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03/30/10 - Cuba-L Analysis (Albuquerque) - Cuban Medical Cooperation in
Haiti: One of the World's Best-Kept Secrets

Emily J. Kirk, Cambridge University*
John M. Kirk, Dalhousie University*


Media coverage of Cuban medical cooperation following the disastrous recent
earthquake in Haiti was sparse indeed.  International news reports usually
described the Dominican Republic as being the first to provide assistance,
while Fox News sang the praises of U.S. relief efforts in a report entitled
"U.S. Spearheads Global Response to Haiti Earthquake"-a common theme of its
extensive coverage.  CNN also broadcast hundreds of reports, and in fact one
focused on a Cuban doctor wearing a T-shirt with a large image of Che
Guevara--and yet described him as a "Spanish doctor".

In general, international news reports ignored Cuba's efforts.  By
March 24, CNN for example, had 601 reports on their news website regarding
the earthquake in Haiti-of which only 18 (briefly) referenced Cuban
assistance. Similarly, between them the New York Times and the Washington
Post had 750 posts regarding the earthquake and relief efforts, though not a
single one discusses in any detail any Cuban support.  In reality, however,
Cuba's medical role had been extremely important-and had been present since
1998.


Cuba and Haiti Pre-Earthquake

 In 1998, Haiti was struck by Hurricane Georges. The hurricane caused 230
deaths, destroyed 80% of the crops, and left 167,000 people homeless.[1]
Despite the fact that Cuba and Haiti had not had diplomatic relations in
over 36 years, Cuba immediately offered a multifaceted agreement to assist
them, of which the most important was medical cooperation.

Cuba adopted a two-pronged public health approach to help Haiti. First, it
agreed to maintain hundreds of doctors in the country for as long as
necessary, working wherever they were posted by the Haitian government. This
was particularly significant as Haiti's health care system was easily the
worst in the Americas, with life expectancy of only 54 years in 1990 and one
out of every 5 adult deaths due to AIDS, while 12.1% of children died from
preventable intestinal infectious diseases.[2]


In addition Cuba agreed to train Haitian doctors in Cuba, providing that
they would later return and take the places of the Cuban doctors (a process
of "brain gain" rather than "brain drain"). Significantly, the students were
selected from non-traditional backgrounds, and were mainly poor.  It was
thought that, because of their socio-economic background, they fully
understood their country's need for medical personnel, and would return to
work where they were needed. The first cohort of students began studying in
May, 1999 at the Latin American School of Medicine (ELAM).


By 2007, significant change had already been achieved throughout the
country. It is worth noting that Cuban medical personnel were estimated to
be caring for 75% of the population.[3]  Studies by the Pan American Health
Organization (PAHO) indicated clear
improvements in the health profile since this extensive Cuban medical
cooperation began.



                    Improvements in Public Health in Haiti, 1999-2007[4]

Health Indicator                 1999        2007
Infant Mortality,
per 1,000 live births              80         33
Child Mortality
Under 5 per 1,000                 135         59.4
Maternal Mortality per
100,000 live births               523         285
Life Expectancy
(years)                            54          61


Cuban medical personnel had clearly made a major difference to the national
health
 profile since 1998, largely because of their proactive role in preventive
medicine-as can be seen below.

        Selected Statistics on Cuban Medical Cooperation Dec. 1998-May
2007[5]
        Visits to the doctor            10,682,124
        Doctor visits to patients        4,150,631
        Attended births                     86,633
        Major and minor surgeries          160,283
        Vaccinations                       899,829
        Lives saved (emergency)            210,852



By 2010, at no cost to medical students, Cuba had trained some 550 Haitian
doctors, and is at present training a further 567. Moreover, since 1998 some
6,094 Cuban medical personnel have worked in Haiti. They had given over 14.6
million consultations, carried out 207,000 surgical operations, including
45,000 vision restoration operations through their Operation Miracle
programme, attended 103,000 births, and taught literacy to 165,000. In fact
at the time of the earthquake there were 344 Cuban medical personnel there.
All of this medical cooperation, it must be remembered, was provided over an
11-year period before the earthquake of January 12, 2010.[6]

Cuba Post-Earthquake:


The earthquake killed at least 220,000, injured 300,000 and left 1.5 million
homeless.[7] Haitian PrimeMinister Jean-Max Bellerive described it as "the
worst catastrophe that has occurred in Haiti in two centuries".[8]

