INTERNATIONAL: Cuba exporting doctors

Here’s a long and interesting article on Cuban Medical Diplomacy. Essentially Castro has been exporting doctors all over the place, and now Chavez is using Venezuela’s oil money to pay for it. I was reading along wondering why we hadn’t imported a few Cuban MDs to handle the US inner cities when I discovered that apparently they offered to send 1,000 to Louisiana after Katrina, but were turned down.

The article is pretty favorable, even though it’s clear that the export of doctors and concentration on the medical care system is at least partly a propaganda stunt by the Cuban government. A couple of things worth noting, though.

First, sending doctors overseas to help other poor people may be worthy and all that (and has the positive benefits of upsetting foreign medical associations, as it’s done in Venezuela) but it doesn’t mean that human rights within Cuba are respected any more than there were during the Cold war. And sometimes the lack of human rights compounds the medical problems there. For example a colleague of mine’s daughter went to Cuba  to do a medical mission/training and met and married a Cuban doctor while there. That doctor was not allowed to leave with her to go to the US, and when he formally applied to do so, was fired from his job, and no longer allowed to practice. Thankfully he escaped by sea, after several, several terrifying attempts. But there is no justification for refusing to allow people to leave a country; and in this case it caused his medical training to be wasted.

Second, and this is my cynical side talking—isn’t excessive spending on health care something that only rich country like ours can afford? What has a poor country like Cuba gone without to provide doctors for the rest of the developing world?

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  1. Peter, the truth is that there is no embargo and there hasn’t been for a decade or so. The United States is Cuba’s number one trading partner in everything from soy, to sugar to corn to medical supplies and equiptment. The real problem is that the Cuban government sells everything for dollars to tourists and that includes medical equiptment and supplies.
    Getting adequete health care in Cuba is not just a matter of joining the communist party, but a matter of having dollars to pay for the services tourists get that Cubans are not allowed to get (except for a select few).Cubans are not even allowed to have dollars.
    Cuba is a slave island concentration camp where the people’s labor is sold at (literally) slave wages Cuba is a place where a doctor earns the equivalent of $20 a month and where an egg costs .50 and cooking oil costs $7 a pint. However, Castro sells that doctor’s labor to places liek Venezuela for thousands of dollars more as well as to tourists.
    People like Michael Moore who make it appear as if Cubans are getting this wonderful healthcare system for free are simply unconscionable and lose all credibility with anyone who knows what is going on in that island.
    I will tell anyone that thinks Cuba’s healthcare is acceptable to anyone that they should try living there. If it isn’t good enough for you then why is it good enough fo the people of Cuba?

  2. It always amazes me how little the average US citizen knows about the rest of the world. Cuba has one of the best educational systems in the western world and that is judging by international indicators. In fact, they do better than the US at the high school level in many subjects. They train more doctors etc. than they can use. As a Jamaican I have benefitted from Cuban doctors greatly.

  3. I have a very close experience with the Cuban medical system as well as the live in Cuba. I lived in the country for 29 years, suffering the result of an absurd embargo that does not debilitate the Cuban government, but the Cuban people. I graduated from a Cuban medical school after 6 years of nothing but sacrifice, due to the lack of electricity and basic recourses. I might disagree with the quote regarding with the quality of Cuban doctors. It’s not a secret for anyone that Cubans health care professionals has served world wide for many years. Cuba does not provide the best options for health care to its own citizens; number one, due to a lack of recourses that are cause by the embargo.
    Comparison is not a good thing to do when you compare human recourses with technology and fancy diagnostic methods (quite expensive). As a medical student we spend more years doing clinical studies than medical students from USA. The clinical skill knowledge is deliver to medical students meticulously, emphasizing the physical exam. Six years of medical school with four years of clinical science give the doctors a little more chances to learn how to survive in the Amazons without electricity. I am biased due to my origin. The truth about the statistics is quiet uncertain, due to the lack of reliable sources. The Cubans (rafters) that come to the USA generally exaggerate the statistics due to the emotions and the fears that if they speak the truth they are going to be misinterpret, as communist or socialist. Let me tell you the truth about being member of the party having better health care. That is a scheme because they are lots of people that receive the best care possible and this are the military with higher rank in the army and people that are in higher position in the government (that’s is reality in USA, Iraq, China and France). I personally did discriminate any patient for their political belief system and is not tough to us in medical school. If you want the truth for your self make a independent trip to the country and travel with regular Cubans.
    My insight regarding the statistics in the Cuban system is probably not reliable, due to the lack of information that is release, other than what looks good. The statistics are manipulated in the island, like putting the last death of the year (December 31st), on January first of the following year. Cuba is good about inflaming the statistics in other sectors. Regarding the 10% of Cuban population that belongs to the communist party it’s larger than that. In Cuba the benefits of being a communist party member for a small minority the old communist is due to job positions; for others is a burden due to the unwanted activities that it requires to perform. The majority of the health care professionals are recruited to join either the young communist league or the communist party. They most accept the preposition or the offer. The benefits are minimal, other than leave the country and have a credibility to finish the mission and comeback to the island. For some doctors is a way to escape form the hard work in the country and bring a bit of saving from the mission that is given to them after they return 3-5 years latter. For others is a way to earn the trust and have more options in the future to have better international work experience. Nevertheless the doctors learn more medicine while serving people that are really in needs and display the book cases presentations and do something about it.

