Tag Archives: Medical System
FIFTY YEARS OF CUBA'S MEDICAL DIPLOMACY: FROM IDEALISM TO PRAGMATISM
Posted on July 13, 2015 by Arch Ritter
Julie M. Feinsilver
Cuban Studies, Volume 41, 2010, pp. 85-104
Complete Article here: Feinsilver – Fifty Years of Cuba's Medical Diplomacy
Medical diplomacy, the collaboration between countries to simultaneously produce health benefits and improve relations, has been a cornerstone of Cuban foreign policy since the outset of the revolution fifty years ago. It has helped Cuba garner symbolic capital (goodwill, influence, and prestige) well beyond what would have been possible for a small, developing country, and it has contributed to making Cuba a player on the world stage. In recent years, medical diplomacy has been instrumental in providing considerable material capital (aid, credit, and trade), as the oil-for-doctors deals with Venezuela demonstrates. This has helped keep the revolution afloat in trying economic times. What began as the implementation of the one of the core values of the revolution, namely health as a basic human right for all peoples, has continued as both an idealistic and a pragmatic pursuit. This article examines the factors that enabled Cuba to conduct medical diplomacy over the past fifty years, the rationale behind the conduct of this type of soft power politics, the results of that effort, and the mix of idealism and pragmatism that has characterized the experience. Moreover, it presents a typology of medical diplomacy that Cuba has used over the past fifty years.
Medical diplomacy has been a cornerstone of Cuban foreign policy since the outset of the revolution fifty years ago. It has been an integral part of almost all bilateral relations agreements that Cuba has made with other developing countries. As a result, Cuba has positively affected the lives of millions of people per year through the provision of medical aid, as well as tens of thousands of foreign students who receive full scholarships to study medicine either in Cuba or in their own countries under Cuban professors. At the same time, Cuba's conduct of medical diplomacy with countries whose governments had not been sympathetic to the revolution, such as Pakistan, Guatemala, Honduras, and El Salvador, to name only a few, has led to improved relations with those countries. Medical diplomacy has helped Cuba garner symbolic capital (goodwill, influence, and prestige) well beyond what would have been possible for a small, developing country, and it has contributed to making Cuba a player on the world stage. In recent years, medical diplomacy has been instrumental in providing considerable material capital (aid, credit, and trade), as the oil-for doctors deals with Venezuela demonstrates. This has helped keep the revolution afloat in trying economic times.
What began as the implementation of one of the core values of the revolution, namely health as a basic human right for all peoples, has continued as both an idealistic and a pragmatic pursuit. As early as 1978, Fidel Castro argued that there were insufficient doctors to meet demand in the developing world, despite the requesting countries' ability to pay hard currency for their services. Because Cuba charged less than other countries, with the exception at that time of China, it appeared that it would win contracts on a competitive basis. In fact, during the following decade (1980s), Cuba's medical contracts and grant aid increased. In most cases, aid led to trade, if not to considerable income. With the debt crises and the International Monetary Fund's structural adjustment programs of the 1980s, grant aid predominated. In 1990, Cuban medical aid began to dwindle as neither the host countries nor Cuba could afford the costs, the former because of structural adjustment–mandated cuts in social expenditures and the latter because of the collapse of its preferential trade relationships following the demise of the Soviet Union. As Cuba's ability to provide bilateral medical aid diminished, its provision of medical aid through multilateral sources (contracts) increased.56 Cuba's medical diplomacy continued, albeit on a smaller scale during the 1990s, until the rise of Hugo Chavez in Venezuela.
With medical services leading economic growth in the twenty-first century, it seems unlikely that even the more pragmatic Raul Castro will change direction now. In contrast, dependency on one major benefactor and/or trade partner can be perilous, as the Cubans have seen more than once. If Chavez either loses power or drastically reduces foreign aid in an effort to cope with Venezuela's own deteriorating economic conditions and political opposition,
Cuba could experience an economic collapse similar to that of the Special Period in the early 1990s. In fact, the global financial and economic crisis has compounded existing problems. In an effort to avert that type of collapse, Raul Castro has been trying to further diversify Cuba's commercial partners.57 In July 2009, Cuba received a new US$150 million credit line from Russia to facilitate technical assistance from that country, and companies from both countries signed various agreements, including four related to oil exploration.
Furthermore, Raul Castro made clear in his August 1, 2009, speech before the National Assembly of People's Power, that Cuba could not spend more than it made. He asserted that it was imperative to prioritize activities and expenditures to achieve results, overall greater efficiency, and to rationalize state subsidies to the population. Despite a little help from its Venezuelan friend, the Cuban government has had to embark on austerity measures that hark back to the worst of times right after the collapse of the former Soviet Union.60 With two budget cuts already this year, restrictions on electricity distribution, and a 20 percent decrease in imports, it is likely that the Cuban government will attempt to increase its medical exports to countries that can afford to pay for them. In fact, in August 2009, Raul Castro indicated that Cuba would need to increase the production of services that earn hard currency.62 Pragmatism clearly dictates this course of action even if it also is imbued with strong revolutionary idealism about humanitarian assistance.
Economic and political benefits of medical diplomacy aside, Fidel, both when he was president and today as an elder statesman and blogger, most sincerely cares about health for all, not just for Cubans. His long-term constant involvement in the evolution both of the domestic health system and of medical diplomacy has been clear through both his public pronouncements and actions, and the observations and commentary of his subordinates and external observers. Today, this concern for health is part of the social agenda of ALBA, through which, for example, additional Cuban medical aid to Haiti post-2010 earthquake is being conducted.
Unable to offer financial support, Cuba provides what it excels at and what is easily available, its medical human resources. International recognition for Cuba's health expertise has made medical diplomacy an important foreign policy tool that other, richer countries would do well to emulate. After all, what country could refuse humanitarian aid that for all intents and purposes appears to be truly altruistic?
