Steve Brouwer, Revolutionary Doctors: How Venezuela and Cuba are Changing the World’s Conception of Health Care

Monthly Review Press, New York, 2011. 256pp., $18.95 / £15.00 pb, ISBN 9781583672396

Reviewed by Syd Shall

About the reviewer: Syd Shall trained and worked as a medical doctor in Africa. He is now retired.

This book describes a new approach to medical education and practice that was originally developed in Cuba. This novel, Marxist approach to a worldwide problem is a striking example of the inventiveness of the Cubans to the development of socialism in their country.

Socialists say that they want to replace the contemporary system of political economy, based on the profit motive, by one in which production and exchange are predicated on the necessary and sensible needs of the population. But a critical question is: how do we get from a capitalist system to a socialist system? This book describes relevant, empirical data derived from the Cuban experience of health assistance to their South American neighbours. In particular, it addresses two key questions.

Firstly, is prior political power necessary for a serious advance to socialism? Secondly, how does one set about changing the attitudes of people? The challenge here is that we start with a population submerged in obscurantism and hostility to science. The people need to embrace science, the search for truth, and cooperation instead of competition. This book describes the author’s close observation of the implementation of this new approach to public health in a collaboration between the government and people of rural Venezuela, and Cuban medical volunteers. This type of collaboration was field-tested in Venezuela, and is being extended to Bolivia, Nicaragua and Haiti, as well as to several countries in Africa.

The author is a journalist who tells us that he has been a socialist all his adult life. He is clearly very impressed by his experience with the Cuban-Venezuelan health collaboration but he also describes the difficulties and shortcomings of the programme. He attributes the origins of the new view of medical education and practice to an initiative of Dr Che Guevara soon after the overthrow of the dictatorial regime in Cuba. Although Guevara was primarily a revolutionary he was always informed by his background as a medical doctor and gave considerable thought to the best way to solve the widespread and devastating public health problems of South America, particularly those that faced the new Cuban government in 1959. With much trial and error, and careful evaluation, it eventually arrived at a viable plan. This was adopted very quickly as a key weapon in the defence of Cuban socialism.

Castro and his colleagues decided that educational and health assistance to other countries, especially sympathetic South American countries, could contribute significantly to the defence of the new Cuban socialist state. As Cuba was driven more and more to socialism, partly forced by the profound hostility of the United States, it needed all the support it could muster. Initially, the Cubans concentrated on educational assistance but they soon realised that medical assistance to poor countries could be very valuable too. Fundamental to this approach is the recognition, sadly inadequate in other states that previously aspired to build socialism, that international collaboration and mutual support are the bedrock of a successful attempt to do this in the face of capitalist aggression. Castro and his colleagues set about training as many educators and teachers as they could, despite the very difficult situation in which Cuba found itself. Cuba now has the prestige of providing the world with what may be the most efficacious method for combating illiteracy in poor countries. Its literacy system is widely employed, and not only by those sympathetic to the Cuban social system. Because they appreciated the political value of this success, the Cubans decided to extend this approach to tackling the problems of public health. These have proved intractable in all capitalist systems; for there never has been a capitalist state, rich or poor, that has provided adequate health care for its population. The same may be noted regarding housing, education, care of the disabled or of those past working age. The best that any capitalist system has achieved was the National Health Service created in Britain after the Second World War, but which has been systematically dismantled by successive administrations since then.

The middle section of this book describes in graphic detail the evolution of the Cuban plan for better public health for the poorest parts of South America. This has had mixed results, which provides important lessons about what is needed to develop a society based on socialist principles….

Read the entire review in Marx & Philosophy Review of Books