11 ms·

In the medical response to Ebola, Cuba is punching above its weight

200 points by megalodon 12y ago

VLM 12y ago
Decades ago Cuba made training and exporting medical personnel their "thing" and they ended up owning that part of the world market despite being a small and very poor country. There is a direct tech analogy with Finland and cell phones. From the small country PoV, if you can't compete in the strategic nuclear bomber world market, or the manufacturing robot world market, you can probably find some market segment, however small, to focus on and take over. Like cellphones, or 3rd world medical care. Other countries could, and probably will, do the same. There is the interesting analogy that Finland isn't doing so well in the post Nokia, iphone and android world. Wonder what could happen to Cuba if the demand for docs dried up (optimistically due to 3rd world advancing into training their own medical workers, and not by the entire 3rd world dying of ebola or in ensuing strife after the epidemic)
- will_brown 12y ago
  Cuba's healthcare niche is not necessarily limited to 3rd world medical care. Throughout the US/Cuba embargo the US had routinely carved out an exception to trade for Cuba's cancer/anti-cancer medications which have been viewed as cutting edge for over a decade. So perhaps another niche 1st world cancer research and treatments.
  - toomuchtodo 12y ago
    I'm both astounded and shamed as a US citizen that we enact broad trade sanctions against Cuba today while happily creating exceptions for anti-cancer drugs.
    - will_brown 12y ago
      Yea, living in Miami, I see how the embargo negatively impacts people on a daily basis. That said the Cuban ex-pats I know are split on the issue - and fiercely - with half die hard supporters of the embargo and half opposed. As long as the embargo is in place, I prefer we bring in Cuban drugs at least for clinical trials, but I don't think US is happy to create exceptions and it is probably embarrassing a tiny island nation which the US has lead a economic crusade against for nearly 50 years produces any cancer drugs superior to those produced in the US.
- Retric 12y ago
  What I thought was most interesting in the Cuba case was how little technology it takes to train Doctors. Outside of surgery Doctors tend to have other people doing the high tech hands on work like operating an MRI or Doing blood-work. But, as they training people to operate in the 3rd world even surgery tends to be fairly low tech. In reality it's the opportunity costs that makes training doctors so expensive. So, in many ways less developed nations have a huge cost advantage when supplying doctors. The real issue is after exporting them they probably don't send all that much money back home.
  - guard-of-terra 12y ago
    The real issue is that developed countries refuse to import doctors. Developed countries have medical doctors associations which keep a close eye on who can become doctor and how, thus limiting the number of doctors in the country and sustaining their high wages. From what I've heard, you have to get an expensive education and then live thru a long and undercompensated and exhausting internship in order to become a full doctor and get all the perks. Any immigrant will also have to face that kind of internship (not easy for someone without a source of income) plus they have to re-learn a lot of things in order to pass the certification. I might be fuzzy on the details, but still: we're lucky in our IT, we have comparative small amount of bullshit and entrenching.
    - maxerickson 12y ago
      It's just the opposite: http://www.ft.com/cms/s/0/9647519c-207a-11e3-b8c6-00144feab7de.html#axzz3FNWxlNtQ http://www.ft.com/cms/s/0/9647519c-207a-11e3-b8c6-00144feab7... Doctors tend to leave undeveloped countries for developed countries.
      - guard-of-terra 12y ago
        It's behind paywall.
        maxerickson 12y ago
- calibraxis 12y ago
  Any rich country could replicate Cuba's efforts, but they don't want to. (That is, not sufficiently to actually get it done.) In contrast, some seem to have no problem exporting anti-doctors — uniformed killers and drones. And all that from an island despite US's decades-long embargo and forcing the criminal Guantanamo Bay prison on them.
- kaonashi 12y ago
  I also find it interesting that this option would not be available to Cuba if it were more integrated economically with the rest of the world. The first thing the IMF would force them to get rid of would be high-end public education programs, or at least put them out of reach economically for a large portion of the population.
  - marcosdumay 12y ago
    The IMF can only "force" countries to do things if those countries want to lend money from them. And even then, a country can lie with impunity in a round - unless it wants repeating lending rounds, and lies in important and bad ways. Also, I've never hear about the IMF forcing a country to dismantle its public-education programs. When Brazil was on their hook they did anything but that, and in the later years IMF helped improving it.
    - kaonashi 12y ago
      That seems to have been the general result any time a structural adjustment (or the rebranded, poverty-reduction) program was implemented.
      - randomafrican 12y ago
        Quite often the IMF is an easy scapegoat. You'd be surprised by how often the IMF advice is ignored or by how sound it can be at times. For instance, in Ukraine a few years ago, the IMF's advice was to cut down on some structural expenses (gas subsidies mostly) and not to touch investment expenses as doing that would trigger a recession. For political reasons IMF did the opposite.
        kaonashi 12y ago
        What it usually is is political cover for local elites to betray their populations; remove barriers to capital flow and trade, gut environmental and labor protections.
- masklinn 12y ago
  > Decades ago Cuba made training and exporting medical personnel their "thing" and they ended up owning that part of the world market despite being a small and very poor country. Not just medical personnel, in the 60s they were one of the biggest provider of trained personnel in general in the newly independent congo (before being forced out as Zaïrisation ramped up) to both staff the country and provide training (Belgium had avoided/refused to establish a local elite, so when they hightailed the newly independent Congo had no administrators, no teachers, no doctors, …)
- atourgates 12y ago
