[Marxism] Cuban doctors bring relief, but controversy mars work

Walter Lippmann walterlx at earthlink.net
Sun Mar 5 07:24:33 MST 2006

Even though this is the MIAMI HERALD, normally not a source 
of objective, balanced reporting on Cuba, this article in
today's paper is an exception to that general rule.

A careful reading of this story will reward anyone with a
good understanding of how and why the Cuban medical assistance
program works. Cuba is a relatively small country of only eleven
million people. Cuban society is also under relentless pressure
from its northern neighbor whose population is just about to be 
300 million. The U.S. government is engaged in an unceasing
campaign to overthrow the Cuban government and the society it

In this context, it's essential to know that the more friends
Cuba has in the world, the harder it would be for Washington 
to isolate the island. The Cubans, who are guided by the ideas
of Jose Marti, whose famous phrase "Patria es humanidad", which
roughly translated means "Homeland is humanity", understand it
wouldn't be either possible or desireable to try to build a
self-succient society on a small island. Cuba's international
vision and approach reflects this. Cuba's medical care system,
which provides essentially free medical care for its population,
which it views as a basic social and human right, is a model 
well-worth understanding. Today, Cuban doctors in nearly 100
countries of the world provide desperately-needed medical care
to people, leaving smiles, but no bills in their wake. It it 
any wonder that those who believe medical care must be seen as
a business whose purpose is to make profit, are resentful of
the example with the Cubans are proding wherever they work?

Last year the Wall Street Journal provided a template for such
hostility in "Castro's Medical Missionaries Blanket Honduras"
where this exact same issue has been raised here. (The HERALD's 
article is a considerably more balanced, less demagogic essay.)

True, some Cubans complain that they can't get to see their
doctor as easily because she or he is working abroad. Yes,
Cuban doctors receive a modest financial incentive for their
being willing to work far from home and family, but that's a
trade-off which helps soften the impact of the sacrifice.

With all the dramatic publicity given in the Miami media to
desperate Cubans trying to come to the United States where in
their dreams life will be better, it's remarkable that so few
Cubans living and working abroad have defected. Guatemalan
doctors, educated in the capitalist spirit that health care 
should be seen as a business rather than a human right aren't
in any rush to go out to the Guatemalan boondocks to care for
the poor people living that. Cubans are quite willing to do is.

At the same time, Cuba is providing a free medical education to
hundreds of Guatemalans so that they'll be able to return to
their homeland and and provide medical care to the poor who
cannot afford private profit-oriented care in that country.

Walter Lippmann, CubaNews

Posted on Sun, Mar. 05, 2006	  
Cuban doctors bring relief, but controversy mars work
Cuban doctors offer needed help to such poor countries as Guatemala, 
but their presence is a source of controversy at home and in the Americas.
Special to The Miami Herald

USPANTAN, Guatemala - At the hospital in this central Guatemala mountain
town, Cuban doctors outnumber their local colleagues two to one. And all the
five specialists are Cubans, including the surgeon and anesthesiologist.

Eight other Cuban doctors live and work in remote health posts in the
region, sometimes trudging up to six hours on foot to vaccinate children and
attend to emergencies.

''It's a beautiful, unique experience,'' said María Josefa Herrera, a Cuban
general practitioner who works in Uspantán. ``Often the patients have never
been treated by a medical professional.''

Herrera is one of the thousands of Cuban medical personnel sent abroad by
Cuban leader Fidel Castro in a campaign to alleviate health crises, support
his political allies and earn badly needed hard currency -- a campaign that
also has angered some Cubans on the communist-ruled island.

Recent media reports from Havana have noted that Cubans are increasingly
resenting the absence of physicians once provided free of charge by a
totally government-run system whose strength was in a massive network of
neighborhood doctors, and not in its hospitals or technology.

One recent U.N. mission to Cuba found a clinic in the eastern city of
Santiago where 60 of the 140 staff doctors were abroad, according to the
Interamerican Dialogue, a think tank in Washington. And it's not just a
problem for Cubans.


In Venezuela, the doctors' association sued the President Hugo Chávez's
government for using doctors unlicensed to practice in that country. The
program continued despite a court ruling backing the association. And in
Honduras, the Professional Association of Honduran Doctors has complained
over the presence of Cuban healthcare workers there at a time when 1,500
recent Honduran medical graduates are out of work.

Cuba touts its medical missions as a show of solidarity with the world's
needy that it can well afford, with one of the highest doctor-patient ratios
in the world -- one doctor for every 165 residents, according to the World
Health Organization.

But there are more palpable benefits for the island. Cuban medical personnel
sent abroad earn hard currency for their perennially cash-strapped
government, and the estimated 20,000-22,000 deployed in Venezuela are being
paid in part with cheap oil.

In Guatemala, the Cuban medical deployment also has its ups and downs.

For its part, the Guatemalan government has gained 285 physicians and 128
other medical personnel at very low costs, with government public health
officials saying the Cubans earn about $400 per month -- less than half a
typical Guatemalan public sector doctor's salary. Last October, Cuba sent
600 extra medical personnel to Guatemala after Hurricane Stan, but they have
since returned home.

Yet that $400 is also about 16 times the average salary of a doctor in Cuba,
so the Cubans here have been using their comparatively huge salaries to buy
refrigerators, stereos and other items that they couldn't afford in Cuba.
They take the goods home when they finish their work here.


Guatemalan officials say the full $400 goes to the Cubans here, who have to
pay for their own housing, food and local transportation. No part goes to
the Havana government, they said, although in many other countries the host
government pays the Cuban government, which then passes part of the money to
the medical personnel. It's not clear why the Guatemalan arrangement is

And for that kind of money, the Cubans are willing to toil under harsh
conditions in remote areas where local doctors are not available or don't
want to work. Almost three-quarters of Guatemala's 12,000 registered doctors
work in the capital and surrounding suburbs, and about one-third of the
country's municipalities don't have a single resident doctor, according to
the Guatemalan Association of Physicians and Surgeons.

``It's difficult finding Guatemalan doctors to work in the most isolated
areas,`` said Alvar Pérez, director of Guatemala's rural health extension

Some experts worry, however, that the public health system has become too
dependent on the Cuban medical personnel.

''The Cubans came to fill a medical need,'' said Juan Carlos Verdugo of the
National Health Platform, a nongovernment organization that focuses on
public health issues. ``But this can't be a permanent solution . . . they
could leave any day.''

To gradually replace the island's doctors, the Cuban government has been
offering free medical school to low-income students from Guatemala and other
countries. More than 12,000 students from 83 countries are studying at the
Latin American Medical School in Havana and Castro has predicted that it
will graduate 100,000 in the next 10 years.

The school's first graduation last August included 187 Guatemalans.

In exchange for free tuition, those students promised to work for the
Guatemalan public health service for up to 6 ½ years after graduation. The
government also requires foreign-educated doctors to work for one year for
free in rural health posts and hospitals.

But many of the new graduates have said they're not willing to work for a
Cuban's salary.

''No one's going to work in the mountains for a salary of $400,'' said
Carlos Flores, one of the new doctors.


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