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U.S. takes aim at program that provides Cuban-trained doctors to assist poor countries

By Peter Beaumont and Ed Augustin

A Cuban medical program that has helped some of the world’s poorest communities has become the latest target of the Trump administration’s escalating attempts to pressure Havana’s faltering economy.

A team of young Cuban doctors prepares for an overseas mission.

Dubbed “Cuban doctors”, the celebrated – if controversial – humanitarian medical mission was founded more than half a century ago in the aftermath of Fidel Castro’s revolution, in part to enhance the country’s international influence.

Currently active in over 60 countries, the plan has provided healthcare across the globe, from indigenous Amazon peoples to slum residents in Africa to the victims of Haiti’s 2010 earthquake.

Now its work has come under renewed fire via a combination of allegations, led by Washington, which has accused Havana of using the doctors to undermine democracy, not least in Venezuela, which hosts one of the biggest missions.

Havana has also been accused – in claims taken up by Washington – of “exploiting” the medical staff sent on the missions. One report suggested work conditions, low salaries and coercion amounted to “modern slavery”.

In response, Cuban officials, and analysts who have closely studied the work of the medical missions, accuse the U.S. of using the claims as cover for its policy of strangling the Cuban economy in the hope of damaging the left-wing regime, while warning that poor patients around the world will be the biggest victims.

According to Cuba’s ministry of foreign affairs, more than 600,000 Cuban medical staff, including doctors, nurses and technicians, have been sent to more than 160 countries since the 1960s.

While some two dozen missions are provided free of cost by Havana, other countries where the doctors are deployed pay Cuba for the medical services, bringing in $5.2 billion annually, Havana’s largest source of foreign currency.

The U.S. campaign against the Cuban doctors has intensified amid recent political changes in Latin America, which have led to the expulsion of the missions from several countries, including Bolivia and Brazil, where left-wing governments have been replaced by right-wing regimes closely aligned with Trump and Washington.

In Ecuador, the program ended in 2019 through mutual agreement due to an oversupply of doctors produced the country’s medical schools.

At the forefront of the allegations against the Cuban program is U.S. secretary of state Mike Pompeo, who has both depicted the deployment of Cuban doctors in countries from Venezuela to Brazil and Ecuador as sinister interference in their affairs, and congratulated countries – like Bolivia – that have expelled them.

Cuban doctors with a Brazilian patient in 2016.

Pompeo has been backed by other senior U.S. officials and agencies, including deputy secretary of state Michael Kozak, who has also latched on to recent claims about the doctors’ working conditions.

“The Castro regime sends up to 50,000 Cuban medical staff overseas to work in harsh conditions. Stories of abuses abound. The regime pockets 75% of the doctors’ salaries, and using (sic) them to keep allied regimes in power,” Kozak tweeted before Christmas.

The main U.S. development agency, USAid, has also weighed in, offering to fund organizations helping to expose negative aspects of the scheme. They have accused Cuba of “exploit[ing] its medical professionals … using them to buy international financial and political support and keep its struggling economy afloat, while pocketing the majority of these workers’ salaries and subjecting them to poor living conditions, constant surveillance, and threatening those who wish to leave their mission”.

The claims surrounding the doctors’ work conditions were fuelled by a report last year by NGO Prisoners Defenders, which claimed to have interviewed more than 100 doctors, allegations taken up by two UN rapporteurs.

Critics say Washington’s campaign against the doctors, which includes attempts to persuade them to defect, is little more than an attempt to strangle the amount of foreign revenue that they bring in – much of which is ploughed back into Cuba’s health and social services.

In December, Johana Tablada, deputy director of North America at the Cuban ministry of foreign affairs, said Trump administration officials had been pressuring Latin American governments to end the medical support programs, hurting healthcare in those countries.

“The government of President Trump has crossed the red line of decency by taking the foreign relations of the United States to levels of hypocrisy and double standards that none of his predecessors have done,″ Tablada said.

While the Cuban doctors have been criticized in the past, not least by those who say they undercut poor countries’ development of their own healthcare systems and medical training, the current U.S. pressure on the program coincides with the election of Donald Trump and his apparent determination to reverse the warming of relations between the U.S. and Cuba that took place under the Obama administration.

“The [US policy] is targeting the two main sources of external income for Cuba, first tourism and now medical services,” explained Pavel Vidal Alejandro, a Cuban-born academic at the Xavierian University in Colombia.

