Tag Archives: Medical System

CUBA’S EXTRAORDINARY GLOBAL MEDICAL RECORD SHAMES THE US BLOCKADE; From Ebola to earthquakes, Havana’s doctors have saved millions. Obama must lift this embargo.

cuba ebola B Seumas Milne, The Guardian, Wednesday 3 December 2014 20.07 GMT

Original article here: CUBA’S GLOBAL MEDICAL RECORD

Four months into the internationally declared Ebola emergency that has devastated west Africa, Cuba leads the world in direct medical support to fight the epidemic. The US and Britain have sent thousands of troops and, along with other countries, promised aid – most of which has yet to materialise. But, as the World Health Organisation has insisted, what’s most urgently needed are health workers. The Caribbean island, with a population of just 11m and official per capita income of $6,000 (£3,824), answered that call before it was made. It was first on the Ebola frontline and has sent the largest contingent of doctors and nurses – 256 are already in the field, with another 200 volunteers on their way.

While western media interest has faded with the receding threat of global infection, hundreds of British health service workers have volunteered to join them. The first 30 arrived in Sierra Leone last week, while troops have been building clinics. But the Cuban doctors have been on the ground in force since October and are there for the long haul.

The need could not be greater. More than 6,000 people have already died. So shaming has the Cuban operation been that British and US politicians have felt obliged to offer congratulations. John Kerry described the contribution of the state the US has been trying to overthrow for half a century “impressive”. The first Cuban doctor to contract Ebola has been treated by British medics, and US officials promised they would “collaborate” with Cuba to fight Ebola.

But it’s not the first time that Cuba has provided the lion’s share of medical relief following a humanitarian disaster. Four years ago, after the devastating earthquake in impoverished Haiti, Cuba sent the largest medical contingent and cared for 40% of the victims. In the aftermath of the Kashmir earthquake of 2005, Cuba sent 2,400 medical workers to Pakistan and treated more than 70% of those affected; they also left behind 32 field hospitals and donated a thousand medical scholarships.

That tradition of emergency relief goes back to the first years of the Cuban revolution. But it is only one part of an extraordinary and mushrooming global medical internationalism. There are now 50,000 Cuban doctors and nurses working in 60 developing countries. As Canadian professor John Kirk puts it: “Cuban medical internationalism has saved millions of lives.” But this unparalleled solidarity has barely registered in the western media.

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Cuban doctors have carried out 3m free eye operations in 33 countries, mostly in Latin America and the Caribbean, and largely funded by revolutionary Venezuela. That’s how Mario Teran, the Bolivian sergeant who killed Che Guevara on CIA orders in 1967, had his sight restored40 years later by Cuban doctors in an operation paid for by Venezuela in the radical Bolivia of Evo Morales. While emergency support has often been funded by Cuba itself, the country’s global medical services are usually paid for by recipient governments and have now become by far Cuba’s largest export, linking revolutionary ideals with economic development. That has depended in turn on the central role of public health and education in Cuba, as Havana has built a low-cost biotech industry along with medical infrastructure and literacy programmes in the developing countries it serves – rather than sucking out doctors and nurses on the western model.

Internationalism was built into Cuba’s DNA. As Guevara’s daughter, Aleida, herself a doctor who served in Africa, says: “We are Afro-Latin Americans and we’ll take our solidarity to the children of that continent.” But what began as an attempt to spread the Cuban revolution in the 60s and became the decisive military intervention in support of Angola against apartheid in the 80s, has now morphed into the world’s most ambitious medical solidarity project.

Its success has depended on the progressive tide that has swept Latin America over the past decade, inspired by socialist Cuba’s example during the years of rightwing military dictatorships. Leftwing and centre-left governments continue to be elected and re-elected across the region, allowing Cuba to reinvent itself as a beacon of international humanitarianism.

But the island is still suffocated by the US trade embargo that has kept it in an economic and political vice for more than half a century. If Barack Obama wants to do something worthwhile in his final years as president he could use Cuba’s role in the Ebola crisis as an opening to start to lift that blockade and wind down the US destabilisation war.

There are certainly straws in the wind. In what looked like an outriding operation for the administration, the New York Times published six editorials over five weeks in October and November praising Cuba’s global medical record, demanding an end to the embargo, attacking US efforts to induce Cuban doctors to defect, and calling for a negotiated exchange of prisoners.

The paper’s campaign ran as the UN general assembly voted for the 23rd time, by 188 votes to 2 (US and Israel), to demand the lifting of the US blockade, originally imposed in retaliation for the nationalisation of American businesses and now justified on human rights grounds – by a state allied to some of the most repressive regimes in the world.

The embargo can only be scrapped by congress, still stymied by the heirs of the corrupt US-backed dictatorship which Fidel Castro and Guevara overthrew. But the US president has executive scope to loosen it substantially and restore diplomatic ties. He could start by releasing the remaining three “Miami Five” Cuban intelligence agents jailed 13 years ago for spying on anti-Cuba activist groups linked to terrorism.

The obvious moment for Obama to call time on the 50-year US campaign against Cuban independence would be at next April’s Summit of the Americas – which Latin American governments had threatened to boycott unless Cuba was invited. The greatest contribution those genuinely concerned about democratic freedoms in Cuba can make is to get the US off the country’s back.

If the blockade really were to be dismantled, it would not only be a vindication of Cuba’s remarkable record of social justice at home and solidarity abroad, backed by the growing confidence of an independent Latin America. It would also be a boon for millions around the world who would benefit from a Cuba unshackled – and a demonstration of what can be achieved when people are put before corporate profit.

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A CUBAN BRAIN DRAIN, COURTESY OF THE U.S.

New York Times, THE EDITORIAL BOARD; NOV. 16, 2014

Leer en español (Read in Spanish) »

Secretary of State John Kerry and the American ambassador to the United Nations, Samantha Power, have praised the work of Cuban doctors dispatched to treat Ebola patients in West Africa. The Centers for Disease Control and Prevention recently sent an official to a regional meeting the Cuban government convened in Havana to coordinate efforts to fight the disease. In Africa, Cuban doctors are working in American-built facilities. The epidemic has had the unexpected effect of injecting common sense into an unnecessarily poisonous relationship.

