The Locomotive of Cuba’s Economy: Health Services Abroad

FERNANDO RAVSBERG*

Cuban health professionals currently work in 60 countries around the world. Photo: Raquel Perez

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.

Cuban doctors are willing to work in the poorest and remotest areas. Photo: Raquel Perez

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 39th best, while Brazil occupies the 125th 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.
—–
(*) See Fernando Ravsberg’s blog (in Spanish).


15 thoughts on “The Locomotive of Cuba’s Economy: Health Services Abroad

  • June 12, 2013 at 3:38 pm
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    No, your second statement has the most aggregate of clichés I’ve ever seen. Repeated ‘ad nauseum’ as yourself put this, it becomes propaganda.

  • June 12, 2013 at 10:41 am
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    Luis, My [second sentence] was a factual statement that has been discussed ad nauseum and is so self evident that there’s no need to repeat it; hardly cold war stuff.

    As for the bombing comment…lighten up Luis, it’s all tong-in-cheek

  • June 12, 2013 at 8:19 am
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    Just look at yourself – your second sentence looks like what I’d expect from a child trying to discuss the Cold War.

    Marvin Gaye said to ‘Save the Children’. Your motto is to kill them.

  • June 12, 2013 at 8:16 am
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    And they spend $680+ billions with the military, half of the total spent globally. How altruistic and ‘good’ they are.

  • June 11, 2013 at 3:14 pm
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    Appeal to authority: you’re doing it wrong. El País correspondent traded ‘ELAM’ for ‘Iran’, for goodness sake. Well after that phony Chavéz photo, you can expect anything.

  • June 11, 2013 at 3:01 pm
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    An excellent article, informative and enjoyable. Thanks to Fernando and HT!

  • June 11, 2013 at 1:18 pm
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    El Pais is an internationally-recognized news organization that happens to have an anticastrista bias. Your source is likely some guy working out of the basement of his mom’s house. I do fail to pick up when you are being “ironic”. You tend toward the “theatrical” in your comments that it is hard to discern the literal from the figurative. BTW, PRISM pays in cash these days.

  • June 11, 2013 at 12:25 pm
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    you do realize that disagreeing with you is not “propaganda”. Cuban communism’s failures are so egregious and numerous that no propaganda is needed to showcase it’s failings.

    The recent revelations about the extent of the US surveillance program aimed at US citizens (I could care less about their international surveillance…it’s their job after all) is a indeed a concern. Many US citizens and government officials are up in arms about the whole affair. the difference however is that in this country we have recourse, which in Cuba you do not have my fine feathered communist friend. In Cuba you have to take your medicine and like it!

    As for bombing Pakistanis…what better way to show you love your friend?

  • June 11, 2013 at 8:45 am
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    In 2011, the US government provided $17.8 billion in foreign aid to numerous countries around the world. Private organizations and charities in the US provided a further $71.2 billion in foreign aid.

    In 2012, the Canadian government provided $5.67 billion in foreign aid, including $5,698,000 to Cuba.

  • June 11, 2013 at 4:51 am
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    Oh those news are bogus, propaganda, fake El País distortions of our
    health minister’s declaration (he was referring to those formed in
    ELAM):

    http://revistaforum.com.br/blog/2013/05/el-pais-anuncia-que-governo-dilma-desistiu-de-contratar-medicos-cubanos/

    It seems that relying on conservative media’s propaganda when the facts are against you is your expertise.

    You
    don’t get my irony, just like the other (mis)informed propagandist. The
    Pakistanis from example are getting those bombs from free. Detonated in
    their children’s heads. I don’t blame you, figurative language can be a
    bit difficult, you know.

    How’s your check from the PRISM program going BTW?

  • June 10, 2013 at 10:08 pm
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    You miss the whole point. It’s coerced labor. Why must Cuban citizens be forced to do this?

    I agree about your bomb comment. We should require the countries we bomb to pay for each and every ounce of TNT we drop. That’s stuffs expensive you know

  • June 10, 2013 at 8:52 pm
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    Luis, it looks like you won’t get the chance to do even that.

    The latest news is that Brazil does not share your preference to import the “life” from Cuba that you reference. Source:
    http://www.ibtimes.com/brazil-says-they-will-not-hire-cuban-doctors-turns-spanish-portuguese-physicians-instead-1275847.

    On the other hand, your government has purchased $829 million dollars in arms(sorta’ like bombs, no?) from US sellers in the last ten years. Source: http://www.fas.org/sgp/crs/weapons/R41539.pdf

    That’s more than they would have spent with Cuba on “life” as you put it. This total ranks Brazil in third place in this hemisphere in arms imports from the US behind US allies Canada and Colombia. Wow!! BTW, how is your proof that I am a US paid troll coming along?

  • June 10, 2013 at 1:07 pm
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    The remittances amount to $2.6 billion in cash, but another $2 billion in goods: clothes, electronics, food & medicines. The delivery costs of this income is paid for by the sender, not the receiver. Therefore, the net income from remittances to Cuba is much greater than any other sector of the economy.

  • June 10, 2013 at 11:27 am
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    While your country exports bombs for free, Cuba exports doctors for some money.

    I’d rather import life for a fee than death for free.

  • June 10, 2013 at 11:14 am
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    Once again, education in Cuba is NOT FREE. Effective income tax rates of 95% more than pay for the health care and education services that Cubans receive. Second, remittances from abroad are increasingly becoming the biggest source of hard currency to the Castro regime. Remittances, unlike the income received from medical services and nickel, tobacco, and other exports is free money. Even tourism requires initial and ongoing costs to maintain revenues. Last year alone, Cuba received more than $2.6 billion according to CafeFuerte http://cafefuerte.com/. Please keep in mind that few doctors would volunteer to spend years away from their loved ones were it not for the crappy salaries they earn in Cuba. Likewise, they do not “volunteer’ to serve in areas where the local doctors are reluctant to practice. They are assigned to these posts. Their passports are taken from them and they are closely watched. The Castros like to play up the altruistic aims of their medical “diplomacy”. The truth is that it is like any other export business (read garments in Pacific Rim countries) based on exploiting human labor.

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