Cuban medical internationalism

How is Cuba healing the world?

How did Cuba save 4 million people?

Cuban medical internationalism is the Cuban programme, since the 1959 Cuban Revolution, of sending Cuban medical personnel overseas, particularly to Latin America, Africa and, more recently, Oceania, and of bringing medical students and patients to Cuba.

We investigate the machinary behind what is wide recognised as the world’s most effective health care system.

How does a small country manage and coordinate an international effort on this scale where others have failed? How does their system differ from other approaches and how has this lead to its success (Medical treatment in Cuba is more hands-on and less technology-driven, mostly because MRIs and lab tests are expensive. They call it preventive — meaning people see their doctor regularly, before there is a crisis.)

Focus is both internal, in Cuba and international. How does education in Cuba differ (ethics)? What are the challenges doctors face aboard? How do they deal with cultural difference? What kind of support do they get from Cuba and local governments? How have they transformed healthcare abroard? How do they deal with/ answer accusations they aren’t “real doctors”?

Some facts:

Cubans have more doctors per person than anyone else on the planet. Most residential blocks still have a local medical consultorio — a doctor’s office with the doctor living upstairs on call.

Cuba’s ELAM is the World’s Largest Medical School

ELAM has 9675 students from 100 countries in the Havana area. The 7777 students from 15 Latin American countries account for over 80%. But Africa has the largest number of countries (36) represented. They are from Angola, Benin, Burkina Faso, Cameroon, Cape Verde, Chad, Congo, Djibouti, Equatorial Guinea, Ethiopia, Gabon, Ghana, Guinea Republic, Guinea-Bissau, Kenya, Lesotho, Madagascar, Malawi, Mali, Mauritania, Mozambique, Namibia, Niger, Nigeria, Sao Tome Principe, Sarhawi Arab Democratic Republic, Seychelles, Sierra Leone, South Africa, Swaziland, Tanzania, Togo, Tunisia, Uganda, Zambia and Zimbabwe.

African students are 9.1% of those at ELAM, followed by the Caribbean with 7.3%. A much smaller portion of the student body is made up of those from Asia (0.7%), Europe (0.1%), the Middle East (0.5%), Canada/US (1.2%), and the Pacific Islands (0.7%).

Medical treatment is more hands-on and less technology-driven, mostly because MRIs and lab tests are expensive. They call it preventive — meaning people see their doctor regularly, before there is a crisis.

Cuba was the first country in the world to eliminate polio and measles.

It has the lowest rate of AIDS in the Americas.

Cuba has a lower infant mortality rate than the United States.

The average lifespan in Cuba is 78.

There are 68,600 Cuban doctors now and more than 20 per cent of them — or 15,407 — are on missions in 66 countries.

They claim to have saved 4 million lives over the past five decades.

Cuba provides more medical personnel to the developing world than all the G8 countries combined.

Patients are not charged for services, and the recipient countries are expected to cover only the cost of collective housing, air fare, and limited food and supplies not exceeding $200 a month. While Cuban doctors are abroad, they continue to receive their salaries as well as a stipend in foreign currency.

Women and Afro-Cubans have been an important presence in international missions since their inception.

It is widely believed that medical workers are Cuba’s most important export commodity.

Focus countries:

Venezuela: Cuba’s largest and most extensivle medical aid effort is with Venezuela. Via the “oil for doctors” program, Castro’s Cuba provides Venezuela with 31,000 Cuban doctors and dentists and provides training for 40,000 Venezuelan medical personnel. In exchange, Venezuela provides Cuba with 100,000 barrels of oil per day.

South Africa: Cuban role in National Health Insurance (NHI) – new deal (http://www.businessday.co.za/articles/Content.aspx?id=172709)

Pakistan – in Muslim countries cuban doctors dressed appropriately and wear headscarves to estiblish good will.

Angola – first large international campaign

Haiti – first on the ground after the quake

Resources

Wikipedia:

Cuba-trained doctors making difference around the world, The Star Canada

Cuba exports health, Le Monde diplomatque, Hernando Calvo Ospina

Cuba’s Campaign Against Medical Racism Spreads to Africa, Upside Down World, by Don Fitz

Cuban Medical Internationalism: Domestic and International Impacts, Sarah A. Blue, Northern Illinois University

One of the World’s Best Kept Secrets: Cuban Medical Aid to Haiti, by EMILY J. KIRK And JOHN M. KIRK

Cuban health care profile

Books

Huish, Robert and John M. Kirk (2009) Cuban Medical Internationalism in Africa: The Threat 
of a Dangerous Example. The Latin Americanist. 53(3) 125 – 139.

Huish, Robert (2009). How Cuba’s Latin American School of Medicine challenges the Ethics of Physician Migration. Social Science and Medicine. 69(3) 301 – 304.

Steve Brouwer. Revolutionary Doctors: How Venezuela and Cuba are Changing the World’s Conception of Health Care, Monthly Review Press, 2011. Pp 256.

John M. Kirk and H. Michael Erisman. Cuban Medical Internationalism: Origins, Evolution, and Goals. Palgrave Macmillan, May 2009

Julie Margot Feinsilver. Healing the Masses: Cuban Health Politics at Home and Abroad. University of California Press, 28 Oct 1993

Cristina Perez. Caring for Them From Birth to Death: The Practice of Community based Cuban Medicine. Lanham, MD, Lexington Books, 2008

Susan E. Mason, David L. Strug, Joan Beder, eds. Community Health Care in Cuba: An Enduring Model. Chicago, Lyceum Press, 2009

Linda M. Whiteford, Laurence G. Branch. Primary Health Care in Cuba: The Other Revolution. Lanham, MD, Rowman and Littlefield Publishers, Inc, 2007
pp., $24.95, paperback.

Elizabeth Kath. Social Relations and the Cuban Health Miracle. Brunswick, NJ, Transaction Publishers, 2010

How Cuba’s Latin American School of Medicine challenges the ethics of physician migration, Social Science & Medicine, Volume 69, Issue 3

Castrocare in Crisis Will Lifting the Embargo Make Things Worse? Laurie Garrett, Foreign Affairs July/August 2010. page 63.

Film

Salud, 93 minutes, produced and directed by Connie Field (website includes resources)

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