Cuba’s ‘slaves’: Doctors around the world
Isn’t it strange that the United States government is concerned about fair pay for workers from another country when it doesn’t pay its workers fairly?
This oddity is evident in U.S. policy regarding Cuban doctors serving on missions around the world. According to the Trump administration, they are “slaves of the regime” because they are not paid what the United States considers appropriate, and an entire international campaign has been mounted against these missions based on the assumption that we are witnessing the crime of “human trafficking.”
We are discussing health professionals—doctors, nurses, and technicians—who, through government collaboration agreements, are hired to address healthcare gaps in various countries, especially in areas underserved by local medical personnel. This also includes shorter-term emergency missions to assist victims of natural disasters, pandemics, or other contingencies. It is estimated that over 400,000 Cuban health workers have carried out such missions in 134 countries, in most cases free of charge. This mission was initially intended as a task of “solidarity with other peoples.” Participants, therefore, received no additional salary, although they were acknowledged through various forms of recognition from Cuban society and the state. This collaboration also encompasses training foreign doctors in Cuba through scholarships awarded by the Cuban government to developing countries.
It was then understood as fulfilling an “internationalist duty,” which conformed to the values advocated by the Cuban Revolution in educating its citizens. Furthermore, it provided the Cuban state with international prestige and influence that could be capitalized on in light of the isolationism that US policy sought to impose on the country.
Subsequently, although free services remain available for the neediest countries, scholarships continue to be awarded, and commercial criteria do not govern emergency missions, the national economy’s inability to cover these large-scale expenses forced most of these services to be charged.
Depending on the country and the established agreement, these doctors receive a stipend for their expenses, and another portion is deposited in Cuban banks in foreign currency. Their salaries remain in Cuba for the duration of their mission. The Cuban state collects the remainder of the payment for the services, which currently constitutes one of the country’s primary exportable resources. Their influence on the Cuban economy and the benefits they bring to foreign policy explain the United States’ unusual “commitment to justice” in the case of these individuals.
Despite limited success, the US government has made significant efforts to prevent these contracts from being signed or to encourage the doctors involved to defect. In 2006, it implemented the Cuban Medical Professionals Parole Program (CMPP), which granted visas to doctors and their families who abandoned their missions; paradoxically, this did not allow them to practice their profession in the United States. As a result, the “exploited” Cuban doctors ended up “driving Ubers” on the streets of Miami.
This plan was in effect until the final days of Barack Obama’s administration in January 2017. This was, although months earlier, during his visit to Cuba, the president had declared that “the service that thousands of Cuban doctors have provided to the poor and suffering cannot be denied.” Along the same lines, in 2014, then-Secretary of State John Kerry had already expressed his justification for the unusual collaboration established between Cuba and the United States to combat the deadly Ebola pandemic in several African countries, which threatened to spread to the rest of the world.
That same year, the World Health Organization (WHO) awarded the Medal of Merit to Cuba’s Henry Reeve medical contingent “for their assistance to the world’s disadvantaged.” The WHO and the Pan American Health Organization (PAHO) established agreements with the Cuban government to utilize these doctors worldwide.
Very few countries have yielded to U.S. pressure to end this collaboration. Recently, Secretary of State Marco Rubio, one of the architects of the absurdity of turning doctors into slaves, received a resounding rebuke from several Caribbean leaders when he threatened to ban them from entering the United States if they continued to hire these services. At a joint press conference in Kingston, Jamaican Prime Minister Andrew Holness rebutted Rubio, saying, “Let’s be clear, the Cuban doctors in Jamaica have been tremendously beneficial to us… We are very careful not to exploit the Cuban doctors who are here. We ensure they are treated according to our labor laws and benefits like any other worker.”
Although commercialization has somewhat modified its original nature and introduced additional challenges to its implementation, objective reasons, established awareness, and created infrastructure explain these doctors’ willingness to join these missions and the fact that only the Cuban State can offer this service to so many countries around the world.
Faced with the commitment to provide universal medical care during the exodus of most of the country’s doctors, one of the Revolution’s first measures was to train large numbers of doctors willing to work wherever needed, including abroad. Any young person who desires it and meets the requirements can access the highest level of this profession at no cost, an opportunity unique to Cuba, and entails an additional moral commitment to society.
However, the dimensions of this service also pose limitations and contradictions. Although, comparatively speaking, it has always been one of the highest-paid public sectors in the country, Cuban doctors have fallen far short of receiving what they deserve and need to fully satisfy their existential needs.
More clearly than in any other area of national life, one of the most significant contradictions of Cuban socialism is evident here: the human capital being produced cannot be fully absorbed and compensated by the state labor market, where most jobs are located.
Cuban doctors are not trained for private practice like in other countries, nor is such practice possible in Cuba. This explains the emigration of some to other countries and more lucrative employment opportunities within the national labor market. Factors such as professional vocation and social conscience, varying in intensity depending on the individual but inherent to the practice of medicine in Cuba, characterize the work of these individuals and explain why most choose to stay.
This discrepancy between their social contribution and the salary they receive is currently increasing due to the country’s economic crisis. Doctors and nurses endure the same hardships as most of the population; yet, amid the most challenging conditions, they perform a daily job that requires a high degree of dedication and a sense of humanity. To a certain extent, they are “slaves of their duty,” and for this reason, the Cuban people appreciate and honor them.
Not without great personal sacrifice, missions abroad help alleviate this situation in part. It can be argued that they deserve more, and indeed, very few would object, even if other necessary revenues for the country are affected. It is also true that the administration has not been free of shortcomings and has sometimes implemented arbitrary and counterproductive administrative measures, leading to complaints and discontent among doctors. This administration can be improved, but any Cuban knows that no one has been sent against their will, even against their wishes, which would be practically impossible.
Only a twisted mind can discredit an effort that should be praised and emulated by more developed countries, especially the United States, which is reducing its foreign aid programs, and should become a natural part of human relations. This effort is needed in a world with too many sick people and too few doctors and nurses willing to care for them.
