May 18, 2010 - No. 92 - Supplement

Cuban Medical Aid to Haiti:
One of the World's Best Kept Secrets

- Emily J. Kirk and John M. Kirk*, April 1, 2010 -

Cuban field hospital in Jacmel, Haiti, January 2010. Left: Cubans set up the fields hospital.
Right: Cuban doctors administer a tetanus vaccine. (Granma)

Media coverage of Cuban medical cooperation following the disastrous recent earthquake in Haiti was sparse indeed. International news reports usually described the Dominican Republic as being the first 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. CNN also broadcast hundreds of reports, and in fact one focused on a Cuban doctor wearing a T-shirt with a large image of Che Guevara -- and yet described him as a "Spanish doctor."

In general, international news reports ignored Cuba's efforts. By March 24, CNN for example, had 601 reports on their 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 regarding the earthquake and relief efforts, though not a single one discusses in any detail any Cuban support. In reality, however, Cuba's medical role had been extremely important -- and had been present since 1998.

Cuba and Haiti Pre-Earthquake

In 1998, Haiti was struck by Hurricane Georges. The hurricane caused 230 deaths, destroyed 80% of the crops, and left 167,000 people homeless.[1] Despite the fact that Cuba and Haiti had not had diplomatic relations in over 36 years, Cuba immediately offered a multifaceted agreement to assist them, of which the most important was medical cooperation.

Cuba adopted 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 easily the worst in the Americas, with life expectancy of only 54 years in 1990 and one out of every 5 adult deaths due to AIDS, while 12.1% of children died 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 places of the Cuban doctors (a process of "brain gain" rather than "brain drain"). Significantly, the students were selected from non-traditional backgrounds, and were mainly poor. It was thought that, because of their socio-economic background, they fully understood their country's need for medical personnel, and would 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. It is worth noting that Cuban medical personnel were estimated to be caring for 75% of the population.[3] Studies by the Pan American Health Organization (PAHO) indicated clear improvements in the health profile since this extensive Cuban medical cooperation began.

Improvements in Public Health in Haiti, 1999-2007[4]

Health Indicator                           1999   2007

Infant Mortality, per 1,000 live births      80     33
Child Mortality Under 5 per 1,000           135     59.4
Maternal Mortality per 100,000 live births  523    285
Life Expectancy (years)                      54     61

Cuban medical personnel had clearly made a major difference to the national health profile since 1998, largely because of their proactive role in preventive medicine -- as can be seen below.

Selected Statistics on Cuban Medical Cooperation, Dec. 1998-May 2007[5]

Visits to the doctor       10,682,124
Doctor visits to patients   4,150,631
Attended births                86,633
Major and minor surgeries     160,283
Vaccinations                  899,829
Lives saved (emergency)       210,852

By 2010, at no cost to medical students, Cuba had trained some 550 Haitian doctors, and is at present training a further 567. Moreover, since 1998 some 6,094 Cuban medical personnel have worked in Haiti. They had given over 14.6 million consultations, carried out 207,000 surgical operations, including 45,000 vision restoration operations through their Operation Miracle programme, attended 103,000 births, and taught literacy to 165,000. In fact at the time of the earthquake there were 344 Cuban medical personnel there. All of this medical cooperation, it must be remembered, was provided over an 11-year period before the earthquake of January 12, 2010.[6]

Cuba and Haiti Post-Earthquake

The earthquake killed at least 220,000, injured 300,000 and left 1.5 million homeless.[7] Haitian Prime Minister Jean-Max Bellerive described it as "the worst catastrophe that has occurred in Haiti in two centuries."[8]

International aid began flooding in. It is important to note the type of medical aid provided by some major international players. Médecins Sans Frontières (MSF), for example, an organization known for its international medical assistance, 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.[9]

Jacmel, Haiti: Cuban pediatrician with mother and child in January 2010. (Granma)

Canada's contribution included the deployment of 2,046 Canadian Forces personnel, including 200 DART personnel. The DART (Disaster Assistance Response Team) received the most media attention, as it conducted 21,000 consultations -- though it should be noted they do not treat any serious trauma patients or provide surgical care. Indeed, among the DART personnel, only 45 are medical staff, with others being involved in water purification, security, and reconstruction. In total, the Canadians stayed for only 7 weeks.[10]

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 7 weeks, in which time they treated 871 patients, performing 843 surgical operations.[11] Both the Canadian and US contributions were important -- while they were there.

