The news of Cuban doctors arriving in the country, was met with unease by many South Africans. The 213-strong team alighted at the Waterkloof Airbase in Pretoria to a show of support normally reserved for visiting Heads-of-State. No less than three members of the Cabinet were on hand to roll out the red carpet for these visiting health workers.
Among others at the welcoming committee, were Minister of International Relations and Cooperation Naledi Pandor, who earlier had reiterated South Africa’s commitment to advancing “the agenda of the South.”(1) Along with Pandor were Defence and Military Veterans Minister, Nosiviwe Mapisa-Nqakula and Cooperative Governance and Traditional Affairs Minister, Dr Nkosazana Dlamini-Zuma.
The fanfare around what would normally be a somewhat innocuous event, had more of a political rather than medical overtone. South Africa joins some 22 other nations, including Italy, which are welcoming Cuban doctors. This worldwide presence affords Cuba quite an extensive global platform and concomitant influence.
As so often happens, the welcome was replete with revolutionary undercurrents and veiled Marxist allusions to the “struggle.” According to an article in The Citizen of 27 April headed “Western Cape begrudgingly accepts help from Cuban doctors,” Mapisa-Nqakula opined “The fact that the doctors arrived on Freedom Day was significant.”(2)
Alas, what should have been an opportune occasion to reflect on the repression, poverty, lack of freedom and political intolerance in Cuba, was supplanted by the standard eulogizing and platitudes.
The Citizen article further noted, “The arrival of Cuban medical experts was a response to a request by [President] Ramaphosa to his Cuban counterpart Díaz Canel Bermúdez. The Presidency said the group comprised epidemiology, biostatistics, and public health workers; family physicians, healthcare technology engineers and medical experts. The family physicians were expected to guide processes in door-to-door testing and to assist local health workers in health promotion and disease surveillance at community level.”(3)
Is Cuban Medical Assistance Needed?
However, not everyone viewed the Cubans arrival with the same rapture… Seemingly there was little if any consultation with the local medical establishment, allowing one to conclude that such an omission points to a political not a medical decision.
“Times Live” (28 April), in an article headed “Bringing in Cuban doctors is ‘premature’ – Medical Association,” reveals a little disconcerting sentiment under the surface… “The South African Medical Association (SAMA) says the arrival of over 200 medical specialists from Cuba is a ‘little bit premature.’”(4)
“So far we have managed quite well without outside help,” SAMA Chairperson Dr Angelique Coetzee said on the SAfm Sunrise Show with Stephen Grootes. “Coetzee added that there were many retired doctors in the country that could have played a key role in mentoring younger doctors during the outbreak.” “Only when you have exhausted all your internal resources, then it could be prudent to get people from the outside in. We are not unhappy that there are doctors coming in; we just say that it is premature and that we must first look at our own resources and look at our own people. It is quite a lot of money and we could have probably spent that money a little bit better.”
Also expressing misgivings in a “News” article of the 27 April headlined “Nursing union raises concerns following arrival of Cuban doctors,” Democratic Nursing Organisation of SA (DENOSA) lamented that “the arrival of Cuban health professionals can be unpatriotic while SA nurses are unemployed.”(5)
“DENOSA President Simon Hlungwani, in an interview on Radio 702, said there are many nurses’ vacancies in South Africa that shouldn’t necessarily be there during a global pandemic. Hlungwani explained that the deployment of over 200 Cuban doctors would not be all that helpful if trained healthcare professionals in South Africa remain unemployed.” Hlungwani further listed the numbers of unemployed professional nurses along with the huge number of applications received for advertised positions in the Department of Health… (5)
According to a report on News24 (29 April) headed “South Africa spent at least R400m ($25 million) on Cuban Medical Brigade deployment,” Kevin Halama, Spokesperson for the Health and Other Services Personnel Trade Union of South Africa (Hospersa), said that while they welcomed the Cuban medical brigade’s assistance in South Africa, they felt they should have been consulted first.
“We welcome any help from outside the country and from partners of government to assist with this pandemic, but obviously there needs to be due consultation that is done with all the health bodies,” Halama stated. He added that for unemployed health professionals in South Africa, this would be a “bitter pill to swallow”, especially because of the cost attached. “It is quite a depressing situation where government goes ahead and takes decisions like this, especially in a country like ours where we know that there are quite a lot of unemployed health professionals sitting at home,” Halama said.(6)
Sorry State of Cuban Health Care
The April 28 edition of The Sowetan, voicing a popular concern in “What’s the price of Cuban help?” quotes Health Minister Zweli Mkhize saying, “The advantage of Cuba is that they are a community health model, one that we would like to use.”(7)
The facts do not support such a conclusion. The Cuban health system is mired in controversy and evidently in serious trouble. Not even Fidel Castro trusted the system. He preferred to go to Spain for his healthcare needs.
