John M Kirk
This superb study shows us all how even a poor country can provide good health care not only to its own people but to people in other countries. As President Jimmy Carter said, “Of all the so-called developing nations, Cuba has by far the best health system. And their outreach program to other countries is unequalled anywhere.”

On World Bank figures, in 2010 Cuba had 6.7 doctors per 1,000 people, as against the USA’s 2.4 and Britain’s 2.7. Since 1960, Cuban medical personnel have served in 158 countries, conducted 1.2 billion consultations, attended 2.2 million births and performed more than 8 million surgeries.

In September 2014, Cuba had 50,731 medical personnel, including 25,412 doctors, serving in 66 countries. Cuban medical staff were caring for more than 70 million people in the world, more than the whole G8 plus the World Health Organisation and Médicins Sans Frontières put together. 1.5 million people owe their lives to Cuba’s medical programmes.

This level of humanitarian solidarity is unprecedented, with Cuba doing more to assist the world’s poorer nations than any other country in the world. This is what a sovereign country can and should do.
Since 2004, Cuba’s Operation Milagro has restored the sight of 3 million people from 34 countries, through free eye surgery. Ban Ki-moon, the UN secretary-general, wrote that it “has given us a new vision of the world – one of generosity and solidarity: we are all one, human beings who are all brothers and sisters. Healthcare has to cease being a privilege for a few, and
should become the right of the majority.”

In Venezuela, Cubans carried out 80 per cent of the 647 million medical consultations between 2003 and 2014. Infant mortality fell from 25 per 1,000 live births in 1990 to 13 in 2010. In 2013-14 Cuba sent 11,400 doctors to work in Brazil to support the Rousseff government’s Mais Médicos effort to provide healthcare to 50 million people living in poor rural areas in Brazil’s north.

In Timor Leste, Cuban doctors made up two-thirds of the country’s doctors, set up a medical faculty in Dili, the country’s capital and educated 1,000 doctors. They saved 11,400 lives between 2003 and 2008.

The 33 Cuban medical personnel were a quarter of the medical workers in the Solomon Islands, Kiribati, Tuvalu and Vanuatu. The arrival of ten Cuban doctors in Kiribati reduced the child mortality rate from 50 in every 1,000 to 9.9.
Cuban medical personnel surveyed the health of almost the entire populations of Venezuela, Ecuador, Nicaragua, Bolivia and St Vincent and the Grenadines, to find citizens with disabilities and to support them. 337,000 Venezuelans with disabilities benefited from Cuba’s support.

Kirk observes, “Cuba is a world leader in disaster response, and in the last decade has responded on a government level to international natural disasters more than any industrialized country.” For example, when the 2005 earthquake in Pakistan killed 80,000 people, Cuba at once sent 2,500 members of the newly formed Henry Reeve Contingent with 32 field hospitals (all given to the people of Pakistan) and provided 1,000 medical scholarships to local students.

The Cubans stayed for seven months, treating 1,743,000 patients, 73 per cent of those medically assisted in all of Pakistan after the earthquake. The USA and the European Union sent one base camp each and stayed for a month. Between 1990 and 2010 Cuba treated 23,000 child victims of the Chernobyl disaster, without charge.

Before Haiti’s 2010 earthquake, Cuban medical personnel provided health care for 75 per cent of Haitians. By 2012 they had saved 312,584 lives. In the areas covered by Cuban doctors, infant mortality fell from 80 to 28 per 1,000 live births, child mortality from 159 to 39 per 1,000 live births and maternal mortality from 523 to 259 per 100,000 live births.

In 2014, when Ban Ki-moon and Margaret Chan, director general of the World Health Organization, appealed to the world to help the West African countries afflicted by Ebola, Cuba was first to offer help. It sent 103 nurses and 62 doctors, all volunteers. Ban Ki-moon said, “They are always the first to arrive and the last to leave – and they always remain after the crisis.

Cuba has a lot to show the entire world with its health system, a model for many countries.” Ms Chan said, “Cuba has shown that it is possible to have health and well-being for all.” These are medical cooperation programmes, not paternalistic ‘aid’.

As Kirk notes, “the fundamental nature of Cuban medical internationalism is to provide a sustainable system – one that is not dependent on foreign participation, but instead trains local talent to take over from the Cubans.” In 1984-85 Cuba had 22,000 scholarship students from 82 countries studying at high schools and universities.
By contrast, the USA provided just 7,000 university scholarships to students from developing countries.

Cuba has provided free medical education for thousands of Cubans (it now has 70,000 doctors) and (since 1959) for 52,000 people from 130 other countries. Its Latin American Medical School, with an enrolment of more than 8,000 students from Third World countries, is the world’s largest medical school. Ban Ki-moon called it ‘the most advanced medical school in the world’. ELAM blends evidence-based medical education, an understanding of health as a right for all, and compassionate care, guided by need not by the patient’s ability to pay.

Students are not charged tuition fees. They get monthly pocket money and free housing, food and toiletries. “Rather than using a business model of a university as a profit machine, the school only requires that the students sign a contract agreeing to practice in an underserved community upon graduation.”

The World Health Organization estimates that the world needs another 2.4 million health personnel. Poorer countries are in particular need.

Of the 57 countries with a critical shortage, 36 are in sub-Saharan Africa. WHO observed in 2006 that Africa had 11 per cent of the world’s population and 24 per cent of the world’s disease burden, but just 3 per cent of its health workers and less than 1 per cent of its health spending. Its countries need another million health workers.

Africa has 2.3 healthcare workers for every 1,000 people, the Americas 25. In 16 African countries more than half their nationally educated doctors have left to work abroad, in Liberia and Burundi 80 per cent, in Mozambique 75 per cent. Zimbabwe educated 1,200 doctors in the 1990s, but by 2000 only 360 remained.

Half Ghana’s nurses work in Britain, the USA and Canada. Ghana has one doctor for 17,489 patients, Britain one for 300. Zambia needs 15,000 doctors yet has only 800. Malawi has 100 doctors and 2,000 nurses to serve 12 million people. Uganda has just one doctor for 24,700 people.

Surely countries like Britain can and should do far more to meet the world need for health workers. An independent Britain can and should follow Cuba’s excellent example.

Source: PHM