“Medical services represent around 60% of Cuba’s total foreign income,” he told the Guardian. “It’s the old policy of applying a high pressure cooker strategy in the hope it will produce social protests. That didn’t happen in the past and is not happening now.”

John Kirk, an academic at Dalhousie University in Nova Scotia who has interviewed several hundred Cuban doctors is also skeptical about some of the claims – which he believes are “exaggerated” – and about the real reasons for the targeting of the Cuban doctors.

“Over the last 12 years I’ve interviewed 270 doctors, nurses and technicians and stayed with them on missions,” he said.

And, Kirk said, while it is clear that some doctors on the missions do defect or complain about working conditions, salaries and political pressure, his impression has been that many are motivated to join the missions and are happy at the opportunity to earn far more than they would practising medicine in Cuba.

“It’s in the DNA, the idea of a vocation,” he added. “One thing the doctors always said to me is how they can earn more than in Cuba. Another motivation mentioned was the experience they gained in some of these places, which they described as a living medical text book. They go to places others won’t go.”

Kirk mentioned the Mais Médicos (More Doctors) program originally set up in Brazil by former president Luiz Inácio Lula da Silva and ended when the right-wing demagogue and Trump supporter Jair Bolsonaro came to power last year.

“If you look at the situation in Brazil, Mais Médicos brought healthcare to to indigenous populations, to places like the Amazon that had never never seen doctors before.

“And what’s also missed [in the criticism] is that the program brings in money to subsidize the Cuban healthcare.”

Guardian interviews with Cuban doctors who have served on medical missions, including those shut down in Bolivia and Brazil, portrayed a far more nuanced story than that depicted by the US and some of the critics.

While many would prefer to keep more of their salaries and enjoy better working conditions, they denied they felt like “slaves”.

Instead, for Dr. Yoandra Muro, until recently the head of the expelled mission in Bolivia, the threats came instead from the new right-wing government that ousted left-wing president Evo Morales. She said they were accused of “being a white-coated army”.

“[Towards the end of the mission] the police entered our houses and took belongings of our colleagues. These were the same people we’d been giving healthcare to. It was very difficult to understand how overnight you turn from a doctor into a terrorist.

“We were in 35 hospitals where the majority of our professionals were specialists. This means there are 35 hospitals– where children are being born, where urgent surgery is required – that today don’t have those professionals.

“You can imagine the insecurity that they feel. There were lots of patients who cried when we left, that felt the pain of their doctor going, that said ‘what am I going to do now? Who will treat me now’?”

She added: “What a contradiction! Either we’re victims or we are threats.”

It appears likely that Muro and other Cuban doctors will return to Boliva after tha May elections, in which a leftist or centrist is expected to be elected president.

Yanet Rosales, 32, is a family doctor in Cuba who has completed two foreign medical missions including with Mais Médico . Like many, she said the ability to earn far more than a doctor in Cuba was a strong motivating factor.

“From a personal point of view, I’d always wanted to go to Brazil and this was my opportunity. There’s also the economic factor. They pay us much more to be there, so this was a factor.

“The Brazilian government paid around $5,000 a month for our services [as doctors] of which we got to take home $1,300. The Cuban government took the rest to buy medical equipment and to improve health here.

“I never felt exploited. On the contrary … but we’re not totally in agreement with it. We were the ones working and far away from the family. Of course, we’ve got to help the country, we are there thanks to our government. We are aware that we are doctors thanks to the state, but we didn’t agree with the percentage we were getting. We think it should have been 50-50.

“But at the same time, if we weren’t fully in agreement with the contract, we wouldn’t have gone. They put those conditions to us before we went, so we can’t complain either.”

For Kirk, the outlook is worrying. “If Trump gets re-elected all bets are off. The U.S. policy is a continuing process. Death by a thousand cuts.”
__________________

Credit: The Guardian, www.theguardian.com

23 thoughts on “U.S. takes aim at program that provides Cuban-trained doctors to assist poor countries

  1. I wonder why Trump likes to see people with brown skin not get Healthcare The entire Republiklan Party is like that!! I hope they vote him out of office and put him in jail!!!

