Where No Doctor Has Gone Before: Cuba’s Place in the Global Health Landscape

Chapter 1. Against the Garden Path That Justifies Health Inequity: Making the Case for Health Care as a Human Right

1 CHAPTER AGAINST THE GARDEN PATH THAT JUSTIFIES HEALTH INEQUITY: MAKING THE CASE FOR HEALTH CARE AS A HUMAN RIGHT 1 Just at dusk, I stood on the rooftop 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 flares from the petroleum developments shoot up above the rain forest. This clinic, surrounded by thick jungle and standing pools of water ripe with mosquitoes—the kind that make you burn alive with dengue or go mad with malaria (Ribeiro Galardo et al., 2007; Sideridis, Canario, & Cunha, 2003)—had received a fourteen-year-old girl who had gone into labour while we were in the village dining on the indigenous delicacy of gusanos al carbon. The physicians who were on duty received her in the emergency room. Holding back tears, Dania said, “I remember treating her nine months ago after she was raped.” “She’ll be okay, yeah? I mean Jacqueline is taking care of her, and the others are there,” I said. Sure enough, the skilled attendants on staff helped the girl give birth to her child safely. It was the end of another day in the La Joya de los Sachas clinic. While working with locally trained Ecuadorian health-care workers, Dania and Jacqueline, both Cuban-trained doctors, see days and nights of disasters and miracles. In the only public clinic for eighty kilometres, these doctors, trained at Cuba’s Latin American School of Medicine (ELAM), serve on the front lines of primary care for the poor. The clinic is severely underfunded and resources are always scarce. Still, the patients who come to the humble clinic have most, but not all, of their primary care needs met. Some men come in injured from working in the petroleum developments (Sawyer, 2004). Many women and WHERE NO DOCTOR HAS GONE BEFORE 2 children visit these doctors, sick from the effects of poverty (Farrow, Larrea, Hyman, & Lema, 2005). In 2006, the clinic had six consultorios (consultation rooms), three of which had been flooded out because of a lack of a foundation that consequently let in water from a nearby standing cesspool. With the floodwater came mosquitoes , and with them dengue and malaria. In the three functioning consultorios, everything was in short supply. The examining table was bare, sanitation was a miracle, and the medicine ancient. We tore cotton balls into smaller cotton balls, and those pieces were torn into even smaller pieces because there were no others. The examination equipment needed repair, as did the diagnostic equipment , worn out from much usage and not enough maintenance. The story of La Joya de los Sachas could be story of countless communities in the global South, ones that sit on top of a wealth of resources but suffer a paucity of public health service. This book is about understanding the role of committed health workers like Dania who are part of a Cuban-trained global health workforce that aims to serve the poor in communities like La Joya de los Sachas. Since 1960, Cuba has sent over 135,000 of its own health workers to 101 different countries. In addition, the country has trained tens of thousands of foreigners, like Dania, as health professionals in the hopes that they will return to their homes and practise where they are needed the most. In addition to this program are other Cuban initiatives that pursue international cooperation through disaster relief, free eye surgeries, pharmaceutical development, and public health campaigns. Some have called this medical diplomacy (Feinsilver, 1993), others label it soft power (Kirk & Erisman, 2009). In 2007, John Kirk and I first referred to this as “Cuban medical internationalism” because the impacts of these health campaigns go well beyond strategic foreign policy (Huish & Kirk, 2007). Alongside political gains for Cuba, these interventions are saving the lives and easing the suffering of millions. This book is about understanding Cuba’s place in the global health landscape . There are several objectives. One is to take notice of the political rationale for a small and relatively poor nation to make enormous investments in health, especially in an era when some of the wealthiest countries in the world call for greater cuts to public health. Another is to understand the actual impacts Cuban medical internationalism2 makes on the ground. But the main goals of the book are • to recognize the transformative impacts of Cuban medical internationalism • to acknowledge Cuba’s efforts as a global health...