Dr. Julie Feinsilver
Posted in Blog | Tagged Development Assistance, Health, International Relations, Medical System | Leave a comment
FRENCH GROUP TRUMPETS CUBAN DRUGS INNOVATION
Posted on May 26, 2015 by Arch Ritter
Financial Times, May 26, 2015
Andrew Ward, Pharmaceuticals Correspondent
Original here: Cuban Drugs Innovation
Cuba has the potential to become a force in the life science industry as its economy gradually reopens to the world, according to Abivax, a French company that has licensed a hepatitis B treatment from Cuban researchers.
Abivax is planning an initial public offering in Paris to finance clinical trials of the ABX203 therapeutic vaccine developed by the Center for Genetic Engineering and Biotech in Havana.
Hartmut Ehrlich, Abivax chief executive, said that Cuba had world-class medical science ready to be tapped as the country re-engages with the US and the broader global economy.
He highlighted the 500 products developed by 40 pharmaceuticals companies during past decades when Cuba's isolation made it difficult to access some foreign drugs.
"They have a strong public health system and a strong science base because [Fidel] Castro decided in the 80s that in order to fulfil the medical needs of the population they needed to develop their own medicines," said Mr Ehrlich.
Abivax was among the French companies that accompanied President François Hollande on a visit to Cuba this month — highlighting growing international interest in the commercial opportunities created by Cuba's economic reforms. The Paris company owns the rights to ABX203 in 80 countries across Europe, Asia and Africa and will share revenues with its Cuban partners should the treatment reach market. Late-stage trials of the vaccine started in February.
Cuban products are still barred from the US, the world's biggest pharmaceuticals market, by a trade embargo but the chances of this being lifted appear to be rising as talks continue about resuming diplomatic relations severed since the cold war.
Mr Ehrlich said that Abivax would be interested in US rights to ABX203 should the market open. European companies hope they will have a head start in Cuba over US rivals held back by the embargo.
"It takes time to build trust with our partners in Cuba and we believe we have achieved that trust," said Mr Ehrlich. "We have found the Cubans to be very collaborative. For us it has been a real pleasure to work with them."
ABX203 is a first-in-class immunotherapy that aims to provide longer-lasting suppression of the virus than existing treatments — and potentially a cure. An estimated 350m people worldwide have the chronic form of hepatitis B, which kills more than 1m people every year.
Analysts say that both ABX203 and a separate HIV treatment being developed by Abivax in France have lots of potential if trials prove successful. Mr Ehrlich said that the company was open to a partnership with a larger pharmaceuticals group to help reach market. He would not say how much money would be raised in the IPO, announced last week, but Abivax was on course to burn €20m of cash this year and €30m next year. PPG: Cuba's Wonder Heart Drug, (also Cuba's Viagra)
Institute of Genetic Engineering and Biotechnology, Havana
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CUBA'S HAD A LUNG CANCER VACCINE FOR YEARS, AND NOW IT'S COMING TO THE U.S.
The Huffington Post | By Erin Schumaker
Original here: Cuba's Cancer Vaccine
When New York Governor Andrew Cuomo (D) headed to Havana on a historic trade mission in April, he returned with the promise of an important commodity: a Cuban-developed lung cancer vaccine.
The vaccine, called CimaVax, has been researched in Cuba for 25 years and became available for free to the Cuban public in 2011. The country's Center for Molecular Immunology signed an agreement last month with Roswell Park Cancer Institute in Buffalo, New York to import CimaVax and begin clinical trials in the United States.
"We're still at the very early stages of assessing the promise of this vaccine, but the evidence so far from clinical trials in Cuba and Europe has been striking," Dr. Kelvin Lee, Jacobs Family Chair in Immunology and co-leader of the Tumor Immunology and Immunotherapy Program at Roswell Park, told The Huffington Post.
When President Obama loosened the United States' 55-year long trade embargo against the island nation in December, he allowed for such joint research deals to be finalized. Similar programs might have been impossible just a few years ago.
Cuba has long been known for its high-quality cigars, and lung cancer is a major public health problem and the fourth-leading cause of death in the country. A 2007 study of patients with stages IIIB and IV lung cancer, published in the Journal of Clinical Oncology, confirmed the safety of the CimaVax and showed an increase in tumor-reducing antibody production in more than half of cases. It proved particularly effective for increased survival if the study participant was younger than 60.
So far, 5,000 patients worldwide have been treated with CimaVax, including 1,000 patients in Cuba. Lee said the latest Cuban study of 405 patients, which has not yet been published, confirms earlier findings about the safety and efficacy of the vaccine. What's more, the shot is cheap — it costs the Cuban government just $1, Wired reported. And studies have found there are no significant side effects.
"We think it may be an effective way to prevent cancer from developing or recurring, so that's where a lot of our team's excitement comes in," Lee said. "There's good reason to believe that this vaccine may be effective in both treating and preventing several types of cancer, including not only lung but breast, colorectal, head-and-neck, prostate and ovarian cancers, so the potential positive impact of this approach could be enormous."
Preclinical investigations of CimaVax at Roswell Park and the unpublished findings of the 405-patient Cuban study are promising, according to Lee. CimaVax works by blocking a hormone that causes lung cancer tumors to grow, a method which has also been shown to be effective in treating colon cancer. That fuels researchers' hope that the vaccine will be an effective treatment for other types of cancer as well.
Still, he acknowledged that the vaccine needs rigorous testing in each of these different disease areas to know whether or not the drug will work as well as the scientists at Roswell Park hope. To be clear, the CimaVax doesn't cure cancer. It's a therapeutic vaccine that works by targeting the tumor itself, specifically going after the proteins that allow a tumor to keep growing. (And as PBS points out, a person can't just take a shot of CimaVax and continue to smoke without fear of lung cancer.)
"We hope to determine in the next few years whether giving CimaVax to patients who've had a lung cancer removed, or maybe even to people at high risk of developing lung or head-and-neck cancers because of a history of heavy smoking, may be beneficial and may spare those people from having a cancer diagnosis or recurrence," Lee said.
The United States is currently at work developing two lung cancer vaccines of its own, GVAX and BLP 25, though neither has been studied for as long as CimaVax.
