Steve BrouwerÂs remarkable book ÂRevolutionary DoctorsÂ (Monthly Review Press, 2011) traces Cuban Â Venezuelan collaboration in medical care and teaching.Â That story, little known even to North American leftists, is of ideas and action converting health care into a driving force for international solidarity.
Brouwer emphasizes that bi-national cooperation plays out within the Bolivarian Alliance of the Peoples of Our America, the solidarity alliance known as ALBA. Cuba has sent 15,000 physicians to Venezuela in exchange for reliable access to relatively cheap oil.Â TheyÂve not only delivered health care to 80 percent of Venezuelans, most of them underserved, but also taught 30,000 Venezuelan young people who study in Âmedical schools without walls.Â
Having lived in Sanare, a small city in VenezuelaÂs northwestern countryside, Brouwer was able to follow the daily routines of Cuban doctors practicing and teaching there. He also probed the learning processes and aspirations of Venezuelan medical students living in the area. Dr. Ernesto ÂCheÂGuevera gets credit for helping inspire the project. Brouwer cites CheÂs belief that doctors are best judged Âby their practice of solidarity and equality.Â
The author looks at antecedents for CubaÂs massive medical outreach to Venezuela, among them: experimentation with new methods of health care delivery and medical education, hothouse expansion of health personnel and facilities, and achievement of markedly improved health outcome measures.Â He lauds CubaÂs Latin American School of Medicine that sends 1500 new doctors every year to take up medical work in dozens of countries.
With combined populations of 39 million people, Venezuela and Cuba provide free education for 73,000 of their own medical students. (The United States, population 307 million, trains 70,000 future doctors.)
Over many years, more than 70,000 Cuban doctors have worked in over half the worldÂs countries. The 2500 Cuban doctors arriving in Pakistan in 2005 to care for earthquake victims epitomize commitment to disaster relief worldwide. Brouwer highlights 12 years of Cuban medical support for Haiti, a program going into campaign mode after HaitiÂs 2010 earthquake.
Roger AnnisÂ recent interview in Canada with Dr. Jorge Balseiro Estevez confirms CubaÂs contribution.Â The psychiatrist and health administrator heading a Cuban field hospital in post-earthquake Haiti was touring Canada in support of a project there assisting Cuban medical work in Haiti. www.canadahaitiaction.ca/content/interview-cubas-health-care-miracle-haiti
Excerpts of the interview follow:
Roger Annis (RA), Could you describe the origin of CubaÂs medical brigade to Haiti?
Dr. Jorge Balseiro Estevez (JBE): Yes, it began in 1998. Following the devastation of Hurricane George that year, Fidel Castro announced to the Cuban people that the country would undertake a commitment to deliver important health services to the Haitian people in the form of a volunteer, internationalist medical brigade. A bilateral agreement was signed between the governments of Cuba and Haiti.
The Ministry of Public Health and Population of the Haitian government decided where the brigadeÂs services were most needed. As much as possible, it would make use of existing medical services and infrastructure. The first Cuban doctor arrived in Port au Prince in December of that first year. In 1999, 63 family medicine and specialist doctors arrivedÂ The two governments began to plan HaitiÂs first ever medical schoolÂ Unfortunately, the school was closed down by the coup dÂetat of 2004. We were obliged to move the students to Cuba if they wished to continue to study. Three hundred and twenty one of them moved to the campus of the Latin America School of Medicine in Santiago de Cuba. Seventy students per year continued to enroll in the School.
Notwithstanding the coup, Cuba brought ÂOperation MiracleÂ to Haiti in 2005. This is the joint eye care program with the Government of Venezuela that has improved or restored eyesight to nearly 2 million people in Latin America, notably through cataract surgery. We opened three ophthalmology clinics in Haiti that year. In December, 2006, we signed an agreement with the Government of Haiti, and in cooperation with Venezuela, to establish ten comprehensive diagnostic centers. The first one to be completed was in Cite Soleil in February 2007. These centers were also to be used for training of Haitian medical students.
RA: Please describe what happened following the earthquake.