Lost in the media shuffle was the fact that, for the first 72 hours following the earthquake, Cuban doctors were in fact the main medical support for the country. Within the first 24 hours, they had completed 1,000 emergency surgeries, turned their living quarters into clinics, and were running the only medical centers in the country, including 5 comprehensive diagnostic centers (small hospitals) which they had previously built. In addition another 5 in various stages of construction were also used, and they turned their ophthalmology center into a field hospital -- which treated 605 patients within the first 12 hours following the earthquake.[12]

Cuba soon became responsible for some 1,500 medical personnel in Haiti. Of those, some 344 doctors were already working in Haiti, while over 350 members of the "Henry Reeve" Emergency Response Medical Brigade were sent by Cuba following the earthquake. In addition, 546 graduates of ELAM from a variety of countries, and 184 5th and 6th year Haitian ELAM students joined, as did a number of Venezuelan medical personnel. In the final analysis, they were working throughout Haiti in 20 rehabilitation centers and 20 hospitals, running 15 operating theatres, and had vaccinated 400,000. With reason Fidel Castro stated, "we send doctors, not soldiers."[13]

A glance at the medical role of the various key players is instructive.

Comparative Medical Contributions in Haiti by March 23[14]

                                                               MSF   Canada   USA      Cuba

No. of Staff              3,408       45   550     1,504
No. of Patients Treated  54,000   21,000   871   227,143
No. of Surgeries          3,700        0   843     6,499

These comparative data, compiled from several sources, are particularly telling as they indicate the significant (and widely ignored) medical contribution of the Cubans. In fact, they have treated 4.2 times the number of patients compared with MSF (which has over 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). Also notable is the fact that the Cuban medical contingent was roughly three times the size of the American staff, although they treated 260.7 times more patients than U.S. medical personnel. Clearly, there have been significant differences in the nature of medical assistance provided.

It is also important to note that approximately one-half of the Cuban medical staff was working outside the capital, Port-au-Prince, where there was significant damage as well. Many medical missions could not get there, however, due to transportation issues. Significantly, 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. Noted Cuban artist Kcho also 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.

Map indicating the location of Cuban hospitals in Haiti on February 5, 2010. (AIN Infographics)

Perhaps most impressively, following the growing concern for the health of the country, due to a poor and now largely destroyed health care system Cuba, working with ALBA (the Alianza Bolivariana para los Pueblos de Nuestra América) countries, presented to the WHO an integral program to reconstruct the health care system of Haiti. Essentially, they are offering to rebuild the entire health care system. It will be supported by ALBA and Brazil, and run by Cubans and Cuban-trained medical staff. This is to include hospitals, polyclinics, and medical schools. In addition, the Cuban government has offered to increase the number of Haitian students attending medical school in Cuba. This offer of medical cooperation represents an enormous degree of support for Haiti.[15] Sadly, this generous offer has not been reported by international media.

While North American media might have ignored Cuba's role, Haiti has not. A pointed remark was made by Haitian President Mr. René Préval, who noted, "you did not wait for an earthquake to help us."[16] Similarly, Haiti's Prime Minister Jean-Max Bellerive has also repeatedly noted that the first three countries to help were Cuba, the Dominican Republic and Venezuela.