  4. This is why thousands of Americans are swimming the shark infested waters into Cuba………..
    I worked with Cuban physicians in Africa and heard the same story – if you aren’t a member of the Party – you get substandard care.
    PS most of their training was VERY outdated and basic and there have been MANY lawsuits against them in Southern African countries – very nice people though and willing to learn – most despise Fidel.
    One of them , a urologist , told me how grateful he was to be doing primary care in rural Botswana , because back home he was working as a waiter in the hotel zone after hours to make ends meet.
    I absolutely do not believe their figures on infant mortality and neither do most Cuban expats – this is a country that put HIV positive people into labour camps to “protect” the population – you have to be a far left nutbar to believe Fidel’s propaganda.

  5. “What Cuban medicine does poorly is, for most citizens, advanced hospital care, where lack of good facilities and technology results from their weak economy. The economy is bad because of over centralized mismanagement”
    I would say that an American embargo on trade would be the main reason. Why do you think Haiti does so poorly. When the slaves revolted there and took control the U.S. would not trade in fear that slave revolt would spread to its shores. I guess they were viewed as just a bunch of terrorists. That legacy continues today.
    No political regime can exist without surviving ecomically. Research the amount of U.S. aid that goes to Israel, billions and billions. We continue to punish Cuba but continue to support Saudi Arabia, another despotic regime, but they have oil. I agree that politics plays a large role in statistical reporting, look at the Iraq war stats from the White House, you’d think we were already at, “Mission Accomplished”. Sorry, couldn’t resist it. Vote early and vote often, especially if Diebold is your Republican voting machine of choice.

  6. A note on Cuban medical statistics: Don’t believe them without independent evidence. Several emigre Cuban doctors have told me that their offices fudged disease reports, as their career advancement depends on reporting good results. This is true all the way up the chain. Some knew staff in the bureau of medical statistics who acknowledged fudging also at the aggregate level. There are several diseases, including HIV, that these doctors’ personal experiences indicate are underestimated in the official statistics. Not that personal experiences are any proof, but they do raise suspicions. Are the low levels of Cuban infant mortality correct? Can’t say no, but only blind faith allows one to say yes.

  7. With regard to the quality of physician training in Cuba and their approach to medicine generally: What Cuba does well is systematic, thorough tracking and treatment of the basic, simple health needs. Thus every small community has their personal doctor who knows each individual, as well as their families and friends, and follows up with preventive information and less technology intensive procedures. Thorough and consistent basic medical service is way ahead of our own non-systematic approaches to health care in this regard. I have this from my daughter, a physician who studied in Havana for 8 mos. and shadowed a primary care doctor there, and from my son-in-law, a Cuban physician.
    My son-in-law tells me that physicians in Cuba have 2 more years of with intensive clinical practice in Cuba, compared to American medical students. Thus, by the time they get to residency, they know far more what they’re doing than American residents do.
    What Cuban medicine does poorly is, for most citizens, advanced hospital care, where lack of good facilities and technology results from their weak economy. The economy is bad because of over centralized mismanagement, but that is another chapter. I have anecdotes from friends and family there of dreadfully lacking monitoring equipment (e.g., no blood sugar testing equipment in a region’s main hospital); however, I also saw the joyful smile of a young girl who was saved by a very impressive abdominal surgery.
    Interestingly, Cuban dental care seems not to have anywhere near the same level of consistency as other medical care: Most young Cubans who arrive here need extensive dental work.

