Cuba’s Unique Model of Medical Internationalism

The Bullet | Tuesday, 28 April 2020 | Click here for original article

Cuba Standard (CS): What is the Henry Reeve Brigade?

John Kirk (JK): The Henry Reeve Brigade was formed in 2005. Responding to the massive problems in the wake of Hurricane Katrina, Cuba offered 1,400 medical personnel and 32 tons of medicine to help in New Orleans, which was refused by the George W. Bush administration. Shortly afterwards, there was a major health problem in the Kashmir area of Pakistan after an earthquake. Cuba formed the brigade in response, and named it after an American who fought in the first war of independence, 1868-1878, against Spanish colonialism.

Since 2005, the Henry Reeve Brigade has been involved in all kinds of natural medical emergencies. This is a brigade of several thousand specially-trained doctors, nurses and technicians who go to natural emergencies, whether it be earthquakes, hurricanes or epidemics. They have been involved in emergencies in 16 countries, and counting. As a result of the Coronavirus pandemic they have sent medical brigades to 16 countries. No. 15 was Trinidad and Tobago; the British Virgin Islands were the latest.

A group of First Nations in Manitoba, Canada, have requested their support. There are rumors about brigades being sent to Argentina, about Germany, about Spain, about France. It’s unclear what that means at the moment, but the Coronavirus pandemic has caused many, many people to wake up to the severity of this problem, and the Cubans have got a surplus of medical personnel that are very, very well-trained in difficult circumstances so they can easily adapt.

The third reason was – a bit like some North Americans’ backpacking in the 1960s – a sense of adventure, combined with the fact that the Cubans wanted to see medical conditions in the developing world of the Global South, which they had only seen in medical textbooks. So for all these reasons, they volunteered.

The people I interviewed were not dragooned into going; I suspect that most of them were speaking the truth. I think this was a meaningful opportunity for them to make money, to develop their medical education, and to do what everybody else was doing. Beyond that, it’s in the preamble of the Cuban constitution to share what they have, as opposed to giving leftovers; so many Cuban doctors have done it, and it is part of the DNA.

If you look at the Lineamientos of reform introduced by the Cuban government under Raúl Castro, you will see that there is a deliberate reining-in of the international medical program, because of his natural pragmatism. Fidel Castro had been far more ideological. If you compare the size of medical missions that went under Raúl, you see that they were significantly smaller.

Under Miguel Díaz-Canel, we now have the opportunity for a new president to put his imprimatur, his seal, on what Cuba wants to do in this regard. Cuba has a surplus of doctors, particularly after the conclusion of agreements with Brazil, Ecuador and Bolivia for political reasons. You’ve got a lot of doctors and nurses, you’ve got a massive wealth of experience, you have a new international context where for the first time a European country has requested Cuban medical support – the symbolism of that is important – and clearly this is Cuba’s opportunity to show its potential.

The United Nations’ World Health Organization has talked at times about having an emergency medical force ready to go and resolve serious health problems around the globe. If any country can do that, it’s Cuba. Should the WHO want to invest in this program – which would make enormous sense for international health purposes as we see with this pandemic – it raises the opportunity for Cuba to provide healthcare at a fraction of what European- and North American-trained medical support would cost. This is a good opportunity for Cuba to demonstrate economically viable ways to deal with international health problems.

This is done by Washington purely for political reasons in exactly the same way that they are talking about bringing back the ‘medical parole’ program that was introduced by George W. Bush and ended by Barack Obama. The only people that were affected by defecting Cuban doctors were those in the Global South who had access to healthcare for the first time in their lives, which was then pulled away from them as a result of the medical parole program.

I think the current administration’s pushing of this idea of encouraging other countries to reject Cuba is totally immoral.

However, for countries such as Qatar, where Cuba has got a hospital of 400 Cuban medical personnel, Cuba charges a lot of money. It charges less than what the European and North American-trained doctors and nurses would charge, but it does receive money from that. Estimates vary, but I would calculate about $6-billion goes into Cuban coffers as a result of Cuban medical services abroad.

This money goes to maintain the Cuban medical system. So it is a form of subsidizing the Cuban healthcare system, which I think makes eminent sense. For the number of countries that pay for medical services, there is a sliding scale. Some countries can afford to pay. Arab countries have a lot of petro-dollars that they use. Angola, South Africa are fairly wealthy, they can pay. But if you go to countries such as Gambia or Niger, you will see that – if they do pay – they will pay significantly less.

JK: I think this remains an area of tremendous potential for Cuba, as is biotechnology. The political winds have changed, bringing about an end to the pink tide and beginning a blue wave of very conservative governments in Latin America. This had a tremendously negative impact on Cuba’s potential for exporting medical services. A lot depends on the governments that are in power in Latin America, and how much they value the health of their populations.

The government of Brazil under Bolsonaro is a good example. It refused to consider the continuity of Cuban medical personnel, and as we know about 8 per cent of the Cuban medical personnel remained in Brazil, and about 8,000 returned to Cuba. In Argentina right now there is a debate going on as to whether they want to invite Cuban medical personnel, but it all depends on the political winds.

I would argue that the country that needs the greatest amount of Cuban medical care is the United States. I’m not holding my breath that President Trump will invite in the Henry Reeve Brigade. But clearly, underserved populations in the United States, people who cannot afford private healthcare and who are not part of the population that can receive state-assisted medical care – they deserve medical care, and the Henry Reeve Brigade could provide that. This is obviously not going to happen. In synthesis, it depends on the political winds that are blowing at any particular time and the magnitude of threat to the public health in individual countries.

The World Health Organization needs to be bolstered. I think that this pandemic might be a wake-up call to the international community that we need to have medical personnel on standby. Ebola affected West Africa more than anybody else, it didn’t affect Europe and North America the way it affected West Africa.

Now that the coronavirus is affecting the Global North, this could be a very useful wake-up call. Under these circumstances, nobody offers the potential for having on standby a medical army as does Cuba. So the potential for Cuba in the future, if the international community has the will, can be quite great.

The potential is there. It’s a question of whether countries in the Global North can recognize the potential of the Cuban model. The jury is out on that, but I think the experiment in Italy and Andorra, and maybe other European countries coming on board, will assist them. •

John Kirk is professor at the Latin America program of Dalhousie University in Nova Scotia.

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