  I was just discussing this the other day with one of my friends. We both grew up in the Seventh-Day Adventist church, a church that has made "medical evangelism" a big part of its strategy. The discussion was brought about by seeing an Adventist doctor we'd eaten dinner with a few months ago in California, being interviewed on CNN from a hospital in Liberia where she was caring for Ebola patients. I have grandparents, aunts and uncles who were all trained at Adventist medical institutions, and spent time working at hospitals in 3rd world countries. The Adventist church has its own medical school, as well as a health system (though neither is directly operated by the church). I took a "student missions" year out of college (somewhat like Mormon mission years, only typically more a religiously-driven piece-corps-type year of teaching, medical assistance etc. than direct-evangelism) and spent it in Belize volunteering at a hospital. 3 of the hospital's 5 physicians were Cubans, and I learned first-hand that Cuba and the Adventist church have remarkably similar strategies when it comes to training doctors, and using them as a PR tool. In both cases it seems to be quite effective. In Belize, many people I met thought highly of Cuba, because their most direct interaction was through the doctors they sent. Even here in the states, when the Adventist church is mentioned I'll often hear, "Oh, I think my Doctor is one of those."
- deleted 12y ago
  [deleted]
cgar 12y ago
How interesting, just yesterday I watched a TED[1] talk about Cuba's ELAM (Latin American School of Medicine)[2]. > Established in 1999 and operated by the Cuban government, ELAM has been described as possibly being the largest medical school in the world by enrollment with approximately 19,550 students from 110 countries reported as enrolled in 2013. [1] http://www.ted.com/talks/gail_reed_where_to_train_the_world_s_doctors_cuba http://www.ted.com/talks/gail_reed_where_to_train_the_world_... [2] https://en.wikipedia.org/wiki/ELAM_%28Latin_American_School_of_Medicine%29_Cuba https://en.wikipedia.org/wiki/ELAM_%28Latin_American_School_...
- illumen 12y ago
  It's one of Cuba's top exports.
- 616c 12y ago
  I assume it must be the same school, but a undergrad friend and roommate was a pre-med and came from a very interesting family. His family was all about immigration in the US, and was very tight with the Latin American community where they lived (he even grew up for a period in Mexico, and spoke perfect Mexican Spanish, as was his American father who raised him there). He clued me into the existence of full-ride scholarships for Americans to study in medicine. American students with a full medical education in Cuba! I was very impressed. I guess it is this. http://www.ifconews.org/node/707 http://www.ifconews.org/node/707 This kid was amazing and very altruistic. However, he pulled his application bc of the sad reality of US medicine; he was told point blank by some med school mentors he would never practice medicine in the US with that degree, and it was pointless as he would likely redo all of his medical education and required certification/boards stateside lest he have any intention of ever practicing medicine in the States. I am still glad, despite all the fucked up political harassment by the USG, this scholarship remains.
  - jessaustin 12y ago
    Preventing foreign physicians from practicing in USA is kind of the whole point of having a "profession" with lobbyists like the AMA. If they had to compete with H-1B'ers, they couldn't afford to spend so many years and dollars in training. Also health care would be much cheaper, which would step on a lot more toes than just those of the M.D.'s.
brohoolio 12y ago
Their contribution will save thousands of lives. Ebola is a slow moving tsunami that we, as a world, can stop. If we don't step up and contribute the needed resources, literally hundreds of thousands of people will die. The sooner the better. Hats off to Cuba, but for the rest of the world, especially countries that can contribute, this should be a wake up call.
- jessaustin 12y ago
  Is there any doubt that "hundreds of thousands will die" of ebola in the next year? The reports I've seen are a bit more pessimistic.
api 12y ago
Can we end the stupid sanctions now? The USSR is gone and we trade massively with China for F's sake. Cuba doesn't have the best human rights record on Earth, but neither does China or Saudi Arabia to give two other examples with which we trade extensively. All this does is harm the Cuban people and paradoxically actually strengthens the existing regime there.
- bdevani 12y ago
  China can be considered capitalist, they trade actively with us, and honestly we don't have the ability go to against them. Saudi Arabia, needs to be on our side, to provide the natural resources we consume. Cuba..that would be just us trading with a Communist country. It would mean allowing Americans to consider a communist country, instead of writing that idea off as crazy. Neither political party in the US wants that. Neither party in the US believes a friendly more transparent relationship with Cuba will strengthen American belief in capitalist democracy across all of society.
  - guard-of-terra 12y ago
    Cuba already has small private business. It will swiftly transform to China-like capitalism if you let them do so.
  - piokuc 12y ago
    "China can be considered capitalist, they trade actively with us [...] Cuba..that would be just us trading with a Communist country." - this is just pure hypocrisy.
- equoid 12y ago
  America needs China and the Saudis (for investment/loans/manufacturing and oil respectively). It does need Cuba so can happily pretend to be principled by bullying them.
  - emodendroket 12y ago
    I thought that was the point of seemingly endless bombing campaigns.
benbeltran 12y ago
Off-topic, but I had the opportunity to have several cuban PhDs teach some of the final classses in college (Multi-agent systems, computer intelligence, etc) ... All of them were incredibly good in their fields, better than any other professors I had in school, and as good as some of the brightest I've met in this field. There were also some docs in other disciplines and they were all incredibly good. Based on that experience I think cuba is hardly "punching far above its weight", but reflecting great care, passion and responsibility as they do in other fields... We just assume a lot of things about cuba. I sure did before.
