Cuba's health diplomacy in the age of Ebola By Eduardo J Gomez

King's College, London Published duration 14 November 2014

image copyright AFP image caption The first team of Cuban health workers arrived in Sierra Leone in early October

Amid the worst Ebola outbreak of our time, it has been the small island nation of Cuba that has provided arguably the most impressive policy response.

Instead of offering financial assistance to those West African nations most in need, the Cuban government has focused on providing skilled healthcare workers passionate about helping Ebola victims.

The Cuban response is based on a combination of pre-existing government commitments to the provision of universal healthcare, the establishment of a medical education system emphasizing service to others, and Cuba's efforts to bolster its international reputation.

Health diplomacy

Cuba's government has a long history of providing universal healthcare as a human right, a belief that was enshrined in the 1976 constitution.

image copyright Getty Images image caption Cuban doctors were dispatched to Haiti following the 2010 quake and helped fight the cholera outbreak there

image copyright Getty Images image caption Cuban doctors have been sent to Brazil to provide healthcare in remote rural areas with little medical care

Consequently, it has always been committed to helping other nations in need, extending the government's policy beliefs beyond its borders.

These efforts were partly inspired by Ernesto Che Guevara, the Argentine-born doctor who fought alongside Fidel Castro during the Cuban revolution.

Che Guevara repeatedly encouraged doctors to use their medical skills in the service of others.

Cuba's international reputation

Cuba has been run by the Communist Party since the 1959 overthrow of the US-backed regime of Fulgencio Batista

The revolution, led by Fidel Castro and Che Guevara, still shapes to a large extent how the Cuban government is seen abroad

Left-wing activists praise its ability to withstand pressure from the United States, which has maintained a trade embargo against the island since 1960

According to the World Bank, Cuba has the best education system in Latin America and the Caribbean

2010 WHO figures suggest Cuba's doctor-to-patient ratio was among the top three in the world

Many governments and non-governmental organisations have raised concerns over Cuba's human rights situation, criticising the jailing of government critics

Human Rights Watch says it is "the only country in Latin America that represses virtually all forms of political dissent"

Its Communist Party leadership and its president, Raul Castro, remain in firm control of the country

Its current parliament was elected in 2013, in a poll which saw 612 pre-approved candidates stand unopposed for its 612 seats

These beliefs were first put into practice during the 1960s, beginning with the provision of medical aid to Chile in response to its May 1960 earthquake.

In the 1970s and 80s, Cuba offered medical assistance to warn-torn South Africa, Algeria, Zaire, Congo, and Ghana.

More recently, Cuban doctors travelled to Sri Lanka following the 2004 tsunami.

They also treated victims of the 2005 earthquake in Pakistan and the 2010 quake which devastated much of Haiti.

Last year, Cuba sent 4,000 doctors to Brazil alone in order to help provide healthcare in remote rural areas.

image copyright Getty Images image caption Cuban doctors have helped establish universal healthcare systems in Bolivia and Venezuela

At present, more than 50,000 Cuban medical personnel are working in over 66 countries.

'To serve'

Cuba's medical students have always been taught that it is their duty to serve others.

image copyright AP

An inscription by Fidel Castro emblazoned on a wall of Cuba's most prestigious medical school, the Escuela Latinoamericana de Medicina, sums up this ethos,

"This will be a battle of solidarity against selfishness," it reads.

Thus even prior to their arrival in West Africa, Cuba's healthcare workers believed that it was their duty to sacrifice themselves in the service of others, viewing themselves as true public servants, gladly volunteering and risking their lives to fight a virus that they had no experience of working with.

"We know that we are fighting against something that we don't totally understand … But it is our duty. That's how we've been educated," Leonardo Fernandez, a 63-year-old doctor told Reuters news agency before departing Cuba for Liberia.

image copyright Reuters image caption Leonardo Fernandez told Reuters he felt it was "his duty" to fight Ebola in Africa

Cuba's geopolitical strategy

Cuba has also viewed its involvement in West Africa as an opportunity to bolster its international reputation as a nation capable and committed to helping others.

And the government's strategy appears to have paid off.

World Health Organisation (WHO) Director-General Margaret Chen recently applauded Cuba's efforts, stating that she was "extremely grateful for the generosity of the Cuban government and these health professionals for doing their part to help us contain the worst Ebola outbreak ever known".

image copyright Reuters image caption Margaret Chen has praised the Cubans for their role in fighting the Ebola outbreak

WHO's Director of Epidemiology Sylvia Brian and the United Nation's Ebola chief, David Nabarro, also praised Cuba's quick response.

Various international humanitarian organisations have also expressed their thanks and support, in turn strengthening Cuba's international reputation.

Cuba also sees the Ebola outbreak as an opportunity to establish a stronger partnership with the United States.

Writing in Cuba's state newspaper Granma, Fidel Castro recently stated that he would be glad to work with the US in containing the epidemic, setting aside the two countries' political differences in order to help Ebola-affected countries.

While the US has not formally agreed to work with Cuba, US Secretary of State John Kerry praised Havana for its efforts in West Africa.

The US Ambassador to the UN, Samantha Power, echoed his sentiments, saying that she was "very grateful" to Cuba for its response.

Big lessons

Cuba's international reputation has in large part stemmed from its efforts to provide much needed human resources in response to Ebola.

image copyright Reuters image caption Cuba hosted an extraordinary summit on Ebola of the left-of-centre Alba group in October

The island nation has so far provided the largest number of healthcare workers in the fight against Ebola: a total of 256, including doctors, nurses, surgeons and paediatricians, with another 200 expected to arrive shortly.

While the US has provided 3,000 military troops, none of them provide medical assistance, instead mainly focussing on constructing Ebola Treatment Units.

Apart from providing treatment, Cuba's medical workers also help to locate Ebola victims and guide them towards clinics.

By providing constant reassurance of good treatment and care, Cuba's volunteers play a key part in helping Ebola victims overcome their fears of seeking medical treatment.

This passion for locating, encouraging, and treating patients reflects Cuban health workers' unwavering belief in behaving in a selfless manner, treating patients with warmth, dignity, and respect.

In this respect, little Cuba provides big lessons for other nations.

While providing financial support is important, providing quality healthcare workers with a passion for helping others is equally - if not more - important for helping West Africa eradicate Ebola.

Governments that have been ideologically committed to working closely with patients and ensuring universal access treatment in the past should strive to mimic Cuba's efforts, in turn establishing their reputation as caring, peaceful partners in the global fight against disease.