Medical Internationalism

The Conspiracy of Silence

Vijay Prashad & Eve Ottenberg

Cuba's doctors live among the people, like in Haiti after the earthquake, not in luxury hotels, like American doctors. It does not rely on the thinking that there is a pill for every ailment. It is successful. Cuba has suffered 88 deaths from Covid, and the 3408 infected people have not gone bankrupt receiving care. To repeat, that's because Cuban doctors and pharmaceutical entities are not in it for the money. Cuba's astonishingly good health statistics derive from its emphasis on preventive medicines; something not stressed nearly enough in the US.

Cuba's medical achievements have enabled it, for decades, despite devastating and criminal sanctions from the US, to send tens of thousands of physicians and nurses to poor countries across the globe. When Covid slammed the world, Cuba was ready. Its medical brigades went to Italy, when that country was hardest hit, and its doctors received a standing ovation when they arrived in the airport. A medicine Cuba developed, interferon alpha 2b, showed so much promise with Covid patients in China back Five years ago, this writer read the story of Dr Félix Báez, a Cuban doctor who had worked in West Africa to stop the spread of Ebola. Dr Báez was one of 165 Cuban doctors of the Henry Reeve International Medical Brigade who went to Sierra Leone to fight a terrible outbreak in 2014 of a disease first detected in 1976. During his time there, Dr Báez contracted Ebola.

The World Health Organisation and the Cuban government rushed Dr Báez to Geneva, where he was treated at the Hôpitaux Universitaires de Genève. He struggled with the disease, but thanks to the superb care he received, his Ebola receded. He was flown to Cuba. At the airport in Havana, he was received by his wife Vania Ferrer and his sons Alejandro and Félix Luis as well as Health Minister Roberto Morales.

At the website Cubasí, Alejandro-a medical student had written, "Cuba is waiting for you." In Liberia, the other Cuban doctors also fighting Ebola cheered for Dr Báez. A Facebook page was started called Cuba Is With Félix Báez, while on other social media forums the hashtag #FélixContigo and #FuerzaFélix went viral.

Dr Báez recovered slowly, and then, miraculously, decided to return to West Africa to continue to fight against Ebola.

No wonder that there is an international campaign to have the Cuban doctors be honored with the Nobel Peace Prize. This aspect of Cuba's work is essential to its socialist project of international solidarity through care work.

When Dr Báez returned to West Africa, his colleague Dr Ronald Hernández Torres, based in Liberia, wrote on Facebook, "We are here by our decision and we will only withdraw when Ebola is not a health problem for Africa and the world." This is an important statement, a reaction to the offensive campaign led by the United States government against Cuban internationalism.

The US Congressional Research Service reported that "In June 2019, the [US] State Department downgraded Cuba to Tier 3 in its 2019 Trafficking in Persons Report," for, among other reasons, not taking "action to address forced labour in the foreign medical mission programme." This policy came alongside pressure by the US government on its allies to expel the Cuban missions from their countries.

Strikingly, the UN Human Rights Council-under pressure from Washington-said it would investigate Cuban doctors. Urmila Bhoola (UN special rapporteur on contemporary forms of slavery) and Maria Grazia Giammarinaro (UN special rapporteur on trafficking in persons) wrote a letter to the Cuban government in November 2019. The letter made grand statements-such as alleging that the Cuban doctors suffered from forced labour; but there was no evidence in the letter. Even their statement of concern seemed plainly ideological rather than forensic.

In early 2020, the US government intensified its attempt to delegitimise the Cuban medical mission program. On January 12, 2020, US Secretary of State Mike Pompeo tweeted, "We urge host countries to end contractual agreements with the Castro regime that facilitate the #human rights abuses occurring in these programmes."

US allies in Latin America, such as Brazil, Bolivia, and Ecuador, expelled the Cuban medical missions. This would become a catastrophic decision for these countries as the COVID-19 pandemic developed across Latin America.

In July 2020, the New York-based Human Rights Watch published a document accusing the Cuban government of formulating "repressive rules for doctors working abroad." It focuses on Resolution 168, adopted in 2010, that provides a code of conduct for Cuban doctors, including ensuring that the medical workers honour the laws of their hosts and do not exceed the remit of their mission, which is to take care of the medical needs of the population.

Human Rights Watch merely offers this resolution-and other regulations-as evidence; it accepts that it cannot prove that these regulations have ever been implemented: "Human Rights Watch has not been able to determine the extent to which Cuban health workers have broken the rules and law, or whether the Cuban government has enforced criminal or disciplinary sanctions against them." It is stunning that a human rights organization would spend so much time with so little evidence assaulting a program that is widely recognized for bringing an improvement of living standards for people.

The organising committee for the group Nobel Peace Prize for Cuban Doctors responded to Human Rights Watch with a stinging rebuttal. It pointed out that the HRW report said nothing about the attacks on the Cuban medical program, including the official US government attempt to bribe Cuban doctors to defect to the United States and the expenditure by USAID of millions of dollars to create disinformation against the program.

Even more egregious, the HRW document misreads the evidence it does offer, including the transcript of a dialogue between the Cuban ministry of health and medical workers. The HRW report uses as factual a text by Prisoners Defenders, a Spain-based NGO led by an anti-Cuban activist; HRW does not declare the political opinions of this highly controversial source.

The HRW report reads less like a credible account by a human rights organisation and more like a press release from the three Republican senators-Ted Cruz, Marco Rubio, and Rick Scott-who recently introduced a bill to scuttle Cuba's medical mission program.

