Cuban medical cooperation in Haiti
Media coverage of Cuban medical cooperation following the disastrous earthquake in Haiti on January 12 was sparse indeed. International news reports usually described the Dominican Republic as being the first country 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. Among CNN’s hundreds of reports, one focused on a Cuban doctor wearing a T-shirt with a large image of Che Guevara – and yet presented him as a “Spanish doctor.” By March 24, CNN had 601 reports on its 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 about the earthquake and relief efforts, but not a single one reported on Cuban support in any meaningful way.
In reality, however, Cuba’s medical role has been extremely important, and it started long before the earthquake.
Eleven years of cooperation
In September 1998, Haiti was stuck by Hurricane Georges. The hurricane caused 230 deaths, destroyed 80 per cent of the country’s crops and left 167,000 people homeless.1 Even though Cuba and Haiti had not had diplomatic relations in more than 36 years, Cuba immediately offered a multifaceted aid agreement, of which the most important element was medical cooperation.
Cuba took 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 by far the worst in the Americas. The country had a life expectancy of only 54 years in 1990, with one out of every five adult deaths due to AIDS and 12.1 per cent of children dying 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 place of the Cuban doctors (a process of “brain gain” rather than “brain drain”). The students were selected from nontraditional backgrounds and were mainly poor. It was thought that because of their socioeconomic background, they would – unlike many Haitian doctors practising in the United States and Canada – 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; Cuban medical personnel were estimated to be caring for 75 per cent of the population under care.3 Studies by the Pan American Health Organization (PAHO) indicated clear improvements in the health profile since this extensive Cuban medical cooperation began. Cuban medical personnel clearly made a major difference, largely because of their proactive role in preventive medicine, as can be seen in Tables 1 and 2.
At no cost to medical students, Cuba had trained some 550 Haitian doctors by 2010, and is currently training a further 567. Moreover, since 1998 some 6,094 Cuban medical personnel had worked in Haiti. They gave more than 14.6 million consultations, carried out 207,000 surgical operations, including 45,000 vision restoration operations through their Operation Miracle program, attended 103,000 births and taught literacy to 165,000 people. All of this medical cooperation, it must be remembered, was provided over an 11-year period before the 2010 earthquake.4 At the time of the earthquake, there were 344 Cuban medical personnel in Haiti.
After the earthquake
The January 12 earthquake killed at least 220,000 people, injured 300,000 and left 1.5 million homeless. Prime Minister Jean-Max Bellerive described it as “the worst catastrophe that has occurred in Haiti in two centuries.” International aid began flooding in. Médecins Sans Frontières (MSF), for example, 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.5
Canada’s contribution included the deployment of 2,046 Canadian Forces personnel, including 200 Disaster Assistance Response Team (DART) personnel. DART received the most media attention, as it conducted 21,000 consultations. Among the DART personnel, however, were only 45 medical staff, who did not treat any serious trauma patients or provide surgical care, with others being involved in water purification, security and reconstruction. In total, the Canadians stayed for only seven weeks.6
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 seven weeks, in which time they treated 871 patients, performing 843 surgical operations.7 Both Canada and the United States made important contributions – while they were there.
Lost in the media shuffle was the fact that, for the first 72 hours following the earthquake, Cuban doctors were the main medical support for the country. Within the first 24 hours, having turned their living quarters into clinics, they had completed 1,000 emergency surgeries. In addition, they were running the only medical centres in the country, including five comprehensive diagnostic centres (small hospitals) which they had previously built. Another five in various stages of construction were also put to use, and their ophthalmology centre was transformed into a field hospital, which treated 605 patients within the first 12 hours following the earthquake.8
Cuba soon became responsible for some 1,500 medical personnel in Haiti. Of those, some 344 doctors were already working in Haiti, while more than 350 members of the Henry Reeve Emergency Response Medical Brigade were sent by Cuba following the earthquake.9 In addition, 546 graduates of ELAM from a variety of countries and 184 fifth- and sixth-year Haitian ELAM students joined, as did a number of Venezuelan medical personnel. They ended up working throughout Haiti in 20 rehabilitation centres and 20 hospitals, running 15 operating theatres and carrying out 400,000 vaccinations.10 A glance at the medical role of the various key players (Table 3) is telling.
These comparative data, compiled from several sources, indicate the significant (and widely ignored) medical contribution the Cubans have made. In fact, in the period up to March 23 they treated 4.2 times as many patients as did MSF (which has more than 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 U.S. medical personnel had left by March 9). Moreover, while the Cuban medical contingent was roughly three times the size of the American staff, it treated 260.7 times as many patients.
It is also important to note that approximately half of the Cuban medical staff was working in areas outside the capital, Port-au-Prince; these areas also saw significant damage and other medical missions could not get to them. 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. And noted Cuban artist Kcho 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, Cuba, working with ALBA (the Alianza Bolivariana para los Pueblos de Nuestra América) countries,11 presented an integrated program to the World Health Organization to build hospitals, polyclinics and medical schools, to be run by Cubans and Cuban-trained medical staff, to reconstruct Haiti’s largely destroyed health care system. In addition, the Cuban government has offered to increase the number of Haitian students attending medical school in Cuba. This offer of medical cooperation constitutes an enormous effort in support of Haiti. Sadly, this generous offer has not been reported by international media.
For as long as necessary
While North American media might have ignored Cuba’s role, Haiti has not. Haitian President René Préval noted pointedly in February, “You did not wait for an earthquake to help us.”12 Similarly, Prime Minister Bellerive has repeatedly noted that the first three countries to help were Cuba, the Dominican Republic and Venezuela.
In a March 27 meeting in Port-au-Prince between President Préval, Cuban Health Minister José Ramón Balaguer and Brazilian Health Minister 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 health care system, supported by well-trained professionals … We will provide this, together with Cuba – a country with 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.13
While Cuba’s efforts to assist Haiti increased, international efforts soon dwindled. The head of the Cuban medical mission, Dr. Carlos Alberto García, noted just two weeks after the tragedy that many foreign delegations were beginning to leave and aid levels were beginning to drop. “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,” he said. “However we will still be here long after they have all gone.”14 This in fact has been the case.
Today Cuba, with the support of ALBA and Brazil, is working to build not 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 for the past 11 years, for as long as necessary. This is an extraordinary story of true humanitarianism, and of effectiveness in saving lives going back to 1998. It is a story of providing preventive, culturally sensitive health care (at no cost to the patients) to millions of Haitians. It is a story that needs to be told, and yet it is one that international media have chosen not to tell. The television cameras have left Haiti, and it remains one of the world’s best-kept secrets.