International aid began flooding in. It is important to note the type of
medical aid provided by some major international players. Médecins Sans
Frontières (MSF), for example, an organization known for its international
medical assistance, flew in some 348 international staff, in addition to the
3,060 national staff it already employed. By March 12 they had treated some
54,000 patients, and completed 3,700 surgical operations.[9]


Canada's contribution included the deployment of 2,046 Canadian Forces
personnel, including 200 DART personnel. The DART (Disaster Assistance
Response Team) received the most media attention, as it conducted 21,000
consultations-though it should be noted they do not treat any serious trauma
patients or provide surgical care. Indeed, among the DART personnel, only 45
are medical staff, with others being involved in water purification,
security, and reconstruction. In total, the Canadians stayed for only 7
weeks.[10]


The United States government, which received extensive positive media
attention, sent the USNS "Comfort", a 1,000-bed hospital ship with a
550-person medical staff and stayed for 7 weeks, in which time they treated
871 patients, performing 843 surgical operations.[11]  Both the Canadian and
US contributions were important-while they were there.


Lost in the media shuffle was the fact that, for the first 72 hours
following the earthquake, Cuban doctors were in fact the main medical
support for the country. Within the first 24 hours, they had completed 1,000
emergency surgeries, turned their living quarters into clinics, and were
running the only medical centers in the country, including 5 comprehensive
diagnostic centers (small hospitals) which they had previously built.  In
addition another 5 in various stages of construction were also used, and
they turned their ophthalmology center into a field hospital-which treated
605 patients within the first 12 hours following the earthquake.[12]


Cuba soon became responsible for some 1,500 medical personnel in Haiti. Of
those, some 344 doctors were already working in Haiti, while over 350
members of the "Henry Reeve" Emergency Response Medical Brigade were sent by
Cuba following the earthquake.  In addition, 546 graduates of ELAM from a
variety of countries, and 184 5th and 6th year Haitian ELAM students joined,
as did a number of Venezuelan medical personnel.   In the final analysis,
they were working throughout Haiti in 20 rehabilitation centers and 20
hospitals, running 15 operating theatres, and had vaccinated 400,000. With
reason Fidel Castro stated, "we send doctors, not soldiers".[13]

A glance at the medical role of the various key players is instructive.

Comparative Medical Contributions in Haiti by March 23[14]

                     MSF        Canada     United States     Cuba
No. of Staff         3,408        45        550                1,504
No. of Patients
     Treated        54,000        21,000    871              227,143
No. of Surgeries     3,700        0         843                6,499



These comparative data, compiled from several sources, are particularly
telling as they indicate the significant (and widely ignored) medical
contribution of the Cubans. In fact, they have treated 4.2 times the number
of patients compared with MSF (which has over twice as many workers, as well
as
significantly more financial resources), and 10.8 times more than the
Canadian DART team. (As noted, Canadian and US medical personnel had left by
March 9).  Also notable is the fact that the Cuban medical contingent was
roughly three times the size of the American staff, although they treated
260.7 times more patients than U.S. medical personnel. Clearly, there have
been significant differences in the nature of medical assistance provided.

It is also important to note that approximately one-half of the Cuban
medical staff was working outside the capital, Port-au-Prince, where there
was significant damage as well. Many medical missions could not get there,
however, due to transportation issues. Significantly, the Cuban medical
brigade also worked to minimize epidemics by making up 30 teams to educate
communities on how to properly dispose of waste, as well as how to minimize
public health risks.  Noted Cuban artist Kcho also headed a cultural brigade
made up of clowns, magicians and dancers, supported by psychologists and
psychiatrists, to deal with the trauma experienced by Haitian children.

Perhaps most impressively, following the growing concern for the health of
the country, due to a poor and now largely destroyed health care system
Cuba, working with ALBA (the Alianza Bolivariana para los Pueblos de Nuestra
América) countries, presented to the WHO an integral program to reconstruct
the health care system of Haiti. Essentially, they are offering to rebuild
the entire health care system.   It will be supported by ALBA and Brazil,
and run by Cubans and Cuban-trained medical staff. This is to include
hospitals, polyclinics, and medical schools. In addition, the Cuban
government has offered to increase the number of Haitian students attending
medical school in Cuba.   This offer of medical cooperation represents an
enormous degree of support for Haiti.[15]  Sadly, this generous offer has
not been reported by international media.

