Cuban Medical Internationalism in Africa: The Threat of a Dangerous Example

CUBAN MEDICAL INTERNATIONALISM IN AFRICA: THE THREAT OF A DANGEROUS EXAMPLE Robert Huish and John M. Kirk “We come here [Havana] with a feeling of great indebtedness to the Cuban people [. . .] Which other country has a history of greater altruism than Cuba has shown in its relations with Africa?” Nelson Mandela, 1991 In an April 19, 2009 press conference at the Summit of the Americas in Port of Spain, President Barack Obama noted a key theme from his meetings with his fellow leaders: “One thing that I thought was interesting [. . .] hearing from these leaders who when they spoke about Cuba talked very specifically about the thousands of Cuban doctors that are dispersed all throughout the region, and upon which many of these countries heavily depend.”1 He picked up on a major issue, since Cuba’s medical internationalism has had a wide-ranging impact throughout the developing world since the first emergency medical team was dispatched to Chile in 1960 following a massive earthquake there.2 There are many examples of this exceptional humanitarianism, but one remains largely unknown— Cuba’s role in the struggle to save lives in the poorest region of the world, Africa. This article seeks to highlight some of Cuba’s major contributions to bringing health to the region. To begin we will offer a brief historical synopsis of Cuba’s medical internationalism, which has evolved to enormous proportions with more than 38,000 health-care workers working in 74 countries, and caring for 70 million patients as of early 2009. In all some 185,000 medical professionals have served in 103 countries, saving over 2 million lives.3 We will then focus on the stages of Cuba’s health-care interventions in Africa. Three trends have prevailed in terms of Cuban medical internationalism in Africa. The first stage was military-driven cooperation, where medical provision runs alongside active military operations in places like Ethiopia and Angola. The second stage is large-scale capacity-building cooperation where Cuba has spearheaded efforts to train human resource specialists to run health care operations in poor countries, and for the poor of all countries in Africa. Here we examine South Africa and Ghana. The third stage can be termed comprehensive cooperation, which is by the far the most widespread approach to date, and currently involves 30 African nations. We focus upon The Gambia as a case where, thanks C  2009 Southeastern Council on Latin American Studies and Wiley Periodicals, Inc. 125 The Latin Americanist, September 2009 to the cooperation provided by Cuba, the country has been able to build a valuable malaria treatment and prevention program, even though it still has a long way to go in completely eradicating the disease. Finally, we offer some concluding thoughts, both upon successful strategies that can be deduced from Cuba’s cooperation with Africa, and some general thoughts on the impact of Cuba’s extraordinary record in the region. We hope that through this discussion Cuba’s extensive medical internationalism in Africa we will provide both insightful and logical examples on what is needed for twenty-first century global health care. The health problems facing Africa are enormous. To take one example—malaria—it is clear that the disease is having a disastrous effect on the continent. In Africa some 212 million episodes were recorded in 2006, fully 86% of the world’s cases. The World Health Organization’s best guess is that 881,000 people died from malaria in 2006, of which 801,000 were in Africa.4 But there are solutions. We know how to prevent and cure malaria—yet we are sorely lacking in health-care workers to treat it. Sadly, most of the international support to date has been spent on curative campaigns rather than on strengthening public health systems that bolster primary care—a process that makes eminently more sense. This emphasis on preventive medicine and basic primary care is precisely what has been the focus of Cuba’s medical internationalism in Africa for nearly five decades. Indeed Cuba’s strategy is an excellent working example of how comprehensive health strategies have assisted in building and sustaining health-care capacity—and in the process have helped save...