12. Cuba Provided the Greatest Medical Aid to Haiti after the Earthquake

Cuba was the first to come into Haiti with medical aid when the January 12, 2010, earthquake struck. Among the many donor nations, Cuba and its medical teams have played a major role in treating Haiti’s earthquake victims. Public health experts say the Cubans were the first to set up medical facilities among the debris and to revamp hospitals immediately after the earthquake struck. Their pivotal work in the health sector has, however, received scant media coverage. “It is striking that there has been virtually no mention in the media of the fact that Cuba had several hundred health personnel on the ground before any other country,” said David Sanders, professor of public health from Western Cape University in South Africa.

Student Researcher:

Sarah Maddox (Sonoma State University)

Faculty Evaluators:

José Manuel Pestano Rodríguez and José Manuel de Pablos Coello (University of La Laguna, Canary Islands)
William Du Bois (Southwest Minnesota State University)

The Cuban team coordinator in Haiti, Dr. Carlos Alberto Garcia, said the Cuban doctors, nurses, and other health personnel worked nonstop, day and night, with operating rooms open eighteen hours a day. During a visit to La Paz Hospital in the Haitian capital Port-au-Prince, Dr. Mirta Roses, director of the Pan American Health Organization, which is in charge of medical coordination between the Cuban doctors, the International Committee of the Red Cross (ICRC), and a host of health sector nongovernmental organizations (NGOs), described the aid provided by Cuban doctors as “excellent and marvelous.”

Haiti and Cuba signed a medical cooperation agreement in 1998. Before the earthquake struck, 344 Cuban health professionals were already present in Haiti, providing primary care and obstetrical services as well as operating to restore the sight of Haitians blinded by eye diseases. More doctors were flown in shortly after the earthquake as part of the rapid response. “In the case of Cuban doctors, they are rapid responders to disasters, because disaster management is an integral part of their training,” explains Maria Hamlin Zúniga, a public health specialist from Nicaragua. Cuban doctors have been organizing medical facilities in three revamped hospitals, five field hospitals, and five diagnostic centers, with a total of twenty-two different care posts aided by financial support from Venezuela. They are also operating nine rehabilitation centers staffed by nearly seventy Cuban physical therapists and rehabilitation specialists, in addition to Haitian medical personnel. The Cuban team has been assisted by one hundred specialists from Venezuela, Chile, Spain, Mexico, Colombia, and Canada, as well as seventeen nuns.

However, in reporting on the international aid effort, Western media have generally not ranked Cuba high on the list of donor nations. One major international news agency’s list of donor nations credited Cuba with sending over thirty doctors to Haiti, whereas the real figure stands at more than 350, including 280 young Haitian doctors who graduated from Cuba. A combined total of 930 Cuban health professionals make Cuba’s the largest medical contingent on the ground in Haiti. Another batch of 200 Cuban-trained doctors from twenty-four countries in Africa and Latin American, and a dozen American doctors who graduated from medical schools in Havana, went to Haiti to provide reinforcement to existing Cuban medical teams. By comparison, the internationally renowned Médecins Sans Frontières (MSF or Doctors without Borders) has approximately 269 health professionals working in Haiti. MSF is much better funded and has far more extensive medical supplies than the Cuban team.

But while representatives from MSF and the ICRC are frequently in front of television cameras discussing health priorities and medical needs, the Cuban medical teams are missing in the media coverage. Richard Gott, the Guardian’s former foreign editor and a Latin America specialist, explains, “Western media are programmed to be indifferent to aid that comes from unexpected places. In the Haitian case, the media have ignored not just the Cuban contribution, but also the efforts made by other Latin American countries.” Brazil is providing $70 million in funding for ten urgent care units, fifty mobile units for emergency care, a laboratory, and a hospital, among other health services. Venezuela has canceled all of Haiti’s debt and has promised to supply oil, free of charge, until the country has recovered from the disaster. Western NGOs employ media officers to ensure that the world knows what they are doing. According to Gott, the Western media has grown accustomed to dealing with such NGOs, enabling a relationship of mutual assistance to develop. Cuban medical teams, however, are outside this predominantly Western humanitarian-media loop and are therefore only likely to receive attention from Latin American media and Spanish language broadcasters and print media.