- crpatino 12y ago
  I don't think the "above its weight" in the title refers to the quality of Cuban education, but the size of its economy. So, if you look at the number of qualified personnel committed to the epidemic by country, and divide over their per capita GNP, indeed Cuba is punching way above its weight.
spiritplumber 12y ago
Cuban doctors are incredible for doing much with little.
scardine 12y ago
It is easier to create new drugs if you are not subject to strict regulations and if you are not afraid of lawsuits from people that participate in trials. What slows down the research in USA is the safety mechanisms imposed by FDA. This is almost the same for every country that is not a dictatorship. source: worked a decade for pharmaceutical companies.
- jdimov 12y ago
  There's a more general and more interesting pattern at work here. As humanity, we have grown too fond of our safety and comfort over the past 50 years to the point of being unwilling to take the risks that are necessary for us to grow further. The levels of risk-aversion we have reached, especially in developed countries is actually akin to a terminal disease that is already ensuring the demise of most "western powers". It's paradoxical in a very beautiful way.. that will eventually serve to remind us that life isn't really about being safe and secure. Safety, security and privacy are unnatural values that have been drilled into us, quite elaborately, over generations. They are fake values that only serve to hold us back and inhibit our innate greatness.
dreamweapon 12y ago
Aside from the condescending title, we also have this, in the first sentence: Cuba, a country of just 11 million people that still enjoys a fraught relationship with the United States To describe Cuba's position with regard to the U.S. (entering its 6th decade of basically vindictive and pointless economic sanctions) as a "fraught relationship" is certainly an interesting circumlocution. It's kind of like saying that the skinny kid in junior high who keeps getting pushed into lockers "enjoys a fraught relationship" with his peers.
- Someone1234 12y ago
  Seems like you got offended just for the sake of getting offended. The title isn't THAT condescending, they're giving Cuba props for weighing in more than another country of its size and GDP. As to the "fraught relationship" issue, what? I'm not sure what terminology you would have prefered they used but most of the alternative words choices are just 'fraught' synonyms anyway. The Cuba sanctions are well known and a lot of people (myself included) think they're unwarranted. I'd definitely call what Cuba and the US have a fraught relationship. Do I think the US bullies Cuba a bit? Yes. Do I think that the word choice was bad? No.
  - dreamweapon 12y ago
    I wasn't "offended"; I was making an observation. You don't have to agree with it, but there's no need to inject an emotional aspect into it simply doesn't have.
  - dreamweapon 12y ago
    Anyway, the point about the "fraught relationship" depiction is that it's basically an elephant-in-the-room thing. Such language might work to describe the relationship between the U.S. and Russia (or China), because those countries are essentially peers on the global stage. But to use it in the US/Cuba case pointedly ignores the fundamentally one-sided and, in the view of many inside (and essentially everyone outside) the U.S., petty-minded and abusive nature of that country's treatment of its much more vulnerable southern neighbor. There's also an unpleasant blame-the-victim tinge to it. The Post could have stated the obvious, of course, and acknowledged the elephant in the room. But it knows very well that in order to maintain its image as the (lessor of two) "papers of record" within the center of Federal power, that just would not do.
throwaway_yy2Di 12y ago
Would these Cuban doctors be likely to escape to the US via Liberia? Normally it's illegal for them (doctors) to travel outside of the country: http://www.bbc.com/travel/blog/20130116-cuba-lifts-travel-restrictions http://www.bbc.com/travel/blog/20130116-cuba-lifts-travel-re... (edit) Apparently the US explicitly permits Cuban doctors working abroad to emigrate to the US -- in contrast with most refugees, who have to physically set foot in the country to gain asylum. https://en.wikipedia.org/wiki/Cuban_medical_internationalism#Defection https://en.wikipedia.org/wiki/Cuban_medical_internationalism... http://www.state.gov/p/wha/rls/fs/2009/115414.htm http://www.state.gov/p/wha/rls/fs/2009/115414.htm http://online.wsj.com/articles/SB10001424052970203731004576045640711118766 http://online.wsj.com/articles/SB100014240529702037310045760... "...a wave of Cubans who have defected to the U.S. since 2006 under the little-known Cuban Medical Professional Parole immigration program, which allows Cuban doctors and some other health workers who are serving their government overseas to enter the U.S. immediately as refugees. Data released to The Wall Street Journal under the Freedom of Information Act shows that, through Dec. 16, 1,574 CMPP visas have been issued by U.S. consulates in 65 countries."
- megalodon 12y ago
  That's funny, the US are keen on maintaining the embargo against Cuba but at the same time don't mind welcoming their doctors and thus admitting their superiority in medical education.
  - freehunter 12y ago
    I'm not sure that welcoming Cuban doctors necessarily means admitting superior medical education. Most countries like well-educated immigrants, no matter what their former nation was. The US welcomed Nazi scientists to help build rockets and bombs, too. That wasn't a commentary on the Nazi regime other than that they had good scientists that were willing to defect.
    - mercurial 12y ago
      I don't know, hearing stories of immigrants with good degrees having to do menial work in Europe isn't that uncommon.
ctdonath 12y ago
A chronically under-recognized point is buried in the article: It's not a simple picture. Critics have complained that Cuba has begun to sacrifice the health of its citizens at home to make money sending medical workers abroad, and the conditions for these medical workers themselves have been criticized
- guard-of-terra 12y ago
  Cuba now has roughly the same life expectancy as the USA - a bit more than 79 years. I.e. it doesn't seem that they sacrificed a lot.
  - ecocentrik 12y ago
    The US isn't exactly setting the bar for healthcare.
    - funcSoulBrother 12y ago