How does a tiny island nation with limited economic resources pioneer a powerhouse cancer vaccine? "They've had to do more with less," Candace Johnson, CEO of Roswell Park, told Wired. "So they've had to be even more innovative with how they approach things. For over 40 years, they have had a preeminent immunology community."
Despite decades of economic problems and the U.S. trade embargo, Cuba has been a model of public health. According the New York Times, life expectancy for Cubans is 79 years, on par with the United States, despite the fact that its economy per person is eight times smaller. While many drugs and even anesthesia have been hard to come by over the years, Cuba has one of the best doctor to patient ratios in the world. Moreover, the Cuban government's investment in primary care for residents and preventative health measures like public education, housing and nutrition have paid huge dividends in the health of citizens, especially relative to similarly poor countries.
Looking forward, ongoing research collaborations between the two nations are almost certainly on the horizon as relations between Cuba and the U.S. continue to thaw. For now, Lee says the researchers at Roswell Park have their eyes trained on about 20 cancer treatment and prevention technologies in Cuba — including another lung cancer vaccine called racotumomab that the group hopes to study in clinical trials at Roswell. Centro de Inmunología Molecular – Cuba
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CUBA'S EXTRAORDINARY GLOBAL MEDICAL RECORD SHAMES THE US BLOCKADE; From Ebola to earthquakes, Havana's doctors have saved millions. Obama must lift this embargo.
Posted on December 6, 2014 by Arch Ritter
Seumas Milne, The Guardian, Wednesday 3 December 2014 20.07 GMT
Original article here: CUBA'S GLOBAL MEDICAL RECORD
Four months into the internationally declared Ebola emergency that has devastated west Africa, Cuba leads the world in direct medical support to fight the epidemic. The US and Britain have sent thousands of troops and, along with other countries, promised aid – most of which has yet to materialise. But, as the World Health Organisation has insisted, what's most urgently needed are health workers. The Caribbean island, with a population of just 11m and official per capita income of $6,000 (£3,824), answered that call before it was made. It was first on the Ebola frontline and has sent the largest contingent of doctors and nurses – 256 are already in the field, with another 200 volunteers on their way.
While western media interest has faded with the receding threat of global infection, hundreds of British health service workers have volunteered to join them. The first 30 arrived in Sierra Leone last week, while troops have been building clinics. But the Cuban doctors have been on the ground in force since October and are there for the long haul.
The need could not be greater. More than 6,000 people have already died. So shaming has the Cuban operation been that British and US politicians have felt obliged to offer congratulations. John Kerry described the contribution of the state the US has been trying to overthrow for half a century "impressive". The first Cuban doctor to contract Ebola has been treated by British medics, and US officials promised they would "collaborate" with Cuba to fight Ebola.
But it's not the first time that Cuba has provided the lion's share of medical relief following a humanitarian disaster. Four years ago, after the devastating earthquake in impoverished Haiti, Cuba sent the largest medical contingent and cared for 40% of the victims. In the aftermath of the Kashmir earthquake of 2005, Cuba sent 2,400 medical workers to Pakistan and treated more than 70% of those affected; they also left behind 32 field hospitals and donated a thousand medical scholarships.
That tradition of emergency relief goes back to the first years of the Cuban revolution. But it is only one part of an extraordinary and mushrooming global medical internationalism. There are now 50,000 Cuban doctors and nurses working in 60 developing countries. As Canadian professor John Kirk puts it: "Cuban medical internationalism has saved millions of lives." But this unparalleled solidarity has barely registered in the western media.
Cuban doctors have carried out 3m free eye operations in 33 countries, mostly in Latin America and the Caribbean, and largely funded by revolutionary Venezuela. That's how Mario Teran, the Bolivian sergeant who killed Che Guevara on CIA orders in 1967, had his sight restored40 years later by Cuban doctors in an operation paid for by Venezuela in the radical Bolivia of Evo Morales. While emergency support has often been funded by Cuba itself, the country's global medical services are usually paid for by recipient governments and have now become by far Cuba's largest export, linking revolutionary ideals with economic development. That has depended in turn on the central role of public health and education in Cuba, as Havana has built a low-cost biotech industry along with medical infrastructure and literacy programmes in the developing countries it serves – rather than sucking out doctors and nurses on the western model.
Internationalism was built into Cuba's DNA. As Guevara's daughter, Aleida, herself a doctor who served in Africa, says: "We are Afro-Latin Americans and we'll take our solidarity to the children of that continent." But what began as an attempt to spread the Cuban revolution in the 60s and became the decisive military intervention in support of Angola against apartheid in the 80s, has now morphed into the world's most ambitious medical solidarity project.
Its success has depended on the progressive tide that has swept Latin America over the past decade, inspired by socialist Cuba's example during the years of rightwing military dictatorships. Leftwing and centre-left governments continue to be elected and re-elected across the region, allowing Cuba to reinvent itself as a beacon of international humanitarianism.
But the island is still suffocated by the US trade embargo that has kept it in an economic and political vice for more than half a century. If Barack Obama wants to do something worthwhile in his final years as president he could use Cuba's role in the Ebola crisis as an opening to start to lift that blockade and wind down the US destabilisation war.
There are certainly straws in the wind. In what looked like an outriding operation for the administration, the New York Times published six editorials over five weeks in October and November praising Cuba's global medical record, demanding an end to the embargo, attacking US efforts to induce Cuban doctors to defect, and calling for a negotiated exchange of prisoners.
The paper's campaign ran as the UN general assembly voted for the 23rd time, by 188 votes to 2 (US and Israel), to demand the lifting of the US blockade, originally imposed in retaliation for the nationalisation of American businesses and now justified on human rights grounds – by a state allied to some of the most repressive regimes in the world.
The embargo can only be scrapped by congress, still stymied by the heirs of the corrupt US-backed dictatorship which Fidel Castro and Guevara overthrew. But the US president has executive scope to loosen it substantially and restore diplomatic ties. He could start by releasing the remaining three "Miami Five" Cuban intelligence agents jailed 13 years ago for spying on anti-Cuba activist groups linked to terrorism.
