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10 The Heart of the Matter The Impact of Cuban Medical Internationalism in the Global South Robert Huish See if you can guess who said this: Our nation supports a lot of different things. We develop water, we do economic development, we do education all over the world, we do joint research, we train soldiers, we provide weapons, and we even give money. But there is nothing more powerful that we do than to administer to the health of people who are in need. Why? Because, the language of health is really heard in the heart. The richest and poorest of us are bound together by the uncertainty of our mortality and the desperation of pain. Given that this chapter is part of a collaborative publication on Cuban internationalism , you might mistake this as an excerpt from one of Fidel Castro’s speeches. Or maybe you guessed that it was in a missive of Che’s? But no, not even close. Here’s another hint. The speaker went on to say: You give a mother with HIV/AIDS the ability to live and raise her children , and she will give you a gratitude that will never wane. Heal a father’s child and he’ll never forget. You give a teenager with disfigured limbs the gift of mobility and the dignity of mobility and he will praise your name forever. . . . Health diplomacy is the highest octane fuel that a soft power machine has. These are the words of Michael Leavitt, George W. Bush’s onetime secretary of health and human services.1 In this speech given at the Center for Strategic and International Studies in Washington, DC, in late 2008, after he had left his post as secretary, Leavitt defended the Bush administration’s hard power interventions in Iraq and Afghanistan, but he argued that this was not the way for the country to proceed in the future. He suggested that the best way for the United States to secure its immediate and long-term interests was through The Impact of Cuban Medical Internationalism in the Global South 177 strategies of medical diplomacy. In other words, he called for policies to heal bones, not for actions to break them. At a time when many nations, including the United States, are seeking ways to embrace global health,2 Cuba’s fifty-year history of medical internationalism provides an invaluable example. The case of Cuban medical internationalism illustrates how dedicated attention to global health can serve to fulfill national policy objectives while providing much-needed humanitarian assistance.3 Many Cuba scholars and policy critics, regardless of ideological affinity, have recognized Cuba’s impressive example of cooperation aimed at strengthening the most feeble health-care systems in the global South. Cuba’s medical internationalism is a working example of how ethical health strategies can assist low-income countries to build important foundations for comprehensive health-care capacity. Cuba’s provision of health-care services and its strategies for building long-term human resource capacity are seen as successes in both political and public health terms.4 As Ken Cole notes, many economists are puzzled as to how Cuba can suffer from such enormous economic hardships and still maintain its own social institutions, let alone develop a global health workforce.5 This impressive effort has helped to improve the quality of life for millions by building much-needed capacity in areas that have been traditionally marginalized by medical systems. Yet a great deal of work still lies ahead. Cuba’s medical internationalism serves to benefit both the country’s own foreign relations and its long-term strategic objectives.6 Indeed, no nation would willingly construct foreign policy that goes against its own interests. To pursue such policy through methods that alleviate suffering among the desperately poor is an innovative approach that may challenge the realist presumptions of foreign policy. With the economic superpowers—in particular, the United States and China—looking toward health-care provision as a means of meeting their global strategic objectives, it is important to understand the impact of medical internationalism beyond that of serving a nation’s own political interests. Economic superpowers could contribute enormous amounts of wealth and social capital to overcoming suffering and disease for the world’s poor. And yet without appropriate vision and foresight, health aid resources could be limited through highly symbolic interventions, such as short-term responses after natural disasters, instead of building long-term capacity within marginalized communities. The global health challenge for...

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