      It's not about the United States being the best, it's about them being the "reference standard" for life quality in developed nations. Everybody compares themselves to the US from economic metrics to quality of life, as one will do when a superpower has dominated geopolitical dynamics for as long as the US has.
      - danohuiginn 12y ago
        In many areas, yes. But from Europe at least, the US healthcare system seems so obviously broken that it's relatively rarely used for comparisons. Sweden is more common, I'd say. Now if we're talking about innovation, technology, culture -- THEN there will be wistful comparisons to the US
        deleted 12y ago
        [deleted]
      - grecy 12y ago
guelo 12y ago
Cuba was the world's best experiment in total communism. Unfortunately the US ruined the experiment by imposing an embargo for decades out of spite. Still, when you compare Cuba to neighboring Dominican Republic they're doing better under many measures, including health, education and a GNP per capita of $5890 vs DR's $5620.
- jacobolus 12y ago
  Cuba did much better than all the Latin American countries that allowed the US to dominate them; it’s quite amazing, considering the economic strain put on by the embargo. Though the Cuban regime was hardly friendly to dissidents, journalists, or activists, and hardly democratic (to say the least), their actions are nothing compared to the fascist police states backed by the US up through the 1980s throughout Latin America. It’s really not until the 1990s when the US stopped worrying quite so much about Communism and focused our attention elsewhere in the world that most of Latin America was able to start acting more autonomously and solving their own problems. US relative non-involvement for the past 25 years has seen the growth of democracy, checks on the power of militaries, de-escalation of border conflicts and increasing economic cooperation. One can only wonder what would have happened if the US government hadn’t spent the several decades before that installing and propping up puppet dictators, and overthrowing democratic governments.
  - randomafrican 12y ago
    Costa Rica has done as well or even better
    - wwweston 12y ago
      Costa Rica may be the exception that proves the rule, or at least is notable for what it didn't do -- it didn't let itself become a colony/client state/banana republic, there was a state-led internal industrialization effort integrated with measured open-ness for international trade/investment, it didn't keep a standing military after its revolution. And Cuba likely still would have done better without the US embargo.
argumentum 12y ago
Don't be unduly impressed. It's common for a totalitarian state to focus its resources and "punch above its weight" in a specific area or two, but it's at the expense of the rest of their economy and the general well-being of its people. Its also a common tactic used to shore up support at home and win superficial plaudits abroad. The Soviets were able to keep pace with the US militarily and in space. The also had world-beating athletics, chess and classical arts (ballet, orchestra etc). All this came at the high price of individual freedom and basic human prosperity. Milton Friedman aptly observed this gap between "public affluence and private squalor" as the defining outcome of centralized socialism. Christopher Hitchens, at that time a committed socialist, described his disillusionment w/Cuba while volunteering there in 1968 as follows: Cuba was torn between grim austerity for its people and flamboyant hedonism for its revolutionaries, and one’s elementary socialist principles managed to register the gross injustice of this even while hoping (perhaps) that the engine of history would make up the deficit. - http://www.city-journal.org/2008/18_2_spring_1968.html http://www.city-journal.org/2008/18_2_spring_1968.html It is, I guess, better that Cuba has chosen to focus on healthcare rather than war-mongering, but it doesn't recommend their method of government as preferable to our own. It doesn't recommend their hundreds (perhaps thousands) of political executions or their death squads or their forced labor camps. It doesn't recommend their complete suppression of free speech and their prosecution of Cubans wanting to leave this self-proclaimed "paradise". And it seems quite unethical to praise Cuba for it's export of medical expertise while ignoring the fact that relatives of these experts are essentially held hostage to ensure they won't defect. If you don't see something extremely sinister and disgusting about this, I'd posit you don't have the capacity for suspicion and disgust. .. the government "bars citizens engaged in authorized travel from taking their children with them overseas, essentially holding the children hostage to guarantee the parents' return. Given the widespread fear of forced family separation, these travel restrictions provide the Cuban government with a powerful tool for punishing defectors and silencing critics." - Human Rights Watch, http://en.wikipedia.org/wiki/Health_care_in_Cuba http://en.wikipedia.org/wiki/Health_care_in_Cuba I'd posit that a fair (and fairly obvious) measure of a political system is the market for voluntarily migration. The fact is that almost no one migrates into Cuba and millions have braved, and continue to brave, incredible costs and dangers to migrate away from Cuba. American style democratic capitalism is not without its flaws, and we must be eternally vigilant to resist and reverse attempts by both state and corporate power to impinge on our rights & freedoms in their own selfish interests. But, unlike Cubans (and former East Germans etc), we have the political infrastructure and basic human freedom to improve our system for the better. We shouldn't sacrifice these hard earned and extremely rare circumstances in the vain hope of securing marginally better health outcomes (or marginally better security, chess skills, literacy rates etc) by means of totalitarian socialism.
PauloManrique 12y ago
Brazil got a program that imports around 10 thousand cuban doctors. And they are nearly slaves to the cuban regime. Brazil pays around 4k USD for each doctor, but he only keeps 1,2k. Everything else goes to the Castro's regime. And that's because our oposition made a huge noise about that, because they used to receive about 400 USD, and the rest of the money to castro. They have a good health program? Maybe. But I won't swap my freedom for that.

