Some 14,000 Cuban doctors now give free treatment to Venezuela’s poor and 3,000 Cuban medical staff worked in the aftermath of last year’s Kashmir earthquake. Cuba has plans to heal those poorer than itself.

When Hurricane Katrina ripped through the southern United States in August 2005, the authorities were overwhelmed and the governor of Louisiana, Kathleen Babineaux Blanco, appealed to the international community for emergency medical aid. The Cuban government immediately offered assistance to New Orleans and to the states of Mississippi and Alabama, also affected by the storm, and promised that within 48 hours 1,600 doctors, trained to deal with such catastrophes, would arrive with all the necessary equipment plus 36 tonnes of medical supplies. This offer, and another made directly to President George Bush, went unanswered. In the catastrophe at least 1,800 people, most of them poor, died for lack of aid and treatment.

In October 2005, the Kashmir region of Pakistan experienced one of the most violent earthquakes in its history, with terrible consequences in the poorest and most isolated areas to the north. On 15 October an advance party of 200 emergency doctors arrived from Cuba with several tonnes of equipment. A few days later, Havana sent the necessary materials to erect and equip 30 field hospitals in mountain areas, most of which had never been previously visited by a doctor. Local people learned of Cuba’s existence for the first time.

To avoid causing offence in this predominantly Muslim country, the women on the Cuban team, who represented 44% of some 3,000 medical staff sent to Pakistan in the next six months, dressed appropriately and wore headscarves. Good will was quickly established; many Pakistanis even allowed their wives and daughters to be treated by male doctors.

By the end of April 2006, shortly before their departure, the Cubans had treated 1.5 million patients, mostly women, and performed 13,000 surgical operations. Only a few severely injured patients had to be flown to Havana. Pakistan’s President Pervez Musharraf, an important ally of the US and friend of Bush, officially thanked the Cuban authorities and acknowledged that this small nation in the Caribbean had sent more disaster aid than any other country.

First medical brigade

Cuba set up its first international medical brigade in 1963 and dispatched its 58 doctors and health workers to newly independent Algeria. In 1998 the Cuban government began to create the machinery to send large-scale medical assistance to poor populations affected by natural disasters. After hurricanes George and Mitch blew through Central America and the Caribbean, it offered its medical personnel as part of an integrated health programme. The Dominican Republic, Honduras, Guatemala, Nicaragua, Haiti and Belize all accepted this aid.

Cuba offered massive medical assistance to Haiti, where healthcare was chronically inadequate. In 1998 Cuba even approached France, Haiti’s former colonial power, with a proposal to establish a humanitarian association to help the people of Haiti. The French government did not respond (although, finally, in 2004, it sent troops). Since 1998 Cuba has sent 2,500 doctors and as much medicine as its fragile economy permits.

This free aid - the Cuban government funds the personnel - has been effective. The willingness of the new barefoot doctors (1) to intervene in areas where their local equivalents refuse to go, because of the poverty of the clientele or the danger or difficulty of access, has persuaded other countries, especially in Africa, to apply for assistance.

Between 1963 and 2005 more than 100,000 doctors and health workers intervened in 97 countries, mostly in Africa and Latin America (2) By March 2006, 25,000 Cuban professionals were working in 68 nations. This is more than even the World Health Organisation can deploy, while Médecins Sans Frontières sent only 2,040 doctors and nurses abroad in 2003, and 2,290 in 2004 (3).

The most seriously ill patients are often brought to Cuba for treatment. Over the decades these have included Vietnamese Kim Phuc, the little girl shown in the famous war photograph running naked along a road, her skin burned by US napalm. Cuba also took in some 19,000 adults and children from the three Soviet republics most affected by the Chernobyl nuclear accident of 1986.

In June 2001 the United Nations General Assembly met in special session to discuss Aids. Cuba, with an HIV infection rate of 0.09% compared with 0.6% in the US, made an offer of “doctors, teachers, psychologists, and other specialists needed to assess and collaborate with the campaigns to prevent Aids and other illnesses; diagnostic equipment and kits necessary for the basic prevention programmes and retrovirus treatment for 30,000 patients”.