There have, however, been notable exceptions to this reporting syndrome. On January 19, a CNN reporter broke the silence on the Cuban role in Haiti with a report on Cuban doctors at La Paz Hospital. Cuban doctors received global praise for their humanitarian aid in Indonesia. When the US requested that their military planes be allowed to fly through Cuban airspace for the purpose of evacuating Haitians to hospitals in Florida, Cuba immediately agreed despite almost fifty years of animosity between the two countries.

Although Cuba is a poor, developing country, their wealth of human resources—doctors, engineers, and disaster management experts—has enabled this small Caribbean nation to play a global role in health care and humanitarian aid alongside the far-richer nations of the west. Cuban medical teams played a key role in the wake of the Indian Ocean tsunami and stayed the longest among international medical teams treating the victims of the 2006 Indonesian earthquake. They also provided the largest contingent of doctors after the 2005 earthquake in Pakistan. In the Pakistan relief operation, the US and Europe also dispatched medical teams. Each had a base camp with most doctors deployed for a month. The Cubans, however, deployed seven major base camps, operated thirty-two field hospitals, and stayed for six months.

A Montreal summit of twenty donor nations agreed to hold a major conference on Haiti’s future at the United Nations in March 2010. Some analysts see Haiti’s rehabilitation as a potential opportunity for the US and Cuba to bypass their ideological differences and combine their resources—the US has the logistics while Cuba has the human resources—to help Haiti. “Potential US-Cuban cooperation could go a long way toward meeting Haiti’s needs,” says Dr. Julie Feinsilver, author of Healing the Masses, a book about Cuban health diplomacy, who argues that maximum cooperation is urgently needed. Feinsilver is convinced that “Cuba should be given a seat at the table with all other nations and multilateral organizations and agencies in any and all meetings to discuss, plan and coordinate aid efforts for Haiti’s reconstruction.” In late January 2010, Secretary of State Hillary Clinton thanked Cuba for its efforts in Haiti and welcomed further assistance and cooperation. In Haiti’s grand reconstruction plan, Feinsilver argues, “There can be no imposition of systems from any country, agency or institution. The Haitian people themselves, through what remains of their government and NGOs, must provide the policy direction, and Cuba has been and should continue to be a key player in the health sector in Haiti.”

Sources:

Ernesto Wong Maestre, “Haití y el Paradigma Cubano de Solidaridad” (Haiti and the Cuban Paradigm of Solidarity), Rebelión, January 24, 2010, http://www.rebelion.org/noticia.php?id=99233.

Tom Fawthrop, “Cuba’s Aid Ignored By The Media?” Al Jazeera English, February 16, 2010, http://english.aljazeera.net/focus/2010/01/201013195514870782.html.

Emilio González López, “La Otra Realidad de Haití y la Ayuda de 400 Médicos Cubanos” (Haiti’s Other Reality and the Aid from 400 Cuban Doctors), Público (Madrid), February 7, 2010, letter to the editor, http://rreloj.wordpress.com/2010/01/15/intensa-actividad-de-los-medicos-cubanos-en-haiti.

Radio Santa Cruz, “La Oficina Panamericana de la Salud Califica de ‘excelente’ la Ayuda Médica Cubana a Haití” (The Pan American Heath Organization Evaluates the Cuban Aid to Haiti as “Excellent”), January 25, 2010, http://www.radiosantacruz.icrt.cu/noticias/internacionales/califica-excelente-ops-ayuda-medica-cubana-haiti.htm.

Al Ritmo de los Tiempos, “EEUU Olvidó la Inmensa Ayuda de Médicos Cubanos a Haití,” (USA Forgets Cuban Doctors’ Massive Help to Haiti), January 18, 2010, http://actualidad.rt.com/actualidad/america_latina/issue_3106.html.