And yet, Cuban doctors serving in West Africa today could easily abandon their posts, take a taxi to the nearest American Embassy and apply for a little-known immigration program that has allowed thousands of them to defect. Those who are accepted can be on American soil within weeks, on track to becoming United States citizens.

There is much to criticize about Washington’s failed policies toward Cuba and the embargo it has imposed on the island for decades. But the Cuban Medical Professional Parole Program, which in the last fiscal year enabled 1,278 Cubans to defect while on overseas assignments, a record number, is particularly hard to justify.

It is incongruous for the United States to value the contributions of Cuban doctors who are sent by their government to assist in international crises like the 2010 Haiti earthquake while working to subvert that government by making defection so easy.

American immigration policy should give priority to the world’s neediest refugees and persecuted people. It should not be used to exacerbate the brain drain of an adversarial nation at a time when improved relations between the two countries are a worthwhile, realistic goal.

The program was introduced through executive authority in August 2006, when Emilio González, a hard-line Cuban exile, was at the helm of the United States Citizenship and Immigration Services. Mr. González described the labor of Cuban doctors abroad as “state-sponsored human trafficking.” At the time, the Bush administration was trying to cripple the Cuban government. Easily enabling medical personnel posted abroad to defect represented an opportunity to strike at the core of the island’s primary diplomatic tool, while embarrassing the Castro regime.

Cuba has been using its medical corps as the nation’s main source of revenue and soft power for many years. The country has one of the highest numbers of doctors per capita in the world and offers medical scholarships to hundreds of disadvantaged international students each year, and some have been from the United States. According to Cuban government figures, more than 440,000 of the island’s 11 million citizens are employed in the health sector.

Havana gets subsidized oil from Venezuela and money from several other countries in exchange for medical services. This year, according to the state-run newspaper Granma, the government expects to make $8.2 billion from its medical workers overseas. The vast majority, just under 46,000, are posted in Latin America and the Caribbean. A few thousand are in 32 African countries.

Medical professionals, like most Cubans, earn meager wages. Earlier this year, the government raised the salaries of medical workers. Doctors now earn about $60 per month, while nurses make nearly $40. Overseas postings allow these health care workers to earn significantly more. Doctors in Brazil, for example, are making about $1,200 per month.

The 256 Cuban medical professionals treating Ebola patients in West Africa are getting daily stipends of roughly $240 from the World Health Organization. José Luis Di Fabio, the head of the W.H.O. in Havana, said he was confident the doctors and nurses dispatched to Africa have gone on their own volition. “It was voluntary,” Mr. Di Fabio, an Uruguayan whose organization has overseen their deployment, said in an interview. “Some backtracked at the last minute and there was no problem.”

10-03-2014cuban_ebolaCuban Doctors Arriving in Sierra Leone

Some doctors who have defected say they felt the overseas tours had an implicit element of coercion and have complained that the government pockets the bulk of the money it gets for their services. But the State Department says in its latest report on human trafficking that reported coercion of Cuban medical personnel does “not appear to reflect a uniform government policy.” Even so, the Cuban government would be wise to compensate medical personnel more generously if their work overseas is to remain the island’s economic bedrock.

Last year, the Cuban government liberalized its travel policies, allowing most citizens, including dissidents, to leave the country freely. Doctors, who in the past faced stricter travel restrictions than ordinary Cubans, no longer do. Some 20,000 Cubans are allowed to immigrate to the United States yearly. In addition, those who manage to arrive here in rafts or through border crossing points are automatically authorized to stay.

The Cuban government has long regarded the medical defection program as a symbol of American duplicity. It undermines Cuba’s ability to respond to humanitarian crises and does nothing to make the government in Havana more open or democratic. As long as this incoherent policy is in place, establishing a healthier relationship between the two nations will be harder.

Many medical professionals, like a growing number of Cubans, will continue to want to move to the United States in search of new opportunities, and they have every right to do so. But inviting them to defect while on overseas tours is going too far.

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PAYING FOR THE PORT OF MARIEL: ARE CUBA AND BRAZIL PARTNERS IN HUMAN TRAFFICKING?

Capitol Hill Cubans – Oct 24, 2014 – By Maria C. Werlau in Spain’s ABC

Original article: http://www.capitolhillcubans.com/2014/10/must-read-are-cuba-and-brazil-partners.html

The Brazilian government has committed huge taxpayer funds —in loans, subsidies, and direct humanitarian assistance— to support infrastructure projects, food exports, and other initiatives in or for Cuba. Brazil has also provided decisive international political backing to the Cuban military dictatorship. This support is nowhere more evident than in the Port of Mariel, refurbished to great fanfare with Brazilian public financing of over one billion dollars.

Brazil’s massive lending for Cuba seems reckless from a financial/due diligence perspective, as Cuba does not meet basic standards of creditworthiness. The island is technically insolvent; it has US$75 billion in external debt, a long history of defaults, and a classification from The Economist Intelligence Unit as one of the four riskiest countries on the planet to invest in. Meanwhile, the port project is apparently not viable, as the two main reasons given to justify the gigantic investment are shaky at best. Several ports in the vicinity look better positioned to take advantage of the Panama Canal expansion and the U.S. embargo does not seem anywhere close to ending.

df919cc65a58e4d82fdff81f6504895e Brazil’s huge government loans and subsidies for Cuba have been granted with unprecedented levels of secrecy and are currently under investigation for allegations of corruption, kickbacks, and favoritism towards the port builder, Odebrecht, which received Brazil´s development bank (BNDES) loans for the port construction and is a large campaign contributor of the ruling Partido dos Trabalhadores (P.T.). Moreover, while Brazil has greatly increased financing for projects of politically-compatible foreign governments such as Cuba’s —growing the deficit to 4% of GDP—, public funding for infrastructure projects within Brazil has been lacking.

The manifest commitment to support Cuba at all costs may seem puzzling, but can be explained by the strong political-ideological alliance of P.T. leaders with the Cuban regime in the pursuit of a radical hemispheric agenda (inspired in the Foro de Sao Paulo). The hyped-up business opportunities surrounding the port seek to exert pressure against the U.S. embargo and attract investors.