200 points by megalodon 12y ago

VLM 12y ago

Decades ago Cuba made training and exporting medical personnel their "thing" and they ended up owning that part of the world market despite being a small and very poor country. There is a direct tech analogy with Finland and cell phones. From the small country PoV, if you can't compete in the strategic nuclear bomber world market, or the manufacturing robot world market, you can probably find some market segment, however small, to focus on and take over. Like cellphones, or 3rd world medical care. Other countries could, and probably will, do the same. There is the interesting analogy that Finland isn't doing so well in the post Nokia, iphone and android world. Wonder what could happen to Cuba if the demand for docs dried up (optimistically due to 3rd world advancing into training their own medical workers, and not by the entire 3rd world dying of ebola or in ensuing strife after the epidemic)

will_brown 12y ago
Cuba's healthcare niche is not necessarily limited to 3rd world medical care. Throughout the US/Cuba embargo the US had routinely carved out an exception to trade for Cuba's cancer/anti-cancer medications which have been viewed as cutting edge for over a decade. So perhaps another niche 1st world cancer research and treatments.
- toomuchtodo 12y ago
  I'm both astounded and shamed as a US citizen that we enact broad trade sanctions against Cuba today while happily creating exceptions for anti-cancer drugs.
  - will_brown 12y ago
    Yea, living in Miami, I see how the embargo negatively impacts people on a daily basis. That said the Cuban ex-pats I know are split on the issue - and fiercely - with half die hard supporters of the embargo and half opposed. As long as the embargo is in place, I prefer we bring in Cuban drugs at least for clinical trials, but I don't think US is happy to create exceptions and it is probably embarrassing a tiny island nation which the US has lead a economic crusade against for nearly 50 years produces any cancer drugs superior to those produced in the US.
Retric 12y ago
What I thought was most interesting in the Cuba case was how little technology it takes to train Doctors. Outside of surgery Doctors tend to have other people doing the high tech hands on work like operating an MRI or Doing blood-work. But, as they training people to operate in the 3rd world even surgery tends to be fairly low tech. In reality it's the opportunity costs that makes training doctors so expensive. So, in many ways less developed nations have a huge cost advantage when supplying doctors. The real issue is after exporting them they probably don't send all that much money back home.
- guard-of-terra 12y ago
  The real issue is that developed countries refuse to import doctors. Developed countries have medical doctors associations which keep a close eye on who can become doctor and how, thus limiting the number of doctors in the country and sustaining their high wages. From what I've heard, you have to get an expensive education and then live thru a long and undercompensated and exhausting internship in order to become a full doctor and get all the perks. Any immigrant will also have to face that kind of internship (not easy for someone without a source of income) plus they have to re-learn a lot of things in order to pass the certification. I might be fuzzy on the details, but still: we're lucky in our IT, we have comparative small amount of bullshit and entrenching.
  - maxerickson 12y ago
    It's just the opposite: http://www.ft.com/cms/s/0/9647519c-207a-11e3-b8c6-00144feab7de.html#axzz3FNWxlNtQ http://www.ft.com/cms/s/0/9647519c-207a-11e3-b8c6-00144feab7... Doctors tend to leave undeveloped countries for developed countries.
    - guard-of-terra 12y ago
      It's behind paywall.
      - maxerickson 12y ago
calibraxis 12y ago
Any rich country could replicate Cuba's efforts, but they don't want to. (That is, not sufficiently to actually get it done.) In contrast, some seem to have no problem exporting anti-doctors — uniformed killers and drones. And all that from an island despite US's decades-long embargo and forcing the criminal Guantanamo Bay prison on them.
kaonashi 12y ago
I also find it interesting that this option would not be available to Cuba if it were more integrated economically with the rest of the world. The first thing the IMF would force them to get rid of would be high-end public education programs, or at least put them out of reach economically for a large portion of the population.
- marcosdumay 12y ago
  The IMF can only "force" countries to do things if those countries want to lend money from them. And even then, a country can lie with impunity in a round - unless it wants repeating lending rounds, and lies in important and bad ways. Also, I've never hear about the IMF forcing a country to dismantle its public-education programs. When Brazil was on their hook they did anything but that, and in the later years IMF helped improving it.
  - kaonashi 12y ago
    That seems to have been the general result any time a structural adjustment (or the rebranded, poverty-reduction) program was implemented.
    - randomafrican 12y ago
      Quite often the IMF is an easy scapegoat. You'd be surprised by how often the IMF advice is ignored or by how sound it can be at times. For instance, in Ukraine a few years ago, the IMF's advice was to cut down on some structural expenses (gas subsidies mostly) and not to touch investment expenses as doing that would trigger a recession. For political reasons IMF did the opposite.
      - kaonashi 12y ago
        What it usually is is political cover for local elites to betray their populations; remove barriers to capital flow and trade, gut environmental and labor protections.
masklinn 12y ago
> Decades ago Cuba made training and exporting medical personnel their "thing" and they ended up owning that part of the world market despite being a small and very poor country. Not just medical personnel, in the 60s they were one of the biggest provider of trained personnel in general in the newly independent congo (before being forced out as Zaïrisation ramped up) to both staff the country and provide training (Belgium had avoided/refused to establish a local elite, so when they hightailed the newly independent Congo had no administrators, no teachers, no doctors, …)
atourgates 12y ago
I was just discussing this the other day with one of my friends. We both grew up in the Seventh-Day Adventist church, a church that has made "medical evangelism" a big part of its strategy. The discussion was brought about by seeing an Adventist doctor we'd eaten dinner with a few months ago in California, being interviewed on CNN from a hospital in Liberia where she was caring for Ebola patients. I have grandparents, aunts and uncles who were all trained at Adventist medical institutions, and spent time working at hospitals in 3rd world countries. The Adventist church has its own medical school, as well as a health system (though neither is directly operated by the church). I took a "student missions" year out of college (somewhat like Mormon mission years, only typically more a religiously-driven piece-corps-type year of teaching, medical assistance etc. than direct-evangelism) and spent it in Belize volunteering at a hospital. 3 of the hospital's 5 physicians were Cubans, and I learned first-hand that Cuba and the Adventist church have remarkably similar strategies when it comes to training doctors, and using them as a PR tool. In both cases it seems to be quite effective. In Belize, many people I met thought highly of Cuba, because their most direct interaction was through the doctors they sent. Even here in the states, when the Adventist church is mentioned I'll often hear, "Oh, I think my Doctor is one of those."
deleted 12y ago
[deleted]

