Where No Doctor Has Gone Before
Cuba’s Place in the Global Health Landscape
Publication Year: 2013
Tens of thousands of people around the world die each day from causes that could have been prevented with access to affordable health care resources. In an era of unprecedented global inequity, Cuba, a small, low-income country, is making a difference by providing affordable health care to millions of marginalized people.
Cuba has developed a world-class health care system that provides universal access to its own citizens while committing to one of the most extensive international health outreach campaigns in the world. The country has trained thousands of foreign medical students for free under a moral agreement that they serve desperate communities. To date, over 110,000 Cuban health care workers have served overseas.
Where No Doctor Has Gone Before looks at the dynamics of Cuban medical internationalism to understand the impact of Cuba’s programs within the global health landscape. Topics addressed include the growing moral divide in equitable access to health care services, with a focus on medical tourism and Cuba’s alternative approach to this growing trend. Also discussed is the hidden curriculum in mainstream medical education that encourages graduates to seek lucrative positions rather than commit to service for the marginalized. The author shows how Cuba’s Escuela Latinoamericana de Medicina (ELAM) serves as a counter to this trend.
An acknowledgement of Cuba’s tremendous commitment, the book reveals a compelling model of global health practice that not only meets the needs of the marginalized but facilitates an international culture of cooperation and solidarity.
Published by: Wilfrid Laurier University Press
Title Page, Copyright Page
On any beach, in any language, a red fl ag erected in the sand means “stay out of the water!” On April 29, 2001, while swimming at Playa Santa Maria, just east of Havana, I missed that message and ran full speed into an angry sea. A wave came up on me, threw my feet in the air, and drove my head into the ground, shredding my shoulder to pieces. A bloody mess, I dragged myself out of the ...
While I hold that fateful wave fully responsible for setting this project in motion, I, too, hold responsible all those who have provided their support throughout this project. Without them, this could never have succeeded the way that it did. As the author of this book, my role was actually minimal. ...
List of Acronyms
A Note on Sources
Primary research for this study took place between 2004 and 2010 with forty-seven fi rst-person interviews. Participants included ELAM students, graduates, teachers, and administrators, members of MINSAP and MINREX, and villag-ers in rural Ecuador. I also collected interview data through multiple fi eld site visits coordinated through MEDICC. Multiple method research was used for ...
Chapter 1 Against the Garden Path That Justifies Health Inequity: Making the Case for Health Care as a Human Right
Just at dusk, I stood on the rooft op of the public clinic in La Joya de los Sachas,1 a small town in Ecuador’s Amazon, with Cuban-trained doctor Dania Suarez. We watched the gas fl ares from the petroleum developments shoot up above the rain forest. Th is clinic, surrounded by thick jungle and standing pools of water ripe with mosquitoes—the kind that make you burn alive with dengue or ...
Chapter 2 Sowing the Seeds of Health as a Right: The Origins of Health Care in Cuba
Th ere are so many stories of structural and economic hardships coming out of Cuba, from overcrowded buses to faulty water systems (Ritter, 2010). In rural areas, there are outspoken complaints about the distribution of certain resources and sporadic transportation. Th ere are critiques against the freedom of expres-sion of political opposition movements and the nature of political representation ...
Chapter 3 Growing Alternatives through Foreign Policy: Foreign Policy and Perspectives on International Health
Th e twentieth century was one of the most violent periods in human history. Humanity mastered its ability and effi ciency for war and violence at an alarm-ing rate. On a global scale, the twentieth century will be remembered as a time when governments raised armies and invested in innovative ways to break bones than ways to heal them. Military weapons have been advanced with ruthless ...
Chapter 4 The New Doctor Blooms: The Ethics of Medical Education
As a form of development and security assistance to Latin America, the United States trained more than sixty-one thousand soldiers and police at the School of the Americas (Gill, 2004). It was a military training base funded by the US government but located in Panama. Many of the graduates went to work for dictatorships in Chile, Argentina, Guatemala, Nicaragua, and Bolivia. Offi cially ...
Chapter 5 The Blossom of Cooperation: Cuban Medical Internationalism through ELAM in Ecuador
Advancements in medical technology are truly amazing. Research continues to evolve understanding of the human body, and diagnostic and treatment capaci-ties continue to progress at an amazing rate. Consider that a diagnosis of HIV/AIDS or some cancers in the 1980s was a death sentence. Today, with access to a proper pharmaceutical regime, HIV positive patients can live a full life and ...
Chapter 6 The Fruit of Solidarity: How to Maintain Hope for Global Health
Recently I was at a conference on medical education. I gave a brief presentation on Cuban medical internationalism. A senior medical specialist asked me, “Do you think that the Cubans would benefi t from my knowledge?” He was a top surgeon in his fi eld, and fi guring that Cuba was defi ned by poverty and lacked resources in its health-care system, he felt that the Cuban people needed his ...
Page Count: 222
Publication Year: 2013