The much ballyhooed hype around the Cuban health system is dismissed by many observers. One cannot trust the comparisons and statistics issuing from a repressive regime. This is borne out quite clearly in a recent study by the Cato Institute which found “that Cuba’s seemingly impressive health performance is partly due to data manipulation and coercion.” The article compares a number of countries and shows how other nations (without any “revolution”) achieved impressive and much greater achievements!(8)
An article by the Foundation for Economic Education (23 Jan 2019) says it all: “The Myth of Cuba’s Glorious Health Care System.” The article pulls no punches in debunking many of the regime’s health care “accomplishments” including supposed successes in “infant mortality” – an area of discussion that must be considered useless due to the existence of liberal abortion legislation.(9)
Quoting liberally from a number of studies, the article recalls a National Review study on Cuba by Jay Nordlinger: “The Left has always had a deep psychological need to believe in the myth of Cuban health care. On that island, as everywhere else, Communism has turned out to be a disaster: economic, physical, and moral. Not only have persecution, torture, and murder been routine, there is nothing material to show for it.”(10)
He notes the existence of three tiers of health care in Cuba. The first is known as “medical tourism.” Foreigners travel to Cuba and pay in hard currency for specialized medical care. The second health-care system is for Cuban leaders from the Party, the military, official artists and writers. Finally, there is the real Cuban system of the ordinary people that is wretched. Testimony and documentation abounds on this system. Hospitals and clinics are falling apart. Conditions are so unsanitary that patients are better off at home. At these hospitals, patients must bring their own bedsheets, soap, towels, food and even toilet paper. Basic medications are scarce. All the equipment is old or non-existent.
One of the conclusions reached amongst the many research papers quoted in the article offers this insight, “One of the most readily apparent problems with the health care system in Cuba is the severe shortage of medicines, equipment, and other supplies. …Many Cubans (including a number of health professionals) also had serious complaints about the intrusion of politics into medical treatment and health care decision-making.” Another paper makes the case for a deeper analysis of the so-called “successes” of the Cuban health model with the following assertion, “The role of Cuban economic and political oppression in coercing ‘good’ health outcomes, merits further study.”(11)
The Adam Smith Institute (12 Sept. 2019), also carried a realistic evaluation with some comments by Cuban journalist and academic, Boris Gonzalez Arenas in a piece titled, “The Myth of Cuban Health Care.” He claims that “it’s really important for the Cuban government to hide the real situation in Cuban public health… there’s been a massive decrease in the number of hospitals in Cuba in the last 20 years – and that hospital staff often steal from hospitals to sell medication on the black market.”(12)
“Doctors’ Diplomacy” – a lucrative export…
The dismal state of healthcare in Cuba leads one to believe that there is much more than humanitarianism, solidarity or “socialist largesse” at play with the Cuban mission to South Africa.
Indeed, Cuba utilises this massive medical “export” as a kind of “doctor’s diplomacy” where the regime makes ample political capital out of its army of doctors to curry favour, lessen isolation, and gain sympathy and prestige across the globe, thus minimizing any scrutiny of its appalling human rights record and socio-economic conditions.
The regime also accrues economic capital from these medical missions. A case study is Brazil where the left-wing Lula government invited thousands of medical practitioners to Brazil. With the recent souring of this relationship and their recall by Cuba, some 2000 of the odd 8000 maneuvered to stay in the country. Their withdrawal from Brazil came in the wake of the Brazilian government questioning their medical proficiency as well as the repetitive accusation against Cuba that their doctors were akin to “slave labour,” receiving only a 25% portion of their salaries from the Cuban regime.(13)
Cuba has the highest per capita number of doctors in the world and it uses this skewered statistic greatly to its advantage. The medical expeditioners constitute the biggest generators of vital foreign exchange for the government, raking in an annual 11 Billion dollars (200 Billion Rand)! It is Cuba’s main and most lucrative export and the salaries of the doctors are levied by the Cuban government on the host country – so it is clear who is benefitting. The doctors receive a small portion of “their salaries.” Wherever they are serving, they are often dogged by diverse problems which are mostly related to dissatisfaction with their employment conditions.
In an extensive BBC Report of the 14th May 2019 titled, “The hidden world of the doctors Cuba sends overseas,” the experiences of numerous Cuban medical orderlies serving in foreign destinations, were featured… The article cited a report by the opposition-linked “Cuban Prisoners Defenders,” based on direct testimony from Cuban doctors in overseas medical missions. The report’s authors found that 89% said they had no prior knowledge of where they would be posted; 41% said Cuban officials took their passports on arrival in the host country and 91% said they were watched over by Cuban security officials while on their mission.(14)
A political or medical decision?
Cuba is hardly a model for South Africa in any field. It suffers under a military dictatorship. Political repression is endemic. Democracy is non-existent. There is no free press, free assembly, free elections or rule of law. Religious freedom is gravely restricted. Sixty years of “socialism” have reduced Cuba to basket-case status, a veritable prison-island, serial human-rights’ abuser and public health disaster.
It is hard to see what Cuba has to offer South Africa. In fact, South Africans would do well to critically assess all the hype and glamour that often accompanies references to this failed State, and be wary of this country with such a checkered past and dismal human rights record. Due to Cuba being the main beneficiary of this arrangement, they ought to question what sort of expertise the Cubans will be sharing and under what onerous conditions they will be operating…
With so many unemployed locals crying out for work in a depressed economy, does it make sense to spend so much, which will simply be to bolster a failed regime? Do these doctors have other roles beyond those of goodwill medical ambassadors?
Finally, it is strange indeed that the Cuban involvement entered so seamlessly into the coronavirus crisis. The virus seems to have ably lent itself to Cuba’s mission of exporting its Revolution all over the world…
Written by Bernard Tuffin www.familyaction.co.za