cgar 12y ago

How interesting, just yesterday I watched a TED[1] talk about Cuba's ELAM (Latin American School of Medicine)[2]. > Established in 1999 and operated by the Cuban government, ELAM has been described as possibly being the largest medical school in the world by enrollment with approximately 19,550 students from 110 countries reported as enrolled in 2013. [1] http://www.ted.com/talks/gail_reed_where_to_train_the_world_s_doctors_cuba http://www.ted.com/talks/gail_reed_where_to_train_the_world_... [2] https://en.wikipedia.org/wiki/ELAM_%28Latin_American_School_of_Medicine%29_Cuba https://en.wikipedia.org/wiki/ELAM_%28Latin_American_School_...

illumen 12y ago
It's one of Cuba's top exports.
616c 12y ago
I assume it must be the same school, but a undergrad friend and roommate was a pre-med and came from a very interesting family. His family was all about immigration in the US, and was very tight with the Latin American community where they lived (he even grew up for a period in Mexico, and spoke perfect Mexican Spanish, as was his American father who raised him there). He clued me into the existence of full-ride scholarships for Americans to study in medicine. American students with a full medical education in Cuba! I was very impressed. I guess it is this. http://www.ifconews.org/node/707 http://www.ifconews.org/node/707 This kid was amazing and very altruistic. However, he pulled his application bc of the sad reality of US medicine; he was told point blank by some med school mentors he would never practice medicine in the US with that degree, and it was pointless as he would likely redo all of his medical education and required certification/boards stateside lest he have any intention of ever practicing medicine in the States. I am still glad, despite all the fucked up political harassment by the USG, this scholarship remains.
- jessaustin 12y ago
  Preventing foreign physicians from practicing in USA is kind of the whole point of having a "profession" with lobbyists like the AMA. If they had to compete with H-1B'ers, they couldn't afford to spend so many years and dollars in training. Also health care would be much cheaper, which would step on a lot more toes than just those of the M.D.'s.

brohoolio 12y ago

Their contribution will save thousands of lives. Ebola is a slow moving tsunami that we, as a world, can stop. If we don't step up and contribute the needed resources, literally hundreds of thousands of people will die. The sooner the better. Hats off to Cuba, but for the rest of the world, especially countries that can contribute, this should be a wake up call.

jessaustin 12y ago
Is there any doubt that "hundreds of thousands will die" of ebola in the next year? The reports I've seen are a bit more pessimistic.

api 12y ago

Can we end the stupid sanctions now? The USSR is gone and we trade massively with China for F's sake. Cuba doesn't have the best human rights record on Earth, but neither does China or Saudi Arabia to give two other examples with which we trade extensively. All this does is harm the Cuban people and paradoxically actually strengthens the existing regime there.

bdevani 12y ago
China can be considered capitalist, they trade actively with us, and honestly we don't have the ability go to against them. Saudi Arabia, needs to be on our side, to provide the natural resources we consume. Cuba..that would be just us trading with a Communist country. It would mean allowing Americans to consider a communist country, instead of writing that idea off as crazy. Neither political party in the US wants that. Neither party in the US believes a friendly more transparent relationship with Cuba will strengthen American belief in capitalist democracy across all of society.
- guard-of-terra 12y ago
  Cuba already has small private business. It will swiftly transform to China-like capitalism if you let them do so.
- piokuc 12y ago
  "China can be considered capitalist, they trade actively with us [...] Cuba..that would be just us trading with a Communist country." - this is just pure hypocrisy.
equoid 12y ago
America needs China and the Saudis (for investment/loans/manufacturing and oil respectively). It does need Cuba so can happily pretend to be principled by bullying them.
- emodendroket 12y ago
  I thought that was the point of seemingly endless bombing campaigns.

benbeltran 12y ago

Off-topic, but I had the opportunity to have several cuban PhDs teach some of the final classses in college (Multi-agent systems, computer intelligence, etc) ... All of them were incredibly good in their fields, better than any other professors I had in school, and as good as some of the brightest I've met in this field. There were also some docs in other disciplines and they were all incredibly good. Based on that experience I think cuba is hardly "punching far above its weight", but reflecting great care, passion and responsibility as they do in other fields... We just assume a lot of things about cuba. I sure did before.

