For decades, the propaganda machine of Fidel Castro’s dictatorial communist regime created an illusion woven from Havana. It made the world believe that the professionalism of Castro’s Cuba’s doctors was almost irreplaceable. That their knowledge was superior to the health care offered in the rest of the world. That medical propaganda was woven over the years, and many countries -accomplices- embraced such fantasy.
An article by Octavio Gómez Dantés for Nexos Magazine
In search of explanations for the growing problems in the health sector, President López Obrador spoke a few months ago about the alleged lack of doctors in the country: “There are 270,000 doctors, and we must have, according to international standards, 393,000. We are short 123 000”. “Besides, the doctors there are,” he added, “do not want to go and work in remote communities”.
These statements seemed to pave the way for a measure that will hardly help solve the critical situation our country’s health services are going through: the hiring of Cuban doctors who, until recently, worked in the Mais Medicos program in Brazil. The government has not ruled out the possible arrival of a group of Cuban doctors specialized in intensive care that would help meet the demand associated with Covid-19.
The international medical brigades, which made Cuba so famous, have long since ceased to exist. In their place, commercial missions were set up and are operated by doctors who work under conditions of open slavery: guarded by personnel from the security apparatus of their country, prevented from traveling accompanied by their families, and deprived of most of their salary.
These are three questions that the Mexican authorities will have to answer before requesting the Cuban government’s help in confronting the pandemic:
I) Is the support of this group of Cuban doctors necessary – can’t Mexican doctors go it alone?
II) If the help is accepted, will the violation of human and labor rights of the doctors who serve in the so-called foreign missions, as it already happened in the eyes of the whole world in Brazil, be overlapped?
III) Will members of the Cuban security apparatus who usually form part of these missions be allowed to enter Mexican territory?
The first international medical brigades were organized shortly after the triumph of the Cuban Revolution, in 1963, in support of Algeria, which suffered a massive exodus of doctors after its independence, followed by brigades to support the national liberation movements of Guinea-Bissau and Angola, and later by the Sandinista Revolution in Nicaragua.
These brigades have also been mobilized in cases of natural disasters. They were sent to Chile, Nicaragua, and Iran to support the victims of the earthquakes that hit those countries in 1960, 1972 and 1990, respectively; to Honduras, Guatemala and Haiti in 1998, after Hurricanes Mitch and George; to the states of Vargas, Miranda and Falcon in Venezuela after the storms of 1999 that killed more than 20,000 people, and to Indonesia after the 2004 tsunami.
Since the 1980s, however, these missions began to pursue commercial rather than humanitarian and geopolitical objectives. Their numbers grew after the fall of the Berlin Wall, as a result of the dramatic decline in economic subsidies Cuba received from the Soviet Union and the disappearance of the preferential trade treaties the island’s government had established with the socialist countries of Eastern Europe. In 1998, after the so-called “white flight” following the demise of apartheid, no fewer than 400 Cuban doctors arrived in South Africa. Within a few years, medical missions were sent to Cape Verde, Ivory Coast, Gambia, Equatorial Guinea, Mozambique, and Zambia.
The turning point in this process, however, came with the cooperation program that Cuba established with Venezuela as part of the trade agreements they signed in 2000 and 2005. This program, known as Doctors for Oil, involved the export of more than 30,000 Cuban doctors and dentists to Venezuela in exchange for 105,000 barrels of oil a day.
The next waves of exports were to Bolivia, Ecuador, Guatemala, Haiti, Honduras, and Nicaragua. In 2013, Brazilian President Dilma Rousseff announced the hiring of four thousand Cuban doctors to provide medical care in vulnerable rural areas of Brazil through the Mais Médicos program. The number of Cuban doctors in this country increased year by year until it reached 15,000 in 2018.
It is estimated that half of the Cuban doctors, no less than 40 000, work in more than 60 countries in Asia, Africa, and Latin America. According to Cuba’s Trade Minister, the export of medical services is the country’s primary source of foreign exchange, ahead of sugar, tobacco, nickel, tourism, and remittances. It is estimated that these services generate around 11.5 billion dollars annually.
The cross-border movement of health workers has become a global phenomenon that brings enormous economic benefits to exporting countries. In principle, there is nothing questionable about Cuba renting its surplus doctors to foreign countries. The problem is the conditions under which it is doing so. This export of medical services, which the Cuban government insists on calling “proletarian internationalism” or “solidarity support,” is being implemented in a context of enormous control and in violation of the labor rights of Cuban doctors and the International Labor Organization agreements on wage protection. The Cuban government, which operates through the company Comercializadora de Servicios Médicos Cubanos (CMSC), has been accused of human trafficking and sued in Brazilian courts.
