[See also "Cuba: Reversing the medical `brain drain’ – the many faces of ELAM".]

By Nina Lakhani

Castro's doctors and nurses are the backbone of the fight against cholera

December 26, 2010 -- The Independent -- They are the real heroes of the Haitian earthquake disaster, the human catastrophe on America's doorstep which Barack Obama pledged a monumental US humanitarian mission to alleviate. Except these heroes are from [the United States'] arch-enemy Cuba, whose doctors and nurses have put US efforts to shame.

A medical brigade of 1200 Cubans is operating all over earthquake-torn and cholera-infected Haiti, as part of Fidel Castro's international medical mission which has won the socialist state many friends, but little international recognition.

* * * STOP PRESS: New Henry Reeve Brigade arrives in Haiti By Juan Diego Nusa Peñalver December 23, 2010 -- Granma International -- A new group of 60 Cuban health workers belonging to the Henry Reeve International Contingent of doctors specialising in situations of disaster and serious epidemics arrived December 23 in the Haitian capital Port-au-Prince, in order to join the Cuban Medical Brigade battling against the cholera epidemic in this Caribbean nation. The brigade now has a total of 1295 members: 515 doctors, 447 nurses, 244 technicians and 89 support personnel. Through December 23, the Cuban and Latin American volunteer health corps has saved the lives of more than 44,000 Haitians suffering from cholera, while reducing to 0.61% of the death rate of patients treated. The Ministry of Public Health of the Dominican Republic confirmed nine additional cases of cholera, raising the total of cholera patients in that country to 82. The United States has also reported cases of the infection.

Translated by Granma International. * * *

Observers of the Haiti earthquake could be forgiven for thinking international aid agencies were alone in tackling the devastation that killed 250,000 people and left nearly 1.5 million homeless. In fact, Cuban healthcare workers have been in Haiti since 1998, so when the earthquake struck the 350-strong team jumped into action. And amid the fanfare and publicity surrounding the arrival of help from the US and the UK, hundreds more Cuban doctors, nurses and therapists arrived with barely a mention. Most countries were gone within two months, again leaving the Cubans and Médecins Sans Frontières as the principal healthcare providers for the impoverished Caribbean island.

Figures released last week show that Cuban medical personnel, working in 40 centres across Haiti, have treated more than 30,000 cholera patients since October. They are the largest foreign contingent, treating around 40 per cent of all cholera patients. Another batch of medics from the Cuban Henry Reeve Brigade, a disaster and emergency specialist team, arrived recently as it became clear that Haiti was struggling to cope with the epidemic that has already killed hundreds.

Since 1998, Cuba has trained 550 Haitian doctors for free at the Escuela Latinoamericana de Medicina en Cuba (ELAM), one of the country's most radical medical ventures. Another 400 are currently being trained at the school, which offers free education – including free books and a little spending money – to anyone sufficiently qualified who cannot afford to study medicine in their own country.

John Kirk is a professor of Latin American studies at Dalhousie University in Canada who researches Cuba's international medical teams. He said: "Cuba's contribution in Haiti is like the world's greatest secret. They are barely mentioned, even though they are doing much of the heavy lifting."

This tradition can be traced back to 1960, when Cuba sent a handful of doctors to Chile, hit by a powerful earthquake, followed by a team of 50 to Algeria in 1963. This was four years after the revolution, which saw nearly half the country's 7000 doctors voting with their feet and leaving for the US.

The travelling doctors have served as an extremely useful arm of the government's foreign and economic policy, winning them friends and favours across the globe. The best-known program is Operation Miracle, which began with ophthalmologists treating cataract sufferers in impoverished Venezuelan villages in exchange for oil. This initiative has restored the eyesight of 1.8 million people in 35 countries, including that of Mario Teran, the Bolivian sergeant who killed Che Guevara in 1967.

The Henry Reeve Brigade, rebuffed by the Americans after Hurricane Katrina, was the first team to arrive in Pakistan after the 2005 earthquake, and the last to leave six months later.