crpatino 12y ago
I don't think the "above its weight" in the title refers to the quality of Cuban education, but the size of its economy. So, if you look at the number of qualified personnel committed to the epidemic by country, and divide over their per capita GNP, indeed Cuba is punching way above its weight.

spiritplumber 12y ago

Cuban doctors are incredible for doing much with little.

scardine 12y ago

It is easier to create new drugs if you are not subject to strict regulations and if you are not afraid of lawsuits from people that participate in trials. What slows down the research in USA is the safety mechanisms imposed by FDA. This is almost the same for every country that is not a dictatorship. source: worked a decade for pharmaceutical companies.

jdimov 12y ago
There's a more general and more interesting pattern at work here. As humanity, we have grown too fond of our safety and comfort over the past 50 years to the point of being unwilling to take the risks that are necessary for us to grow further. The levels of risk-aversion we have reached, especially in developed countries is actually akin to a terminal disease that is already ensuring the demise of most "western powers". It's paradoxical in a very beautiful way.. that will eventually serve to remind us that life isn't really about being safe and secure. Safety, security and privacy are unnatural values that have been drilled into us, quite elaborately, over generations. They are fake values that only serve to hold us back and inhibit our innate greatness.

dreamweapon 12y ago

Aside from the condescending title, we also have this, in the first sentence: Cuba, a country of just 11 million people that still enjoys a fraught relationship with the United States To describe Cuba's position with regard to the U.S. (entering its 6th decade of basically vindictive and pointless economic sanctions) as a "fraught relationship" is certainly an interesting circumlocution. It's kind of like saying that the skinny kid in junior high who keeps getting pushed into lockers "enjoys a fraught relationship" with his peers.

Someone1234 12y ago
Seems like you got offended just for the sake of getting offended. The title isn't THAT condescending, they're giving Cuba props for weighing in more than another country of its size and GDP. As to the "fraught relationship" issue, what? I'm not sure what terminology you would have prefered they used but most of the alternative words choices are just 'fraught' synonyms anyway. The Cuba sanctions are well known and a lot of people (myself included) think they're unwarranted. I'd definitely call what Cuba and the US have a fraught relationship. Do I think the US bullies Cuba a bit? Yes. Do I think that the word choice was bad? No.
- dreamweapon 12y ago
  I wasn't "offended"; I was making an observation. You don't have to agree with it, but there's no need to inject an emotional aspect into it simply doesn't have.
- dreamweapon 12y ago
  Anyway, the point about the "fraught relationship" depiction is that it's basically an elephant-in-the-room thing. Such language might work to describe the relationship between the U.S. and Russia (or China), because those countries are essentially peers on the global stage. But to use it in the US/Cuba case pointedly ignores the fundamentally one-sided and, in the view of many inside (and essentially everyone outside) the U.S., petty-minded and abusive nature of that country's treatment of its much more vulnerable southern neighbor. There's also an unpleasant blame-the-victim tinge to it. The Post could have stated the obvious, of course, and acknowledged the elephant in the room. But it knows very well that in order to maintain its image as the (lessor of two) "papers of record" within the center of Federal power, that just would not do.

throwaway_yy2Di 12y ago

Would these Cuban doctors be likely to escape to the US via Liberia? Normally it's illegal for them (doctors) to travel outside of the country: http://www.bbc.com/travel/blog/20130116-cuba-lifts-travel-restrictions http://www.bbc.com/travel/blog/20130116-cuba-lifts-travel-re... (edit) Apparently the US explicitly permits Cuban doctors working abroad to emigrate to the US -- in contrast with most refugees, who have to physically set foot in the country to gain asylum. https://en.wikipedia.org/wiki/Cuban_medical_internationalism#Defection https://en.wikipedia.org/wiki/Cuban_medical_internationalism... http://www.state.gov/p/wha/rls/fs/2009/115414.htm http://www.state.gov/p/wha/rls/fs/2009/115414.htm http://online.wsj.com/articles/SB10001424052970203731004576045640711118766 http://online.wsj.com/articles/SB100014240529702037310045760... "...a wave of Cubans who have defected to the U.S. since 2006 under the little-known Cuban Medical Professional Parole immigration program, which allows Cuban doctors and some other health workers who are serving their government overseas to enter the U.S. immediately as refugees. Data released to The Wall Street Journal under the Freedom of Information Act shows that, through Dec. 16, 1,574 CMPP visas have been issued by U.S. consulates in 65 countries."

megalodon 12y ago
That's funny, the US are keen on maintaining the embargo against Cuba but at the same time don't mind welcoming their doctors and thus admitting their superiority in medical education.
- freehunter 12y ago
  I'm not sure that welcoming Cuban doctors necessarily means admitting superior medical education. Most countries like well-educated immigrants, no matter what their former nation was. The US welcomed Nazi scientists to help build rockets and bombs, too. That wasn't a commentary on the Nazi regime other than that they had good scientists that were willing to defect.
  - mercurial 12y ago
    I don't know, hearing stories of immigrants with good degrees having to do menial work in Europe isn't that uncommon.