The obvious moment for Obama to call time on the 50-year US campaign against Cuban independence would be at next April's Summit of the Americas – which Latin American governments had threatened to boycott unless Cuba was invited. The greatest contribution those genuinely concerned about democratic freedoms in Cuba can make is to get the US off the country's back.
If the blockade really were to be dismantled, it would not only be a vindication of Cuba's remarkable record of social justice at home and solidarity abroad, backed by the growing confidence of an independent Latin America. It would also be a boon for millions around the world who would benefit from a Cuba unshackled – and a demonstration of what can be achieved when people are put before corporate profit.
Posted in Blog | Tagged Development Assistance, EBOLA, Health, Medical System, US-Cuba Relations | 3 Comments
A CUBAN BRAIN DRAIN, COURTESY OF THE U.S.
Posted on November 17, 2014 by Arch Ritter
New York Times, THE EDITORIAL BOARD; NOV. 16, 2014
Leer en español (Read in Spanish) »
Secretary of State John Kerry and the American ambassador to the United Nations, Samantha Power, have praised the work of Cuban doctors dispatched to treat Ebola patients in West Africa. The Centers for Disease Control and Prevention recently sent an official to a regional meeting the Cuban government convened in Havana to coordinate efforts to fight the disease. In Africa, Cuban doctors are working in American-built facilities. The epidemic has had the unexpected effect of injecting common sense into an unnecessarily poisonous relationship.
And yet, Cuban doctors serving in West Africa today could easily abandon their posts, take a taxi to the nearest American Embassy and apply for a little-known immigration program that has allowed thousands of them to defect. Those who are accepted can be on American soil within weeks, on track to becoming United States citizens.
There is much to criticize about Washington's failed policies toward Cuba and the embargo it has imposed on the island for decades. But the Cuban Medical Professional Parole Program, which in the last fiscal year enabled 1,278 Cubans to defect while on overseas assignments, a record number, is particularly hard to justify.
It is incongruous for the United States to value the contributions of Cuban doctors who are sent by their government to assist in international crises like the 2010 Haiti earthquake while working to subvert that government by making defection so easy.
American immigration policy should give priority to the world's neediest refugees and persecuted people. It should not be used to exacerbate the brain drain of an adversarial nation at a time when improved relations between the two countries are a worthwhile, realistic goal.
The program was introduced through executive authority in August 2006, when Emilio González, a hard-line Cuban exile, was at the helm of the United States Citizenship and Immigration Services. Mr. González described the labor of Cuban doctors abroad as "state-sponsored human trafficking." At the time, the Bush administration was trying to cripple the Cuban government. Easily enabling medical personnel posted abroad to defect represented an opportunity to strike at the core of the island's primary diplomatic tool, while embarrassing the Castro regime.
Cuba has been using its medical corps as the nation's main source of revenue and soft power for many years. The country has one of the highest numbers of doctors per capita in the world and offers medical scholarships to hundreds of disadvantaged international students each year, and some have been from the United States. According to Cuban government figures, more than 440,000 of the island's 11 million citizens are employed in the health sector.
Havana gets subsidized oil from Venezuela and money from several other countries in exchange for medical services. This year, according to the state-run newspaper Granma, the government expects to make $8.2 billion from its medical workers overseas. The vast majority, just under 46,000, are posted in Latin America and the Caribbean. A few thousand are in 32 African countries.
Medical professionals, like most Cubans, earn meager wages. Earlier this year, the government raised the salaries of medical workers. Doctors now earn about $60 per month, while nurses make nearly $40. Overseas postings allow these health care workers to earn significantly more. Doctors in Brazil, for example, are making about $1,200 per month.
The 256 Cuban medical professionals treating Ebola patients in West Africa are getting daily stipends of roughly $240 from the World Health Organization. José Luis Di Fabio, the head of the W.H.O. in Havana, said he was confident the doctors and nurses dispatched to Africa have gone on their own volition. "It was voluntary," Mr. Di Fabio, an Uruguayan whose organization has overseen their deployment, said in an interview. "Some backtracked at the last minute and there was no problem."
Cuban Doctors Arriving in Sierra Leone
Some doctors who have defected say they felt the overseas tours had an implicit element of coercion and have complained that the government pockets the bulk of the money it gets for their services. But the State Department says in its latest report on human trafficking that reported coercion of Cuban medical personnel does "not appear to reflect a uniform government policy." Even so, the Cuban government would be wise to compensate medical personnel more generously if their work overseas is to remain the island's economic bedrock.
Last year, the Cuban government liberalized its travel policies, allowing most citizens, including dissidents, to leave the country freely. Doctors, who in the past faced stricter travel restrictions than ordinary Cubans, no longer do. Some 20,000 Cubans are allowed to immigrate to the United States yearly. In addition, those who manage to arrive here in rafts or through border crossing points are automatically authorized to stay.
The Cuban government has long regarded the medical defection program as a symbol of American duplicity. It undermines Cuba's ability to respond to humanitarian crises and does nothing to make the government in Havana more open or democratic. As long as this incoherent policy is in place, establishing a healthier relationship between the two nations will be harder.
Many medical professionals, like a growing number of Cubans, will continue to want to move to the United States in search of new opportunities, and they have every right to do so. But inviting them to defect while on overseas tours is going too far.
Posted in Blog | Tagged Emigration, Health, Medical System, US-Cuba Relations | Leave a comment
PAYING FOR THE PORT OF MARIEL: ARE CUBA AND BRAZIL PARTNERS IN HUMAN TRAFFICKING?
Capitol Hill Cubans – Oct 24, 2014 – By Maria C. Werlau in Spain's ABC
Original article: http://www.capitolhillcubans.com/2014/10/must-read-are-cuba-and-brazil-partners.html
The Brazilian government has committed huge taxpayer funds —in loans, subsidies, and direct humanitarian assistance— to support infrastructure projects, food exports, and other initiatives in or for Cuba. Brazil has also provided decisive international political backing to the Cuban military dictatorship. This support is nowhere more evident than in the Port of Mariel, refurbished to great fanfare with Brazilian public financing of over one billion dollars.