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http://www.gnutelephony.org David Alexander Sugar

I am not entirely surprised. Cuba already had a rather large number of volunteer doctors offering free medical clinics and care to the people in Haiti before the earthquake. I also could image that Cubans see some common aspect between the slave rebellion that originally liberated Haiti and their own revolution.
http://www.projectcensored.org Peter Phillips

NEWS ABOUT CHOLERA IN HAITI

By Fidel Castro Ruz
November 30, 2010

There is a lot to talk about when the United States is embroiled in a colossal scandal as the result of the documents published by Wikileaks; nobody doubts their authenticity –notwithstanding any other motivation of that website.

However, at this time our country is immersed in a battle against cholera in Haiti, something that becomes a threat for all the other peoples of Latin America and the Third World.

In the midst of the consequences of an earthquake that killed and injured more than half a million persons and caused enormous destruction, an epidemic broke out that, almost immediately, was aggravated by the ravages of a hurricane.

The number of persons affected by the disease was going up yesterday, on November 29th, to 75,888; of these, the Cuban Medical Brigade looked after 27,015, with 254 deaths for 0.94 %. The rest of the state hospital facilities, the NGOs and the private ones, looked after 48,875; of these, 1,721 died for 3.03%.

Today, November 30th, the Cuban Medical Mission which has 201 graduates of the Latin American School of Medicine in its ranks looked after 521 cholera patients, for a total of 27,536.

Last Sunday, November 28th, 18 persons in very critical condition arrived at the Centre for Cholera treatment, in the community reference hospital, located in the commune of L’Estere in Artibonite Department; they were from a sub-commune called Plateau and were immediately cared for by the Cuban Medical Brigade’s 11 doctors and 12 nurses who were working there. Fortunately they were able to save the lives of all of them.

On Monday the 29th, 11 more cases arrived from the same sub-commune; among them was a five-year-old child whose parents had died from cholera. Again, their lives were saved.

Faced with such a situation, Dr. Somarriba, chief of the Medical Mission, decided to send an all-terrain vehicle with 5 doctors, 2 nurses, one male nurse and a rehabilitation specialist to the sub-commune with the resources necessary to provide emergency treatment for the cases there.

Of the five doctors, four are ELAM graduates: a Uruguayan, a Paraguayan, a Nicaraguan, a Haitian and the Cuban brigade chief from the Artibonite Department.

They travelled six kilometres on the highway, walked six more kilometres along the embankment and finally another two kilometres over rough terrain carrying all the equipment and resources in order to reach the sub-commune.

Plateau is located among five mountains, with humble houses clustered at three points; the number of inhabitants is calculated to be around five thousand. They tell me there are no streets or electricity or stores, and just one Protestant church.

The extremely poor population basically grows peanuts, millet, beans and squash.

When they arrived in Plateau, the church’s pastor offered to organize a treatment centre inside the church, with six cots and four pews, thus allowing for emergency treatment for 10 persons.

Today eight were admitted, three of them in critical condition.

The villagers say that around 20 have died. Those figures do not appear in the official death toll. During the night they will work under the light of flashlights they brought in.

The Mission decided to set up a 24-bed Cholera Medical Centre in that remote community. Tomorrow all the resources shall be sent there, including the electrical generator.

There was also information about camera crews going to the community when they heard about the news.

Today there were no deaths and another centre was opened up in the north, for a total of 38 centres and units to treat cholera.

I mention this case to explain the circumstances and methods with which they are fighting the epidemic over there, an epidemic that with dozens of people dying every day is now coming close to 2,000 casualties.

With the work methods being used and the scheduled reinforcements, it shall be more difficult for the number of deaths to stay at the former rate.

Being aware of the passions that traditional electoral processes bring with them, besides the typical abstentions that characterize many of them, we were concerned about what could happen in Haiti in the midst of the epidemic’s destruction. A basic and never-to-be-violated principle is respect for law, the parties and the religious beliefs of the countries where our doctors of the Henry Reeve Brigade provide their services.

However, we were worried about the versions that were being widely circulated by the international press, presenting a picture of generalized violence in the country, something far from being reality. International observers were astounded by that news being spread abroad when actually the facts that occasioned them were isolated, affecting only a small percentage of the electors who voted.

The leaders themselves that called the people into the streets understood that it was not correct, in the middle of the country’s tragic situation, to do things that could encourage violent confrontations that would make it impossible to control and overcome the epidemic. If that aim is not achieved, this could become endemic and lead to a health disaster in Haiti and a permanent threat for the Caribbean area, as well as for Latin America, where millions of poor in growing numbers are agglomerating in the large cities; and likewise for many other poor nations in Asia and Africa.