In a study published in April 2020, the Instituto de Comunicação e Informação Científica e Tecnológica em Saúde found that Mais Médicos (More Doctors) programme of the Cuban doctors in Brazil improved health indicators of the population; this program brought medical care to remote areas, often for the first time.

Alexandre Padilha of the Workers Party (PT) was a minister of health under President Dilma Rousseff and a member of the team that created the Mais Médicos program. He said that after the Cuban doctors had been ejected, there was an increase in infant mortality and increased pneumonia among the Indigenous communities where they worked; all this was catastrophic during the COVID-19 pandemic.

In June 2020, President Jair Bolsonaro, who had expelled the Cuban doctors in December 2019, asked for them to start work again in Brazil; they were needed to compensate for Brazil's catastrophic reaction to the COVID-19 virus. Even USAID money to compensate for the loss of the Cuban doctors was not sufficient; Bolsonaro wanted the Cuban doctors to stay.

Cuban medical workers are risking their health to break the chain of the COVID-19 infection. Cuban scientists developed drugs-such as interferon alpha-2b-to help fight the disease. Now Cuban scientists have announced that their vaccine is in trials; this vaccine will not be treated as private property but will be shared with the peoples of the world. This is the fidelity of Cuban medical internationalism.

On August 21, Raúl Castro-the first secretary of the Central Committee of the Communist Party of Cuba-spoke at an event for the 60th anniversary of the Federation of Cuban Women (FMC). At the meeting, Castro mentioned that 61 percent of the medical workers in the Henry Reeve Brigade were women; since the start of Cuban medical internationalism in 1960, over 400,000 medical workers have worked in more than 40 countries. These medical workers believe in the twin missions of medical care and internationalism; it is a lesson that they learned from the teachings of Che Guevara, a doctor and an internationalist.

It is a lesson that should be learned in Oslo, Norway, as they adjudicate the Nobel Peace Prize.

With COVID-19 roaring through the US, now is a good time to discuss Cuban health care. It's about as different from the American variety as in January that 45 countries have since requested it from Cuba. But there is no mention of this Covid treatment in the US media. Cuba, a small, relatively poor island country, has shared its medicines and its medical personnel—at great risk to their lives—with countries across the globe throughout the Covid pandemic. This has led to a push for Cuban doctors to get the Nobel Prize. They certainly deserve it.

An incidental benefit of awarding Cuban doctors the Nobel would be breaking the conspiracy of silence about Cuba's remarkable medical successes. Don Fitz eloquently documents that conspiracy and the feats of heroism that it conceals, in his new book, Cuban Health Care. "Since 1961, over 124,000 health professionals [from Cuba] have worked in over 154 countries," Fitz writes. "By 2009, in addition to 11 million people in their own country, Cuban doctors were providing medical care for over 70 million people." Like the US, Cuba has a 78-year life expectancy, but "spends only four percent per person of US health costs." The Cuban infant mortality rate is lower than the US one and half that of the US black population, Fitz reports.

After its 1959 revolution, Cuba "eliminated polio in 1962, malaria in 1967, neonatal tetanus in 1972, diphtheria in 1979, congenital rubella syndrome in 1989, post-mumps meningitis in 1989, measles in 1993, rubella in 1995 and tuberculosis meningitis in 1997." Cuba had only 200 AIDS patients when New York City had 43,000. During crushing US economic sanctions, Cuba achieved all this because of its uniquely rational health care model. Instead of reserving care only for the affluent few, as in the US, Cuba provides it to everybody, free. It does so through its family doctor program, begun in 1984.

In this programme, each doctor and nurse team "included 600-800 [patients] within two to three square blocks in most cities and towns. The teams were required to see every patient at least twice a year… These new family doctors were…very different from the old general practitioners." The doctor and nurse team lives in its patients' neighborhood, often in apartments above the clinic. They frequently walk to patients' houses or apartments to examine them or treat them at home. Thus they know first-hand critical details about their patients' life-styles and illnesses. There is nothing impersonal about this medical system. And that's just within Cuba. Outside it, "52,000 Cuban medical workers [offer] their services in 92 countries," which is more than either the World Health Organisation or "the combined efforts of the G-8 Nations."

A media blackout hides these feats. And in some countries, hostile medical associations try to drive Cuban doctors out. "The conspiracy of silence surrounding the resounding success of Cuba's health system," Fitz writes "is egregious and it casts a doubt on the good intentions of" international health organizations. Fitz is too kind. This conspiracy reveals active, bad intentions. Those were never so fully on display as during Hurricane Katrina, when Cuba offered to send 1500 doctors to New Orleans. The Bush administration refused, revealing, as Fitz comments, that the US preferred needy Americans to die than to accept help from Cuba and thus concede the superiority of Cuban medicine.

The same happened with COVID-19. As the lousy US for profit health care system has led to over 175,000 deaths, Cuban medical personnel have travelled the world, saving lives. Just as they did after Chernobyl, when Cuba took in 25,000 Ukrainian patients and treated them gratis—for years. For many in the Global South, the only doctor they'll ever see is a Cuban doctor. And in these covid—ravaged times, Cuban medical workers risk their lives to save those of patients in other countries. For this alone, Cuban doctors deserve praise and recognition of their heroism. What better way than awarding them the Nobel Prize?

Vol. 53, No. 15, Oct 11 - 17, 2020