    1. It is always hard to get reliable figures of any kind about regimes like Cuba because most of the available statistics are based on what the regime decides to let the world (or international organizations) know. I am therefore highly sceptical – my impression of the Cuban health system, as observed from up close, is that I´d rather NOT want to become sick there. For a dissenting view on the infant mortality rate topic, see

      Infant Mortality in Cuba: Myth and Reality
      ROBERTO M. GONZALEZ
      Cuban Studies
      No. 43 (2015), pp. 19-39
      Published by: University of Pittsburgh Press

      Abstract:
      Because of its low infant mortality rate (IMR), Cuba is often portrayed as a poor country that has reached social development levels of rich nations. In this article, however, I show that Cuba’s reported IMR seems very misleading. By exploring a sharp discrepancy between late fetal and early neonatal deaths, I develop a method for adjusting Cuba’s reported IMR. The results indicate that the adjusted IMR might be twice the reported one. Furthermore, Cuba’s adjusted IMR, although lower than those of Latin American and middle-income countries, is not at par with those of developed countries, as previously believed.

      1. This is how you provide a link to a study:

        https://sci-hub.tw/10.1353/cub.2015.0005

        Now go back and read the entire article, not just the abstract, and come back and tell the class if you really want to hitch your wagon to such nonsense. Now I understand why you never provide a link to your sources. You’re afraid someone might actually read them and figure out that your arguments are nothing more than ideology-driven rants full of sound and fury, signifying nothing.

        1. It is interesting how you pounce here yet avoid ANY comment on the PROOF that was given by Chiconahui in their comment on what it is truly like to live in a communist country.

  2. The most dishonest and corrupt President in the history of US is at it again // He is filled with so much hatred for all but his pets around him wiling to kiss his ass that only intensifies his deeply rooted hatred for all Obama did to improve our relationship with Latin america This man is ignorant // an elected despot spreading infection in south america // the poorest are suffering // just imagine this region without Cuban medical professionals //

    1. You are condemning the wrong person. It’s the Cuban government that is doing the wrong (and should be blamed). The ones that are trying to right the wrong should not be held responsible for the unacceptable behavior of the Cuban communist government.

    2. Trump gave a short speech yesterday and mispronounced over ten words that any five year old would know. He has no problem pronouncing profanity or telling people where he grabs young women. Any true Christian would do what they could to remove this person from office and send him off to Mar a Lago to wrought in peace!

  3. Medical diplomacy has helped Cuba gain votes in the United Nations from beneficiaries in Latin America, the Caribbean, Africa and the Middle East, and it has been a large source of government revenue: $6.3 billion in 2018. The wages on offer were strong incentive for Dr. Dayli, who was sent to “serve” to South America, who is originally from the small Cuban city of Camagüey. Going from a doctor’s salary on the island of just $15 a month in 2011, she says she was paid $125 monthly for the first six months in Venezuela, a figure that rose to $250 after six months and $325 during her third year. Her family in Cuba also received a bonus of $50 a month while the Cuban government receives about $5,000.00 per month per doctor. The U.N. Human Rights Council’s rapporteur on contemporary forms of slavery and forced labor made an official inquiry to the Cuban government.

    According to a report by the opposition-linked Cuban Prisoners Defenders, based on direct testimony from 46 doctors with experience of overseas medical missions, plus public-source information from statements by 64 other medics:

    – 89% said they had no prior knowledge of where they would be posted within a particular country
    – – –
    – 41% said their passport was removed from them by a Cuban official on arrival in the host country

    – 91% said they were watched over by Cuban security officials while on their mission, and the same percentage reported being asked to pass on information about colleagues to security officials

    – 57% said they did not volunteer to join a mission, but felt obliged to do so, while 39% said they felt strongly pressured to serve abroad.
    The BBC made repeated requests for a response from the Cuban government but received no reply.

    The Trump Administration is calling on Cuban doctors to defect.

    While Dr. Dayli at least managed to escape becoming a victim of violence in Venezuela, a compatriot and fellow woman medic was less fortunate. The 48-year-old family doctor wishes to be identified by the pseudonym “Julia” to spare her family knowledge of her ordeal. She says, “I woke up one night, with someone holding my mouth shut. The doctor in the other room was screaming. There were two men in balaclavas, armed with guns.” Julia says she was raped by both men. While on a mission in Bolivia, Julia defected across the border into Chile, and now lives in Spain, where she has asked for asylum and works as a surgeon’s assistant.