While the Mariel port project does not meet standard repayment conditions, Brazilian officials insist Cuba is meeting its financial commitments, presumably the amortization of its own loans from Odebrecth. In fact, it appears that repayment is coming from exploiting Cuba’s citizens as export raw material for goods and services —purchased mostly by public entities in Brazil— in what arguably constitutes a government-to-government collaboration in human trafficking. Referred to as “health cooperation,” these exports consist of:

  • Export services provided by approximately 11,400 Cuban doctors hired out for a Brazilian government program launched in 2013 that generates Cuba estimated annual net revenues of US$404 million.
  •  Export products reported under standard trade codes for blood — including plasma and medicines and other products derived from blood — and for extracts of glands and organs.

Both have grown exponentially since former Brazilian president Lula da Silva launched the Brazil-Cuba alliance in 2003. Blood imports by Brazil from Cuba were only US$570 thousand in 2002, grew to US$16.9 million in 2011, and totaled US$4.8million in 2013; imports of extracts of glands and organs increased phenomenally from almost nothing in 2003 (US$25,804) to US$88.4 million in 2013.

These exports raise serious ethical concerns. The doctors are deployed as “exportable commodities” to remote zones of Brazil in violation of several ILO (International Labor Organization) conventions as well as of international standards and agreements on the prohibition of human trafficking, servitude, and bondage.

Regarding the export products, details are lacking, but if the trade is in products of human origin, as it appears, it would have very troubling implications. In Cuba, blood and organs/tissues/body parts are obtained from voluntary and uncompensated donors unaware of a profit motive by their government and practices involved in their collection —some quite scandalous— are unacceptable by standards of the World Health Organization and other international bodies.

Additional concerns pertain to safety, quality, effectiveness, and the potential political purpose driving the purchases.

While the service of Cuban doctors has raised ample debate and media coverage in Brazil, the import of products purportedly derived from human blood and body parts has, as of yet, remained out of the public sphere.

In addition, while Brazilian authorities move forward with plans to integrate its biopharmaceutical production with Cuba, that this industry is under the absolute control of the secretive Cuban military regime or that it collaborates with rogues states such as Iran and Syria —including with exports of dual-use technology— have yet to raise attention in Brazil. In Cuba, this discussion cannot be had, as all media and mass communications belong to and are run by the state.

Maria WerlauMaria Werlau

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Lopez-Levy and Piccone: UNITED STATES, CUBA and EBOLA

Fighting Ebola: A new case for U.S. engagement with Cuba

Original Article: http://tbo.com/list/news-opinion-commentary/fighting-ebola-a-new-case-for-us-engagement-with-cuba-20141028/

BY ARTURO LOPEZ-LEVY
Special To The Tampa Tribune; October 28, 2014

The simple fact that Cuba and the United States are in the same boat fighting the Ebola epidemics in Western Africa demonstrates how the level of conflict between the two countries is irrational. While Havana and Washington have considerable differences — and no parallel efforts against a common enemy as Ebola can bridge them — it is evident that narratives of suspicion and intransigence prevent such joint efforts for the benefit of both countries and the world in general.

But, words matter. The recent statements by John Kerry and Samantha Power praising what Cuba is doing to fight Ebola in Africa on behalf of the U.S. State Department — as well as the declarations by Fidel and Raul Castro that Cuba would welcome collaborative efforts on Ebola with the United States — show that a revision of the bilateral relations is long overdue.

President Obama now needs to apply the dictum of his former chief of staff, Rahm Emanuel, and not waste the opportunity presented by the Ebola crisis. Cuba and the United States should advance long-term cooperation in international health efforts under the auspices of the WHO.

Political leadership in the White House and the Palace of Revolution would transform a fight against a common threat into joint cooperation for the advancement of human rights (the right to health is a human right) all over the developing world and the national interests of the two neighbors.

Political conditions are ripe for such turn. Americans strongly support aggressive actions against Ebola and would applaud a president who put lives and medical cooperation with Cuba above ideology and resentment.

As more information comes out about Cuba’s international health effort, it is becoming clearer how unreasonable it is to assume that all Cuban presence in the developing world is damaging to U.S. national interests. The more than 40 000 Cuban doctors and health personnel working in 80 countries are playing a key role to improve human development and protect the world from the spread of Ebola and other contagious diseases.

During the Bush administration and even under Obama, the United States spent lavishly to support groups in Miami that focus on undermining Cuba’s international health presence in Africa and Latin America.

The U.S Cuban Medical Professional Parole Immigration Program (CMPP) is reminiscent of the Cold War. The program encourages Cuban doctors to abandon their contracts in third countries and immigrate to the United States.

Washington’s ideology-driven hostility toward Cuba’s international health efforts has further divided the United States from other democratic countries. The trouble for Miami die-hard Cold Warriors is that examples of how Cuba shares the burden and merits of international health efforts with U.S. allies are expanding. Cuba is cooperating with several institutions of the European Union, Brazil, Canada and Norway in projects of medical education on the island, and in Haiti and other countries. The programs might even grow as result of the current negotiation in Brussels between the EU and Cuba for a comprehensive agreement on cooperation and political dialogue.

The good news is that two former U.S. presidents, Jimmy Carter and Bill Clinton, have talked positively about Cuba’s health achievements and international programs. President Carter and former first lady Rosalyn even visited Cuba’s Latin American School of Medicine in 2002. In a meeting with then Cuban minister of health Carlos Dotres, Mrs. Carter mentioned that their presidential center’s Global Health program would like to collaborate with Cuba’s international medical educational assistance. There is no moral, political or national security explanation for why such humanitarian endeavors are not happening already.

As a senator and presidential candidate, Obama was one of the loudest critics of looking at Cuba through the glasses of the Cold War. As a president, it isn’t enough for him just to retune the same policy of embargo implemented by his predecessors. He must adjust the official U.S. narrative about post-Fidel Cuba: It is not a threat to the United States but a country in transition to a mixed economy, and a positive force for global health.