Never forget that Haiti also has to be rebuilt right from its foundations, with the help and cooperation of all. It is what we expect for its noble and self-sacrificing people.
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http://www.projectcensored.org Peter Phillips

DUTY AND THE EPIDEMIC IN HAITI

By Fidel Castro Ruz
December 5, 2010

Last Friday, on December 3rd, the UN decided to devote one General Assembly session to analyzing the cholera epidemic in that sister country. News of that decision was heartening. Surely it would serve to alert international opinion about the seriousness of the fact and to mobilize its support of the Haitian people. After all, its raison d’être is to confront problems and promote peace.
At the present, Haiti’s situation is very serious, and the emergency aid required is far too little. Our hectic world invests one million 500 thousand million dollars every year on weapons and wars; Haiti, a country that less than a year ago suffered a brutal earthquake that caused 250,000 dead, 300,000 injured and enormous destruction, needs an ever growing amount for its reconstruction and development; according to experts’ calculations the figure totals around 20 billion, just 1.3% of what is being spent in one year for such purposes.
But now that is not what we are dealing with; that would be a mere dream. The UN is not only calling for a modest economic request that could be resolved in a few minutes but also for 350 doctors and 2,000 nurses, something that poor countries do not have and the rich countries are used to ripping away from the poor countries. Cuba responded immediately by providing 300 doctors and nurses. Our Cuban Medical Mission in Haiti looks after almost 40% of those suffering from cholera. Quickly, after the call from the international organization, the task was set to look for the concrete causes of the high death rate. The low rate for the patients they look after is less than 1%; it grows smaller and smaller day by day. Compare this to the 3% death rate of persons looked after in the other health centres at work in the country.
It is clear that the number of deaths is not limited just to the more than 1,800 persons who are being reported. That figure does not include the persons who die without having gone to any doctor or any of the existing health centres.
Investigating the reasons for those most serious cases that come to the centres dealing with the fight against cholera that are run by our doctors, they observed that these persons were coming from the sub-communes which were further away and had less communication. Haiti has a mountainous geography, and one can only reach many of the isolated areas by walking over rough terrain.
The country is divided into 140 communes, both urban and rural, and 570 sub-communes. In one of the isolated sub-communes, where approximately 5,000 persons are living – according to the Protestant pastor’s calculations – 20 people had died from the epidemic without having gone to any health centre.
According to emergency research done by the Cuban Medical Mission, in coordination with the health authorities, it has been shown that 207 Haitian sub-communes in the most isolated areas have no access to the centres fighting against cholera or providing medical care.
At the abovementioned UN meeting, the need was confirmed by Valerie Amos, UN Under-Secretary General for Humanitarian Affairs, who made a two-day emergency visit to the country and calculated the figure of 350 doctors and 2,000 nurses. What was needed was to calculate how many human resources were already in the country in order to figure out the number of personnel required. That factor will also depend on the hours and days devoted by the personnel fighting against the epidemic. An important fact to bear in mind is not only the time being dedicated to work, but also the daily hours. In analyzing the high death rate one can observe that 40% of the deaths occur during the night; this proves that during those hours affected patients do not receive the same treatment for the disease.
Our Mission thinks that better use of personnel would reduce the abovementioned totals. Mobilizing the human resources available from the Henry Reeve Brigade and the ELAM graduates who are there, the Cuban Medical Mission is certain that, even in the midst of the enormous adversity caused by the destruction from the earthquake, the hurricane, the unpredictable rain and the poverty, the epidemic can be conquered and the lives of thousands of people who under the present conditions are inexorably dying could be saved.
On Sunday the 28th, they held elections for the presidency, all of the House of Representatives and for a part of the Senate; this was a tense, complicated event that greatly concerned us because of its relationship with the epidemic and the traumatic situation of the country.
In his statement of December 3rd, the UN Secretary General indicated, and I quote: “Whatever the complaints or reservations about the process, I urge all political actors to refrain from violence and to start discussions immediately to find a Haitian solution to these problems — before a serious crisis develops”, an important European news agency reported.
The Secretary General, agreeing with that agency, urged the international community to carry out the delivery of 164 million dollars, of which only 20% has been supplied.
It is not right to approach a country as it one were scolding a small child. Haiti is a country that, two hundred years ago, was the first one in this hemisphere to put an end to slavery. It has been the victim of all kinds of colonial and imperialist aggressions. It was occupied by the government of the United States just six years ago after promoting a civil war. The existence of the foreign occupying army, on behalf of the UN, does not take away this country’s right for respect for its dignity and its history.
We believe that the position of the UN Secretary General to urge Haitian citizens to avoid confrontations among each other is correct. On the 28th, relatively early in the day, the opposition parties signed a call for street protests, causing demonstrations and creating notable confusion within the country, especially in Port-au-Prince; and especially abroad. However, both the government and the opposition were able to avoid violence. The next day, the nation was calm.
The European agency informed that Ban Ki-moon had declared in regards to the elections last Sunday in Haiti [...] that ‘the irregularities’ recorded ‘now appear more serious than what was thought at first’.”
Whoever reads the information from Haiti and the later statements by the main opposition candidates, cannot understand how the person who is appealing for avoiding civil strife after the confusion created among the voters, just before the results of the vote count that will determine the two rival candidates in the January election, now states that the problems were more serious than what he had thought at the beginning; it’s like adding coals to the fire of political antagonisms.
Yesterday, December 4th, it was 12 years from the arrival of the Cuban Medical Mission in the Republic of Haiti. Since then, thousands of doctors and public health technicians have provided their services in Haiti. With their people, we have lived through times of peace and war, earthquakes and hurricanes. We are by their side in these days of intervention, occupation and epidemics.
The President of Haiti, the central and local authorities, whatever their religious or political ideas, all know that they can count on Cuba.
http://www.canadahaitiaction.ca Roger Annis