Brazil's massive lending for Cuba seems reckless from a financial/due diligence perspective, as Cuba does not meet basic standards of creditworthiness. The island is technically insolvent; it has US$75 billion in external debt, a long history of defaults, and a classification from The Economist Intelligence Unit as one of the four riskiest countries on the planet to invest in. Meanwhile, the port project is apparently not viable, as the two main reasons given to justify the gigantic investment are shaky at best. Several ports in the vicinity look better positioned to take advantage of the Panama Canal expansion and the U.S. embargo does not seem anywhere close to ending.
Brazil's huge government loans and subsidies for Cuba have been granted with unprecedented levels of secrecy and are currently under investigation for allegations of corruption, kickbacks, and favoritism towards the port builder, Odebrecht, which received Brazil´s development bank (BNDES) loans for the port construction and is a large campaign contributor of the ruling Partido dos Trabalhadores (P.T.). Moreover, while Brazil has greatly increased financing for projects of politically-compatible foreign governments such as Cuba's —growing the deficit to 4% of GDP—, public funding for infrastructure projects within Brazil has been lacking.
The manifest commitment to support Cuba at all costs may seem puzzling, but can be explained by the strong political-ideological alliance of P.T. leaders with the Cuban regime in the pursuit of a radical hemispheric agenda (inspired in the Foro de Sao Paulo). The hyped-up business opportunities surrounding the port seek to exert pressure against the U.S. embargo and attract investors.
While the Mariel port project does not meet standard repayment conditions, Brazilian officials insist Cuba is meeting its financial commitments, presumably the amortization of its own loans from Odebrecth. In fact, it appears that repayment is coming from exploiting Cuba's citizens as export raw material for goods and services —purchased mostly by public entities in Brazil— in what arguably constitutes a government-to-government collaboration in human trafficking. Referred to as "health cooperation," these exports consist of:
Export services provided by approximately 11,400 Cuban doctors hired out for a Brazilian government program launched in 2013 that generates Cuba estimated annual net revenues of US$404 million.
Export products reported under standard trade codes for blood — including plasma and medicines and other products derived from blood — and for extracts of glands and organs.
Both have grown exponentially since former Brazilian president Lula da Silva launched the Brazil-Cuba alliance in 2003. Blood imports by Brazil from Cuba were only US$570 thousand in 2002, grew to US$16.9 million in 2011, and totaled US$4.8million in 2013; imports of extracts of glands and organs increased phenomenally from almost nothing in 2003 (US$25,804) to US$88.4 million in 2013.
These exports raise serious ethical concerns. The doctors are deployed as "exportable commodities" to remote zones of Brazil in violation of several ILO (International Labor Organization) conventions as well as of international standards and agreements on the prohibition of human trafficking, servitude, and bondage.
Regarding the export products, details are lacking, but if the trade is in products of human origin, as it appears, it would have very troubling implications. In Cuba, blood and organs/tissues/body parts are obtained from voluntary and uncompensated donors unaware of a profit motive by their government and practices involved in their collection —some quite scandalous— are unacceptable by standards of the World Health Organization and other international bodies.
Additional concerns pertain to safety, quality, effectiveness, and the potential political purpose driving the purchases.
While the service of Cuban doctors has raised ample debate and media coverage in Brazil, the import of products purportedly derived from human blood and body parts has, as of yet, remained out of the public sphere.
In addition, while Brazilian authorities move forward with plans to integrate its biopharmaceutical production with Cuba, that this industry is under the absolute control of the secretive Cuban military regime or that it collaborates with rogues states such as Iran and Syria —including with exports of dual-use technology— have yet to raise attention in Brazil. In Cuba, this discussion cannot be had, as all media and mass communications belong to and are run by the state.
Maria Werlau
Posted in Blog | Tagged Cuba-Brazil Relations, Foreign Investment, Health, Mariel, Medical System | Leave a comment
Lopez-Levy and Piccone: UNITED STATES, CUBA and EBOLA
Posted on November 5, 2014 by Arch Ritter
Fighting Ebola: A new case for U.S. engagement with Cuba
Original Article: http://tbo.com/list/news-opinion-commentary/fighting-ebola-a-new-case-for-us-engagement-with-cuba-20141028/
BY ARTURO LOPEZ-LEVY
Special To The Tampa Tribune; October 28, 2014
The simple fact that Cuba and the United States are in the same boat fighting the Ebola epidemics in Western Africa demonstrates how the level of conflict between the two countries is irrational. While Havana and Washington have considerable differences — and no parallel efforts against a common enemy as Ebola can bridge them — it is evident that narratives of suspicion and intransigence prevent such joint efforts for the benefit of both countries and the world in general.
But, words matter. The recent statements by John Kerry and Samantha Power praising what Cuba is doing to fight Ebola in Africa on behalf of the U.S. State Department — as well as the declarations by Fidel and Raul Castro that Cuba would welcome collaborative efforts on Ebola with the United States — show that a revision of the bilateral relations is long overdue.
President Obama now needs to apply the dictum of his former chief of staff, Rahm Emanuel, and not waste the opportunity presented by the Ebola crisis. Cuba and the United States should advance long-term cooperation in international health efforts under the auspices of the WHO.
Political leadership in the White House and the Palace of Revolution would transform a fight against a common threat into joint cooperation for the advancement of human rights (the right to health is a human right) all over the developing world and the national interests of the two neighbors.
Political conditions are ripe for such turn. Americans strongly support aggressive actions against Ebola and would applaud a president who put lives and medical cooperation with Cuba above ideology and resentment.
As more information comes out about Cuba's international health effort, it is becoming clearer how unreasonable it is to assume that all Cuban presence in the developing world is damaging to U.S. national interests. The more than 40 000 Cuban doctors and health personnel working in 80 countries are playing a key role to improve human development and protect the world from the spread of Ebola and other contagious diseases.
During the Bush administration and even under Obama, the United States spent lavishly to support groups in Miami that focus on undermining Cuba's international health presence in Africa and Latin America.
