The ‘white coat’ brigades: Cuba’s international bid to combat COVID-19

A team of medical and nursing staff arriving in Milan, Italy, on 22 March, to help in the fight against the pandemic. (AP/Antonio Calanni)

An army of Cuban doctors and health specialists has become one of the most active frontline forces in the global fight against coronavirus. Its rapid deployment and effectiveness over recent months has turned it into a positive example of international health cooperation in the face of a pandemic. Criticism of the initiative, largely emanating from the United States, nonetheless accuses the communist government in Havana of using its doctors as a source of hard currency, with no regard for their working conditions, and as a political propaganda tool aimed at whitewashing Cuba’s image around the world.

From Honduras to Mexico, Togo to South Africa, from the worst affected areas in the Italian region of Lombardy to Qatar, Suriname and Andorra, 1,400 doctors have so far been deployed to around 20 countries as part of the Cuban overseas medical brigades dedicated to tackling the COVID-19 pandemic on the ground. This assistance, in many cases free of charge, in others charged for in foreign currency, has stirred outrage in some of these states among conservative political sectors aligned with the harsh stance taken by President Donald Trump’s administration and its accusations regarding the working conditions of Cuban doctors abroad or their alleged role as political ‘commissars’ and spies in the countries benefiting from their cooperation.

In addition to the efforts of President Trump’s Republican government to thwart Cuba’s international medical missions, there is also the issue of the US embargo on the island. The economic blockade, combined with the absence of tourism due to the suspension of international flights to Cuba and the ban on the entry of cruise ships, means that the overseas medical missions are almost the only source of foreign income on the island at the moment. According to official data from 2018, provided by Cuba’s state media, the island received over US$6 billion (some €5.44 billion) for these medical services that year. In 2017, the same revenues had been in excess of US$9 billion (some €8.16 billion), before Trump’s tightening of the blockade against Cuba and the distortion of its cooperation with Brazil and other south American countries now friendly with the head of the US administration.

The US embargo does not only affect the importation of essential medical equipment needed to care for the sick in Cuba but also the supplies of the medical brigades working overseas, often in countries without adequate resources. The embargo does not bar Cuba from purchasing medical equipment but it does make it very difficult, with the additional red tape it entails for companies that are willing to send supplies to the island, and the very strict surveillance they are placed under by US economic authorities.

“The consensus in Washington is that President Donald Trump is unlikely to relax the 60-year-old embargo against Cuba. Let’s not forget that we are in an election year, and Trump is looking to win four more years in the White House in November,” Spanish-American international affairs analyst Alberto Garcia Marrder tells Equal Times.

“Trump needs the vote of the Cuban exile community in Florida, and cannot afford to disappoint his loyal white, working class and conservative followers,” he adds.

He explains that, for the White House, maintaining the blockade on Cuba during these difficult times is not a question of ethics or a lack of them. “What bothers Trump, and bothers him a great deal, is Cuba’s support for the Maduro regime in Venezuela. That is what’s keeping Maduro alive, in spite of the tough US sanctions on Venezuela. If Havana were to turn its back on Maduro, Trump may reward it by relaxing the embargo.”

US pressure on Cuban health operations abroad has been successful in Brazil, Ecuador and Bolivia, where recent changes in their governments and the arrival of administrations closer to Washington have led to the removal of thousands of Cuban doctors working in the most economically depressed parts of these countries. Jair Bolsonaro’s differences with Havana after his election as president of Brazil in 2018, for example, immediately put an end to the work of more than 8,400 Cuban doctors in the country.

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Cuban idealism and pragmatism

More than 30,000 Cuban doctors, including the ‘white coats’ fighting the coronavirus, are working overseas, in 67 countries. Most of them, around 20,000, are in Venezuela. Algeria was the first country to which Cuban doctors were deployed as part of an overseas mission, in 1963. Since then, around 400,000 Cuban doctors and health professionals have worked in 164 countries around the world.

“The medical missions represent the continuation of a praxis rather than an ideal at this stage, the continuation of an internationalist approach that has characterised the Revolution’s relations with the outside world since the outset. Perhaps the pinnacle of that internationalism was Operation Carlota, launched in November 1975 to support the MPLA and the Angolan independence movement. Already back then, the Cubans deployed a large pool of civilian support staff: teachers, engineers and also doctors,” Cuba expert Vanni Pettina, a researcher and associate professor at the College of Mexico’s Centre for Historical Studies, told Equal Times.

In a speech delivered in Buenos Aires in May 2003, Fidel Castro provided some keys to understanding this system of overseas medical cooperation: “Our country does not drop bombs on other peoples, nor does it send thousands of planes to bomb cities; our country does not have nuclear weapons, chemical weapons or biological weapons. The tens of thousands of scientists and doctors we have in our country have been educated in the idea of saving lives.”