Arturo Lopez-Levy is a visiting lecturer at Mills College in California and a PhD candidate at the Josef Korbel School of International Studies at the University of Denver.

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Ebola Could Bring U.S. and Cuba Together

By: Ted Piccone, Brookings Institution

On October 28, the United Nations General Assembly voted overwhelmingly for the 23rd year in a row to condemn the United States’ tough embargo on Cuba as a unilateral interference in free trade. Coincidentally, the UN system is tackling the devastating spread of the Ebola virus in West Africa and urging states to contribute medical and financial resources to stem the outbreak.

Ironically, Cuba and the United States have led the world in responding to the call for help, rushing hundreds of medical workers, military personnel, equipment, and other resources to Liberia, Sierra Leone, and Guinea to treat Ebola’s victims and prevent the epidemic from spreading. Could this be the moment for both countries to set aside their differences and join forces for the greater good?

The answer is a qualified yes. The onerous U.S. embargo poses no obstacles to such cooperation, and in any event, bilateral assistance for humanitarian reasons, including food and medicine, is a well-established exception to the rule. So there is no legal reason why U.S. personnel could not work alongside Cuban doctors and nurses in a third country to provide humanitarian aid to the stricken.

Moreover, there are precedents for this kind of cooperation. In 2010, in response to the devastating earthquake in Haiti, American and Cuban personnel worked together to provide emergency care, including the provision of U.S. medical supplies to field hospitals staffed by Cuban doctors.

Cooperation was so positively received that the two sides launched high-level discussions about a joint project to build a new hospital in rural Haiti to be staffed in part by Cuban medical personnel.

Yet, as in so many other instances, cooperation between Havana and Washington broke down. This time, the dispute concerned a Bush-era program allowing Cuban doctors and other health personnel easy immigration into the United States. Cuba insisted that the program be dropped.

Already, nearly 1,600 Cuban health workers have taken advantage of the enticement, which undermines Cuba’s well-regarded health-care system, a pride of the revolution.

Proponents of the expedited visa program, on the other hand, argue that these medical workers are forced to work for Cuba’s public health service under the island’s restrictive labor laws. Given their specialized medical training, they also have a much harder time than other Cubans gaining permission to leave the island, even under the more relaxed travel policies that Cuba adopted in 2012.

U.S. President Barack Obama has a unique opportunity to show the world that the United States can rise above old hostilities for the sake of saving lives. He can immediately use his executive authority to suspend the discretionary parole program for any Cuban medical worker who is deployed to West Africa in response to the Ebola outbreak, and thereby stem Cuba’s professional brain drain.

Cuba has sent more than 50,000 medical personnel to 66 countries (more than those deployed by the G7 combined), and is now the biggest single provider of health-care workers to the Ebola crisis in West Africa. For their part, the Cubans could address concerns about the nature of their highly touted medical missionary work by giving participants in their medical brigades the option of serving abroad as volunteers, not conscripts, at no cost to their careers if they say no, and with higher pay if they say yes.

The timing for such a move is ripe. Since Obama eased the embargo in his first term by allowing more Cuban Americans to visit and send remittances to their relatives, and facilitating other categories of travel to the island, people on both sides of the Florida Straits are reconnecting in myriad ways, slowly rebuilding the bridge that has long divided the two countries.

Both sides have begun cooperating in modest but pragmatic ways, in such areas as counter-narcotics, aviation security, marine environmental affairs, and migration. This would be one additional step on the path toward the reconciliation that a majority of Americans, including Cuban Americans in Florida, want and deserve.

The next steps, however, will be even more important. After the November elections, President Obama should signal his willingness to improve relations with Cuba by ending more travel and remittances restrictions, expanding support to Cuba’s emerging private sector, and engaging in high-level talks to remove Cuba from the U.S. list of state sponsors of terrorism.

Action on key cases involving citizens held in prison in both countries should be on the agenda as well, but not as a precondition for talks. And, assuming cooperation in West Africa goes well, President Obama should broaden the scope and timeline of the suspension of the medical parole program.

Now is the time to take these steps, before President Obama travels to the Summit of the Americas in Panama in April. There, he and Cuban President Raúl Castro should finally talk face-to-face, without preconditions, and set a path toward reconciliation through dialogue. It would be a great legacy for both presidents as they depart office in just a few years.

This piece was originally published by The Mark.

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IN THE MEDICAL RESPONSE TO EBOLA, CUBA IS PUNCHING FAR ABOVE ITS WEIGHT

4 Octobre 2014 – The Washington Post – Adam Taylor

 Original Here: http://www.washingtonpost.com/blogs/worldviews/wp/2014/10/04 /

10-03-2014Cuban_Ebola While the international community has been accused of dragging its feet on the Ebola crisis, Cuba, a country of just 11 million people that still enjoys a fraught relationship with the United States, has emerged as a crucial provider of medical expertise in the West African nations hit by Ebola.

On Thursday, 165 health professionals from the country arrived in Freetown, Sierra Leone, to join the fight against Ebola – the largest medical team of any single foreign nation, according to the World Health Organization (WHO). And after being trained to deal with Ebola, a further 296 Cuban doctors and nurses will go to Liberia and Guinea, the other two countries worst hit by the crisis.

Cuba is, by any measure, not a wealthy country. It had a Gross Domestic Product (GDP) of slightly more than $68 billion in 2011, according to the World Bank, putting it a few places higher than Belarus. At $6,051, its GDP per capita was less than one-sixth of Britain’s. However, its official response to Ebola seems far more robust than many countries far wealthier than it – and serves as further proof that health-care professionals are up there with rum and cigars in terms of Cuban exports.

Cuba’s universal health-care system enables such an export. The country nationalized its health care shortly after its revolution, ending private health care and guaranteeing free health care in its constitution. The results have been widely praised. In 2008, evaluating 30 years of Cuba’s “primary health care revolution,” the WHO noted impressive strides that the country had made in certain health indicators. “These indicators – which are close or equal to those in developed countries – speak for themselves,” Gail Reed noted, pointing to a huge reduction in number of deaths for children under five years old and Cuba’s high life expectancy of 77 years.