The Brazilian government paid the doctors working at “Mais Médicos” a monthly salary of USD 4,150 in addition to providing them with food, transportation, and health insurance. However, the Cuban doctors received only US$1,000 per month, of which US$600 was deposited in accounts in Cuba to which they had no access until they returned home at the end of their mission. The rest, $3,150 per month, was appropriated by the Cuban government in an act that can legally be considered “withholding of salary,” which is a criminal offense.
To this should be added prohibitions and continuous surveillance. Health workers operating medical missions are not allowed to establish personal relations with the local population or speak to journalists or diplomats and must request authorization to travel outside their jurisdiction.
Cuban security personnel are responsible for ensuring compliance with these measures. Janoi Gonzales, a Cuban doctor, exiled in the United States since 2013, said: “In each mission, there is a person who is called a ‘juridical.’ Everyone knows that … he is a state security agent, who controls everything, who accuses, who has the right to review your private documents, your phone, everything. Offenses are punishable by penalties ranging from warnings and confiscation of a percentage of your salary to expulsion from the mission and immediate return to the island”.
Julie Feinsilver, author of the book Healing the Masses: Cuban Health Politics at Home and Abroad, says Cuban doctors trained under the Revolution know no other system and see missions abroad as an honor and an opportunity to learn and serve. But the reality seems to be more complicated. Cuban doctors, who earn less than $50 a month at home, leave the island in search of freedom and prosperity, which they often find in exile.
The number of health care workers assigned to international missions who have defected has increased dramatically, in part as a result of the implementation of the Conditional Intake Program for Cuban Medical Professionals, established by President George W. Bush in 2006, which granted Cuban doctors working on international missions residency visas. The Obama administration discontinued this program in January 2017 because it was affecting the health of the Cuban people.
According to El País, no fewer than 5,000 Cuban doctors, nurses, and therapists have deserted their missions in the last decade. In 2013, 3,000 Cuban doctors arrived in the United States from Venezuela. The same phenomenon was observed with Cuban health workers employed in the Mais Médicos program. Ramona Matos Rodriguez, the first Cuban doctor to leave this program and apply for asylum in Brazil, said: “I am sure that if I return to Cuba, I will be arrested. The Cuban government deceived me”. She sued not only the Brazilian government and the municipal government of Pacajá, where she worked but also the CMSC and the Pan American Health Organization (PAHO), which acted as an intermediary for her mission in Brazil.
To this, we should now add the lawsuits that several Cuban exiled doctors recently filed against PAHO, in general, and several of its officials, in particular. According to the plaintiffs, this organization not only supervised the “Mais Médicos Programme” – and therefore implicitly approved the conditions under which it was being carried out – but also obtained direct monetary benefits. They cite a Brazilian government document stating that Brazil paid PAHO $1.5 billion, and PAHO transferred $1.425 billion to Cuba. The Cuban government paid Cuban doctors 125 million dollars and kept 1.3 billion dollars. PAHO withheld the remaining US$ 75 million, which it could not have used for program management costs because these were the responsibility of the Brazilian government.
Journalist Andrés Oppenheimer, who has been writing about the irregularities of the Mais Médicos program for several years, said:
“When I first wrote about the situation of Cuban doctors in Brazil in September 2013, I described this agreement -and the supervision of PAHO- as “scandalous.” Now, if it turns out that PAHO also made US$75 million from this program, we would be looking at a UN agency that would have profited from a modern-day slave trade. That would no longer be just immoral but could be criminal.
The next chapter in this saga could be the hiring by the Mexican government of several thousand Cuban doctors who are leaving Brazil. The spearhead of this hiring could be the intensivist doctors who would support the response to the coronavirus pandemic.
The problems that the government of President López Obrador will have to face if it decides to incorporate Cuban doctors into its response strategy to the Covid-19 pandemic – and to INSABI later on – are diverse and complex.
Three stand out among them:
I) The existence of a high level of underemployment and unemployment among Mexican doctors, who will rightly feel discriminated against.
II) The necessary revalidation of the studies of these health professionals, which is usually very strict in Mexico and takes several years,
III) The acceptance by the Mexican authorities of the working conditions prevailing in international medical missions, which have been described as violating the human and labor rights of Cuban doctors
An additional, but not minor, issue is the presence of members of the Cuban government’s security apparatus on national territory. In Guatemala, a few years ago, a high-ranking official from the Mexican embassy commented that two people were better aware than the president himself of what was happening daily in Guatemalan territory. In essence, one was President Bush, through the CIA, and the other, President Castro, through the “juridical” missions operating throughout the country.
It was with the Cuban medical missions that these obscure characters also arrived in Hugo Chávez’s Venezuela. Today they hold positions in the entire Venezuelan government, including the armed forces. Are we going to allow them to enter Mexico? If so, will their presence eventually extend to the whole of government apparatus?
Octavio Gómez Dantés for Revista Nexos
April 07 2020
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Octavio Gómez Dantés is a researcher at the National Institute of Public Health of Mexico.
