In 1965, Cuba had one physician for every 1,200 people, a dire condition made worse by the exodus of middle-class professionals out of Cuba in the wake of the revolution. 40 years later in 2005, however, Cuba boasted one physician for every 167 people — a number unparalleled anywhere else in the world. In 2015, it became the first country in the world to eliminate the mother-to-child transmission of HIV and syphilis.
Astonishingly, the island infant mortality rate in 2017-18 was just one in four per 1000 live births, compared to 5.9 in the United States and 10 times lower than in Haiti, its closest neighbor. “According to the 2019 Ministry of Public Health Statistical Yearbook, Cuba has 479,623 health workers, accounting for 6.6 percent of the workforce, and 71.2 percent of them are women” (Oram, 2021).
Cuba has achieved what seems like an impossibility for most Global South nations. Cuba’s health care is good enough to rival most Western nations, but never mind other islands in the Caribbean or countries in Latin America, which are its most appropriate comparisons. In this article, I hope to demonstrate the success of the former slave colony both domestically, and as a member and ally of the global Black and Brown world, in the realms of healthcare, education, and training.
“True radical ideals do not simply end with us meeting our own needs”
It’s no wonder that WHO (World Health Organisation) put Cuba’s health indicators, such as life expectancy and infant mortality in line with the US and Canada.
As impressive as its domestic achievements are, they are still on the state level and have little to do with radicalism and internationalism. However, what’s truly special about Cuba is their attitude and relationship on the international scale, where they have very little to gain. After all, true radical ideals do not simply end with us meeting our own needs.
“By the Ebola outbreak in 2014, Cuban medical professionals had performed 1.2 billion consultations overseas, attended 2.2 million births, and performed over 8 million surgeries. More than 4,000 Cuban medical professionals, over half of them doctors, were already working in 39 Afri[k]an countries since the early 1960s […] in revolutionary Cuba, around one in 10 Cubans have been on an internationalist mission (YAFFE, 2020, p. 150).”
Two recent examples include the major Ebola outbreak in Guinea and the 2010 earthquake in Haiti.
In March 2014, WHO reported a major Ebola outbreak in Guinea, it quickly spread to Liberia and Sierra Leone. When WHO called for international assistance, rich countries quickly donated money, supplies, and even military personnel, but not urgently needed medics. WHO director Margaret Chan in September stated “human resources are clearly our most important need.”
Cuba was the first country to respond to WHO’s appeals. A general call for medical volunteers attracted over 10,000 people. The initial mortality rates were 50%, horrifically high for even hardened professionals. Cuban medics were, however, able to quickly reduce the mortality rate of patients in their care to 20%. By January 2015, Cuba had helped to train over 13,000 people to deal with Ebola in 28 countries across the continent.
The 2010 earthquake in Haiti was one of the worst natural disasters thus far in the 21st century, made all the worse by international politics and neo-colonialism, which has left Haiti the poorest country in the Western Hemisphere.
Before the earthquake, 86% of Port-au-Prince’s population lived in slums, half had access to latrines, and only 1/3 had access to potable water. When the earthquake hit it killed 230,000 people, injuring another quarter of a million, it left 1.5 million people (15% ) of Haiti’s population homeless.
The US government’s immediate response was not to send medics, but 22,000 military personnel, both callous and completely predictable given the role of Western imperialism in making Haiti so poor. Cuba by contrast has played a very different role in Haiti’s recent history.
By 2004, on the eve of the Western coup d’etat which removed democratically elected president John Bertrand Aristide, 578 Cubans were responsible for the health of around 75% of the Haitian population.
Within 24 hours of the earthquake, the famed Henry Reeve contingent began to arrive. By April 1 of that same year, an additional 748 professionals had arrived, plus 481 Haitian graduates from ELAM and 278 graduates from 28 other countries.
In 2014 Cuba had 50,000 healthcare workers spread across 65 countries. To put this into perspective that’s more than the Red Cross, UNICEF, and Doctors Without Borders combined.
Unfortunately, the key factor of this approach is that it does not tackle the root of the problems that cause global South nations to have so few doctors and such poor healthcare. One way Cubans try to avoid this pitfall is by training local personnel who can then build sustainable indigenous health systems. This is a key principle of Cuban medical internationalism, it should never foster dependence on Cuban professionals.
“Cuba has offered free – that is, the cost is borne by the Cuban
Akala, Natives: Race and Class in the Ruins of Empire, 2018
people -medical scholarships to thousands of students from across the world on
the condition that they return and serve the poor in their own countries”
They quickly discovered however that many global South nations lacked the infrastructure, schools, and universities to train people. Castro decided instead to train people on the island. This led to the set up of the Institute of Tropical Medicine Pedro Kourí (Pedro Kourí Institute (IPK)). In the 1980s at least 10,000 foreign students, the majority of whom were Afrikans were educated in the country, and they paid nothing! By 1991 more than 3500 medical students had graduated.
Later in 1998, Cuban doctors responded to a hurricane in Central America. It quickly became clear to them that the countries were going to be in the same desperate position as before they arrived. The recipient governments, despite many of them not having diplomatic relations with Cuba, asked them to establish comprehensive health programs. Within weeks plans were announced to open the Latin American School of Medicine (Escuela Latinoamericana de Medicina (ELAM)) to help train urgently needed medical personnel in the region. At its inauguration in 1999, there were almost 2000 students from 18 countries getting free tuition, and by 2019, 29,000 doctors from 105 countries had graduated. Remarkably, half of them were women, and three-quarters were children from lower-class backgrounds. In 2017, this included 70 Americans (despite the ongoing embargo).
Akala writes (and citing from his book Natives: Race and Class in the Ruins of Empire extensively throughout this piece), “Cuba has offered free—that is, the cost is borne by the Cuban people—medical scholarships to thousands of students from across the world on the condition that they return and serve the poor of their own countries.” To anybody who cares about global justice, human life, and human rights, Cuban medical internationalism is without a doubt one of the greatest humanitarian enterprises of the 21st century. Cuba does not demand that Jamaica or Haiti or Liberia sell off their water systems, incur crippling debt, or elect communist leaders that Cuba approves of in exchange for this help, the Cuban people elect to do this work out of genuine revolutionary solidarity with other, overwhelmingly poor Black and Brown people in the global South.” (Akala, 2021., p. 223)