While North American media might have ignored Cuba's role, Haiti has not.
A pointed remark was made by Haitian President Mr. René Préval, who noted,
"you did not wait for an earthquake to help us".[16] Similarly, Haiti's
Prime Minister Jean-Max Bellerive has also repeatedly noted that the first
three countries to help were Cuba, the Dominican Republic and Venezuela.


Sadly (but not surprisingly), while Cuba's efforts to assist Haiti have
increased, international efforts have continued to dwindle. The head of the
Cuban medical mission, Dr. Carlos Alberto García, summed up well the
situation just two weeks after the tragedy: "many foreign delegations have
already begun to leave, and the aid which is arriving now is not the same it
used to be. Sadly, as always happens, soon another tragedy will appear in
another country, and the people of Haiti will be forgotten, left to their
own fate".  Significantly, he added "However we will still be here long
after they have all gone."[17] This in fact has been the case.  Canadian
forces, for example, returned home and the USNS Comfort sailed several weeks
ago. By contrast, Cuban President Raúl Castro noted: "we have accompanied
the Haitian people, and we will continue with them whatever time is needed,
no matter how many years, with our very modest support".[18]

A representative of the World Council of Churches to the United Nations made
the telling comment that "humanitarian aid could not be human if it was only
publicized for 15 days".[19] Today Cuba, with the support of ALBA and
Brazil, is working not to build a field hospital, but rather a health care
system. And, while international efforts have been largely abandoned, the
Cuban staff and Cuban-trained medical staff will remain, as they have done
for the past 11 years, for as long as necessary.  This is a story that
international media have chosen not to tell-now that the television cameras
have gone. Yet it is an extraordinary story of true humanitarianism, and of
great success in saving lives since 1998.  Moreover, in light of Cuba's
success in providing public health care (at no cost to the patients) to
millions of Haitians, this approach to preventive, culturally sensitive, low
cost and effective medicine needs to be told.  That significant contribution
to this impoverished nation, and Cuba's ongoing commitment to its people,
clearly deserve to be recognized.  Until then it will sadly remain as one of
the world's best- kept secrets.


Notes:

[1] "Audit of USAID/HAITI Hurricane Georges Recovery Programme". USAID. 15
May, 2001. Retrieved 10 March, 2010 from <
http://www.usaid.gov/oig/public/fy01rpts/1-521-01-005-p.pdf>
[2] See entry for "Haiti" on the Pan American Health Organization website,
found at http://www.paho.org/english/dd.ais/cp_332.htm.  Accessed February
2, 2010.
[3] William Steif, "Cuban Doctors Aid Strife-Torn Haiti." The State. April
26, 2004, and found at
http://havanajournal.com/culture/entry/cuban_doctors_aid_strife_torn_haiti/
Accessed June 21, 2007.
[4] See entry for "Haiti" on the Pan American Health Organization website,
found at http://www.paho.org/english/dd/ais/cp_332.htm. Accessed February 2
2010.
[5] Anna Kovac, "Cuba Trains Hundred of Haitian Doctors to Make a
Difference," August 6, 2007. Located on the MEDICC website at
http:www.medicc.org/cubahealthreports/chr-article.php?&a=1035. Accessed
February 2, 2010.
[6] Ibid., "Haitian Medical Students in Cuba". Medical Education Cooperation
With Cuba. 12 January, 2010. Retrieved 12 January, 2010 from
, "La colabaración cubana
permanecerá en Haití los años que sean necesarios", Cubadebate. 24 February,
2010. Retrieved 9 March, 2010 from
, "Fact Sheet: Cuban Medical Cooperation With Haiti". Medicc
Review. 15 January, 2009. Retrieved 2 February, 2010 from
http://www.medicc.org/ns/index.php?s=104.
[7] "Haiti Earthquake: Special Coverage". CNN. 20 March, 2010. Retrieved 22
March, 2010 from  
[8] Tyler Maltbie, "Haiti Earthquake: The Nations That Are Stepping Up To
Help", The Christian Science Monitor, Posted January 14, 2010 on
http://www.csmonitor.com/layout/set/print/content/view/print273879. Accessed
January 28, 2010.
[9] "Two Months After the Quake, New Services and New Concerns". MSF. 12
March, 2010. Retrieved 17 March, 2010 from

[10] "Canada's Response to the Earthquake in Haiti: Progress to Date".
Foreign Affairs and International Trade Canada. March 17, 2010. Retrieved 17
March, 2010 from

