Even in death, Fidel Castro remains a divisive figure. Fearless revolutionary and defender of the poor to some, tyrannical dictator to others, the legacy of his five decades of rule for Cuba will doubtless be contested for many years to come. For the wider world, there is a less controversial aspect of Castro’s legacy that has been largely overlooked. As well as bringing free healthcare to his countrymen, he presided over a “Medical Internationalism” programme that exported medical aid to 158 countries and continues to provide more medical personnel to the developing world than all of the G7 countries combined.
As of March this year, some 55,000 Cuban medical personnel were serving in 67 countries, according to Cuban government figures. About half of them are in Venezuela, a political ally currently suffering severe shortages of medical staff and supplies. The rest are serving throughout Africa, Latin America, and the Caribbean. For a country of 11 million – that is a remarkable record.
Castro sent Cuba’s first medical mission to Chile in 1960 following an earthquake there. Since then, the Comprehensive Health Programme (PIS is the Spanish acronym) has provided basic medical coverage to scores of developing countries. Through the Latin American School (ELAM), which Castro founded in 1999, 25,000 doctors from 80 countries have been trained – free of charge for those students from developing countries. Cuba has also provided training to an additional 20,000 physicians in Venezuela.
Meanwhile, Operación Milagro (Operation Miracle) has provided free eye surgery to 3.9 million people in 34 countries, mainly in Latin America and the Caribbean, and the Henry Reeve Brigade (named after an American who fought in Cuba’s first war for independence) has sent medics to respond to natural disasters and disease outbreaks in dozens of countries. In 2014, Cuba selected 256 out of 15,000 medics who volunteered their services to respond to the outbreak of Ebola in West Africa. They joined Cuban PIS personnel already stationed there.
After Fidel Castro handed over power to his brother Raúl in 2008, Cuba’s medical aid programmes continued, but in an effort to revive the country’s ailing economy, the government started to view the delivery of medical services to other countries as an opportunity to generate revenue.
Cuba has nearly 90,000 physicians and the best patient-doctor ratio in the world. In 2011, following lengthy discussions about how to improve economic conditions, the Cuban government decided to start prioritising the exports of goods and medical services. As a result, almost a quarter of Cuban physicians are now working abroad – most in developing countries.
In many countries, particularly in sub-Saharan Africa, Cuba still provides medical assistance at a nominal charge. But Cuba also sends medical personnel to wealthier countries that have a greater ability to pay, such as Saudi Arabia and Qatar. In such countries, Cuba charges a fee that is still considerably lower than the international rate.
In Brazil, after the government failed to find local doctors to fill 15,500 vacant positions in the impoverished northeast of the country, the Pan American Health Organization (PAHO) put out an international call and almost 11,000 Cubans were selected. Each physician receives a salary of about $1,200 dollars a month, while the Cuban government receives $3,000 per month.
The exportation of professional services – mainly medical services – now provides roughly $8 billion to Cuba’s economy, twice the amount generated by tourism. Medical tourism to Cuba is also growing, as is the manufacture and export of medicines, mainly to developing countries.
In recent years, Cuba has continued its wide-ranging medical internationalism programme, inspired by Fidel but tempered with Raúl’s pragmatism. The Comprehensive Health Programme remains as active as ever throughout sub-Saharan Africa and Latin America. Operación Milagro is still functioning throughout Latin America and the Caribbean, although there are concerns that it might be reduced in light of declining funds from Venezuela. ELAM still does not charge students from poor backgrounds, although it does request payment from those who can afford to pay for the six years of medical training.
In the last couple of years alone, the Henry Reeve Brigade, now several thousand strong, has sent medical staff to respond to earthquakes in Nepal and Ecuador, flooding in Mexico, a dengue outbreak in El Salvador and the recent hurricane in Haiti.
It is the task of historians to weigh up Fidel Castro’s legacy, but his policy of medical internationalim saved many lives and will not end with his death. The basic humanitarian commitment to share Cuba’s wealth of medical expertise remains – and will endure for the foreseeable future. The world badly needs it.
(TOP PHOTO: A Cuban ophthalmologist, with Operation Miracle, examines a Guatemalan patient. John Kirk/IRIN)