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Cuban doctors: overlooked champions of the health and human resources crisis

Dr Rhona MacDonald, freelance editor (

This week, the Second Global Forum on health and human resources takes place in Bangkok, Thailand. As the name would suggest, this Forum is a follow up to the initial Global Forum in this crucial area that was held in Kampala, Uganda in March 2008 where Forum participants (1500 people, including donors, experts and ministers of health, education and finance) signed up to the Kampala Declaration and Agenda for Global Action.

The second Forum, (which, according to the blurb is organised by Global Health Workforce Alliance, the Prince Mahidol Award Conference, the World Health Organization and the Japan International Cooperation Agency, supported by many other agencies, especially the Rockefeller Foundation, the China Medical Board and the World Bank) reviews progress towards achieving the Kampala Declaration to date in addition to renewing commitments to health workers towards Millennium Development Goals and beyond. In line with all well organised conferences these days, the Forum has three expected outcomes, one of which is “Coping with new and emerging issues and challenges requiring action and response.

With this outcome in mind, I wonder if the Forum will discuss the potential exodus of a group of health workers who have played a substantial role in keeping weak health systems from falling apart— Cuban doctors.

Cuba’s medical assistance program, which has been running for almost 50 years, has been responsible for 1000s of doctors and paramedics assisting in needy regions of the world, particularly, Central America, The Caribbean, and Africa, through bilateral health contracts. In the 1990’s Cuba’s medical assistance program expanded so much that in 1999, the Latin American School of Medicine, [ELAM (Escuela Latinoamericana de Medicina)] opened, in which students from around the world could come to learn how to practice medicine in underserved communities while having their educational costs covered by Cuba—which, politics aside is an extraordinary act of international health care solidarity on the part of Cuba.

Yet Cuba’s situation is changing. Earlier this month President Barack Obama ordered significant changes to US policies regarding Cuba especially as regards: (1) purposeful travel; (2) non-family remittances; and (3) U.S. airports supporting licensed charter flights to and from Cuba.  According to a WhiteHouse press statement, “These measures will increase people-to-people contact; support civil society in Cuba; enhance the free flow of information to, from, and among the Cuban people; and help promote their independence from Cuban authorities.”

While these measures are an encouraging step in the right direction for the human rights of the Cuban population, the impact of these policies on low-income countries that rely on medical assistance from Cuba is largely unknown but greatly feared.

If the Second Global Forum on Health and Human Resources is serious about tackling new challenges to the global health work force, perhaps a discussion about the potential risk of a decline in the number Cuban doctors working in low-income countries, should be placed firmly on the agenda.

  1. You are romanticizing a system that is exploitive and completely violative of human rights. Cuba sends the impoverished graduates of the Latin American School of Medicine to do residencies in countries like Venezuela, in exchange for oil and cash. These committed doctors. many of whom left their families and countries to get a free medical education in a 7 year program, essentially remain indentured servants to Cuba and Venezuela for the rest of their lives. They are non-competitive in other countries, lacking the knowledge and money to pass licensing exams, seek residencies elsewhere or even prepare a proper CV. Those with no money (Cuba pays them $4 a month while they are in school) wind up with no choice but to go where Cuba sends them for a residency after graduation. Often it is to work in dangerous conditions along the border and risk their lives in Venezuelan jungles. The “residency training” they receive is in public hospitals with antiquated equipment, inadequate medicines and lack of technology. This does not prepare them for anything except continuing to work in Venezuela. They are basically treated like chattel to be exchanged for oil and cash from Venezuela. You mention that they may wind up going to other countries and not be permanent slaves to the Cuban and Venezuelan government as if this was a bad thing. Don’t you think these doctors deserve some human rights too?

  2. I attended the GHA assembly in Bangkok and was amazed that Cuba ‘s unique role if provided free scholarships for thousands of foreign medical students committed to public health back home,went almost unmentioned and unrecognised by this conference.

    No rich western country has ever come close to matching Cuba’s global health role.

    WHO has recognised Cuban health system as being one of the world’s best despite the crippling embargo and limited resources.

    .i have met many African medical students in Cuba and psot-graduates now working back in there countries of origin who are extremely grateful to the knowledge they have acquited,

    Note that South Africans trained in Cuba also come back and sit South African medical exams and then use their committment to public service to stay in the
    public sector. This is exactly the kind of committment that Africa needs most – doctors whose first loyalty is improving the public health system

    This is why more than 70 countries in the world have requested assistance from Cuba medical teams and Cuba aid in natural disasters has been praised from Haiti to Indonesia and many other victims of earthquakes and hurricanes.

    You can lean more from US medical site

  3. […] Rhona McDonald se demande – dans le blogue de Plos “Speaking of Medicine”  – si le Forum discuterait de l’exode potentiel d’un groupe de travailleurs de santé qui ont joué un rôle substantiel pour empêcher les faibles systèmes de santé de sombrer dans l’agonie : les médecins cubains. […]

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