Healthcare without Borders: Understanding Cuban Medical Internationalism

377 Pages·2015·3.28 MB·English

by  John M. Kirk

Healthcare without Borders
Contemporary Cuba
University Press of Florida
Florida A&M University, Tallahassee
Florida Atlantic University, Boca Raton
Florida Gulf Coast University, Ft. Myers
Florida International University, Miami
Florida State University, Tallahassee
New College of Florida, Sarasota
University of Central Florida, Orlando
University of Florida, Gainesville
University of North Florida, Jacksonville
University of South Florida, Tampa
University of West Florida, Pensacola

HealtHcare
witHout Borders
Understanding Cuban Medical Internationalism
John M. Kirk
John M. Kirk, series editor
University Press of Florida
Gainesville · Tallahassee · Tampa · Boca Raton
Pensacola · Orlando · Miami · Jacksonville · Ft. Myers · Sarasota
Copyright 2015 by John M. Kirk
All rights reserved
Printed in the United States of America on acid-free paper
This book may be available in an electronic edition.
20 19 18 17 16 15 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Kirk, John M., 1951– author.
Healthcare without borders : understanding Cuban medical internationalism / by
John M. Kirk.
pages cm — (Contemporary Cuba)
ISBN 978-0-8130-6105-4
1. Medical assistance, Cuban. 2. Medical policy—Cuba. 3. Medical care—Cuba—
Methods. 4. Public health—Cuba. 5. International cooperation. I. Title. II.
Series: Contemporary Cuba.
RA390.C9K58 2015
362.1097291—dc23
2015013773
The University Press of Florida is the scholarly publishing agency for the State
University System of Florida, comprising Florida A&M University, Florida
Atlantic University, Florida Gulf Coast University, Florida International
University, Florida State University, New College of Florida, University of Central
Florida, University of Florida, University of North Florida, University of South
Florida, and University of West Florida.
University Press of Florida
15 Northwest 15th Street
Gainesville, FL 32611-2079
http://www.upf.com
Contents
List of Tables vii
Preface ix
Acknowledgments xiii
Introduction: Setting the Scene 1
1. Origins and Evolution: From “Beggar’s Helper” to a
“White-Jacketed Army” 14
2. ELAM, a School for All Nations 42
3. Dealing with the “Handicapped” of ALBA: Setting the
Balance Right 68
4. Operación Milagro: Bringing Vision to Millions 96
5. Cuba’s International Disaster Responses: From 1960s Chile to the 2005
Henry Reeve Brigade 118
6. South-South Cooperation in Biotechnology: Medicine for
the Masses 139
7. The Cuba-Venezuela Medical Partnership: The Castro-Chávez Dream
Lives On 162
8. Cuba’s Role in Haiti: Hurricanes, an Earthquake, and Cholera 189
9. Cuba’s Medical Internationalism in the South Pacific 215
10. The Children of Chernobyl: 25,000 Treated 236
11. Cuba’s Medical Internationalism in El Salvador since
Hurricane Ida 253
Conclusion: No Longer the World’s Best-Kept Secret 270
Notes 283
Bibliography 313
Index 341

Tables
1.1. Cuba’s Comprehensive Health Program in 15 African nations,
November 1998–June 2004 31
1.2. ELAM enrollment of students from Central America, 2004–2005 33
2.1. Employment status of Haitian ELAM graduates, 2012 51
2.2. Subject material taught at ELAM 56
3.1. Results of disability study in ALBA countries, 2013 94
4.1. Surgical interventions, Operation Miracle, 2004 through May 10,
2013 116
5.1. Cuba’s international disaster response 120
5.2. Impact of the combined Cuban healthcare program in Guatemala,
1998–2009 137
8.1. Selected statistics on the impact of Cuban medical cooperation in
Haiti, December 1998–May 2007 197
8.2. Selected infectious diseases in Haiti, February 2007 and February
2008 197
8.3. Initial response to cholera outbreak by Cuban-led medical team in
Haiti 206
11.1. Form used by Cuban personnel to evaluate health profiles in areas
affected by natural disasters 258
11.2. Accumulated data on the work of the Cuban medical brigade in El
Salvador, November 13, 2009, through February 22, 2010 259
11.3. Principal medical conditions of patients seen by Cuban medical
brigade 260
C.1. Cuban medical internationalism statistics presented by the Unidad
Central de Colaboración Médica in Havana, October 16, 2013 274

Preface
For such a small nation, the number of doctors and nurses that Cuba is sending,
as well as the speed with which the country has responded, is really extraordinary.
Margaret Chan, director general, World Health Organization, September 12, 2014
In the fall of 2014, a deadly outbreak of Ebola swept through the West Af-
rican countries of Liberia, Guinea-Conakry, and Sierra Leone. By mid-
September, 5,000 people had been infected, over half of whom died, and
just four months later the number of patients had risen to over 20,000,
with more than 8,000 deaths recorded. Predictions about the total num-
ber of cases ranged from 20,000 to hundreds of thousands. Faced with an
impending disaster, Ban Ki-moon, secretary-general of the United Nations
and Dr. Margaret Chan, director general of the World Health Organization
(WHO), appealed to the international community for help and stressed
the need for doctors and nurses above all else. The first country to offer
support was Cuba.
At that time the WHO had 170 medical staff working on this campaign
but desperately needed more. (They had deployed some 500 specialists,
but rotated them monthly due to the dangerous conditions, so that at any
given time only about a third would be working in field.) Some interna-
tional charities and NGOs had smaller numbers of medical staff working
for short periods in West Africa, but others had withdrawn their members
because of the dangers faced, and many healthcare workers had died as a
result of infection. Some countries sent field hospitals and bedding, food,
and medicine, while the United States provided extensive military support
and others donated money. It was clear, though, that the greatest need was
for medical personnel—a challenge ignored by most industrialized nations.
Cuba responded to the appeal within days by offering to send to Sierra
Leone 103 nurses and 62 doctors, all of whom had volunteered to help. This
was the first contribution of healthcare personnel by any country, and it