[11] "USNS Comfort Completes Haiti Mission, March 9, 2010". American Forces
Press Service. 9 March, 2010. Retrieved 11 March, 2010 from

[12] John Burnett, "Cuban Doctors Unsung Heroes of Haitian Earthquake",
National Public Radio report, January 24, 2010, and found at
http://www.npr.org/templates/story.ph?storyID=122919202. Accessed 28
January, 2010.
[13] José Steinsleger. "Haiti, Cuba y la ley primera," La Jornada, February
3, 2010., Data in this section came from the address given by Ambassador
Rodolfo Reyes Rodríguez on January, 27, 2010 in Geneva at the 13th Special
Session of the U.N. Human Rights Council on Haiti. It can be accessed at
"Cuba en Ginebra: 'Ante tan difícil situación humanitaria en Haití no puede
haber titubeos ni indiferencia," on the Cubbadebate website:

[14] Connor Gorry. "Two of the 170,000 + Cases". Medicc Review. March 8,
2010. Retrieved 10 March, 2010 from  ,
"Cooperación con Haití debe ser a largo plazo." Juventud Rebelde. 23 March,
2010. Retrieved March 23, 2010 from
,
"Haiti: Two Months After The Quake, New Services and New Concerns". MSF. 12
March, 2010. Retrieved 17 March, 2010 from
http://www.doctorswithoutborders.org/news/article_print.cfm?id=4320>,
"Haiti-USNS Comfort Medical And Surgical Support". U.S. Department of Health
and Human Services. 11 March, 2010. Retrieved 11 March, 2010 from
, Brett Popplewell. "This Haitian
Town Is Singing Canada's Praise". The Star. 26 January, 2010. Retrieved 17
March from , "USNS Comfort
Leaves Haiti". 13 News. 11 March, 2010. Retrieved 11 March, 2010 from

[15] In a March 27, 2010 meeting in Port-au-Prince between President Préval
and the Cuban and Brazilian ministers of health (José Ramón Balaguer and
José Gomes), details were provided about what Balaguer termed "a plot of
solidarity to assist the Haitian people".  Gomes added "We have just signed
an agreement-Cuba, Brazil and Haiti-according to which all three countries
make a commitment to unite our forces in order to reconstruct the health
system in Haiti.  An extraordinary amount of work is currently being carried
out in terms of meeting the most basic and most pressing needs, but now it
is necessary to think about the future  [.] Haiti needs a permanent, quality
healthcare system, supported by well-trained professionals [.]  We will
provide this, together with Cuba-a country with an extremely long
internationalist experience, a great degree of technical ability, great
determination, and an enormous amount of heart.  Brazil and Cuba, two
nations that are so close, so similar, now face a new challenge: together we
will unite our efforts to rebuild Haiti, and rebuild the public health
system of this country".  See "Cuba y Brasil suman esfuerzos con Haití,"
Juventud Rebelde, March 28, 2010 (Translation to English provided  by
authors).
[16] "Presidente Preval agradece a Fidel y Raúl Castro ayuda solidaria a
Haití". 8 February, 2010. Retrieved 9 February, 2010 from <
http://www.cubadebate.cu/noticias/2010/02/08presidente-preval-agradece-fidel
-raul-castro>
[17] María Laura Carpineta, "Habla el jefe de los 344 médicos cubanos
instalados en Haití desde hace doce años". Página 12 [Argentina]. February
4, 2010, found at CUBA-L@LISTA.UNM.EDU
[18] Ibid.
[19] "Press Conference on Haiti Humanitarian Aid," held at the United
Nations on March 23, 2004 and found at
htto://www.un.org/News/briefings/docs/2004/CanadaPressCfc.doc.htm. Accessed
November 21, 2008.

*Emily J. Kirk will be an M.A. student in Latin American Studies at
Cambridge University in September.
* John Kirk is a professor of Latin American Studies at Dalhousie
University, Canada.
Both are working on a project on Cuban medical internationalism
sponsored by Canada's Social Science and Humanities Research Council of
Canada (SSHRC).  Professor Kirk co-wrote with Michael Erisman the 2009 book
"Cuba's Medical Internationalism: Origins, Evolution and Goals" (Palgrave
Macmillan).  He spent most of February and March in El Salvador and
Guatemala, accompanying the Henry Reeve Brigade in El Salvador, and working
with the Brigada Medica Cubana in Guatemala.





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