    According to the Prisoners Defenders report, more than half of 46 doctors with experience of overseas missions who were interviewed reported having to falsify statistics – inventing patients, patient visits and pathologies that did not exist. By exaggerating the missions’ efficacy, the Cuban authorities can, the report says, demand greater levels of payment from the host country, or justify the enlargement of the operation.

    Dr. Dayli says the conflict she had with her senior medical colleagues at El Sombrero over the instructions to boost treatment statistics led to her being posted in lower-level destination in the calmer, more rural town of San José de Guaribe. But the twin pressures of working without sufficient medical equipment and orders to hit artificial or impossible targets remained. She alleges her request to transfer a man with lung cancer to Caracas was denied so he would count towards her clinic’s statistics. “The health of Venezuelans is not important to the mission,” she says. “I had an 11-year-old die in my arms when I was trying to put him on a breathing apparatus that was not working.”

    “Medicines arrived from Cuba out of date, so we had to destroy and bury them before including them in the inventory as used so they could be charged for. We would get our pay from soldiers, who were sometimes months late in coming, and would also take medicines from the hospital,” recalls Dr. Carlos.
    He says he signed up for the medical mission to improve his financial situation. Instead of getting around $20 a month in Cuba at that time, he started earning $300 in Brión, in Venezuela’s Miranda province, although he says that the Cuban government was paid more than 10 times that amount for each doctor on the Barrio Adentro programme.
    Dr. Carlos also made the move from a Brazilian mission to the US, where he is now rebuilding his life in Houston, working as a medical assistant.
    He is now unable to visit Cuba for fear of being imprisoned on the island for desertion. In 2018 he applied for a humanitarian visa to visit his mother who had cancer. It was denied, and he could not see her before she died. “That’s the way they play it, dangling permissions and gifts in front of you so people play ball. I soon realised our mission was more political than humanitarian.”

    The Cuban government is NOT humanitarian, it is NOT about helping the less fortunate in South America and on other continents. For Cuba it’s BUSINESS. It’s about money. It’s ALWAYS about MONEY.

    So remind me again, why is the Trump Administration against Cuban doctors forced “helping” in foreign countries?

    https://www.bbc.com/news/uk-48214513

    1. Thank you very much for the proof that communism is not as cushy as some people try to make it out to be. This just goes to show people that too much socialism, like free university education for doctors, costs money and unfortunately in Cuba’s case they are receiving funds in a dishonest manner.

      This free university education is not so free after all.

      1. Our country was a communist country for a long time. We had Russian tanks on almost every street corner and the Russian government told our government what to do, what not to do. It was terrible. They took all the land from the people, there was no private land any more, no private apartments, houses, everything belonged to the government. My grandparents went through minefield to try to escape from the nightmare country. Than when the Russians left socialism arrived. It was another nightmare. Just remember, nothing is free in life. If someone gets something for “free”, be sure that somebody else had to pay for it. And it is not the government. All those naive, ignorant people who are for communism and socialism, should live in China or Cuba for some years to see how it REALLY is. Because they have no idea whatsoever unless they live it.

        1. I have been a loud opponent of communism on this site because there are a few people here that feel communism socialism and dictatorship and authoritarianism are acceptable and often stick up for it. Of course the chances of them commenting on your proof and what truly do happens in these communist countries are slim.

            1. We/I am more interested in hearing a response to Chiconahui comment on the atrocities in Cuba rather than dodging the subject and nipping at my heels unnecessarily.

        2. I encourage you to keep posting comments on what the people that experience communism are truly experiencing as opposed to politician trying the sell socialism for votes. Most politicians selling socialism rarely tell the voters how these programs will be paid. Look at Venezuela; they sold socialism and now have no legal funds to pay for it. Look at Bolivia they use the illegal drug trade to fill their coffers.

          I’m all for socialism if there is a legal way to pay for it and by not robbing our paychecks and land to get it

            1. Dr Faulkner, I haven’t seen any comments from you on Cuenca High Life (disqus) or anywhere for over a month. I miss them! What’s going on with you? Are you ok?

    1. We are wondering why you have not commented on the PROOF given by Chiconahui about what it is truly like to live in a communist country. Since you often ask for PROOF here we are waiting breathlessly to hear HOW you will respond

        1. “ we” or “I” makes no dif.
          Just waiting for A response on the PROOF since you are always asking for proof.

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