The U.S Cuban Medical Professional Parole Immigration Program (CMPP) is reminiscent of the Cold War. The program encourages Cuban doctors to abandon their contracts in third countries and immigrate to the United States.
Washington's ideology-driven hostility toward Cuba's international health efforts has further divided the United States from other democratic countries. The trouble for Miami die-hard Cold Warriors is that examples of how Cuba shares the burden and merits of international health efforts with U.S. allies are expanding. Cuba is cooperating with several institutions of the European Union, Brazil, Canada and Norway in projects of medical education on the island, and in Haiti and other countries. The programs might even grow as result of the current negotiation in Brussels between the EU and Cuba for a comprehensive agreement on cooperation and political dialogue.
The good news is that two former U.S. presidents, Jimmy Carter and Bill Clinton, have talked positively about Cuba's health achievements and international programs. President Carter and former first lady Rosalyn even visited Cuba's Latin American School of Medicine in 2002. In a meeting with then Cuban minister of health Carlos Dotres, Mrs. Carter mentioned that their presidential center's Global Health program would like to collaborate with Cuba's international medical educational assistance. There is no moral, political or national security explanation for why such humanitarian endeavors are not happening already.
As a senator and presidential candidate, Obama was one of the loudest critics of looking at Cuba through the glasses of the Cold War. As a president, it isn't enough for him just to retune the same policy of embargo implemented by his predecessors. He must adjust the official U.S. narrative about post-Fidel Cuba: It is not a threat to the United States but a country in transition to a mixed economy, and a positive force for global health.
Arturo Lopez-Levy is a visiting lecturer at Mills College in California and a PhD candidate at the Josef Korbel School of International Studies at the University of Denver.
Ebola Could Bring U.S. and Cuba Together
By: Ted Piccone, Brookings Institution
On October 28, the United Nations General Assembly voted overwhelmingly for the 23rd year in a row to condemn the United States' tough embargo on Cuba as a unilateral interference in free trade. Coincidentally, the UN system is tackling the devastating spread of the Ebola virus in West Africa and urging states to contribute medical and financial resources to stem the outbreak.
Ironically, Cuba and the United States have led the world in responding to the call for help, rushing hundreds of medical workers, military personnel, equipment, and other resources to Liberia, Sierra Leone, and Guinea to treat Ebola's victims and prevent the epidemic from spreading. Could this be the moment for both countries to set aside their differences and join forces for the greater good?
The answer is a qualified yes. The onerous U.S. embargo poses no obstacles to such cooperation, and in any event, bilateral assistance for humanitarian reasons, including food and medicine, is a well-established exception to the rule. So there is no legal reason why U.S. personnel could not work alongside Cuban doctors and nurses in a third country to provide humanitarian aid to the stricken.
Moreover, there are precedents for this kind of cooperation. In 2010, in response to the devastating earthquake in Haiti, American and Cuban personnel worked together to provide emergency care, including the provision of U.S. medical supplies to field hospitals staffed by Cuban doctors.
Cooperation was so positively received that the two sides launched high-level discussions about a joint project to build a new hospital in rural Haiti to be staffed in part by Cuban medical personnel.
Yet, as in so many other instances, cooperation between Havana and Washington broke down. This time, the dispute concerned a Bush-era program allowing Cuban doctors and other health personnel easy immigration into the United States. Cuba insisted that the program be dropped.
Already, nearly 1,600 Cuban health workers have taken advantage of the enticement, which undermines Cuba's well-regarded health-care system, a pride of the revolution.
Proponents of the expedited visa program, on the other hand, argue that these medical workers are forced to work for Cuba's public health service under the island's restrictive labor laws. Given their specialized medical training, they also have a much harder time than other Cubans gaining permission to leave the island, even under the more relaxed travel policies that Cuba adopted in 2012.
U.S. President Barack Obama has a unique opportunity to show the world that the United States can rise above old hostilities for the sake of saving lives. He can immediately use his executive authority to suspend the discretionary parole program for any Cuban medical worker who is deployed to West Africa in response to the Ebola outbreak, and thereby stem Cuba's professional brain drain.
Cuba has sent more than 50,000 medical personnel to 66 countries (more than those deployed by the G7 combined), and is now the biggest single provider of health-care workers to the Ebola crisis in West Africa. For their part, the Cubans could address concerns about the nature of their highly touted medical missionary work by giving participants in their medical brigades the option of serving abroad as volunteers, not conscripts, at no cost to their careers if they say no, and with higher pay if they say yes.
The timing for such a move is ripe. Since Obama eased the embargo in his first term by allowing more Cuban Americans to visit and send remittances to their relatives, and facilitating other categories of travel to the island, people on both sides of the Florida Straits are reconnecting in myriad ways, slowly rebuilding the bridge that has long divided the two countries.
Both sides have begun cooperating in modest but pragmatic ways, in such areas as counter-narcotics, aviation security, marine environmental affairs, and migration. This would be one additional step on the path toward the reconciliation that a majority of Americans, including Cuban Americans in Florida, want and deserve.
The next steps, however, will be even more important. After the November elections, President Obama should signal his willingness to improve relations with Cuba by ending more travel and remittances restrictions, expanding support to Cuba's emerging private sector, and engaging in high-level talks to remove Cuba from the U.S. list of state sponsors of terrorism.
Action on key cases involving citizens held in prison in both countries should be on the agenda as well, but not as a precondition for talks. And, assuming cooperation in West Africa goes well, President Obama should broaden the scope and timeline of the suspension of the medical parole program.
Now is the time to take these steps, before President Obama travels to the Summit of the Americas in Panama in April. There, he and Cuban President Raúl Castro should finally talk face-to-face, without preconditions, and set a path toward reconciliation through dialogue. It would be a great legacy for both presidents as they depart office in just a few years.
This piece was originally published by The Mark.