Cuba's constitution lays out an obligation to help the worst-off countries when possible, but international solidarity isn't the only reason, according to Professor Kirk. "It allows Cuban doctors, who are frightfully underpaid, to earn extra money abroad and learn about diseases and conditions they have only read about. It is also an obsession of Fidel's and it wins him votes in the UN."

A third of Cuba's 75,000 doctors, along with 10,000 other health workers, are currently working in 77 poor countries, including El Salvador, Mali and East Timor. This still leaves one doctor for every 220 people at home, one of the highest ratios in the world, compared with one for every 370 in England.

Wherever they are invited, Cubans implement their prevention-focused holistic model, visiting families at home, proactively monitoring maternal and child health. This has produced "stunning results" in parts of El Salvador, Honduras and Guatemala, lowering infant and maternal mortality rates, reducing infectious diseases and leaving behind better trained local health workers, according to Professor Kirk's research.

Medical training in Cuba lasts six years – a year longer than in the UK – after which every graduate works as a family doctor for three years minimum. Working alongside a nurse, the family doctor looks after 150 to 200 families in the community in which they live.

This model has helped Cuba to achieve some of the world's most enviable health improvements, despite spending only $400 (£260) per person last year compared with $3000 (£1950) in the UK and $7500 (£4900) in the US, according to Organisation for Economic Co-operation and Development figures.

Infant mortality rates, one of the most reliable measures of a nation's healthcare, are 4.8 per 1000 live births – comparable with Britain and lower than the US. Only 5 per cent of babies are born with a low birth weight, a crucial factor in long-term health, and maternal mortality is the lowest in Latin America, World Health Organisation figures show. Cuba's polyclinics, open 24 hours a day for emergencies and specialist care, are a step up from the family doctors. Each provides for 15,000 to 35,000 patients via a group of full-time consultants as well as visiting doctors, ensuring that most medical care is provided in the community.

Imti Choonara, a paediatrician from Derby, leads a delegation of international health professionals at annual workshops in Cuba's third city, Camaguey. "Healthcare in Cuba is phenomenal, and the key is the family doctor, who is much more proactive, and whose focus is on prevention ... The irony is that Cubans came to the UK after the revolution to see how the NHS worked. They took back what they saw, refined it and developed it further; meanwhile we are moving towards the US model", Professor Choonara said.

Politics, inevitably, penetrates many aspects of Cuban healthcare. Every year hospitals produce a list of drugs and equipment they have been unable to access because of the US embargo which prevents many US companies from trading with Cuba, and persuades other countries to follow suit. The 2009/10 report includes drugs for childhood cancers, HIV and arthritis, some anaesthetics, as well as chemicals needed to diagnose infections and store organs. Pharmacies in Cuba are characterised by long queues and sparsely stacked shelves, though in part this is because they stock only generic brands.

Antonio Fernandez, from the Ministry of Public Health, said: "We make 80 per cent of the drugs we use. The rest we import from China, former Soviet countries, Europe – anyone who will sell to us – but this makes it very expensive because of the distances."

On the whole, Cubans are immensely proud and supportive of their contribution in Haiti and other poor countries, delighted to be punching above their weight on the international scene. However, some people complain of longer waits to see their doctor because so many are working abroad. And, like all commodities in Cuba, medicines are available on the black market for those willing to risk large fines if caught buying or selling.

International travel is beyond the reach of most Cubans, but qualified nurses and doctors are among those forbidden from leaving the country for five years after graduation, unless as part of an official medical team.

Like everyone else, health professionals earn paltry salaries of around $20 (£13) a month. So, contrary to official accounts, bribery exists in the hospital system, which means some doctors, and even hospitals, are off-limits unless patients can offer a little something, maybe lunch or a few pesos, for preferential treatment.

Cuba's international ventures in healthcare are becoming increasingly strategic. Last month, officials held talks with Brazil about developing Haiti's public health system, which Brazil and Venezuela have both agreed to help finance.