Cuba’s health-care success is built upon its medical training. After the Cuban revolution, half of the country’s 6,000 doctors fled and the country was forced to rebuild its work force. The training system grew so much that by 2008, it was training 20,000 foreigners a year to be doctors, nurses and dentists, largely free of charge.

Ebola isn’t the first time that Cuban health workers have been sent to deal with a global disaster. Even back in 1960, immediately after the revolution, Cuba sent doctors to Chile to help in the aftermath of a devastating earthquake, and the practice has continued for decades since. In 2005, Cuba even offered to send medical workers to the United States after Hurricane Katrina in 2005 (they were apparently rebuffed). Reuters reports that Cuba currently has around 50,000 health workers working in 66 countries. Despite the high-profile acts of charity, the medical diplomacy more often seemed to serve more practical purposes – an estimated 30,000 health workers are currently in Venezuela as a partial payment for oil, for example. Exported medical expertise is predicted to net Cuba $8.2 billion in 2014, according to a recent report in state newspaper Granma. There are hopes that medical tourism and exported medical technology could one day provide similar figures.

It’s not a simple picture. Critics have complained that Cuba has begun to sacrifice the health of its citizens at home to make money sending medical workers abroad, and the conditions for these medical workers themselves have been criticized – The Los Angeles Times reported earlier this year that a significant number of Cuban health-care workers in Venezuela have fled the country to escape “crushing” workloads.

Even so, Cuba’s oversized response to Ebola seems to have brushed aside these criticisms, for now at least. The number of Cuban medical staff in Sierra Leone, Liberia and Guinea looks set to be more than those sent from far-larger countries like China. Israel, a wealthier country with a similar population, caused controversy this week when it rejected calls to send medical teams.

“Money and materials are important, but those two things alone cannot stop Ebola virus transmission,” Dr Margaret Chan, director-general at the World Health Organization, said last month. “Human resources are clearly our most important need.”

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CUBA’S EBOLA AID IS THE LATEST EXAMPLE OF ITS ‘MEDICAL DIPLOMACY’

 

14 September 2014

 Original here: http://www.globalpost.com/dispatch/news/regions/americas/cuba/140914/cubas-ebola-aid-the-latest-example-its-medical-diplomacy

Cuba’s pledge to deploy a 165-strong army of doctors and nurses to help fight the Ebola outbreak is the latest example of the Communist country’s decades-old tradition of “medical diplomacy.”

Since 1960, when Cuba dispatched a team of doctors to help with the aftermath of an earthquake in Chile, the Caribbean island has sent more than 135,000 medical staff to all corners of the globe.

The latest batch being sent to help in west Africa’s Ebola crisis are part of a 50,000-strong foreign legion of Cuban doctors and healthcare workers spread across 66 countries in Latin America, Asia and Africa, according to Cuba’s Health Ministry. Cuban Health Minister Roberto Morales Ojeda told reporters in Geneva on Friday some 62 doctors and 103 nurses were being sent to Sierra Leone to tackle the outbreak. World Health Organization director general Margaret Chan welcomed the Cuban aid, the largest offer of a foreign medical team from a single country during the outbreak. “Money and materials are important, but those two things alone cannot stop Ebola virus transmission,” said Chan. “Human resources are clearly our most important need.” Morales said members of the team had “previously participated in post-catastrophe situations” and had all volunteered for the six-month mission, which begins in early October.

‘Foreign policy cornerstone’

“Medical diplomacy, the collaboration between countries to simultaneously produce health benefits and improve relations, has been a cornerstone of Cuban foreign policy since the outset of the revolution fifty years ago,” said US researcher Julie Feinsilver in a study for Georgetown University. “It has helped Cuba garner symbolic capital — goodwill, influence, and prestige —well beyond what would have been possible for a small, developing country, and it has contributed to making Cuba a player on the world stage,” Feinsilver wrote in her study “Fifty Years of Cuba’s Medical Diplomacy: From Idealism to Pragmatism.”  “In recent years, medical diplomacy has been instrumental in providing considerable material capital — aid, credit, and trade — to keep the revolution afloat.”

Cuba’s medical diplomacy accelerated after the devastation wrought by Hurricanes George and Mitch across the Caribbean in 1998. In the aftermath of the disaster, Cuba sent some 25,000 doctors and health workers to 32 nations in the region. In 2004, former President Fidel Castro and late Venezuelan President Hugo Chavez launched “Mission Miracle,” a program offering free eye surgery that has benefited some 2.8 million people across 35 countries, according to Cuban official sources.

Earthquake assistance

At the same time, Cuba’s “medical brigades” have helped victims from devastating earthquakes in numerous countries including Algeria, Mexico, Armenia and Pakistan. Cuba has also trained several thousand doctors and nurses from no fewer than 121 developing nations.

The biggest deployment has seen 30,000 Cuban health professionals sent to oil-rich Venezuela, a key regional ally. In Brazil, meanwhile, some 11,456 Cubans are working in hard-hit areas suffering from staffing shortages.

Together with educational and sporting services, the export of medical professionals is worth around $10 billion annually to Cuba, making it the most important source of income for the island, outstripping money earned from foreign remittances and exports of nickel.

Yet while the qualifications and dedication of Cuba’s foreign legion are regularly lauded by countries benefiting from their services and organizations such as the WHO, they are not always viewed so positively by local health workers. Trade unions and some politicians in Peru, Brazil, Ecuador, Bolivia, Uruguay and Honduras have criticized the “army in white coats” sent by Cuba.

At the same time, Havana has also been criticized for withholding too big a chunk of the salaries of workers employed overseas.

Despite the thousands of health workers abroad, Cuba’s domestic healthcare remains one of the best staffed networks in the world, with 82,065 doctors, one for every 137 people, according to the National Statistics Office.

imagesThe Ebola Pandemic, Monrovia

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WORKING CONDITIONS IN VENEZUELA SENDING CUBAN DOCTORS TO U.S.

CHRIS KRAUL,  11 September 2014 – Los Angeles Times –

Original article: http://www.latimes.com/world/mexico-americas/la-fg-venezuela-cuba-doctors-20140911-story.html

AAA1Worsening conditions in Venezuela are causing increasing numbers of Cuban medical personnel working there to immigrate to the United States under a special program that expedites their applications, according to Colombian officials who help process many of the refugees.