Posted in Blog | Tagged EBOLA, Health, International Relations, Medical System, US-Cuba Relations | Leave a comment
IN THE MEDICAL RESPONSE TO EBOLA, CUBA IS PUNCHING FAR ABOVE ITS WEIGHT
Posted on October 6, 2014 by Arch Ritter
4 Octobre 2014 – The Washington Post – Adam Taylor
Original Here: http://www.washingtonpost.com/blogs/worldviews/wp/2014/10/04 /
While the international community has been accused of dragging its feet on the Ebola crisis, Cuba, a country of just 11 million people that still enjoys a fraught relationship with the United States, has emerged as a crucial provider of medical expertise in the West African nations hit by Ebola.
On Thursday, 165 health professionals from the country arrived in Freetown, Sierra Leone, to join the fight against Ebola – the largest medical team of any single foreign nation, according to the World Health Organization (WHO). And after being trained to deal with Ebola, a further 296 Cuban doctors and nurses will go to Liberia and Guinea, the other two countries worst hit by the crisis.
Cuba is, by any measure, not a wealthy country. It had a Gross Domestic Product (GDP) of slightly more than $68 billion in 2011, according to the World Bank, putting it a few places higher than Belarus. At $6,051, its GDP per capita was less than one-sixth of Britain's. However, its official response to Ebola seems far more robust than many countries far wealthier than it – and serves as further proof that health-care professionals are up there with rum and cigars in terms of Cuban exports.
Cuba's universal health-care system enables such an export. The country nationalized its health care shortly after its revolution, ending private health care and guaranteeing free health care in its constitution. The results have been widely praised. In 2008, evaluating 30 years of Cuba's "primary health care revolution," the WHO noted impressive strides that the country had made in certain health indicators. "These indicators – which are close or equal to those in developed countries – speak for themselves," Gail Reed noted, pointing to a huge reduction in number of deaths for children under five years old and Cuba's high life expectancy of 77 years.
Cuba's health-care success is built upon its medical training. After the Cuban revolution, half of the country's 6,000 doctors fled and the country was forced to rebuild its work force. The training system grew so much that by 2008, it was training 20,000 foreigners a year to be doctors, nurses and dentists, largely free of charge.
Ebola isn't the first time that Cuban health workers have been sent to deal with a global disaster. Even back in 1960, immediately after the revolution, Cuba sent doctors to Chile to help in the aftermath of a devastating earthquake, and the practice has continued for decades since. In 2005, Cuba even offered to send medical workers to the United States after Hurricane Katrina in 2005 (they were apparently rebuffed). Reuters reports that Cuba currently has around 50,000 health workers working in 66 countries. Despite the high-profile acts of charity, the medical diplomacy more often seemed to serve more practical purposes – an estimated 30,000 health workers are currently in Venezuela as a partial payment for oil, for example. Exported medical expertise is predicted to net Cuba $8.2 billion in 2014, according to a recent report in state newspaper Granma. There are hopes that medical tourism and exported medical technology could one day provide similar figures.
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 – The Los Angeles Times reported earlier this year that a significant number of Cuban health-care workers in Venezuela have fled the country to escape "crushing" workloads.
Even so, Cuba's oversized response to Ebola seems to have brushed aside these criticisms, for now at least. The number of Cuban medical staff in Sierra Leone, Liberia and Guinea looks set to be more than those sent from far-larger countries like China. Israel, a wealthier country with a similar population, caused controversy this week when it rejected calls to send medical teams.
"Money and materials are important, but those two things alone cannot stop Ebola virus transmission," Dr Margaret Chan, director-general at the World Health Organization, said last month. "Human resources are clearly our most important need."
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CUBA'S EBOLA AID IS THE LATEST EXAMPLE OF ITS 'MEDICAL DIPLOMACY'
Posted on September 15, 2014 by Arch Ritter
Original here: http://www.globalpost.com/dispatch/news/regions/americas/cuba/140914/cubas-ebola-aid-the-latest-example-its-medical-diplomacy
Cuba's pledge to deploy a 165-strong army of doctors and nurses to help fight the Ebola outbreak is the latest example of the Communist country's decades-old tradition of "medical diplomacy."
Since 1960, when Cuba dispatched a team of doctors to help with the aftermath of an earthquake in Chile, the Caribbean island has sent more than 135,000 medical staff to all corners of the globe.
The latest batch being sent to help in west Africa's Ebola crisis are part of a 50,000-strong foreign legion of Cuban doctors and healthcare workers spread across 66 countries in Latin America, Asia and Africa, according to Cuba's Health Ministry. Cuban Health Minister Roberto Morales Ojeda told reporters in Geneva on Friday some 62 doctors and 103 nurses were being sent to Sierra Leone to tackle the outbreak. World Health Organization director general Margaret Chan welcomed the Cuban aid, the largest offer of a foreign medical team from a single country during the outbreak. "Money and materials are important, but those two things alone cannot stop Ebola virus transmission," said Chan. "Human resources are clearly our most important need." Morales said members of the team had "previously participated in post-catastrophe situations" and had all volunteered for the six-month mission, which begins in early October.
'Foreign policy cornerstone'
"Medical diplomacy, the collaboration between countries to simultaneously produce health benefits and improve relations, has been a cornerstone of Cuban foreign policy since the outset of the revolution fifty years ago," said US researcher Julie Feinsilver in a study for Georgetown University. "It has helped Cuba garner symbolic capital — goodwill, influence, and prestige —well beyond what would have been possible for a small, developing country, and it has contributed to making Cuba a player on the world stage," Feinsilver wrote in her study "Fifty Years of Cuba's Medical Diplomacy: From Idealism to Pragmatism." "In recent years, medical diplomacy has been instrumental in providing considerable material capital — aid, credit, and trade — to keep the revolution afloat."
Cuba's medical diplomacy accelerated after the devastation wrought by Hurricanes George and Mitch across the Caribbean in 1998. In the aftermath of the disaster, Cuba sent some 25,000 doctors and health workers to 32 nations in the region. In 2004, former President Fidel Castro and late Venezuelan President Hugo Chavez launched "Mission Miracle," a program offering free eye surgery that has benefited some 2.8 million people across 35 countries, according to Cuban official sources.