ctdonath 12y ago

A chronically under-recognized point is buried in the article: It's not a simple picture. Critics have complained that Cuba has begun to sacrifice the health of its citizens at home to make money sending medical workers abroad, and the conditions for these medical workers themselves have been criticized

guard-of-terra 12y ago
Cuba now has roughly the same life expectancy as the USA - a bit more than 79 years. I.e. it doesn't seem that they sacrificed a lot.
- ecocentrik 12y ago
  The US isn't exactly setting the bar for healthcare.
  - funcSoulBrother 12y ago
    It's not about the United States being the best, it's about them being the "reference standard" for life quality in developed nations. Everybody compares themselves to the US from economic metrics to quality of life, as one will do when a superpower has dominated geopolitical dynamics for as long as the US has.
    - danohuiginn 12y ago
      In many areas, yes. But from Europe at least, the US healthcare system seems so obviously broken that it's relatively rarely used for comparisons. Sweden is more common, I'd say. Now if we're talking about innovation, technology, culture -- THEN there will be wistful comparisons to the US
      - deleted 12y ago
        [deleted]
    - grecy 12y ago

guelo 12y ago

Cuba was the world's best experiment in total communism. Unfortunately the US ruined the experiment by imposing an embargo for decades out of spite. Still, when you compare Cuba to neighboring Dominican Republic they're doing better under many measures, including health, education and a GNP per capita of $5890 vs DR's $5620.

jacobolus 12y ago
Cuba did much better than all the Latin American countries that allowed the US to dominate them; it’s quite amazing, considering the economic strain put on by the embargo. Though the Cuban regime was hardly friendly to dissidents, journalists, or activists, and hardly democratic (to say the least), their actions are nothing compared to the fascist police states backed by the US up through the 1980s throughout Latin America. It’s really not until the 1990s when the US stopped worrying quite so much about Communism and focused our attention elsewhere in the world that most of Latin America was able to start acting more autonomously and solving their own problems. US relative non-involvement for the past 25 years has seen the growth of democracy, checks on the power of militaries, de-escalation of border conflicts and increasing economic cooperation. One can only wonder what would have happened if the US government hadn’t spent the several decades before that installing and propping up puppet dictators, and overthrowing democratic governments.
- randomafrican 12y ago
  Costa Rica has done as well or even better
  - wwweston 12y ago
    Costa Rica may be the exception that proves the rule, or at least is notable for what it didn't do -- it didn't let itself become a colony/client state/banana republic, there was a state-led internal industrialization effort integrated with measured open-ness for international trade/investment, it didn't keep a standing military after its revolution. And Cuba likely still would have done better without the US embargo.

argumentum 12y ago

Don't be unduly impressed. It's common for a totalitarian state to focus its resources and "punch above its weight" in a specific area or two, but it's at the expense of the rest of their economy and the general well-being of its people. Its also a common tactic used to shore up support at home and win superficial plaudits abroad. The Soviets were able to keep pace with the US militarily and in space. The also had world-beating athletics, chess and classical arts (ballet, orchestra etc). All this came at the high price of individual freedom and basic human prosperity. Milton Friedman aptly observed this gap between "public affluence and private squalor" as the defining outcome of centralized socialism. Christopher Hitchens, at that time a committed socialist, described his disillusionment w/Cuba while volunteering there in 1968 as follows: Cuba was torn between grim austerity for its people and flamboyant hedonism for its revolutionaries, and one’s elementary socialist principles managed to register the gross injustice of this even while hoping (perhaps) that the engine of history would make up the deficit. - http://www.city-journal.org/2008/18_2_spring_1968.html http://www.city-journal.org/2008/18_2_spring_1968.html It is, I guess, better that Cuba has chosen to focus on healthcare rather than war-mongering, but it doesn't recommend their method of government as preferable to our own. It doesn't recommend their hundreds (perhaps thousands) of political executions or their death squads or their forced labor camps. It doesn't recommend their complete suppression of free speech and their prosecution of Cubans wanting to leave this self-proclaimed "paradise". And it seems quite unethical to praise Cuba for it's export of medical expertise while ignoring the fact that relatives of these experts are essentially held hostage to ensure they won't defect. If you don't see something extremely sinister and disgusting about this, I'd posit you don't have the capacity for suspicion and disgust. .. the government "bars citizens engaged in authorized travel from taking their children with them overseas, essentially holding the children hostage to guarantee the parents' return. Given the widespread fear of forced family separation, these travel restrictions provide the Cuban government with a powerful tool for punishing defectors and silencing critics." - Human Rights Watch, http://en.wikipedia.org/wiki/Health_care_in_Cuba http://en.wikipedia.org/wiki/Health_care_in_Cuba I'd posit that a fair (and fairly obvious) measure of a political system is the market for voluntarily migration. The fact is that almost no one migrates into Cuba and millions have braved, and continue to brave, incredible costs and dangers to migrate away from Cuba. American style democratic capitalism is not without its flaws, and we must be eternally vigilant to resist and reverse attempts by both state and corporate power to impinge on our rights & freedoms in their own selfish interests. But, unlike Cubans (and former East Germans etc), we have the political infrastructure and basic human freedom to improve our system for the better. We shouldn't sacrifice these hard earned and extremely rare circumstances in the vain hope of securing marginally better health outcomes (or marginally better security, chess skills, literacy rates etc) by means of totalitarian socialism.

PauloManrique 12y ago

Brazil got a program that imports around 10 thousand cuban doctors. And they are nearly slaves to the cuban regime. Brazil pays around 4k USD for each doctor, but he only keeps 1,2k. Everything else goes to the Castro's regime. And that's because our oposition made a huge noise about that, because they used to receive about 400 USD, and the rest of the money to castro. They have a good health program? Maybe. But I won't swap my freedom for that.