On Wednesday, the U.S. Citizenship and Immigration Services in Washington said the number of Cuban doctors, nurses, optometrists and medical technicians applying for U.S. visas under the Cuban Medical Professional Parole Program is running as much as 50% ahead of last year’s pace, which was nearly double that of the year before. At the current rate, more than 1,500 Cuban healthcare workers will be admitted to the United States this year.

For geographical reasons, neighboring Colombia is a favored trampoline for Cubans fleeing Venezuela, whose leftist government has struggled to rein in runaway inflation, shortages of goods and services and rising social unrest.

Cuba, which prides itself on a comprehensive healthcare system and has long exported doctors and nurses to friendly countries, maintains an estimated 10,000 healthcare providers in Venezuela. The medical outreach program is intended as partial payment for 100,000 barrels of oil that President Nicolas Maduro’s government ships to the Castro administration each day.

Nelia, a 29-year-old general practitioner from Santiago de Cuba, arrived in Bogota last month after what she said was a nightmarish year working in Venezuela’s Barrio Adentro program in the city of Valencia. She declined to disclose her last name for fear of reprisal back home. Nelia said her disillusionment started on her arrival in Caracas’ Maiquetia airport in mid-2013. She and several colleagues waited there for two days, sometimes sleeping in chairs, before authorities assigned her to a clinic in Valencia, she said.

“It was all a trick. They tell you how great it’s going to be, how you will able to buy things and how grateful Venezuelans are to have you. Then comes the shock of the reality,” Nelia said. Her clinic in Valencia had no air conditioning and much of the ultrasound equipment she was supposed to use to examine pregnant women was broken.

She described the workload as “crushing.” Instead of the 15 to 18 procedures a day she performed in Cuba, she did as many as 90 in Venezuela, she said. Crime is rampant, the pay is an abysmal $20 per month and Cubans are caught in the middle of Venezuela’s civil unrest, which pits followers of the late President Hugo Chavez — whose handpicked successor is Maduro — against more conservative, market-oriented forces. “The Chavistas want us there and the opposition does not. And there are more opposition people than Chavistas,” said Nelia, who was interviewed in a Colombian immigration office in Bogota.

A 32-year-old Cuban optometrist who identified himself as Manuel and who also fled Venezuela to apply for U.S. residency said that at his clinic in Merida he was prescribing and grinding up to 120 pairs of eyeglasses a day, triple his pace in Cuba.

“As a professional you want to be paid for what your work is worth. What we were getting, $20 a month, was not enough to pay even for food and transportation, much less a telephone call to Cuba now and then,” Manuel said. “That’s the main reason I want to go to Miami, to earn what I’m worth.”

Cubans have long had favored status as U.S. immigrants. Virtually any Cuban is guaranteed automatic residency and a path to citizenship simply by setting foot on U.S. territory, legally or not. The Cuban Medical Professional Parole Program gives medical personnel a leg up by allowing them to apply for residency at U.S. embassies. Though some Cubans apply at the U.S. Embassy in Caracas, the Venezuelan capital, others say they fear being seen there. Also, airfare to the United States from Colombia is much cheaper than from Venezuela.

The increasing flow of Cuban doctors is only part of a rising tide of Cubans seeking to reach the United States, many through Colombia. Lacking the special status of medical personnel, many U.S.-bound Cubans first land in Ecuador, where the government requires no visas. They then typically pass through Colombia to Panama with the help of coyotes, or human traffickers. However, many are detained in Colombia. Of 1,006 illegal immigrants detained in Colombia from January through July of this year for failing to have proper visas, 42% were Cuban, according to Colombia’s immigration agency director, Sergio Bueno Aguirre. The flow of Cubans had more than doubled from the year before.

One Colombian Foreign Ministry official who spoke on condition of anonymity because of the political sensitivity said the U.S. policy of allowing Cubans immigrant status simply by arriving in the United States has fed organized crime in Colombia and in other transit countries.

“Coyotes helping the Cubans transit through Colombia often use the migrants to carry drugs or submit to prostitution,” the official said. “Or the coyotes will just abandon them at a border, creating a big headache for the Colombian government, which has to take care of them or send them back home.”

Venezuela's President Maduro speaks with Cuba's President Castro during their meeting in Havana

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Reordenamiento Laboral: Quién se queda, quién se va?; Labor Force Down-Sizing in Cuba’s Medical System

By Archibald Ritter

On April 7, an article in Trabajadores stated that 109,000 workers in the heath sector were to be declared redundant, generating an expected 2 billion pesos in savings in the national budget, ostensibly without damaging the quality of health care services.

The newspaper where the article was published: Trabajadores ;

The original article is  here: Trabajadores, 7 de abril de 2014, Quien se queda, quien se va

This is  an ambitions action. Indeed, it is draconian. It seems to be well beyond the legendary “shock therapies” or “structural adjustment” programs once promoted by the International Monetary Fund that have been criticized vigorously in Cuba and elsewhere in the past.  

Apparently such a down-sizing is necessary due to the over-staffing of the health care system that seems to have built up over the years. This may be the case, as Cuba continued to judge its medical performance partly on numbers of doctors and medical personnel per thousand population and number of hospital beds – quantitative success indicators that probably contributed to an excessive expansion of the system.

However, the personnel of the Ministry of Health already had been cut back significantly from their peak of 335,622  in 2008 falling to 265,617 in 2011.  This was a personnel reduction  of 23.5%, with a 37% reduction of pharmacists, a 10.5% reduction of nurses, and a 45.4% reduction in auxiliary and technical personnel.  Presumably there are many more employees in the medical system not included in the numbers of the Table, people such as custodians, secretaries, receptionists, administrators, drivers, information technologists and tradesmen, but how many of these were employed in the system is not indicated in the ONE Anuario Estadistico.

Were further cuts required after these reductions? Apparently so.

