February 18, 2005

THE AMERICAS
Castro's Medical Missionaries
Blanket Honduras

TEGUCIGALPA, Honduras -- Maybe Fidel Castro, mastermind behind four and a half decades of preposterous Cuban economics, really does understand the market after all. That would explain how the Cuban dictator has managed to maintain some 350 Cuban doctors in this country since 1998, despite President Ricardo Maduro's disapproval of Cuba's human rights record.

The Cuban doctors seem to have already had the effect of polishing Cuba's image as a kinder, gentler dictatorship, and making it more politically costly for Mr. Maduro to support Cuba's dissident movement. More troubling is the potential for soft indoctrination, a kind of tilling the soil in the poor countryside so that it is ready when political opportunity presents itself as it has in Venezuela of late.

The Cuban doctor program was introduced into Honduras when Hurricane Mitch devastated the country in November 1998. With over 50% of the Honduran population living in rural areas and 1.5 million Hondurans with no access to health care, according to a national health official, there was a market for Fidel's foot soldiers of medicine even before the ravages of the hurricane.

But the storm brought about a sense of urgency and then-President Carlos Flores signed a bilateral agreement to let in the doctors.

A little later, after Venezuelan President Hugo Chávez took office in 1999, Castro began a similar effort in that country and today, reportedly 14,000 doctors, 3,000 dentists and 1,500 eye-care specialists can be found in poor Venezuelan barrios. There are reports of Venezuelan doctors denouncing the competence of these Cuban imports but for the poor who have little access to health care, the quality of the medical service may be less important than the fact that a doctor has appeared to hold a dying hand.

By serving the most vulnerable, the Cuban doctors in Venezuela are said to have earned a certain tolerance among the poor for the increased Cuban presence in the country and for Cuba's growing role in Venezuelan domestic affairs.

So why stop with Venezuela? The "Revolution," after all, promises "socialism or death" to all the world. Now Fidel's medicos have fanned out all over the region wherever a dearth of doctors makes them welcome.

Honduras is one such market. Its annual per capita gross domestic product of $711 in 2002 puts it among the poorest countries in Latin America. Yet in the mid-1990s the Honduran congress set the minimum wage for public-sector general practitioners at an unmanageable $1,500 per month. Specialists earn almost $2,500 per month. In the late 1990s, those doctors' salaries were indexed to the minimum wage, putting further upward pressure on the price the government had to pay a physician in its national health system. Most only work six hours per day because they also practice medicine in the private sector.

By pricing services too high, doctors delivered a double whammy to Honduras. Limits to the government's health-care payroll meant that fewer doctors could be hired and more Hondurans had to go without care. One high-ranking official here estimates about half of able Honduran doctors are unemployed.

Enter Cuba with its oversupply of medics, its desperation for hard currency and its expansionist political agenda. What better way to fill the Honduran void for medical care than with low-priced Cuban physicians? The bilateral agreement signed around the time of the hurricane opened the door and set a monthly salary of $300. The doctors have even more value-added because they are willing to work in rural areas where Honduran doctors refuse to go.

Cuba also recognized another market opportunity: training new doctors at rock bottom prices. As part of the same agreement, some 600 Hondurans are now in Cuba studying medicine. The Honduran government pays Cuba $300 to $400 per year, per student. This year the first crop of graduates is set to return home.

A health official here notes that some Honduran specialists who have worked with Cuban specialists have complained that the Cubans are not up to par and that they lack specific training that is required in Honduras. Interestingly, the arriving Cubans do not have to take certification exams to ensure that they meet Honduran standards. Nevertheless, the same health official told me that the populations where they work providing basic services seem pleased with their presence and performance.

Fidel has already earned a handsome return on his "goodwill." The proof surfaced when Mr. Maduro sponsored a resolution in the U.N. Human Rights Commission in 2004 calling on Cuba to open its doors to human rights monitors.

Cuba's harsh treatment of its peaceful dissidents, including solitary confinement in horrific punishment cells, suggests that the Maduro move was a routine expression of solidarity with the oppressed by a civilized people. But it turned out to be an enormous act of political courage by Mr. Maduro, who faced a firestorm of opposition for it. As one official here told me, the work that the Cuban doctors have done here "played a big role" in the outcry against the president.

Respectability at the UNHRC, more favorable treatment from the Organization of American States, spreading the revolutionary dream, these are all objectives of the doctors program. So the good the doctors do for the poor must be balanced against those objectives of a tyrannical regime.

Now see it the way Hondurans might. In a bifurcating Latin America, where a good number of states are giving in to populist demagoguery, Mr. Maduro has spent a lot of political capital to repel atavistic tendencies. He has cracked down on kidnapping rings, deregulated the telecom industry, introduced an important property-titling reform and entered into the Central American Free Trade Agreement.

But Honduras is paying a punishing price for helping the U.S. fight its war on drugs. The U.S. is asking the government to face violence and organized crime, the corruption of fragile institutions and the use of its minimal resources to engage in an absurd struggle with filthy rich narco-traffickers. Meanwhile, the kindly Fidel is offering low-priced medical care. U.S. policy makers take note.