It was Castro who, in 2005, established the Henry Reeve Medical Brigade (in honour of the US soldier who offered his services to Cuba during its fight for independence in the 19th century), a brigade dedicated to providing assistance in disaster areas (after hurricanes, earthquakes or floods) and in countries affected by serious epidemics. The brigade’s work was highlighted in 2014 in the fight against Ebola in Guinea, Liberia and Sierra Leone.

Even though the prime objective of Cuba’s medical missions may not be to improve Havana’s relations with other countries and although there may be a strong economic interest behind these healthcare exports, the outcome is, in fact, an improvement in the country’s image abroad.

“Neither idealism nor pragmatism alone can explain this type of intervention outside the island. The medical missions are not only sources of foreign income, they are also a powerful source of legitimisation, both at home and abroad, because they show the coherence between the supposedly emancipatory ideals of the Cuban Revolution and its benevolent foreign policy, which rushes to the aid of the unprotected. Yet the missions are rooted in an ideal that, given the characteristics of the current revolutionary regime, has become very conformist and conservative, an ideal that is gradually being lost, that is being turned into a praxis, which is continuing almost out of inertia,” adds Pettina, author of the book Del compromiso nacionalista a la insurrección: Cuba y Estados Unidos, 1933-1959 (From Nationalist Commitment to Insurrection: Cuba and United States, 1933-1959).

One of the criticisms hurled by Washington is that the Cuban health workers only receive between 20 and 30 per cent of the money paid to Cuba by the countries where they work. The government of President Miguel Díaz-Canel argues that the revenues are used to guarantee Cuba’s free and universal healthcare system.

“Analysing Cuba’s medical missions, like everything else on this island, is not something that can be taken lightly, or viewed from a superficial perspective. Anyone who dismisses the matter by branding the medical missions as slave labour or lauding them as supreme acts of charity is demonstrating a lack of understanding about how Cuba works. It operates across all shades of grey, not at the extremes,” says Benjamín Morales Meléndez, Havana correspondent for the Puerto Rican daily El Nuevo Día.

According to Morales: “The situation cannot be assessed from a Western perspective, since Cuba still has a different, socialist system. It is a country under a blockade and with a centralised government led by a single party. This reality obviously affects medical care in many ways, and like everything else on the island, it has its contradictions. In Cuba, for instance, a doctor can do subspecialty training – which would cost about half a million dollars in the United States – without paying a cent. Here they receive humanistic training that does not see medical care as a business but as the people’s supreme right. And most of the Cuban doctors I know believe in this philosophy.”

At the same time, the Puerto Rican journalist adds: “The very same system that trains them for free, then sells their services to third countries for a profit, which is a contradiction. But let’s not kid ourselves, Cuban doctors don’t do these missions for free either and, in a very Cuban way, they get a lot out of them, so the issue, like everything in Cuba, is much more complex than it appears at first sight.”

Cuban doctors can only practice outside Cuba if they take part in these medical missions. As many as a quarter of the Caribbean country’s doctors have taken part in them. Joining overseas medical expeditions not only provides them with a substantial increase in their wages but also brings them social prestige.

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There is also an unwritten understanding that the experience may someday be the key to working in another country, be it as a deserter from the Cuban health system or as a result of a change in Cuban migration and labour policies.

In spite of everything, there are those who desert the overseas medical brigades. According to Granma, the official newspaper of the Cuban Communist Party, for example, almost 10 per cent of the 8,471 medical cooperators working in Brazil decided not to return to Cuba. The same figure is set at over 21 per cent by the independent Inventario (Inventory) project, founded by journalist Bárbara Maseda.

The fight against COVID-19 in Cuba

Cuba, unlike other countries hard hit by the coronavirus pandemic, has sufficient medical capacity to be able to spare some of its healthcare workers and send them abroad during this time. The island, with a population of over 11 million people, has nine doctors for every thousand inhabitants, according to the 2019 data in its statistical yearbook, a ratio twice that of Italy, for example.

“We have over 90,000 well-trained doctors, enabling us to deal with COVID-19 in Cuba and to collaborate with other countries,” said Cuba’s foreign trade and investment minister, Rodrigo Malmierca, on Twitter.

According to the public health and care section of the 2018 statistical yearbook, published in 2019, Cuba has 95,487 doctors, which are part of a healthcare collective of 261,947 people. The report, published by the National Office of Statistics and Information (ONEI), indicates that there are 150 hospitals on the island, which are part of a network of 11,887 health and care facilities, including nursing homes. The health system has a total of 61,804 beds, of which 39,468 are in hospitals, the largest density in the entire Caribbean region and in much of central and south America.

On 11 March, the first three coronavirus cases were confirmed in Cuba, when three Italian tourists tested positive. The Cuban government reports daily on the evolution of the infected cases, the number of deaths, the isolation and quarantine measures, and the progress made in developing a vaccine against COVID-19. It is a complex task, but one made easier by making good use of the epidemiological experience gained by Cuban doctors abroad. This article has been translated from Spanish.

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