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11 Cuba’s Medical Internationalism in El Salvador since Hurricane Ida That degree of solidarity which has been generated by the Cuban medical personnel . . . that unquestioning support which they have shown to our people—these are qualities which we would like to see spread to all our countries in Latin America. Dr. María Isabel Rodríguez, minister of public health of El Salvador, interview, February 25, 2010 Former Cuban foreign minister Felipe Pérez Roque has summed up Cuba’s approach to the basis of solidarity contained in medical internationalism: “We don’t give out our leftovers; instead, we share what we have.”1 This sentiment echoes the opinion of Dr. Julio Medina, director of the Chernobyl children’s program studied in the previous chapter, and illustrates the widespread acceptance of medical internationalism in government circles. This chapter focuses on the role of the Cuban medical brigade in El Salvador since its arrival in November 2009. It begins with an analysis of the actions of the medical personnel in the face of the natural disaster caused by Hurricane Ida—the original motivation for the arrival of the brigade. In the first three months after its arrival, the Brigada Médica Cubana Salvadoreña Mons. Oscar Romero saw some 50,000 patients, visiting half of them in their homes. But the multifaceted nature of the work undertaken once the immediate health needs had been met is also exceptional, and the second half of this chapter studies the evolution of this contribution to improving the health of the population of El Salvador. The objective is to evaluate the Cuban contribution to both emergency medicine and public health needs in this country. It is surprising that Cuba would become involved in El Salvador, given the animosity that existed between Havana and the right-wing government in San Salvador. During the Salvadoran civil war (1980–92), which led to the death of 75,000 people in a country the size of the state of Massachusetts (just over 8,000 square miles), Cuba was often vilified. The war had been 254 · Healthcare without Borders fought between the United States–supported military government and five left-wing guerrilla groups (later united as the FMLN), and after the war the right-wing party ARENA held power until 2009, when it was defeated in elections by the FMLN. Death squads, torture, and disappearances had been the order of the day for many years, as had rule by the military and right-wing governments. Not surprisingly, Cuba was identified as one of the principal enemies of the country. Yet despite the lack of diplomatic relations with the Salvadoran government of the day, Cuba provided medical support on various occasions. For example, a large Cuban medical mission came in 2000 and stayed for two months to participate in the nationwide campaign against dengue. Two years earlier, the devastation of Hurricane Mitch in 1998 was in many ways a watershed in bilateral relations. It resulted in the death of 240 people and severe damage to 10,000 homes. Cuba responded by inaugurating the Escuela Latinoamericana de Medicina (ELAM) in Havana, designed primarily to train doctors from the populations of the Central American countries most affected by Mitch. As a result, in the early years of ELAM, most of the graduates were Central Americans. Again it should be remembered that, despite not having diplomatic relations with several of the countries in the region, hundreds of Cuban doctors came to Central America in the aftermath of Mitch. Cuba trained more than 1,000 physicians from the region (at no charge to the medical students) during a period when diplomatic relations had still not been established between Havana and El Salvador, Guatemala, and Honduras. The situation improved in 2009 with the election of journalist Mauricio Funes of the FMLN as president, resulting almost immediately in the normalization of relations with Cuba. Since then medical cooperation, reflecting improved diplomatic ties, has grown. This chapter examines the experience of Cuban medical support following Hurricane Ida and the impact that it has had since then. The Cuban Response to Hurricane Ida Hurricane Ida arrived on the morning of November 8, 2009. The communities of San Vicente and Verapaz were the worst affected. In Verapaz alone, some 355 millimeters of rain fell in just four hours, the same amount that fell when Hurricane Mitch devastated Central America in 1998. This occurred at the end of the rainy season, when the ground was already sodden and therefore incapable...


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