The influence of Cuban medical internationalism

Cuba is a small island nation perhaps best known among Canadians for being a great vacation destination. It cannot be said to be a rich country – which is perhaps why it’s so surprising that Cuba finds itself exporting more medical assistance to developing countries than all the world’s industrialized countries combined.

John Kirk has been a professor at Dalhousie for 33 years, and currently teaches in the Spanish and Latin American Studies department. He has recently released a book, Cuban Medical Internationalism: Origins, Evolution, and Goals, which he co-authored with H. Michael Erisman of Indiana State University.  

The book looks at exactly how and why it came to be that Cuba—a country of eleven million people with a land area comparable to the size of Nova Scotia—has become one of the biggest exporters of doctors and medical care in the world, and a leader in the field of medical internationalism.

A country's commitment

The statistics are surprising: since 1961, approximately 130,000 Cuban health professionals have worked abroad in 102 countries, and as of this year there are nearly 40,000 Cuban medical personnel working in the developing world for periods of two years at a time. In total, Cuba has 23 medical faculties, including the biggest medical school in the world.

The country’s commitment to medical internationalism dates back to the early 60s, when it sent doctors to respond to an earthquake in Chile. Cubans have a reputation for sending response teams into countries regardless of the host country’s politics. Dr. Kirk provides the example of Cuba’s response to the Nicaraguan earthquake of 1972, which killed and injured thousands of people. The Somoza government in Nicaragua had been one of the biggest critics of the Cuban revolution, and yet Cuba was the first country to respond with medical aid to the disaster.

Dr. Kirk says that while all this may be mistaken as medical diplomacy or political maneuvering to get more support in forums like the UN, the ethos of Cuban medical internationalism runs much deeper.

“The need for human solidarity is very deeply rooted in the Cuban government’s psyche,” he explains. While factors like foreign policy promotion play into it, medical internationalism also provides the Cuban government with a source of income—they charge some countries a reduced fee, and produce and sell their own pharmaceutical products—and Cuban medical personnel with a higher salary than they would otherwise make in Cuba.

Perhaps most importantly, it provides a sense of national pride, personal and professional development for the healthcare workers involved, and has gained Cuba an international reputation for humanitarianism.

Fundamentally, Dr. Kirk sees the mentality of Cubans towards healthcare as being very different than most of the world’s. Cuba is not only able to provide enough doctors for its own people, but it is able to help build sustainable health-care systems in the countries where they work by not only practicing preventative medicine, but by training low-income students from other developing countries, at no cost to the students, in Cuban medical universities. They do this with the understanding that they are to return to their home countries to work in underserved areas afterwards.

Learning from Cuba

There may indeed be lots that Canadians can learn from the Cuban example. In fact, Dr. Kirk went to Cuba with a business delegation in 1994 with the then-premier of Nova Scotia, John Savage. The experience would set him on a path to answer the question of why Cubans participate in medical internationalism, and furthermore, what Canadians can learn from their example.

Premier Savage, who had been a family doctor prior to getting into politics, met with Fidel Castro, and Dr. Kirk was present as an interpreter. Dr. Kirk remembers how Castro was “obsessed with public health” and that the two talked at length about the importance of public health and preventative medicine. Later, in 1996, Dr. Kirk returned with Noni Macdonald, Dalhousie’s then-dean of medicine; Jeff Scott, the former chief medical officer for the province; and Anne McGuire, the CEO of the IWK Health Centre. Both experiences served to underline the importance of international knowledge sharing when it comes to such vital issues as health care.

“The provincial government doesn’t appreciate what we can learn from the Cubans,” says Dr. Kirk, “in terms of primary healthcare, saving money, and developing a patient-centric healthcare system.”

He points to the example of our underserved First Nations communities. The Cuban method emphasizes preventative as opposed to curative medicine, and Dr. Kirk sees this as one important aspect of improving the health outcomes of Canada’s vulnerable populations.

“I think in terms of being culturally sensitive but still providing education and quality primary healthcare, living in communities and sharing with the community, doing health-care education with organizations in the communities, lobbying the government to participate in educational programs – all these are things that could be used in rural and First Nations communities and in urban centres where people may also be neglected,” says Dr. Kirk.

“The fact that Cuba produces 83 per cent of its own medicine is useful – perhaps instead of paying lots of money to multinational pharmaceutical companies, we could spend more money to help small and medium-sized companies in Canada to produce our own medicine so we aren’t so dependent on those multinationals.”

A core principle

Dr. Kirk believes that a primary reason for the Cuban emphasis on health care may simply be that they see it as the most fundamental of human rights. Given that Canadians have voted Tommy Douglas, the father of medicare, as our own ‘Greatest Canadian’, many of our own citizens would be likely to agree.

But if that belief is to translate to reality on the ground, we may need to look more closely to the example of the small island state to gain an understanding of how we can not only better care for our own, but provide more effective medical assistance to those in need around the world.

“We refer to it as aid,” says Dr. Kirk, “but the Cubans call it cooperation.”