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Introduction Setting the Scene What other country can point to a record of greater selflessness than Cuba has displayed in its relations with Africa? Where is the country that has sought Cuban help and had it refused? Nelson Mandela, July 26, 1991 It is not easy to understand Cuba. This is a small country of 11.2 million that has the surface area of Virginia or Tennessee, yet for many years it has maintained an extremely high international profile. After four centuries as a colony of Spain, it gained its independence in 1898, and from then until 1959 it was heavily influenced by the United States in everything from politics to economic development, culture to foreign policy. In 1959 the revolution led by Fidel Castro occurred, and from then on a socialist revolutionary government has been in power. As with so many other aspects of Cuba, the country’s foreign policy has been original, vastly different from what one would expect of such a small developing country. Yet as Nelson Mandela pointed out, it has had a major impact on many facets of life in Africa. The same can be said of Cuba’s role in improving the health of millions of people in dozens of developing countries. This book is about medical cooperation. It is a story that deserves to be told, because it has largely been ignored by media sources in developed countries, despite the fact that the contribution of this small island to global health dwarfs that of all other industrialized countries. Cuba maintains diplomatic relations throughout the developing world, where its medical internationalism policy has been in existence since 1960. The data about its role are clear-cut: in all, over 135,000 medical professionals from Cuba have worked abroad since then, and in March 2014 there were some 50,000 (including 25,000 doctors) working in over 60 developing countries.1 Since then, several thousand more have arrived to work in Brazil at the request of the Rousseff administration. 2 · Healthcare without Borders Ban Ki-moon, secretary-general of the United Nations, visiting Cuba in January 2014, commented on how, in his visits to some of the most forgotten areas of the world, there was a common factor—the presence of either Cuban doctors or doctors from those countries trained in Cuba. He noted that many of the leaders in healthcare he met in developing countries had studied on the island and had incorporated lessons learned there into their own healthcare systems. He summed up the Cuban medical presence by saying, “They are always the first to arrive and the last to leave—and they always remain after the crisis. Cuba has a lot to show the entire world with its health system, a model for many countries.”2 To a large degree Cuba’s ambitious program can be carried out because of the extensive human resources that it possesses. World Bank statistics (for 2010) show that Cuba has 6.7 physicians per 1,000 people, approximately three times the corresponding figure for the United States (2.4) and Canada (2.1) and more than twice that of the United Kingdom (2.7).3 More recent data provided by Cuban Minister of Public Health Roberto Morales Ojeda indicate that this has risen to 7.2 doctors per 1,000 people. He added that there were 19,000 students of medicine attending Cuban universities.4 Not surprisingly, the delivery of accessible healthcare services, provided at no cost to the population, has resulted in a positive health profile. The Cuban government website maintained by the National Office of Statistics fleshes out data concerning the current medical situation in Cuba, one which has resulted in Cuba having a lower infant mortality rate (4.76 per 1,000 live births) than that of the United States (5.90) or Canada (4.78). Life expectancy for Cuba (78.05) and the United States (78.62) is similar, with that of Canada being slightly better (81.57).5 The HIV prevalence rate in Cuba is one-sixth that of the United States, and the mortality rate for children under five is lower than in the United States (6 per 1,000 live births compared to 8).6 Speaking in July 2014, Margaret Chan, director general of the World Health Organization, summarized the Cuban approach to healthcare: “Nobody should die nowadays of avoidable diseases simply because they are women or poor. If people do not have real access to healthcare, then we...


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MARC Record
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