Personal facultativo, Ministerio de SaludIs the Cuban government expecting that the numerous Cuban medical personnel abroad, and mainly in Venezuela will be returning to Cuba so that cut-backs will be necessary in order to accommodate them in the medical system?  Indeed, with Venezuela teetering on the brink of serious conflagration and economic melt-down, it may well be the case that Cuban medical personnel may not be in Venezuela at current levels for much longer. Is this the expectation of the Cuban government?

It is of interest to note that as was the case with the announcement of the 500,000 target for layoffs in the state sector in 2010, , the announcement of the job cuts were published in the workers’ newspaper, Trabajadores, and the person explaining the cut-backs was a certain Rafael Guevara Chacón, an employee of the Central de Trabajadores de Cuba (CTC), the labour federation. Is this how Cuba’s labour movement defends workers’ interests?

It will not be easy determining who is and who is not redundant in the medical system. What will be the criteria for determining the redundancies? Will favoritism or a person’s political record be significant factors?  What will be the job prospects for the medical personnel that are being poured out of the educational system?

Then there is the question of where the displaced workers are to go. Some will retire, but others will have to be absorbed elsewhere in the system.

Is the cuenta-propista or self-employment sector capable of creating an additional 109,000 jobs without further liberalization of the policy environment within which it operates?

Can personnel cut-backs of this amount actually avoid damaging the medical care system?

All in all, implementing labour force cut-backs in the medical system of this magnitude will undoubtedly be a major challenge for the government.

Cuba Apr 2012 062.jpg AAAA

Maternity Hospital, Avenida G Vedado, in process of reconstruction, 2012-2014; Photo by Archibald Ritter

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Infant Mortality in Cuba: Myth and Reality

 Roberto M. Gonzalez, Department of Economics, UNC, Chapel Hill

An interesting paper on Cuba’s Infant Mortality Rate (IMR) was presented at the 2013 meetings of the Association for the Study of the Cuban Economy by Roberto M. Gonzalez, a graduate student in Economics at the University of North Carolina. The paper is especially interesting as it focuses on one important indicator of the quality of the health system, human development and socio-economic development which ostensibly has been a major achievement for Cuba. Cuba’s exceedingly low Infant Mortality Rate has been a major “logro” of the Revolution and a source o pride since the early 1960s.

Gonzalez presents information and analysis that casts some doubt on the official IMR figures. His complete argument can be seen in the Power Point presentation that he made at the ASCE meetings here: Infant Mortality in Cuba

The essence of his argument is that Late Fetal Deaths (LFDs) or deaths of fetuses weighing at least 500 grams are abnormally high in Cuba compared to other countries while Early Neonatal Deaths (ENDs) or deaths occurring in the first week of life are abnormally low. In the chart below, Cuba’s high LFD in orange and its low END in green can quickly be seen as outliers for the countries of Europe.

New Picture (12)What’s going on here? Perhaps it is reflects an erroneous mis-classification system, or purposeful mis-reporting or possibly late term and mislabeled abortions (if there is any chance of infant ill-health or a congenital health problems.)

While perhaps further work is needed to analyze this LFD-END puzzle, Gonzalez work has certainly raised serious questions about Cuba’s long-vaunted Infant Mortality Rate.

New Picture (14a )

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How Cubans’ Health Improved When Their Economy Collapsed: Sometimes financial crises can force lifestyle changes for the better.

I well remember in the 1990s in Havana. Food was in short supply; meat was almost unavailable; gasoline was out of the picture; walking. cycling and the “camello” were the chief sources of transportation. The result? My Cuban friends got thin and fit.This indeed was a general phenomenon in Cuba.

But then in the last decade or so, my friends have put on weight, some in a major way. This also seems to be a general phenomenon, and Cuba has climbed back into the ranks of the countries scoring highest in the obesity rankings, with at No. 24, with 20.1% of the male population having a body-mass index of 30 or more. (The Economist, Pocket World in Figures, 2013, p.87.)

A recent study published in the BMJ Group has found that the weight losses, greater physical activity, and increased vegetable and legume consumption in this period had a variety of beneficial impacts on health, notably coronary heart disease and diabetes mortality. Then the increased food consumption (and reduced reliance on the bicycle!) during the 2000-20210 period has coincided with a worsening of some of the basic health measures.

Unfortunately the prospects for obesity and related problems may be serious for Cuba, due in part to greater food availability, and notably meat, and reduced physical activity. There also may be  a psychological factor – the urge to eat a lot when food is available, having gone through earlier periods of hunger. Cuba may now be starting to face some of the same problems as the countries where obesity has become a major challenge.

The write-up of the original medical journal article in the Atlantic is presented below. The  original article from the BMJ Group is located here:  Population-wide weight loss and regain in relation to diabetes burden and cardiovascular mortality in Cuba 1980-2010: repeated cross sectional surveys and ecological comparison of secular trends

Authors: Manuel Franco, associate professor, adjunct associate professor, visiting researcher; Usama Bilal, research assistant, visiting researcher; Pedro Orduñez, regional adviser; Mikhail Benet, professor; Alain Morejón, assistant professor; Benjamín Caballero, professor; Joan F Kennelly, research assistant professor; Richard S Cooper, professor and chair

Richard Schiffman, The Atlantic,, Apr 18 2013

When Cuba’s benefactor, the Soviet Union, closed up shop in the early 1990s, it sent the Caribbean nation into an economic tailspin from which it would not recover for over half a decade.

The biggest impact came from the loss of cheap petroleum from Russia. Gasoline quickly became unobtainable by ordinary citizens in Cuba, and mechanized agriculture and food distribution systems all but collapsed. The island’s woes were compounded by the Helms-Burton Act of 1996, which intensified the U.S. trade embargo against Cuba, preventing pharmaceuticals, manufactured goods, and food imports from entering the country. During this so-called “special period” (from 1991 to 1995), Cuba teetered on the brink of famine. Cubans survived drinking sugared water, and eating anything they could get their hands on, including domestic pets and the animals in the Havana Zoo

The economic meltdown should logically have been a public health disaster. But a new study conducted jointly by university researchers in Spain, Cuba, and the U.S. and published in the latest issue of BMJ says that the health of Cubans actually improved dramatically during the years of austerity. These surprising findings are based on nationwide statistics from the Cuban Ministry of Public Health, together with surveys conducted with about 6,000 participants in the city of Cienfuegos, on the southern coast of Cuba, between 1991 and 2011. The data showed that, during the period of the economic crisis, deaths from cardiovascular disease and adult-onset type 2 diabetes fell by a third and a half, respectively. Strokes declined more modestly, and overall mortality rates went down.

