Cuba’s Medical Missions: A Modern Form of Slavery?
Cuban doctors go with State Security agents, they must hand over their diplomas, and their families remain in Cuba, hostages of the State
By Hector Schamis (Confidencial)
HAVANA TIMES – I attended a hearing of the Inter-American Commission on Human Rights (IACHR). It was requested by “Prisoners Defenders International,” an NGO based in Madrid, whose mission is to make visible and denounce human rights violations, mainly in Cuba. Precisely, the session was titled “Cuba: Human rights of people participating in medical missions.”
I am up on the subject and have written several texts since 2019. The truth is, Cuban medical missions expose with devastating force the hypocritical narrative of the dictatorship, perhaps like no other government action. In the discourse, Cuban missions are about the “excellence of its medicine” and the “solidarity of its revolution.” In reality, however, it is about propaganda, receiving hard currency, and social control. Extraction of surplus value, expressed in Marxist terminology for the party’s nomenclature.
The true conditions of Cuban doctors
In other words, exploitation, a salary that amounts to a fraction of the value produced by the task and well below the average salary for the same task in the destination country. The simple arithmetic of this gigantic business is unequivocal. Of the total program, only 10%-15% is allocated to pay the professionals. The remaining 85% goes to the Cuban government, which by this means collects between 8 to 10 billion dollars each year. It is the leading item in the Cuban state’s current accounts, surpassing tourism.
The evidence presented by Javier Larrondo, president of Prisoners Defenders, the testimony of witnesses, doctors who were part of the program in different countries, and the testimony of European parliamentarians is overwhelming. This is why the missions have been categorized under “contemporary forms of slavery, forced labor, and human trafficking” by the UN Special Rapporteur on contemporary forms of slavery and the Special Rapporteur on human trafficking.
It is a repressive system in which participants are recruited through pressure and threats. When they sign up, they are not informed of the destination, the duration of the trip, or the pay. They are not allowed to travel with family members. Their passport and academic diplomas are retained. Once at the destination, they must perform propaganda and indoctrination functions as requested.
They all live together under surveillance, with restricted schedules and the obligation to report any contact with people who are not members of the mission. They are accompanied by State Security agents who pretend to be doctors but perform intelligence functions with the Cubans to control defection, and political tasks entrusted by the receiving government, including proselytism.
The coercive design is like clockwork. Cuban doctors must hand over their diplomas and any other documentation accrediting them professionally to the mission leaders to prevent their labor insertion in case they decide to abandon the mission. At the same time, their families remain in Cuba, literally hostages of the State to reduce the likelihood of desertion.
The punitive instrument is the final part of the design, a totalitarian chaining. Abandonment of duties is punished with eight years of imprisonment in Cuba, but if the offender does not return, they are declared a “deserter.” At that moment, the Ministry of the Interior declares them “emigrated,” which entails the total loss of rights, including property. Immediately following is the declaration of “undesirable,” which prohibits entry to Cuba for eight years and causes family separation.
This legislation opens the possibility of losing parental rights, as the new “Family Code” of 2022 stipulates that the deserter is susceptible to such punishment, enabling the competent authority to administer it as necessary. Hence, in June 2022, the “Committee on the Rights of the Child” urged Cuba to end all separation of minors from their parents due to their decision to terminate a labor contract and to amend the Penal Code to eliminate obstacles preventing family reunification.
Because of all this, more than 5,000 children are separated from their father and/or mother for up to eight years. The repressive mechanism is hermetic. Children are hostages of the State in Cuba, while parents are hostages abroad. If they alter this condition, they face the worst punishment they can suffer: not seeing their children grow up, as testified tearfully by the witnesses at the hearing.
The romantic revolution that proclaimed the emancipation of the proletariat, in reality enslaves doctors. In Cuba, a healthcare professional must be willing to be a slave if they also want to be a parent to their children.
If the U-turn from socialism to capitalist mode of production, as in the post-communist European transition, was an aberration for Marxist thought, much more anomalous would have been a regression to a slave production mode. For that is what Cuban medical missions are. The party-state has made history go against the tide of history.
The attack on Cuba’s medical programs is another destructive politicized legacy of the Trump Administration which its successor has not had the courage to resist.
Samantha Powers is now the head of USAID. In 2016 she was the Obama Administration’s ambassador to the UN. She gave an acclaimed speech announcing US abstention in the annual virtually unanimous resolution against the embargo. Her remarks concluded:
“Let me close by giving just one example – a very moving example. In 2014, we were confronted with the deadliest outbreak of Ebola in our planet’s history. The most dire projections estimated that more than a million people could be infected within a few months. Yet while experts made clear that the only way to stop the epidemic was to confront it at its source, the international community was slow to step up. Many were paralyzed.
It was in that context that President Obama decided to deploy more than 3,000 U.S. personnel to the epicenter of the outbreak, where they joined hundreds of Americans working for non-governmental organizations and humanitarian agencies in the hardest hit areas. President Obama also set about rallying other Member States to do their part. One of the very first countries to step forward was Cuba, which sent more than 200 health professionals to the region – an awe-inspiring contribution for a country of just 11 million people.