Earthquake assistance
At the same time, Cuba's "medical brigades" have helped victims from devastating earthquakes in numerous countries including Algeria, Mexico, Armenia and Pakistan. Cuba has also trained several thousand doctors and nurses from no fewer than 121 developing nations.
The biggest deployment has seen 30,000 Cuban health professionals sent to oil-rich Venezuela, a key regional ally. In Brazil, meanwhile, some 11,456 Cubans are working in hard-hit areas suffering from staffing shortages.
Together with educational and sporting services, the export of medical professionals is worth around $10 billion annually to Cuba, making it the most important source of income for the island, outstripping money earned from foreign remittances and exports of nickel.
Yet while the qualifications and dedication of Cuba's foreign legion are regularly lauded by countries benefiting from their services and organizations such as the WHO, they are not always viewed so positively by local health workers. Trade unions and some politicians in Peru, Brazil, Ecuador, Bolivia, Uruguay and Honduras have criticized the "army in white coats" sent by Cuba.
At the same time, Havana has also been criticized for withholding too big a chunk of the salaries of workers employed overseas.
Despite the thousands of health workers abroad, Cuba's domestic healthcare remains one of the best staffed networks in the world, with 82,065 doctors, one for every 137 people, according to the National Statistics Office.
The Ebola Pandemic, Monrovia
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WORKING CONDITIONS IN VENEZUELA SENDING CUBAN DOCTORS TO U.S.
CHRIS KRAUL, 11 September 2014 – Los Angeles Times –
Original article: http://www.latimes.com/world/mexico-americas/la-fg-venezuela-cuba-doctors-20140911-story.html
Worsening conditions in Venezuela are causing increasing numbers of Cuban medical personnel working there to immigrate to the United States under a special program that expedites their applications, according to Colombian officials who help process many of the refugees.
On Wednesday, the U.S. Citizenship and Immigration Services in Washington said the number of Cuban doctors, nurses, optometrists and medical technicians applying for U.S. visas under the Cuban Medical Professional Parole Program is running as much as 50% ahead of last year's pace, which was nearly double that of the year before. At the current rate, more than 1,500 Cuban healthcare workers will be admitted to the United States this year.
For geographical reasons, neighboring Colombia is a favored trampoline for Cubans fleeing Venezuela, whose leftist government has struggled to rein in runaway inflation, shortages of goods and services and rising social unrest.
Cuba, which prides itself on a comprehensive healthcare system and has long exported doctors and nurses to friendly countries, maintains an estimated 10,000 healthcare providers in Venezuela. The medical outreach program is intended as partial payment for 100,000 barrels of oil that President Nicolas Maduro's government ships to the Castro administration each day.
Nelia, a 29-year-old general practitioner from Santiago de Cuba, arrived in Bogota last month after what she said was a nightmarish year working in Venezuela's Barrio Adentro program in the city of Valencia. She declined to disclose her last name for fear of reprisal back home. Nelia said her disillusionment started on her arrival in Caracas' Maiquetia airport in mid-2013. She and several colleagues waited there for two days, sometimes sleeping in chairs, before authorities assigned her to a clinic in Valencia, she said.
"It was all a trick. They tell you how great it's going to be, how you will able to buy things and how grateful Venezuelans are to have you. Then comes the shock of the reality," Nelia said. Her clinic in Valencia had no air conditioning and much of the ultrasound equipment she was supposed to use to examine pregnant women was broken.
She described the workload as "crushing." Instead of the 15 to 18 procedures a day she performed in Cuba, she did as many as 90 in Venezuela, she said. Crime is rampant, the pay is an abysmal $20 per month and Cubans are caught in the middle of Venezuela's civil unrest, which pits followers of the late President Hugo Chavez — whose handpicked successor is Maduro — against more conservative, market-oriented forces. "The Chavistas want us there and the opposition does not. And there are more opposition people than Chavistas," said Nelia, who was interviewed in a Colombian immigration office in Bogota.
A 32-year-old Cuban optometrist who identified himself as Manuel and who also fled Venezuela to apply for U.S. residency said that at his clinic in Merida he was prescribing and grinding up to 120 pairs of eyeglasses a day, triple his pace in Cuba.
"As a professional you want to be paid for what your work is worth. What we were getting, $20 a month, was not enough to pay even for food and transportation, much less a telephone call to Cuba now and then," Manuel said. "That's the main reason I want to go to Miami, to earn what I'm worth."
Cubans have long had favored status as U.S. immigrants. Virtually any Cuban is guaranteed automatic residency and a path to citizenship simply by setting foot on U.S. territory, legally or not. The Cuban Medical Professional Parole Program gives medical personnel a leg up by allowing them to apply for residency at U.S. embassies. Though some Cubans apply at the U.S. Embassy in Caracas, the Venezuelan capital, others say they fear being seen there. Also, airfare to the United States from Colombia is much cheaper than from Venezuela.
The increasing flow of Cuban doctors is only part of a rising tide of Cubans seeking to reach the United States, many through Colombia. Lacking the special status of medical personnel, many U.S.-bound Cubans first land in Ecuador, where the government requires no visas. They then typically pass through Colombia to Panama with the help of coyotes, or human traffickers. However, many are detained in Colombia. Of 1,006 illegal immigrants detained in Colombia from January through July of this year for failing to have proper visas, 42% were Cuban, according to Colombia's immigration agency director, Sergio Bueno Aguirre. The flow of Cubans had more than doubled from the year before.
One Colombian Foreign Ministry official who spoke on condition of anonymity because of the political sensitivity said the U.S. policy of allowing Cubans immigrant status simply by arriving in the United States has fed organized crime in Colombia and in other transit countries.
"Coyotes helping the Cubans transit through Colombia often use the migrants to carry drugs or submit to prostitution," the official said. "Or the coyotes will just abandon them at a border, creating a big headache for the Colombian government, which has to take care of them or send them back home."
Posted in Blog | Tagged Cuba-Venezuela Relations, Health, Medical System, US-Cuba Relations | Leave a comment