International medical cooperation has far more potential than we give it credit for
Writer: Maria Stoica
Editor: Ceri Ngai
Artist: Patrick Marenda
Potentially one of the largest medical schools in the world, the Latin American School of Medicine (ELAM), calls Havana, Cuba home. The achievement may come as a surprise given the small size of the island; however, its promotion of healthcare has large implications on the global stage.
The origins of Cuba’s medical diplomacy—the intersection between health policy and foreign policy—are rooted in the nation’s revolutionary project dating back to 1959. Above all else, international solidarity supposedly underpins Cuba’s medical diplomacy. A solidarity so intimately linked to the saving of lives is difficult to dismiss, especially when Cuba’s global medical efforts have achieved great successes. One of Cuba’s first formal deployments of medical diplomacy was in response to Hurricane Georges and Mitch in 1998. The nation sent 107 healthcare personnel to Honduras where they visited 1,300 remote villages which otherwise had no access to health services.
ELAM’s opening in 1999 was no coincidence either—the medical school was built upon the premise that it would ultimately streamline Cuba’s ability to export medical care to rural areas both at home and across the globe. To date, some 29,000 students from over 100 nations have received their medicine diplomas from ELAM, signifying the extent to which Cuba has institutionalised its medical diplomacy. Additionally, such a solid foundation for the education and training of future medical practitioners has translated to Cuba having the highest number of physicians per capita in the world. This foundation has also served as a springboard to medical work on the international scene.
The success of Cuba’s medical diplomacy has been two-fold: firstly, the state has built a reputation for successfully responding to global calls for aid, and secondly, its international efforts can address problems of healthcare worker shortages. In April 2020, Cuba sent 200 doctors to South Africa to help with COVID-19 relief efforts. These doctors, along with an additional 1,200 healthcare workers living and working in 22 countries, are part of Cuba’s expansive international medical coalition fighting COVID-19. Cuba’s medical diplomacy is not without flaws, however. Its global success has overshadowed a system predicated on poor working conditions for doctors, with some having testified that they are prevented from publicly speaking up. If Cuba’s medical diplomacy efforts are to be replicated at an even greater scale, the system must be restructured to the benefit of doctors. International solidarity cannot come at the cost of exploiting healthcare professionals.
Additionally, Cuba’s ability to export medical care through the deployment of health workers tackles an intensifying issue on the global health agenda. The World Health Organization (WHO) estimates that 18 million more health workers are needed by 2030, most notably in low and lower-middle income countries. Cuba’s past history of effective medical diplomacy and its ongoing efforts during COVID-19 offers a compelling reason for increased international medical cooperation. Although the scale of the health worker shortage is far greater than what the Cuban revolutionary leader Fidel Castro could have envisioned, his expansion of Cuba’s medical diplomacy efforts was motivated by enabling low and lower-middle income countries to have access to healthcare. The success of collaborative initiatives such as Operation Miracle, launched by Cuba and Venezuela in 2004, demonstrates that international cooperation is completely possible. Tens of thousands of Latin Americans have had their eyesight restored and repaired as a result of this programme.
Another positive global implication of Cuba’s medical diplomacy is that countries have the potential to send bright students for training at ELAM on Cuban-sponsored scholarships and bursaries. This effectively pre-empts a situation NIAID Director Dr Fauci has warned against: resource-poor countries completely relying on richer countries for healthcare instead of having a sustainable health infrastructure of their own. The process of foreign students receiving their medical education at ELAM and returning to their home countries precisely counteracts this dilemma, leading to the development of a durable health infrastructure. Therefore, a project that started in Cuba largely as a political tool can now be leveraged to lessen the burden of a shortfall of 18 million health workers by 2030. In fact, the WHO sees international cooperation in foreign training as a powerful solution to this issue.
Cuba’s ability to export medical care at the scale and the speed that it has presumes a favorable prognosis for global medical diplomacy. Collaborating with other countries and providing accessible medical training to foreign students are just a few of the ways countries can begin to build a global network of healthcare. With healthcare systems around the world predicted to face increasing strain, we need an international network now, more than ever. And if there is one country that is a testament to the potential that expanded international medical cooperation has, it is Cuba.