Medical training is another example. There are currently 8281 students from more than 30 countries enrolled at ELAM, which last month celebrated its 11th anniversary. The government hopes to inculcate a sense of social responsibly into the students in the hope that they will work within their own poor communities for at least five years.

Damien Joel Suarez, 27, a second-year student from New Jersey, is one of 171 US students; 47 have already graduated. He dismisses allegations that ELAM is part of the Cuban propaganda machine. "Of course, Che is a hero here but he isn't forced down your neck."

Another 49,000 students are enrolled in the El Nuevo Programa de Formacion de Medicos Latinoamericanos, the brainchild of Fidel Castro and Hugo Chavez, who pledged in 2005 to train 100,000 doctors for the continent. The course is much more hands on, and critics question the quality of the training.

Professor Kirk disagrees: "The hi-tech approach to health needed in London and Toronto is irrelevant for millions of people in the Third World who are living in poverty. It is easy to stand on the sidelines and criticise the quality, but if you were living somewhere with no doctors, then you'd be happy to get anyone."

There are nine million Haitians who would probably agree.

[This article first appeared in the mainstream British daily, The Independent. It is reposted non-commercially here in the interests of education and discussion.]

Cuba meets its commitments and Haiti responds

By Juan Diego Nusa Peñalver

December 21, 2010 -- Granma International -- With the recent arrival in Haiti’s capital, Port-au-Prince, of a group of 75 Cuban volunteer health workers, Cuba has more than fulfilled its commitment to send additional health personnel to confront the serious cholera epidemic which this neighbouring Caribbean nation is suffering.

More than 114,000 Haitians, almost all of them from the poorest social sectors of the country, have been infected with this disease.

With this new group, the Cuban government almost immediately met its commitment to the Haitian authorities, announced by Comandante Fidel Castro in his November 27 "Haiti Reflection: underdevelopment and genocide", to reinforce the Cuban Medical Brigade (BMC) with 300 new doctors, nurses and health technicians.

The BMC now numbers 1235 members: 501 physicians, 404 nurses, 244 technicians and 86 support staff. This whole solidarity contingent is linked in one way or another to battling Haiti’s cholera epidemic, which is continuing to spread throughout this nation, particularly in areas with extremely poor sanitary and environmental conditions.

In a statement to Granma, Lorenzo Somarriba López, Cuban deputy minister of health and general coordinator of the BMC, explained that the recent arrivals are to be assigned to complete the staffing of 14 cholera treatment centers provided by the BMC, located throughout Haiti’s rugged terrain.

Dr Somarriba added that this reinforcement will make it possible to fully staff 40 active research groups (GPA) initially anticipated to move, with their backpacks, to 207 rural and mountainous sub-communes of difficult access and lacking adequate medical services, where cholera is creating creates unforeseen ravages and bringing mourning and fear to Haitian families.

In a few days the 32 organized GPA’s have made a study of more than 106,000 people in those remote rural areas and have treated 657 Haitians, who would have died from the disease if they had not received timely medical help.

Moreover, these small mobile groups of no more than five brigade members, including a Haitian doctor graduated from Havana’s Latin American School of Medicine (ELAM), are undertaking important preventive-educational work among the local people, and distributing oral rehydration salts and chlorine to make water safe for human consumption. The Cuban volunteers are also working in the 40 cholera treatment units.

Without any doubt, the congratulations transmitted by Esteban Lazo, member of the political bureau of the Communist Party, came as an added stimulus to the labours of the BMC, whose members have saved the lives of more than 41,000 Haitians suffering from cholera, maintaining a low death rate which has remained at 0.75%.

That spirit of solidarity of the Cuban health volunteers was present in the words Arelys Nápoles Medina, a recently arrived nurse from Holguín, who reiterated the disposition of this troop of Fidel to be the last to leave and to never surrender to an epidemic which is striking at the heart of this nation. Cuba is meeting its commitment and Haiti is responding.