Sadly (but not surprisingly), while Cuba's efforts to assist Haiti have increased, international efforts have continued to dwindle. The head of the Cuban medical mission, Dr. Carlos Alberto García, summed up well the situation just two weeks after the tragedy: "many foreign delegations have already begun to leave, and the aid which is arriving now is not the same it used to be. 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." Significantly, he added "However we will still be here long after they have all gone."[17] This in fact has been the case. Canadian forces, for example, returned home and the USNS Comfort sailed several weeks ago. By contrast, Cuban President Raúl Castro noted: "we have accompanied the Haitian people, and we will continue with them whatever time is needed, no matter how many years, with our very modest support."[18]

A representative of the World Council of Churches to the United Nations made the telling comment that "humanitarian aid could not be human if it was only publicized for 15 days."[19] Today Cuba, with the support of ALBA and Brazil, is working not to build 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 done for the past 11 years, for as long as necessary. This is a story that international media have chosen not to tell -- now that the television cameras have gone. Yet it is an extraordinary story of true humanitarianism, and of great success in saving lives since 1998. Moreover, in light of Cuba's success in providing public health care (at no cost to the patients) to millions of Haitians, this approach to preventive, culturally sensitive, low cost and effective medicine needs to be told. That significant contribution to this impoverished nation, and Cuba's ongoing commitment to its people, clearly deserve to be recognized. Until then it will sadly remain as one of the world's best-kept secrets.