The following article appeared in April 2010: “Cuban Medical Aid to Haiti: One of the World’s Best Kept Secrets,” by Professor John Kirk of Dalhousie University in Nova Scotia, Canada and Emily Kirk, graduate student at Cambridge University. The article appears on the website of the Canada Haiti Action Network here:
http://www.canadahaitiaction.ca/node/347.

There are many additional articles on the same website about Cuba’s medical assistance to Haiti, including:
* Cuba Presents Bold Plan for a Comprehensive Health Care System in Haiti (April 2010) http://www.canadahaitiaction.ca/node/397
* Haiti: Underdevelopment and Genocide, By Fidel Castro
http://www.canadahaitiaction.ca/content/haiti-underdevelopment-and-genocide-fidel-castro

[email protected]
Canada Haiti Action Network
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Harry

Cuba also made and makes a significant medical contribution in East Timor (now Timor-Leste) in 1999-present. This has been acknowledged in the Australian media, but not nearly enough. A problem is the Cubans themselves — those not working at village level are sequestered away from the public view in a barracks-like building in Dili, the capital, and, I was told, did/do not mix much with other people. For acknowledgement, the Cubans must compete for public attention. A lusty chorus of “Guantanamera” in a local bar would be a great ice-breaker! A joke? Kind of tongue in cheek, but it really could work.
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http://www.projectcensored.org Peter Phillips

Cuban medics in Haiti put the world to shame

“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.”

By Nina Lakhani
The Independent/UK: 25 December, 2010

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 America’s
arch-enemy Cuba, whose doctors and nurses have put US efforts to shame.

A medical brigade of 1,200 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.

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 7,000 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 programme 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 $3,000 (£1,950) in the UK and $7,500 (£4,900) 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 1,000 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 American 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 8,281 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 from New Jersey, is one of 171
American 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.
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Maria

This fact is reported by Fidel with much detail in his most recent 2010 “Reflections.” Not being a political analyst I can’t say how Fidel fits into the global world of appearance, intrigue, power and control….and I don’t know that he is a pure soul although sometimes I think he has potential for that yet…and this comes out in his sometimes quite incisive and regular commentaries in the Reflections, although it should be warned that at times he does ramble.
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