One of them was a 43-year-old Cuban doctor named Felix Sarria Baez, who was dispatched to an Ebola Treatment Unit in Sierra Leone. In the course of treating those infected, Dr. Baez came down with the symptoms of the virus – and he quickly went from being the doctor to being a patient. As his condition deteriorated, he was airlifted to Geneva, where, for two days, he drifted in and out of consciousness. He nearly died, yet miraculously he pulled through, and eventually returned to Havana, where he says he regained his strength by cradling his two-year-old son.
I’d like you to think, just for one moment, about what it took to save the life of Dr. Baez – a man who risked his life to save people from a country on the other side of the world. He was initially treated in the clinic where he worked, which had been built with the help of a U.S.-based NGO. From there, he was transported to a clinic run by doctors from the British ministry of defense. Then he was airlifted to Switzerland aboard a medical transport plan operated by an American charter service. Upon arriving at the hospital in Geneva, he was treated by Swiss doctors with a Canadian-developed experimental treatment.
Look at all the nations that played a part in saving the life of that brave doctor – a doctor who, after recuperating in Havana, actually chose to return to Sierra Leone, so that he could rejoin his colleagues in the field, saving the lives of Sierra Leoneans. Dr. Baez and all his colleagues belonged to Cuba’s Henry Reeve Contingent – which responds to international disasters and epidemics – and takes its name from a young American born in Brooklyn, who at the age of 19 traveled to the Cuba to join the country’s struggle for independence, and gave his life in 1876 fighting alongside Cubans for their freedom.
When Dr. Baez returned to Sierra Leone, he was asked why he had come back after all he had been through. He said, simply, ‘I needed to come back. Ebola is a challenge that I must fight to the finish here, to keep it from spreading to the rest of the world.’
That – what I’ve just described – is what the United Nations looks like, when it works. And noble efforts like these are precisely why the United States and Cuba must continue to find ways to engage, even as our differences persist. Today, we will take another small step to be able to do that. May there be many, many more – including, we hope, finally ending the U.S. embargo once and for all.”
When I was a Peace Corps volunteer in Peru, my passport was held in the Lima office and I was not permitted to leave the country without permission. For still unknown reasons, my effort to travel from Puno to Bolivia was blocked, although the next year I was able to travel from Cuzco to Ecuador. If I had terminated Peace Corps service before my two year term ended without approval, I would have been penalized financially. (I think I would have lost the small monthly amount held on my behalf for transition home.)
My Peace Corps salary in Peru was much less than I could have earned in the US or working for the private sector in Peru. My understanding is that Cuban doctors earn more overseas than at home and equivilant to local counterparts. Do Cuban doctors have self interested career and prestige reasons to volunteer? No doubt. Did Peace Corps volunteers? Certainly. For some it was a career path to USAID or the State Department or international business. For others it was a way of delaying if not escaping the military draft during the Vietnam war.
Does Cuba have greater soft-power and propaganda reasons to send medical volunteers than the US does for the Peace Corps? Look at the justifications given during the annual funding debate.
There are two salient differences. No one was trying to induce us to abandon our Peace Corps responsibilities in favor of preferential treatment in Russia or China, inducing paranoid protective behavior by Peace Corps staff. The US also did not usually receive compensation for our services. Of course the US government had not provided us with free university or professional training from which we and the host country benefited. Nor were our services deemed essential enough for the host country to pay for them.
Until Cuba is wealthy enough to provide free medical care to other countries, the higher than compensation payment it receives from most hosts is a reasonable exchange and the rhetoric of enslavement in irresponsible.
The US should return to Ms. Powers sentiments. The more doctors Cuba provides to nations in need the better. Peace Corps volunteers and Cuban medical volunteers should set the example by joining forces to fulfill their shared humanitarian and development goals.
Here in the US, Cuban doctors (and all foreign educated doctors) must take the USMLE exams (4 sets of tests) in order to be accepted for residency which is a precursor to getting licensed as a medical doctor. The Cuban failure rate of the exams is a dismal 90% according to government statistics. Not exactly comforting if you needed to go under the knife. However, I have friends in the Cuban immigrant community who got here, took minimal jobs (think janitors food service) in the hospitals and then went back to university here to retrain in US standards. One recently graduated as a Registered Nurse and is now making $200k a year in New Jersey with hopes to continue to medical school and become a licensed physician. There is a reason that many people from Canada and abroad come here for treatment. On the other hand the Cuban regime is bleeding it’s best and brightest-sad.
Unfair?
1. Participants are recruited through pressure and threats.
2. When they sign up, they are not informed of the destination, the duration of the trip, or the pay.
3. They only receive 10-15% of the money the Cuban government receives. The rest is confiscated.
4. Their families remain in Cuba, hostages of the State.
5. Abandonment of duties is punished with eight years of imprisonment.
6. If the offender does not return, they are declared a “deserter” and are prohibited from Cuba for eight years.
7. They face the worst punishment: not seeing their children grow up.
“Unfair” doesn’t begin to cover it.
Many countries like Canada and some parts of Europe would like to bring in health care workers for a term but not under the current rules. Cuba needs this foreign exchange but I agree the current rules do seem unfair to the people involved.