Notes

1. "Audit of USAID/HAITI Hurricane Georges Recovery Programme." USAID. 15 May, 2001. Retrieved 10 March, 2010 from
2. See entry for "Haiti" on the Pan American Health Organization website, found at http://www.paho.org/english/dd.ais/cp_332.htm. Accessed February 2, 2010.
3. William Steif, "Cuban Doctors Aid Strife-Torn Haiti." The State. April 26, 2004, and found at http://havanajournal.com/culture/entry/cuban_doctors_aid_strife_torn_hai... Accessed June 21, 2007.
4. See entry for "Haiti" on the Pan American Health Organization website, found at http://www.paho.org/english/dd/ais/cp_332.htm3. Accessed February 2, 2010.
5. Anna Kovac, "Cuba Trains Hundred of Haitian Doctors to Make a Difference," August 6, 2007. Located on the MEDICC website at http:www.medicc.org/cubahealthreports/chr-article.php?&a=10354. Accessed February 2, 2010.
6. Ibid., "Haitian Medical Students in Cuba." Medical Education Cooperation With Cuba. 12 January, 2010. Retrieved 12 January, 2010 from , "La colabaración cubana permanecerá en Haití los años que sean necesarios", Cubadebate. 24 February, 2010. Retrieved 9 March, 2010 from , "Fact Sheet: Cuban Medical Cooperation With Haiti." Medicc Review. 15 January, 2009. Retrieved 2 February, 2010 from http://www.medicc.org/ns/index.php?s=104.
7. "Haiti Earthquake: Special Coverage." CNN. 20 March, 2010. Retrieved 22 March, 2010 from
8. Tyler Maltbie, "Haiti Earthquake: The Nations That Are Stepping Up To Help", The Christian Science Monitor, Posted January 14, 2010 on http://www.csmonitor.com/layout/set/print/content/view/print273879. Accessed January 28, 2010.
9. "Two Months After the Quake, New Services and New Concerns." MSF. 12 March, 2010. Retrieved 17 March, 2010 from http://www.doctorswithoutborders.org/news/article_printcfm?id=4320
10. "Canada's Response to the Earthquake in Haiti: Progress to Date." Foreign Affairs and International Trade Canada. March 17, 2010. Retrieved 17 March, 2010 from http://www.internaitonal.gc.ca/humanitarian-humanitaire/earthquake_seisme_h aiti_effort
11. "USNS Comfort Completes Haiti Mission, March 9, 2010?. American Forces Press Service. 9 March, 2010. Retrieved 11 March, 2010 from http://www.trackpads.com/forum/defenselink/928304-usns-comfort-completes-ha ti-mission
12. John Burnett, "Cuban Doctors Unsung Heroes of Haitian Earthquake", National Public Radio report, January 24, 2010, and found at http://www.npr.org/templates/story.ph?storyID=122919202. Accessed 28 January, 2010.
13. José Steinsleger. "Haiti, Cuba y la ley primera," La Jornada, February 3, 2010., Data in this section came from the address given by Ambassador Rodolfo Reyes Rodríguez on January, 27, 2010 in Geneva at the 13th Special Session of the U.N. Human Rights Council on Haiti. It can be accessed at "Cuba en Ginebra: ‘Ante tan difícil situación humanitaria en Haití no puede haber titubeos ni indiferencia," on the Cubbadebate website: http://www.cubadebate.cu/especiales/2010/01/27/cuba-en-ginebra-sobre-reconstruccion-haiti
14. Connor Gorry. "Two of the 170,000 + Cases." Medicc Review. March 8, 2010. Retrieved 10 March, 2010 from http://mediccglobal.wordpress.com/
"Cooperación con Haití debe ser a largo plazo." Juventud Rebelde. 23 March, 2010. Retrieved March 23, 2010 from http://juventudrebelde.cu/internacionales/2010-03-23/cooperacion-con-haiti- debe-ser-a-largo-plazo
"Haiti: Two Months After The Quake, New Services and New Concerns." MSF. 12 March, 2010. Retrieved 17 March, 2010 from http://www.doctorswithoutborders.org/news/article_print.cfm?id=4320
"Haiti-USNS Comfort Medical And Surgical Support." U.S. Department of Health and Human Services. 11 March, 2010. Retrieved 11 March, 2010 from http:www.hhs.gov/Haiti/usns_comfort.html
Brett Popplewell. "This Haitian Town Is Singing Canada's Praise." The Star. 26 January, 2010. Retrieved 17 March from http://www.thestar.com/printarticle/755843
"USNS Comfort Leaves Haiti." 13 News. 11 March, 2010. Retrieved 11 March, 2010 from http://www.wvec.com/internaternalz?st=print&id=87243182&path=/home
15. In a March 27, 2010 meeting in Port-au-Prince between President Préval and the Cuban and Brazilian ministers of health (José Ramón Balaguer and 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 healthcare system, supported by well-trained professionals [...] We will provide this, together with Cuba-a country with an 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." See "Cuba y Brasil suman esfuerzos con Haití," Juventud Rebelde, March 28, 2010 (Translation to English provided by authors).
16. "Presidente Preval agradece a Fidel y Raúl Castro ayuda solidaria a Haití." 8 February, 2010. Retrieved 9 February, 2010 from http://www.cubadebate.cu/noticias/2010/02/08presidente-preval-agradece-f...
17. María Laura Carpineta, "Habla el jefe de los 344 médicos cubanos instalados en Haití desde hace doce años." Página 12 [Argentina]. February 4, 2010, found at CUBA-L@LISTA.UNM.EDU19
18. Ibid.
19. "Press Conference on Haiti Humanitarian Aid," held at the United Nations on March 23, 2004 and found at htto://www.un.org/News/briefings/docs/2004/CanadaPressCfc.doc.htm. Accessed November 21, 2008.

* Emily J. Kirk will be an M.A. student in Latin American Studies at Cambridge University in September. John Kirk is a professor of Latin American Studies at Dalhousie University, Canada. Both are working on a project on Cuban medical internationalism sponsored by Canada's Social Science and Humanities Research Council of Canada (SSHRC). Professor Kirk co-wrote with Michael Erisman the 2009 book "Cuba's Medical Internationalism: Origins, Evolution and Goals" (Palgrave Macmillan). He spent most of February and March in El Salvador and Guatemala, accompanying the Henry Reeve Brigade in El Salvador, and working with the Brigada Medica Cubana in Guatemala. This commentary was first published by Cuba-L Analysis.

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