JBE: At the time of the earthquake, there were 367 Cuban doctors, health workers and technicians serving in Haiti. Within hours of the earthquake, airplanes from Cuba were bringing complete field hospitals and 1,500 more medical personnel. Other medical personnel then followed, including 361 graduates of the Latin American School of Medicine from other countries in Latin America and fifth year, Haitian medical students and Haitian resident doctors in Cuba. There were five comprehensive diagnostic centers in operation in the earthquake zone, plus our brigade personnel went to work in Haitian institutions. We quickly established six field hospitals. The first of those additional, 1,500 medical personnel were those who had already worked in Haiti. All of our doctors were paired up with the Haitian students, as much as possible.
RA: How many Haitians have been served by CubaÂs medical mission?
JBE: According to my most recent statistics from several weeks ago, since 1998, [Cuban doctors have] treated more than 18 million cases in Haiti. We have performed 304,577 surgeries and vaccinated 1,501,076 people. We estimate the number of lives we have saved is 284,239. Since the earthquake, we have treated 347,601 people and performed 8,870 surgeries. We have delivered 1,631 babies and vaccinated 74,493 people.
The post-earthquake work is very complex, with large numbers of injured people to treat. Rehabilitation services have been provided to 75,013 people. So far, 75 people have received prostheses to replace lost limbs. Psychosocial treatment is also needed for survivors. 116,000 children, for example, are receiving some form of psychosocial assistance.
R.A. The cholera outbreak must have been quite a burden to pile onto the existing post-earthquake work?
JBE: Yes, but we had no choice but to respond quickly. The Brigade established 44 cholera treatment units (complete with testing laboratories) Â We also have 46 cholera detection units in operation in communities. Our total number of patients in the first year of the epidemic was 76,130. Thirty percent of those were under the age of 15. We suffered 272 deaths in the areas we were serving, but we are very proud to report that we have had no deaths in the past 267 days. Our mortality rate from cholera has declined to 0.36% per patient, compared to the country-wide rate of 1.41%.
R.A. So give us a summary of CubaÂs medical presence in Haiti today.
JBE: At present we have 786 Cuban doctors and health workers in Haiti, and we are working with an additional 21 from Latin American countries. Since the earthquake, we have received US $23 million in financial assistance from international donors. We have 23 communal (provincial) hospitals in operation and ten comprehensive diagnostic centers (operated in cooperation with Venezuela). We have a total of 30 rehabilitation rooms. There are 28 active epidemiological surveillance and control programs (surveying for such threats as malaria and dengue). There are 12 health (family doctor) centers and we are planning to build a laboratory for producing prostheses and three electro-technical workshops (for equipment maintenance and repair). Two Operation Miracle clinics are still in operation and we are providing technical advice as well as vaccines for vaccination programs.
R.A. Could you say a few words about your personal experiences?
JBE: I work at the field hospital in Leogane (west of Port au Prince, the epicenter of the earthquake). Our work is very complex. I would like to give you an idea of the scope and complexity of the treatment we provide to our patients. We have to deliver medical services. We have treated some 48,000 patients and performed 500 surgeries and 150 deliveries. We have fitted 70 amputees with prostheses. These patients require constant care and follow, including because as a child or adolescent grows, or as a wound heals from an amputation heals, the prosthesis is outgrown and must be replaced. So we must equip ourselves with the capacity to make new ones. Our work is performed in tents, so we must take special care to keep everything hygienic. Food and clean water must be supplied, not only for our hospital but also for the surrounding community, as needed. Everything we do we must include training of student doctors or health workers. And we must conduct health promotion and education among the population we are serving.
R.A. At the international donors conference for Haiti on March 31, 2010, Cuba outlined a plan whereby the world could assist Haiti in creating a comprehensive, national health care system. I believe Cuba mentioned a figure of $170 million per year for the next five years to establish such a system. Is this proposal moving forward, and what are the main obstacles to its success?
JBE: I think this could be moved forward with the collaboration of all countries. The main obstacle is the unfulfilled financial and other promises by some. The world must be more active in fulfilling on time its agreements and commitments to Haiti.
December 10, 2011