  8. According to those that I met, only 10% of the Cuban populace is a member of the Party. I didn’t ask them what was required to become annointed into the Party but next time I will. From this I can only guess that 10% of the Cuban population gets adequate healthcare.
    As to infant mortality, the CDC or a NICU physician will not list “crack baby” as a cause of death but #1,4,5,6,8,9,10 could all be sequelae of the “crack baby” syndrome. However, #1 probably comprises most of them. I am not a NICU physician but my twin daughters were in a level 2 nursery for a couple of weeks and I was astonished by all the premature babies that were in there addicted to crack/cocaine. At one point I would say nearly half of the nursery contained poor little babies whose mothers didn’t give a #$%^* about them. A very scary place indeed.
    “Do you think if blacks were members of the Republican Party they could improve their infant death mortality rate?”
    No, but apparently if they were part of the Cuban Communist Party they could. 😉

  9. I have no way to discount your experience at Gitmo but I would imagine that anyone trying to flee Cuba is not a member of their Communist Party. I also think if that was the only barrier between you and good healthcare then joining the party would be a small price to pay. That’s what the U.S. found in Iraq, people belonged to the Bath Party to get better jobs and perks. Kinda like those that belong to the Republican Party here to advance their job/income/connections/favorable legislation prospects.
    I went on the CDC web site
    http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_19.pdf to see how they document infant mortality. You may have to decipher underneath some of the causes but I couldn’t see where crack babies accounted for a large % unless the catagory “All Other Causes” included crack babies. But I would think that crack or drug induced deaths are easy to document.
    Rates per 100,000 – Data 2004
    Black Population
    All causes 1,362.8
    1 Disorders related to short gestation and low birth weight, not elsewhere classified: 288.4
    2 Congenital malformations, deformations and chromosomal abnormalities: 171.3
    3 SIDs: 111.5
    4 Newborn affected by maternal complications of pregnancy: 101.9
    5 Newborn affected by complications of placenta, cord and membranes: 49.9
    6 Respiratory distress of newborn: 49.4
    7 Accidents(unintentional injuries: 49.0
    8 Bacterial sepsis of newborn: 43.7
    9 Neonatal hemorrhage: 25.6
    10 Necrotizing enterocolitis of newborn: 24.6
    All other causes (Residual): 447.5
    If there is a large % of drug related baby deaths then that is a failure of society to protect its newborn population not the baby’s.
    What’s also important and alarming to look at is rate of infant deaths for the white population (564.8) and that for the black population (1362.8)
    Do you think if blacks were members of the Republican Party they could improve their infant death mortality rate?

  10. I may have some unique knowledge of the Cuban healthcare system. I have been to Club GITMO and delivered free healthcare to several Cuban exiles that got picked up by the US Navy after drifting into Guantanamo Bay. They told me that the healthcare in Cuba is excellent if you are a Member of the Communist Party, but if you are the unfortunate 90% of the populace that is not part of the Party then the care is horrid. Additionally, the poor infant mortality rate in the US is primarily due to the “crack baby” (an all encompassing term) problem which is virtually nonexistent in Cuba.

  11. Posted by: RW
    “Is anyone concerned about the quality of the education these “doctors” are receiving?”
    “From the outset of the revolution, Fidel has made the health of the individual a metaphor for the health of the body politic. Therefore, he made the achievement of developed country health indicators a national priority. Rather than compare Cuban health indicators with those of other countries at a similar level of development, he began to compare them to those of the United States. This was particularly true for the infant mortality and life expectancy rates. Both are considered to be proxy indicators for socioeconomic development because they include a number of other indicators as inputs. Among the most important are sanitation, nutrition, medical services, education, housing, employment, equitable distribution of resources, and economic growth.”
    “In it, Fidel cited the latest data: Cuba’s infant mortality rate was 5.6 per 1000 live births, a figure less than that of the United States, which was 7.0 per 1000 live births according to the latest published data (NCHS 2005, data are for 2002). Life expectancy at birth in Cuba today is the same as for US citizens, 77 years. These achievements make Cuba a model and therefore make possible its medical diplomacy.”
    Do you really think we need to worry about Cuban docs, especially in rural areas with no local medical care? Politics aside I’d like to see Fidel’s medical philosophy here, but there’s too much money to be made from illness.

  12. Is anyone concerned about the quality of the education these “doctors” are receiving?

  13. I’ve also read that doctors from India are finding it much more difficult to get into the country under the new visa requirements the US has imposed after 9/11. Many appear to going to other countries instead.

  14. “their example of serving the poor in areas in which no local doctor would work, by making house calls a routine part of their medical practice and by being available free of charge 24/7, thus changing the nature of doctor-patient relations.”
    I bet a few rural poor areas in the U.S. could do with a few Cuban doctors.

  15. “What has a poor country like Cuba gone without to provide doctors for the rest of the developing world?”
    Wild guess. Viagra?