By Maria C. Werlau, Executive Director, Cuba Archive
Published in The Wall Street Journal, Monday, August 16, 2010
For decades, Cuba has "exported" doctors, nurses and health technicians to earn diplomatic influence in poor countries and hard cash for its floundering economy. According to Cuba's official media, an estimated 38,544 Cuban health professionals were serving abroad in 2008, 17,697 of them doctors. (Cuba reports having 70,000 doctors in all.)
These "missionaries of the revolution" are well-received in host countries from Algeria to South Africa to Venezuela. Yet those who hail Cuba's generosity overlook the uglier aspects of Cuba's health diplomacy.
The regime stands accused of violating various international agreements such as the Trafficking in Persons Protocol and ILO Convention on the Protection of Wages because of the way these health-care providers are treated. In February, for example, seven Cuban doctors who formerly served in Venezuela and later defected filed a lawsuit in Florida federal court against Cuba, Venezuela and the Venezuelan state oil company for holding them in conditions akin to "modern slavery."
They claim the Cuban regime held the funds Venezuela remitted for their services and then paid them—an arrangement they say is a form of "debt bondage." They also say they were forced to work extremely long hours in dangerous areas, including urban zones with high crime rates and the jungle. (The Venezuelan government and its oil company are challenging the court's jurisdiction to hear the case; Cuba hasn't responded.)
Starting in 2002, Hugo Chávez agreed to pay—mostly with subsidized, cheap Venezuelan oil—for Cuba to provide health care to marginalized populations in Venezuela at no cost to patients. But in the past several years he has expanded the effort to other countries, helping to build support for his regional Marxist agenda while keeping the Cuban economy afloat.
Cuba won't release its agreements with host countries, but details have emerged in open sources, including in Cuba's official media. These show that typically the host country pays Cuba hard currency for each health worker and provides accommodations, food and a monthly stipend generally between $150 and $350. Cuba covers airfare and logistical support, and it pays salaries to the health-care workers out of the funds it holds.
Cuba's global health projects also receive support from the developed world. In 2005, at least $27 million was donated to Cuba's Haiti mission, including from France and Japan. International goodwill also translates into direct aid. In 2008, Cuba received $127 million from OECD countries. These transfers explain the recent rise in Cuba's export of services, to $8.6 billion in 2008 from $2.8 billion in 2003. Representing 75% of GDP, they generate far more income than any other industry.
Cuban doctors go abroad because at home they earn a scant $22-$25 a month. When they work in other countries, they typically get a small stipend in local currency while their families back home receive their usual salary plus a payment in hard currency—from $50 to $325 per month.
But with the state as sole employer and the citizens forbidden from leaving the country without permission, the system is tailor-made for exploitation. Several Cuban doctors who have served abroad tell me that in addition to very long hours they may not drive a car, leave their dwellings after a certain hour, or speak to the media. In some countries they are only allowed to associate with "revolutionaries." Thousands of Cuban health professionals have deserted world-wide. Almost 1,500 have made it to the U.S. alone since 2006, according to a Department of Homeland Security report in March.
Cuba's profitable global business has ramifications for its own health-care system. It's been extensively reported, by Cuba's independent journalists as well as by the occasional Westerner who ends up in a hospital for the common people, that Cubans face a chronic shortage of doctors and dilapidated health facilities. Patients or their families must even bring their own food and linens to the hospital.
Meanwhile, the mass production of Cuban doctors for export has led medical associations in host countries such as Bolivia, Paraguay, Uruguay, Brazil and Portugal to question their experience and credentials. Some Venezuelan doctors have complained of being fired and replaced by Cuban missionary physicians. And a few years ago the Bolivian press reported that the country's medical association was complaining about thousands of unemployed health professionals who were earning considerably less than what Mr. Chávez was paying for Cubans.
Humanitarianism cannot be selective. Cuba's health workers deserve full protection of local and international laws, its citizens deserve access to adequate health care, and patients everywhere deserve accountability from their health-care providers.
Ms. Werlau is executive director of nonprofit Cuba Archive, a human rights organization.