Cuba's medical missions making money for cash-strapped island
By Ruth Morris
Havana Bureau
December 18, 2005
VARADERO, Cuba · His medical degree hangs unassumingly between family pictures, above a television set that has seen better days. But the certificate has something unusual: a gold seal in the top right corner distinguishes Rolando Reguera as one of Cuba's top young doctors.
His high marks also earned him an unusual reward: a yearlong stint in the backwaters of Guatemala, where he trudged six hours some days, through mud and mosquitoes and sweltering heat, to heal for free.
Cuba has dispatched medical teams abroad for decades, rewarding its best and brightest not with cushy jobs, but with "difficult access" postings in places like Guatemala, Honduras and Haiti. The doctors have saved countless lives, and have lent credibility to communist Cuba's push for equality and universal health care.
But in a reverse twist, the medical mission is also becoming extremely lucrative. Thousands of Cuban physicians have been sent to Venezuela, where their services help pay for Cuban oil imports. Back home, other doctors treat legions of foreign eye patients, generating stacks of hard currency for their cash-strapped island.
Medical services are bringing in so much foreign income, Cuban economist Anicia García said, the sector is creeping up on tourism as Cuba's top service sector moneymaker.
"I think medical services will have replaced tourism as our most important source of revenue in 2005," said García, who directs the Cuban Economy Study Center at Havana University.
Moving to capitalize on the trend, the government has drastically increased medical student enrollments in recent years, and it is expanding its eye-patient care to other countries. Panamanian President Martín Torrijos arrived in Cuba on a state visit last week with 74 new patients. Analysts, meanwhile, note that Cuba, with few natural resources to fall back on, is turning medical know-how into coin -- a result that helps Cuba sidestep the economic restraints of a longstanding U.S. trade and travel ban.
Only a slender cut of the revenue actually goes to Cuban doctors.
"We go with the idea of helping people, not to make money," said Reguera, the lanky physician who returned home from Guatemala to Varadero, a beachfront tourist town, in March. "The experience was very beautiful, strong. I went to communities where they had never seen a doctor before ... never."
On a secondhand computer, he clicked on photographs from his year. As if inspired by monotony, one photograph depicted the sucking orange mud beneath his boots. Another showed a table laden with tortillas and cacao juice.
His patients were farmers' children and indigenous women in bright woven huipiles. Many didn't speak Spanish, favoring their Mayan dialect. Others were too modest to speak to him at all, relaying symptoms through their husbands.
Reguera made about $395 a month in Guatemala -- a third of what local doctors made, but a huge improvement on his Cuban salary of $25 a month. Now that he has returned to study orthopedic surgery, he also gets an additional monthly stipend of $25. In addition, doctors who work abroad are allowed to bring home such foreign-bought amenities as computers, video equipment and bicycles.
Still, his sister, who works as an events coordinator in the palm-fringed tourist hotels nearby, brings home more money than Reguera.
"Money is lacking, but you have to feel good in your profession," he said.
Medical contracts vary by country, and Cuba often underwrites costs as a goodwill gesture. Cuban doctors were among the first on the scene when the tsunami battered Sri Lanka. A recent documentary on state-run television showed Cuban doctors setting up saline drips against backdrops of camel caravans in Mali.
The partner with the deepest pockets by far, though, is Cuba's left-leaning, oil-rich ally, Venezuela. Of the 25,000 Cuban doctors working abroad, more than half have set up shop in hardscrabble barrios in Caracas and other parts of the country where doctors are in short supply.
The Venezuelan government pays stipends to the physicians and has set up a table of service fees with the Cuban government. Bilateral pacts, meanwhile, allow Venezuela to pay part of its medical bill in crude-oil shipments, taking a huge strain off Cuba at a time of skyrocketing oil prices.
The benefits cut both ways. When Venezuelan President Hugo Chávez handily won a recall referendum last year, analysts said social programs, like the visiting doctors, secured votes.
Cuba has also given over entire hospital wings for visiting Venezuelan eye patients. The island has treated tens of thousands of Venezuelans with cataracts and other eye problems, shuttling them to clinics in brand new buses and roping off beaches for their leisure.
The patients pay nothing, but again, Venezuela and Cuba work out a payment plan.
"Foreign aid is good politics for any country," said analyst Philip Peters, of the Lexington Institute in Arlington, Va. "Cuba has carved out a niche for itself in the kind of medical work it does. It plays well. It allows Cuba to be seen in a favorable light, and to lead with their strength."
He noted that the special relationship with Venezuela had caused strains. Some Cubans complain that their family doctor has been called away, or that the country's poorly stocked hospitals can't handle the influx.
On the other hand, the overall medical mission has been an image booster. After Hurricane Katrina, Cuban President Fidel Castro offered to send 1,500 doctors to Louisiana to care for drained and ailing survivors. The U.S. government responded that it had "robust" medial resources to handle the crisis.
According to the World Health Organization, Cuba has a doctor for every 170 residents, compared to 188 in the United States. The Cuban government also offers full medical scholarships to foreigners who can't afford tuition in their home countries. More than 12,000 medical students from 83 countries are currently enrolled, including 65 students from the United States.
Presiding over the first graduation of foreign medical students in August, Castro characterized Cuba's medical mission as a prime example of how his country had done a lot with a little.
"Someone might think that we are going bankrupt," he said, referring in part to a decades-old embargo imposed on Cuba by the United States.
