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8: Doctors Within Borders: Cuban Medical Diplomacy to Sandinista Nicaragua, 1979–1990
- University of New Mexico Press
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200 · Chapter Eight · Doctors Within Borders Cuban Medical Diplomacy to Sandinista Nicaragua, 1979–1990 5 K. Cheasty Anderson In 1979, when the Sandinista National Liberation Front (FSLN) won its struggle to oust the Somoza dictatorship from Nicaragua, the victorious revolutionaries inherited a nation ravaged not only by war but also by decades of neglect. In addition to problems engendered by economic devastation and a literacy rate of approximately 35 percent, Nicaragua possessed some of the Western Hemisphere’s most appalling health statistics. The number one cause of death was diarrhea, and the official infant mortality rate, which was grossly underreported, was eighty-seven out of every one thousand live births. Almost one half of the population did not have even a latrine, and health services were completely unavailable to 72 percent of the population.1 The new Sandinista government quickly declared that providing comprehensive health care would be one of its key obligations to the Nicaraguan people. In order to implement this ambitious social reform, however, they would need assistance. The new government found an able and willing ally in Fidel Castro, a staunch supporter of the Nicaraguan Revolution. Within a week of the Sandinista victory, the Cubans were on their way to Nicaragua. Opposition groups have rightly criticized the Sandinista regime over the years for ineffectively managing agrarian reform, mishandling the economy, and suppressing dissent. In fact, the time is now ripe for an academic debate Doctors Within Borders 201 about the causes and nature of these shortcomings. A monocular focus on these failures, however, obscures the Sandinista government’s signal triumph: its health care program. From 1979 until 1990, Nicaragua’s Ministry of Health (MINSA), with help from Cuba and other donor nations, built up its hospital network and expanded a nationwide free primary health care system that relied on a distribution of power to the regions, community organization, popular health education, and high levels of popular participation. This system , not coincidentally, was a near replica of the world-renowned health care program in Cuba.2 The Sandinistas’ efforts were so successful that by 1983 Nicaragua was added to the World Health Organization’s short list of countries that provided full-coverage health care to its populations.3 Through systematic , well-planned vaccination and sanitation campaigns, MINSA eradicated polio while greatly reducing levels of measles, whooping cough, diarrhea, respiratory disease, leishmaniasis, malaria, and dengue, all of which were previously endemic, especially in rural areas. Nicaragua could not have done this without Cuba’s technical, material, and advisory support. During the revolution (1974–79), Somoza’s National Guard bombed most of the nation’s hospitals. In the revolution’s aftermath, some 30–40 percent of Nicaragua’s doctors left the country, while Somoza himself emptied the national treasury of all but $3 million on his way out of the country. To further complicate the problems engendered by this lack of personnel and the financial crisis, the erstwhile guerrillas who undertook governance of the Nicaraguan state were young and inexperienced. The oldest member of the FSLN directorate in 1979, Tomás Borge, was only thirtynine years old, and he was almost a decade senior to many other leaders. Some had attended college; few had finished their degrees. Many had dropped out of medical or law school to devote themselves entirely to the revolution. As a result, the new government was, almost from the moment it took power, in crisis. Given its almost total lack of resources in 1979, and the deteriorating economic conditions Nicaragua faced as the 1980s wore on, Nicaragua’s government ministries relied upon foreign assistance programs to maintain services. For example, MINSA depended heavily upon Cuban aid. Among people interested in Nicaragua’s recent history, it is commonly understood that during the Sandinista regime, Cuba assisted the fledgling Ministry of Health in its efforts to build a nationwide socialist health care system.4 It is not, however, broadly realized just exactly how critical that aid was, or how pervasive the Cuban presence in Nicaragua was during the 1980s. Among Nicaraguans, on the other hand, there is a strong cultural memory of [35.172.194.25] Project MUSE (2024-03-29 07:49 GMT) K. Cheasty Anderson 202 Cuba’s role during the Sandinista government. As one Managua taxi driver put it, “Señorita, those Cuban doctors were everywhere. In every hospital, in every clinic, in the cities and in the most rural communities in the country. In those days you couldn’t get up to use the...