This “abrupt downward trend” in illness does not appear to be because of Cuba’s barefoot doctors and vaunted public health system, which is rated amongst the best in Latin America. The researchers say that it has more to do with simple weight loss. Cubans, who were walking and bicycling more after their public transportation system collapsed, and eating less (energy intake plunged from about 3,000 calories per day to anywhere between 1,400 and 2,400, and protein consumption dropped by 40 percent). They lost an average of 12 pounds.

Bicycle Parking Lot, Havana

Hydroponic Urban Agriculture, Havana

It wasn’t only the amount of food that Cubans ate that changed, but also what they ate. They became virtual vegans overnight, as meat and dairy products all but vanished from the marketplace. People were forced to depend on what they could grow, catch, and pick for themselves– including lots of high-fiber fresh produce, and fruits, added to the increasingly hard-to-come-by staples of beans, corn, and rice. Moreover, with petroleum and petroleum-based agro-chemicals unavailable, Cuba “went green,” becoming the first nation to successfully experiment on a large scale with low-input sustainable agriculture techniques. Farmers returned to the machetes and oxen-drawn plows of their ancestors, and hundreds of urban community gardens (the latest rage in America’s cities) flourished.

“If we hadn’t gone organic, we’d have starved!” said Miguel Salcines Lopez in the journal Southern Spaces. Salcines is an agricultural scientist who founded “Vívero Alamar,” one of Cuba’s best known organopónicos, or urban farms, in vacant lots in Havana.

During the special period, expensive habits like smoking and most likely also alcohol consumption were reduced, albeit briefly. This enforced fitness regime lasted only until the Cuban economy began to recover in the second half of the 1990s. At that point, physical activity levels began to fall off, and calorie intake surged. Eventually people in Cuba were eating even more than they had before the crash. The researchers report that “by 2011, the Cuban population has regained enough weight to almost triple the obesity rates of 1995.”

Not surprisingly, the diseases of affluence made a comeback as well. Diabetes increased dramatically, and declines in cardiovascular disease slowed to their sluggish pre-1991 levels. (Heart disease did decline slightly in the 1980s due to improved detection and treatments.) By 2002, “mortality rates returned to the pre-crisis pattern,” according to the authors of the study. Cancer deaths, which fell in the years after the crash, also started inching up after the recovery, rising 5.4 percent from 1996 to 2010.

While the study’s author’s are cautious about attributing all of these changes in disease rates exclusively to changes in weight, Professor Walter Willett, of the Harvard School of Public Health, Boston wrote in an editorial that the study does provide “powerful evidence [that] a reduction in overweight and obesity would have major population-wide benefits.”

The findings have special relevance to the U.S., which is currently in the midst of a type 2 diabetes epidemic. Disease rates more than doubled from 1963 to 2005, and continue to rise precipitously. Diabetes and its attendant complications have been called one of “the main drivers” of rising health care costs in the U.S. by a report which was published last month by the American Diabetes Association (ADA). “Recent estimates project that as many as one in three American adults will have diabetes in 2050,” according to Robert Ratner, the chief scientific and medical officer of the ADA.

Cardiovascular disease is statistically an even bigger scourge. This illness, which was relatively rare at the turn of the twentieth century, has become the leading cause of mortality for Americans, responsible for over a third of all deaths. Heart disease is associated with our increasingly sedentary lifestyles, obesity, and artery-clogging diets.

The Cuban experience suggests that to seriously make a dent in these problems, we’ll have to change the lifestyle that helps to cause them. The study’s authors recommend “educational efforts, redesign of built environments to promote physical activity, changes in food systems, restrictions on aggressive promotion of unhealthy drinks and foods to children, and economic strategies such as taxation.”

But they also acknowledge that the changes that they are calling for are tough to engineer at the government level: “So far, no country or regional population has successfully reduced the distribution of body mass index or reduced the prevalence of obesity through public health campaigns or targeted treatment programs.”

So where does that leave us? If the United States want to stem the rise of diabetes and heart disease, either we get serious about finding ways for to become more physically active and to eat fewer empty calories — or we wait for economic collapse to do that work for us.

Fig 2 Distributions of body mass index as recorded by national surveys conducted in Cienfuegos in 1991, 1995, 2001, and 2010

Fig 4 Obesity prevalence and coronary heart disease, cancer and stroke mortality in Cuba (1980-2010). Red shaded area=period of economic crisis; blue shaded area=period of economic recovery; CHD=coronary heart disease. CHD mortality decreased by 0.50% per year from 1980 to 1996, 6.48% per year from 1996 to 2002, and 1.42% per year from 2002 to 2010. Cancer mortality decreased by 0.12% per year from 1980 to 1996, but increased by 0.47% per year from 1996 to 2010. Stroke mortality fell by 0.39% per year from 1980 to 2000, 5.03% per year from 2000 to 2004, and 0.01% per year from 2004 to 2010

Fig 1 Physical activity, dietary energy intake, and smoking in Cuba, 1980-2010. Red shaded area=period of economic crisis; blue shaded area=period of economic recovery. Physical activity data recorded in 1987, 1988, and 1994 obtained from Havana surveys; data recorded in 1995, 2001, and 2010 come from national surveys. *1 kcal=0.00418 MJ

Fig 3 Prevalence of obesity and diabetes, incidence, and mortality in Cuba, 1980-2010. Red shaded area=period of economic crisis; blue shaded area=period of economic recovery. Diabetes prevalence increased by 2.93% per year from 1980 to 1997, and 6.27% per year from 1997 to 2010. Diabetes mortality increased by 5.85% per year from 1980 to 1989, but fell by 0.68% per year from 1989 to 1996 and 13.95% per year from 1996 to 2002, before increasing by 3.31% per year from 2002 to 2010

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