If this offer had been accepted, “all it would take is for the international community to provide the raw materials for the medicines, the equipment and material resources for these products and services. Cuba will not charge and will pay the salaries in its national currency” (4).

The offer was rejected. But eight African and six Latin American countries did benefit from an educational HIV/Aids intervention project which broadcast radio and television programmes, treated more than 200,000 patients and trained more than half a million health workers.

There are currently some 14,000 Cuban doctors working in poor areas of Venezuela. The two governments have also set up Operation Milagro (miracle) which, during the first 10 months of 2005, gave free treatment to restore the eyesight of almost 80,000 Venezuelans, transferring those suffering from cataracts and glaucoma to Cuba for operations (5). More widely, the project offers help to anyone in Latin America or the Caribbean affected by blindness or other eye problems. Venezuela provides the funding; Cuba supplies the specialists, the surgical equipment and the infrastructure to care for patients during their treatment in Cuba.

So far no other government, private body or international organisation has managed to put together a global medical programme on such a scale or to offer such a level of assistance to those in need of care. Operation Milagro’s goal is to operate on the eyes of a million people every year.

A few hours before he took up office as president of Bolivia in December 2005, Evo Morales signed his first international treaty, which was with Cuba, setting up a joint unit to offer free ophthalmological treatment. As well as the national institute of ophthalmology in La Paz, recently equipped by Cuba, there will be medical centres in the cities of Cochabamba and Santa Cruz. Young Bolivian graduates from the Latin American School of Medicine (ELAM) will take part in the programme.

ELAM was founded in 1998, just as Cuba began to send doctors to the Caribbean and Central America. It operates from a former naval base in a suburb of Havana and trains young people of poor families from throughout the Americas, including the US. There are also hundreds of African, Arab, Asian and European students. Cuba’s 21 medical faculties all participate in training. In July 2005 the first 1,610 Latin American students graduated. Each year some 2,000 young people enroll at the school, where they receive free training, food, accommodation and equipment in return for a commitment to go back home and treat their compatriots (6).

Really doctors?

Ideological considerations have inspired the medical and ophthalmologic associations of some countries to launch a campaign against this initiative. The review of the Argentine council of ophthalmology, for example, questioned whether the Cuban ophthalmologists really were doctors and announced that it was taking steps, along with humanitarian NGOs, to fund a similar programme (7).

There was the same reaction in 1998 in Nicaragua, where, despite the severity of the catastrophe caused by hurricane Mitch, President Arnoldo Alemán refused to admit Cuban doctors. Similar reactions have been seen in Venezuela since 2002 and now in Bolivia. Conservative doctors, who prefer to specialise in diseases of the credit-worthy and refuse to enter shantytowns, accuse Cuba’s barefoot doctors of incompetence, illegal medical practice and unfair competition.

In April 2005 the legal authorities in the Brazilian state of Tocantins ordered out 96 Cuban doctors who had been treating the poor. The state governor disagreed, but could do no more than “recognise the professional bravery of the doctors who were welcome here and whom we wish to thank”.

The medical associations are afraid that if the Cuban medics bring down prices or even offer some services free, medical treatment will cease to be a profitable, elitist service. As each new doctor graduates in Cuba, they intensify their protests and political pressure.

There is also a threat that diplomas obtained in Cuba will not be recognised elsewhere. Excessive charges in Chile have prevented many Cuban-trained doctors from validating their medical qualifications there. But, as the BBC has pointed out, if Latin America’s medical associations persist in their opposition they risk losing the support of populations deprived of access to health services, for whom the project is a glimmer of light in the darkness (8). In the US, where 45 million people have no health cover and medical studies cost about $300,000, a blockade forbids students to study in Cuba, threatening up to 10 years’ imprisonment and fines of up to $200,000.

Sceptics see the humanitarian aid offered by Cuba as a publicity stunt, an investment to secure diplomatic support in the face of continuing US hostility. They point out that when the UN Human Rights Council was established in March 2006, Cuba was elected with the support of 96 of the 191 UN member states, whereas Nicaragua, Peru and Venezuela, where political opposition is legal, as it is not in Cuba, were rejected.

But a western diplomat was prepared to recognise that Cuba’s policy of exporting doctors was an initiative which benefited so many people that it should be applauded even by its political enemies (9).