INTRODUCTORY NOTE
Even though this is the MIAMI HERALD, normally not a source of objective, balanced reporting on Cuba, this article in today's paper is an exception to that general rule.
A careful reading of this story will reward anyone with a good understanding of how and why the Cuban medical assistance program works. Cuba is a relatively small country of only eleven million people. Cuban society is also under relentless pressure from its northern neighbor whose population is just about to be 300 million. The U.S. government is engaged in an unceasing campaign to overthrow the Cuban government and the society it defends.
In this context, it's essential to know that the more friends Cuba has in the world, the harder it would be for Washington to isolate the island. The Cubans, who are guided by the ideas of Jose Marti, whose famous phrase "Patria es humanidad", which roughly translated means "Homeland is humanity", understand it wouldn't be either possible or desirable to try to build a self-succient society on a small island. Cuba's international vision and approach reflects this. Cuba's medical care system, which provides essentially free medical care for its population, which it views as a basic social and human right, is a model well-worth understanding. Today, Cuban doctors in nearly 100 countries of the world provide desperately-needed medical care to people, leaving smiles, but no bills in their wake. It it any wonder that those who believe medical care must be seen as a business whose purpose is to make profit, are resentful of the example with the Cubans are providing wherever they work?
Last year the
Wall Street Journal provided a template for such hostility in "Castro's Medical
Missionaries Blanket Honduras" where this exact same issue has been raised here.
(The Herald article is a considerably more balanced, less demagogic essay.)
http://www.walterlippmann.com/docs070.html
True, some Cubans complain that they can't get to see their doctor as easily because she or he is working abroad. Yes, Cuban doctors receive a modest financial incentive for their being willing to work far from home and family, but that's a trade-off which helps soften the impact of the sacrifice.
With all the dramatic publicity given in the Miami media to desperate Cubans trying to come to the United States where in their dreams life will be better, it's remarkable that so few Cubans living and working abroad have defected. Guatemalan doctors, educated in the capitalist spirit that health care should be seen as a business rather than a human right aren't in any rush to go out to the Guatemalan boondocks to care for the poor people living that. Cubans are quite willing to do is.
At the same time, Cuba is providing a free medical education to hundreds of Guatemalans so that they'll be able to return to their homeland and and provide medical care to the poor who cannot afford private profit-oriented care in that country.
Walter
Lippmann, CubaNews
http://www.walterlippmann.com
http://groups.yahoo.com/group/CubaNews
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USPANTAN, Guatemala - At the hospital in this central Guatemala mountain town, Cuban doctors outnumber their local colleagues two to one. And all the five specialists are Cubans, including the surgeon and anesthesiologist.
Eight other Cuban doctors live and work in remote health posts in the region, sometimes trudging up to six hours on foot to vaccinate children and attend to emergencies.
''It's a beautiful, unique experience,'' said María Josefa Herrera, a Cuban general practitioner who works in Uspantán. ``Often the patients have never been treated by a medical professional.''
Herrera is one of the thousands of Cuban medical personnel sent abroad by Cuban leader Fidel Castro in a campaign to alleviate health crises, support his political allies and earn badly needed hard currency -- a campaign that also has angered some Cubans on the communist-ruled island.
Recent media reports from Havana have noted that Cubans are increasingly resenting the absence of physicians once provided free of charge by a totally government-run system whose strength was in a massive network of neighborhood doctors, and not in its hospitals or technology.
One recent U.N. mission to Cuba found a clinic in the eastern city of Santiago where 60 of the 140 staff doctors were abroad, according to the Interamerican Dialogue, a think tank in Washington. And it's not just a problem for Cubans.
LAWSUIT, COMPLAINTS
In Venezuela, the doctors' association sued the President Hugo Chávez's government for using doctors unlicensed to practice in that country. The program continued despite a court ruling backing the association. And in Honduras, the Professional Association of Honduran Doctors has complained over the presence of Cuban healthcare workers there at a time when 1,500 recent Honduran medical graduates are out of work.
Cuba touts its medical missions as a show of solidarity with the world's needy that it can well afford, with one of the highest doctor-patient ratios in the world -- one doctor for every 165 residents, according to the World Health Organization.
But there are more palpable benefits for the island. Cuban medical personnel sent abroad earn hard currency for their perennially cash-strapped government, and the estimated 20,000-22,000 deployed in Venezuela are being paid in part with cheap oil.
In Guatemala, the Cuban medical deployment also has its ups and downs.
For its part, the Guatemalan government has gained 285 physicians and 128 other medical personnel at very low costs, with government public health officials saying the Cubans earn about $400 per month -- less than half a typical Guatemalan public sector doctor's salary. Last October, Cuba sent 600 extra medical personnel to Guatemala after Hurricane Stan, but they have since returned home.
Yet that $400 is also about 16 times the average salary of a doctor in Cuba, so the Cubans here have been using their comparatively huge salaries to buy refrigerators, stereos and other items that they couldn't afford in Cuba. They take the goods home when they finish their work here.
SALARY DISTRIBUTION
Guatemalan officials say the full $400 goes to the Cubans here, who have to pay for their own housing, food and local transportation. No part goes to the Havana government, they said, although in many other countries the host government pays the Cuban government, which then passes part of the money to the medical personnel. It's not clear why the Guatemalan arrangement is different.
And for that kind of money, the Cubans are willing to toil under harsh conditions in remote areas where local doctors are not available or don't want to work. Almost three-quarters of Guatemala's 12,000 registered doctors work in the capital and surrounding suburbs, and about one-third of the country's municipalities don't have a single resident doctor, according to the Guatemalan Association of Physicians and Surgeons.
``It's difficult finding Guatemalan doctors to work in the most isolated areas,`` said Alvar Pérez, director of Guatemala's rural health extension program.
Some experts worry, however, that the public health system has become too dependent on the Cuban medical personnel.
''The Cubans came to fill a medical need,'' said Juan Carlos Verdugo of the National Health Platform, a nongovernment organization that focuses on public health issues. ``But this can't be a permanent solution . . . they could leave any day.''
To gradually replace the island's doctors, the Cuban government has been offering free medical school to low-income students from Guatemala and other countries. More than 12,000 students from 83 countries are studying at the Latin American Medical School in Havana and Castro has predicted that it will graduate 100,000 in the next 10 years.
The school's first graduation last August included 187 Guatemalans.
In exchange for free tuition, those students promised to work for the Guatemalan public health service for up to 6 ˝ years after graduation. The government also requires foreign-educated doctors to work for one year for free in rural health posts and hospitals.
But many of the new graduates have said they're not willing to work for a Cuban's salary.
''No one's going to work in the mountains for a salary of $400,'' said Carlos Flores, one of the new doctors.