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149 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 benefit from my knowledge?” He was a top surgeon in his field, and figuring that Cuba was defined by poverty and lacked resources in its health-care system, he felt that the Cuban people needed his skills and knowledge. Perhaps Cuban surgeons could benefit from his knowledge , and I am sure they would welcome the dialogue. But I wonder if this surgeon would not benefit more from their knowledge about the ethics of practice, the focus on accessibility, and the issues of long-term patient care. More broadly, one could ask whether the global North could benefit from Cuba’s knowledge and experience. To this, I would say yes. There are many specific lessons to take out of Cuban medical internationalism . There are notions of soft power diplomacy that come from placing health care and outreach into the heart of foreign policy. There are lessons about how medical education can play a role in ensuring that health workers are trained to treat the poor, rather than focusing on the needs of the affluent. There are other lessons about how medical tourism through neoliberal globalization is loaded with potential peril, but how it is possible to use the same tools of globalization to meet the needs of the poor. There are lessons that come from the experiences of Cuban graduates who choose to work in underserviced areas and the struggles that they face in delivering health care. And there are lessons about the migration of health-care workers in the global South who have no viable option to stay and serve their communities. THE FRUIT OF SOLIDARITY: HOW TO MAINTAIN HOPE FOR GLOBAL HEALTH CHAPTER 6 WHERE NO DOCTOR HAS GONE BEFORE 150 But of all the lessons that come from Cuba’s place in the global health landscape , the one that stands out the most is the moral commitment to refuse to accept health inequalities that result from rampant socioeconomic inequality . The commitment and effort of Cuban-trained health-care workers and the political leadership that allows them to serve the underserved is a needed example of global health ethics for which health-care workers in many nations, rich and poor, currently lack. This is not to say that the Cuban experience should or even could be copied everywhere. Rather, Cuba’s place in the global health landscape is as an example of an alternative to the dominant sociopolitical structures that abhor humanitarianism, solidarity, and cooperation. The Cuban case shows that such traits can be part of a normative process and not just as products of altruism and exceptionalism. The Cuban case shows that the desire to help the marginalized should be normative and not exceptional to a health system. Certainly, there is room to embrace such values in the sociopolitical fabric that governs the practice of medicine and the practice of foreign policy—values that embrace the desire to address the needs of others on this planet no matter how desperate, or distant, their situations might be. For broad social change to occur, there must be change to the dominant political discourse, and as history has shown, this may come slowly and with struggles between ideological opponents. But the lofty goals of ensuring global health equity where the receipt of health care is seen as a human right will require a broad, multinational movement that embraces service to the poor as an ethical value. For this, Cuba offers five clear lessons: • Invest in people, not always in physical things. Survival from massive economic hardships need not be found through austerity protocols. It can occur by scaling up education and reinforcing the public sector. • Building strong human resources for health capacity and intersectoral partnerships allows health to flourish even in resource-poor settings. • Building capacity does not have to stop after the management of a national crisis. Capacity building can, and should, address broader global health challenges. Doing so can still act within a nation’s own best interest. • The decision to not close a single university or hospital during an economic disaster requires the popular acceptance of narratives that view health as an intrinsic human value, not as a social burden. • With appropriate political leadership that values health, and with popular support to deal with health through frameworks of disease prevention and health promotion that value community...

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