The Locomotive of Cuba’s Economy: Health Services Abroad

FERNANDO RAVSBERG*

HAVANA TIMES — Contributing some US $5 billion to Cuba’s economy every year, the 40,000 Cuban health professionals currently offering medical services in 60 countries around the world have become the island’s chief source of revenues, well above the tourism sector, family remittances and the nickel industry.

According to the Ministry of Foreign Affairs, Cuba’s global brigade of health professionals is currently made up of 15 thousand physicians, 2,300 ophthalmologists, 15 thousand med-school graduates, 5,000 health technicians and 800 assistants.

In exchange for the services offered by those medical professionals based in Venezuela, Cuba receives 100 thousand barrels of oil a day. Cuban doctors are also working in other countries in the region, and there are some 4,000 in Africa, over 500 in Asia and Oceania and 40 in Europe.

What makes Cuban health professionals an attractive asset for many Third World countries is the fact they are willing to work in places that locals avoid, such as bad neighborhoods or rural areas that are difficult to access, where the lowest-income populations are concentrated.

75 thousand doctors

In 1959, Cuba had a mere 6,000 medical doctors, half of whom left the country. The health crisis that ensued awakened the new government to the need of training physicians on a massive scale. Half a century later, the country has 75 thousand such physicians, one for every 160 inhabitants.

This figure was reached by making all doctors professors of medicine, setting up medical schools across the country and facilitating access to students aspiring to be physicians, all of it made possible by a system of free education where students aren’t even required to pay for their textbooks.

Despite the country’s initial shortage of medical doctors, the first mission of Cuban health campaign workers abroad left for Algeria in 1963, to offer support to the guerrillas that had just secured Independence for the county [from France]. They would be the first of the 130 thousand Cuban health professionals who have worked in 108 different countries since.

In the beginning, Cuban medical services abroad were, for the most part, free. It was on the basis of trade relations with Venezuela that Cuba began to receive benefits in exchange for these services, and Raul Castro’s administration extended this policy to the rest of the world.

The issue is one of the many that have resulted in differences between Cuba and the United States, to the point that Washington has developed a program that makes it easier for Cuban medical doctors working in a third country to obtain a visa to travel to the United States. This helps explain why Havana is so laconic about its health service agreements with different countries.

According to official sources, in Venezuela these services were paid on a doctor’s visit basis and the cheapest was US $8.00 in 2008. We are told that the rates at the Cuban hospital in Qatar are extremely high, while South Africa pays some US $7,000 a month for every physician.

The incentives

The great number of volunteers among the island’s medical professionals is owed to professional, personal and financial reasons, the salaries of health campaign workers being much higher than those of physicians working in Cuba.

Cuba’s Ministry of Public Health avoided addressing the issue and several doctors insisted they needed special authorization to grant us an interview. Finally, two female medical doctors agreed to speak to us anonymously.

The fact the two doctors interviewed are women is nothing out of the ordinary – 64 percent of Cuban health campaign doctors are women. “Alicia” worked in Venezuela for 7 years and, though she is now retired, says that “if they offered me a job there again I would take it without thinking it twice.”

“I was interested in treating diabetics, because I have this condition. I started working at Mision Milagro (“Miracle Mission”), treating people who lost their sight as a result of diabetes,” the doctor tells us, adding: “I was also interested in improving my financial situation, because I couldn’t make ends meet with my salary.”

“When I first arrived in Venezuela, I was earning 400 Bolivars. They gradually raised my salary and, by the time I came back, I was earning 1,400.” The physician adds that, while you’re involved in this kind of work, “they put more money into your bank account in Cuba and give you a card you can use in some hard-currency stores, with a 30% discount on all prices.”

She recalls that she “treated people with feet affected by diabetes, treated and followed up on more than 500 cases and had to amputate only 10 limbs. It was a marvelous experience, something one never forgets. They are very poor people, but some still phone me in Cuba.”

Brazil

“Juana” is 35 years old and is a family doctor in Cuba. Shortly after graduating from medical school, she went to work in Venezuela for four years, leaving behind her husband and daughter. She did it to develop as a professional, travel outside of Cuba and improve her financial situation.

“I had just graduated and had absolutely nothing. Thanks to my work in Venezuela, I was able to furnish my entire house.” Now, she has another opportunity to travel and work abroad: “The Ministry is offering jobs in Brazil, under conditions that are far better than those in Venezuela.”

Recently, Brasilia tried to hire 6,000 Cuban physicians, but Brazil’s medical association protested, claiming Cuban doctors are not adequately trained (though the World Health Organization ranks Cuba’s health system as the world’s 39^th best, while Brazil occupies the 125^th position).

Medical doctors in the 5 continents

Cuba was able to train enough physicians for Fidel Castro to create the Family Doctor’s Offices, small facilities scattered across all neighborhoods and towns, a grassroots-level network of clinics people can resort to before going to a polyclinic or hospital.

This is the care system that has been most affected by the relocation of physicians abroad. The fact some of these clinics have been shut down as a result of this angers the population, because it makes access to doctors more difficult, increases the number of patients at a given care center and lengthens waiting times.

Despite this, Cuba has managed to maintain its commendable health indices, such as an infant mortality rate below 5 for every live births, a life expectancy near 80 and an efficient HIV/AIDS control and treatment program.

Most Cubans are aware of the benefits that international cooperation in the area of health entails. “If it wasn’t for the work of our doctors in Venezuela, we’d still have 8-hour power cuts every day,” Pablo, a man who works at a State workshop, tells me.

In spite of this, accustomed to having a physician a few blocks away from home, most continue to complain, even though Cuba currently has 60 thousand physicians, one for every 200 inhabitants – a better ratio than many developed countries can boast of.
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(*) See Fernando Ravsberg’s blog (in Spanish).