doctors leaving the country and we will be left without medical staff in communities, as the number of Cubans infected with Coronavirus is growing every day and I’m afraid that the virus will spread really quickly.”

On March 29th, the minister of Public Health, Jose Angel Portal, explained in a video conference that Cuba has sufficient human resources to collaborate with other countries, although he also explained that the government was evaluating with “pen-point” accuracy how many health professionals are being sent abroad, so as not to negatively impact local health services.

“People need to keep calm; we will always have professionals working and doing research, as well as Medical students who are willing to help support this work,” epidemiologist Elizabeth Oliva told UPS, minutes before leaving as a brigade member to Saint Kitts and Nevis, on March 28th.

Elizabeth Oliva, an epidemiologist, before leaving for Saint Kitts and Nevis to help fight Covid-19. Photo: Jorge Luis Baños/IPS

Exports of professional services, including doctors, is Cuba’s principal economic sector, and in 2018, medical services brought in 6.4 billion USD in revenue, according to figures from the state’s National Office of Statistics. This figure doesn’t specify what percentage corresponded to medical cooperation missions.

Such revenue gains greater importance after foreign visitors were banned from entering the country as a result of the COVID-19 outbreak, at least until April 24th, with an overwhelming impact on tourism, another of the country’s strategic sectors.

This adds greater tension and uncertainty to the Cuban economy, which has been sunk in a crisis ever since 1991, which is exarcebated by the embargo that the US has imposed on the island since 1962, and which Donald Trump has reinforced with further measures which reverse the brief rapprochement process, initiated by former president Barack Obama, between 2015 and 2017.

Cuban medical missions became another conflict point between Washington and Havana, and a subject of controversy, after different contingents were withdrawn from Brazil, Ecuador and Bolivia, because new governments in these countries were asking questions that the Cuban government found inacceptable.

On April 12th, it will be a year since doctors Landy Rodriguez and Assel Herrera were kidnapped by alleged members of Islamic group Al-Shabaab near the Kenya-Somalia border, which added to tensions surrounding Cuba’s international cooperation efforts.

On March 23rd, the US Department of State urged countries to reject Cuban cooperation brigades to fight COVID-19, because they believe it is a form of labor exploitation and has underlying economic interests.

Cuba’s Foreign Ministry responded with: “the US government’s slander campaign is immoral (and) especially offensive to Cuba and the world during this time of a global pandemic that is threatening all of us.”

One of the main pieces of criticism against Cuba’s medical cooperation brigades is that most of the revenue this results in ends up in the State’s hands.

The Cuban government has argued that this money contributes to upholding its universal and free health system. This year, health and social assistance will drain 28% of the State budget, an expenditure that is the equivalent of 12.74 billion USD.

In May 2017, the Public Health Award in memory of Dr. Lee Jong-Wook was awarded to the Henry Reeve Medical Contigent at the 70th session of the World Health Assembly, for the successful work of its 250 experts in Africa, during the Ebola outbreak.

On March 23rd, former Brazilian president Luis Ignacio Lula da Silva (2003-2010) wrote a letter to Cuban president, Miguel Diaz-Canel, in which he expressed his happiness when he saw a photo of 53 Cuban doctors and nurses arriving in Italy’s northern Lombardy region, to help Coronavirus victims.

Three days later, the US Department of the Treasury updated its visa policy for medical professionals, so as to attract foreign health professionals in coming to the US and fight COVID-19, which is quickly spreading in this country, the new epicenter of the pandemic.

This article was written with the collaboration of Patricia Grogg.

3 thoughts on “Cuban Medical Cooperation Faces Challenges beyond COVID-19

  • April 3, 2020 at 11:16 am

    There is no doubt Nick that Cuban health care is better than that in most other countries. I have been treated a few times in Cuban hospitals (once when visiting Havana) and the other times in our local one. Despite the poor conditions of the facilities holes in doors, broken windows, lack of bedding – the medical staff – doctors and nurses, provided very good services. As far as overseas services are concerned, remember that following graduation, Cuban doctors are subject to direction to join the overseas brigades. Sadly I think you are correct in thinking that many of them will lose their lives. Interesting to know that Fred Olson sails under the Bahamian flag – bet that the Bahamas would not have accepted the cruise ship!
    The articles in HT about Nicaragua and the mentally incompetent Murillo, along with the failure by the Governors of some US states to impose controls, demonstrate that levels of incompetence and denial of reality are not the prerogative of any particular political view.
    I too admire the dedication demonstrated by medical staff around the world in the face of awful adversity. For as a contributor to HT wrote: “Today is about surviving. As individuals, families, nations and species.”

  • April 2, 2020 at 6:24 pm

    Mr MacD,
    I’m pleased you caught up with my previous posts. Sometimes it is tricky to keep up with different comments on different articles. Thank you for your replies.
    The cruise ship is actually Norwegian. It sails under a Bahamian flag and is U.K. based.
    It will now be anchored in the Firth of Forth next three other similarly dormant ships of the Norwegian owned fleet. They can apparently be seen clearly from Fife and East Lothian.
    This current global crisis shines a light on healthcare in its different guises around the world. Is Healthcare a moral human right or is it merely a business like any other?
    Winnie Byanyima, Director of UNAIDS, writes a good article on this topic which is available to read now on Havana Times. I totally agree with her points.
    I understand your cynicism regarding Cuba’s healthcare ‘international brigades’. Your point of view is a critical one. I seem to recall that in the past you have stated that these ‘brigade’ members are exploited for political purposes and are used to bring in hard currency of which they get a relatively small portion themselves.
    I understand this point but comparing Cuba’s healthcare policies with those of the other countries that are now coming under the spotlight…….?
    Cuba’s Healthcare policies ain’t perfect but they sure are looking preferable to those of certain other places.
    In another post you refer to tackling this terrible virus situation across the world regardless of politics. I would agree with this sentiment and would therefore welcome highly skilled Cuban medical experts saving lives anywhere where they can be of assistance – totally regardless of politics.
    My fear as this unfolds is for the poorer parts of the world where living space is cramped and healthcare is much more difficult to access. There could well be a terrible toll.
    Cuban professionals will go on missions to some of these places too at great risk to themselves. Healthcare Professionals of all nationalities, including Cubans, will lose their own lives as they struggle to save others.

  • April 2, 2020 at 12:15 pm

    In addition to being a major source of revenue for the Government, the doctors who form the so-called brigades have as students, had to attend compulsory indoctrination lectures on Marx/Engels/Lenin. Theirs is a dual role when in other countries and Northern Italy has its full share of communists – my late father was Military Governor of the area at the top of the Adriatic centered on Monfalcone and I recall the deadly communists taking retribution against the fascists. It is not surprising that Lula was happy to see the Cuban “brigade” going to Italy, for he is an ardent supporter of the communist regime in Cuba by for example providing the $5 billion for the development of Mariel. Incidentally, the UK cruise ship incident included TV shots of the lonely ship moored at the main dock at Mariel – with the container cranes – but not another ship in sight!

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