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9 Cuba’s Medical Internationalism in the South Pacific The Cubans taught me many things. They taught me to be independent; they taught me to love people more than simply as human beings; they taught me to embody this great love and to express it in the treatment of my patients; they taught me how to live among the people; and they taught me how to make the most of the scarce resources available to them. Dr. Merita Armindo Monteiro, East Timorese graduate, quoted in Cameron, “East Timor” At first glance the idea of Cuba having any role in this exotic area of the world seems strange. After all, Cuba has no strategic interest here, virtually no trade, and definitely no investment. It is also a poor corner of the world, with little to offer. Yet Cuba has been providing medical care to TimorLeste since 2004, with Cuban doctors making up about two-thirds of the physicians in the country. Moreover, Cuba has trained approximately 1,000 physicians and set up a medical faculty in Dili, the country’s capital, where it is now also training scores of young people from other small South Pacific island communities and has sent its own physicians to several of them to improve access to healthcare of their people. It is difficult to imagine why Cuba would take so much interest in TimorLeste , a small (pop. 1.14 million) and poor ($1.27 billion GDP) country. The amount received for the services of a relatively small number of Cuba’s army of physicians abroad in this poor country cannot be great, while the medical students are taught for free by Cuban professors. According to the logic of a developed nation, this role seems inexplicable, given the limited benefits that could accrue. This chapter seeks to shed light on this situation, analyzing Cuba’s medical missions in the South Pacific with a particular focus on Timor-Leste (also known as East Timor), which is the largest medical cooperation project of Cuba outside Latin America and the Caribbean. It is in this region that Cuban medical internationalism has continued to spread, training students from Timor-Leste and increasingly its South Pacific neighbors. 216 · Healthcare without Borders Cuba’s medical collaboration in Timor-Leste is the first of its kind in the South Pacific, and it has evolved since Cuba first responded to a call for support from the newly independent leadership in 2004. This chapter starts with an analysis of the implementation of the Cuban medical model in Timor-Leste in order to highlight some of the characteristics of this approach , as well as its successes and its challenges. The chapter will then analyze some of the problems facing the South Pacific region as a whole and conclude by examining Cuba’s role in other South Pacific island states. The extension of Cuban medical internationalism from Timor-Leste to other South Pacific nations is important, since it shows the widespread regional adaptation of the Cuban medical model. Many of these small, sparsely populated countries will soon have more Cuban-trained medical personnel than doctors prepared under any other medical models by the time their graduates return from Cuba and Timor-Leste. This is already the case in Timor, where there is a state-led preventive, participatory medical model. If it is true that ELAM graduates are changing the face of medicine in Latin America and the Caribbean, the same is also true in the South Pacific. The Cuban Role in Timor-Leste When the Cuban medical staff first arrived in Timor-Leste, they found a desperate situation. The country became independent from Portugal in November 1975, yet nine days later was invaded by the Indonesian military who took control of the country and claimed it as a province. For the next quarter-century the country was ruled with an iron fist, and massive human rights abuses occurred. Almost 25 percent of the population died through conflict, forced migration, malnutrition, and disease.1 Following a national referendum in 1999, the Timorese voted for independence, which was finally obtained in May 2002. Major health problems remained, however. Between 1999 and 2002, for example, the number of healthcare workers fell from 3,540 to 1,500 as the Indonesians left. There had been 135 physicians in 1999—yet three years later only 20 remained, to tend to a population of approximately 1 million. It was then that the Cubans arrived at the request of the new government, and a...


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