"No. We are improving," he told a sea of white lab coats. "Human capital is worth far more than financial capital."
His high marks also earned him an unusual reward: a yearlong stint in the backwaters of Guatemala, where he trudged six hours some days, through mud and mosquitoes and sweltering heat, to heal for free.
Cuba has dispatched medical teams abroad for decades, rewarding its best and brightest not with cushy jobs, but with "difficult access" postings in places like Guatemala, Honduras and Haiti. The doctors have saved countless lives, and have lent credibility to communist Cuba's push for equality and universal health care.
But in a reverse twist, the medical mission is also becoming extremely lucrative. Thousands of Cuban physicians have been sent to Venezuela, where their services help pay for Cuban oil imports. Back home, other doctors treat legions of foreign eye patients, generating stacks of hard currency for their cash-strapped island.
Medical services are bringing in so much foreign income, Cuban economist Anicia García said, the sector is creeping up on tourism as Cuba's top service sector moneymaker.
"I think medical services will have replaced tourism as our most important source of revenue in 2005," said García, who directs the Cuban Economy Study Center at Havana University.
Moving to capitalize on the trend, the government has drastically increased medical student enrollments in recent years, and it is expanding its eye-patient care to other countries. Panamanian President Martín Torrijos arrived in Cuba on a state visit last week with 74 new patients. Analysts, meanwhile, note that Cuba, with few natural resources to fall back on, is turning medical know-how into coin -- a result that helps Cuba sidestep the economic restraints of a longstanding U.S. trade and travel ban.
Only a slender cut of the revenue actually goes to Cuban doctors.
"We go with the idea of helping people, not to make money," said Reguera, the lanky physician who returned home from Guatemala to Varadero, a beachfront tourist town, in March. "The experience was very beautiful, strong. I went to communities where they had never seen a doctor before ... never."
On a secondhand computer, he clicked on photographs from his year. As if inspired by monotony, one photograph depicted the sucking orange mud beneath his boots. Another showed a table laden with tortillas and cacao juice.
His patients were farmers' children and indigenous women in bright woven huipiles. Many didn't speak Spanish, favoring their Mayan dialect. Others were too modest to speak to him at all, relaying symptoms through their husbands.
Reguera made about $395 a month in Guatemala -- a third of what local doctors made, but a huge improvement on his Cuban salary of $25 a month. Now that he has returned to study orthopedic surgery, he also gets an additional monthly stipend of $25. In addition, doctors who work abroad are allowed to bring home such foreign-bought amenities as computers, video equipment and bicycles.
Still, his sister, who works as an events coordinator in the palm-fringed tourist hotels nearby, brings home more money than Reguera.
"Money is lacking, but you have to feel good in your profession," he said.
Medical contracts vary by country, and Cuba often underwrites costs as a goodwill gesture. Cuban doctors were among the first on the scene when the tsunami battered Sri Lanka. A recent documentary on state-run television showed Cuban doctors setting up saline drips against backdrops of camel caravans in Mali.
The partner with the deepest pockets by far, though, is Cuba's left-leaning, oil-rich ally, Venezuela. Of the 25,000 Cuban doctors working abroad, more than half have set up shop in hardscrabble barrios in Caracas and other parts of the country where doctors are in short supply.
The Venezuelan government pays stipends to the physicians and has set up a table of service fees with the Cuban government. Bilateral pacts, meanwhile, allow Venezuela to pay part of its medical bill in crude-oil shipments, taking a huge strain off Cuba at a time of skyrocketing oil prices.
The benefits cut both ways. When Venezuelan President Hugo Chávez handily won a recall referendum last year, analysts said social programs, like the visiting doctors, secured votes.
Cuba has also given over entire hospital wings for visiting Venezuelan eye patients. The island has treated tens of thousands of Venezuelans with cataracts and other eye problems, shuttling them to clinics in brand new buses and roping off beaches for their leisure.
The patients pay nothing, but again, Venezuela and Cuba work out a payment plan.
"Foreign aid is good politics for any country," said analyst Philip Peters, of the Lexington Institute in Arlington, Va. "Cuba has carved out a niche for itself in the kind of medical work it does. It plays well. It allows Cuba to be seen in a favorable light, and to lead with their strength."
He noted that the special relationship with Venezuela had caused strains. Some Cubans complain that their family doctor has been called away, or that the country's poorly stocked hospitals can't handle the influx.
On the other hand, the overall medical mission has been an image booster. After Hurricane Katrina, Cuban President Fidel Castro offered to send 1,500 doctors to Louisiana to care for drained and ailing survivors. The U.S. government responded that it had "robust" medial resources to handle the crisis.
According to the World Health Organization, Cuba has a doctor for every 170 residents, compared to 188 in the United States. The Cuban government also offers full medical scholarships to foreigners who can't afford tuition in their home countries. More than 12,000 medical students from 83 countries are currently enrolled, including 65 students from the United States.
Presiding over the first graduation of foreign medical students in August, Castro characterized Cuba's medical mission as a prime example of how his country had done a lot with a little.
"Someone might think that we are going bankrupt," he said, referring in part to a decades-old embargo imposed on Cuba by the United States.
"No. We are improving," he told a sea of white lab coats. "Human capital is worth far more than financial capital."
Copyright © 2005, South Florida Sun-Sentinel
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