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Conclusion No Longer the World’s Best-Kept Secret Graduating as a doctor is like opening a door to a long road leading to the noblest action that a human being can do for others. Fidel Castro, September 19, 2005 This book has attempted to illustrate the role played by Cuba in medical internationalism , principally among countries of the Global South. Certainly there is an enormous need for such initiatives in medical cooperation, given the many profound health challenges facing the billions of people in the developing world. These include a shortage of medical personnel, a massive “brain drain” of qualified physicians to the industrialized North, the lack of affordable medicines, and rapidly growing populations. To take just one example, over half a million women die in childbirth every year— all from treatable complications. A comparison is pertinent here: women in northern Europe have a 1 in 4,000 chance of dying from pregnancy, yet for women in Africa it is 1 in 16.1 In an article by Clare Nullis-Kapp in 2005 it was estimated that 1 million additional health personnel were needed in Africa over the next decade.2 However, these badly needed doctors and nurses are leaving in droves, mainly to five industrialized countries: Australia , Canada, Germany, the United Kingdom, and the United States. The impoverished populations receive short shrift. The case of Ghana is illustrative of this exodus. There are more Ghanaian doctors working abroad than in the country itself, with 50 percent of its professional nurses working in Canada, the United Kingdom, and the United States. While they flee to the industrialized North, the situation for medical care in Ghana remains desperate, where there is one doctor for 17,489 patients, compared with one for 300 in the UK.3 Sub-Saharan Africa as a whole has 11 percent of the world’s population and 25 percent of global disease, yet it has “only 3 percent of the global health workforce and accounts for less than 1 percent of health expenditure worldwide.”4 The flight Conclusion: No Longer the World’s Best-Kept Secret · 271 of medical personnel is the root of this problem. Zimbabwe, for instance, trained 1,200 doctors during the 1990s, yet by 2000 only 360 remained. In Ghana, a similar phenomenon can be found, since 604 from a total of 871 medical officers who had trained between 1993 and 2002 left to work abroad.5 This situation is repeated throughout the developing world. As can be seen, there is an immense need for a more just and equitable system to ensure access to healthcare there. Cuba’s approach to medical internationalism does, however, make a contribution to resolving that enormous imbalance as well as offering a distinctive alternative. It shows that the adage about steady economic growth being required before healthcare can be provided is not necessarily the case: health before wealth is indeed possible. It also shows that where there is solid political will and commitment to help those who cannot help themselves, accessible, affordable healthcare can be made available, even in developing and underdeveloped countries. As noted in the introduction, Cuba’s contribution to global health is one of the world’s best-kept secrets, despite the fact that this process has been in existence for over five decades. Media in the industrialized world have long ignored it. Yet even allowing for some exaggeration by government bureaucrats , the facts are undeniable, as supported by data from PAHO and the WHO among others. The medical internationalism program has been so successful that the administration of George W. Bush sought to embarrass the Cuban government by encouraging Cuban medical personnel to defect and come to the United States through its Cuban Medical Professional Parole program (CMPP), inaugurated on August 11, 2006.6 So have Cuban physicians defected in droves? An editorial published in the New York Times on November 16, 2014, “A Cuban Brain Drain, Courtesy of the U.S.,” noted that there had been 1,278 defections by Cuban medical personnel that year. The irony of the U.S. position in this strategy to tempt Cuban doctors from their missions in developing countries should not be ignored. At the time of the earthquake in Haiti, and particularly during the Ebola outbreak in West Africa, U.S. ambassador to the United Nations Samantha Powers and Secretary of State John Kerry had expressed support for the work of Cuban medical staff. Yet, at the same time, the government was seeking to...


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MARC Record
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