Cuba to the rescue: Ebola-stricken countries welcome Castro's doctors

The US is the biggest financial donor to Ebola-infected countries in West Africa. But the largest number of healthcare workers deployed in the field hail from an island nation with a cash-strapped communist government.

Cuba has a long history of exporting doctors and nurses, ever since its 1959 revolution led by communist leader Fidel Castro. So when Ebola struck in West Africa, Cuba was quick to step up to the plate. In recent weeks, it has dispatched 165 health workers to Sierra Leone, making it the largest nation-provider of medial professionals working to help contain the epidemic. And it's preparing to send another nearly 300 workers to Liberia and Guinea in the coming weeks. 

More than 4,000 people have died from Ebola and nearly 9,000 have contracted the disease, according to the World Health Organization (WHO). Those numbers are predicted to grow at a rapid pace if Ebola is not contained: WHO has forecast that West Africa could see 10,000 new cases a week by December.

While financial aid and other support like food and security have trickled into the region as the world wakes up to the threat posed by Ebola, human resources are in highest demand. “Money and materials are important, but those two things alone cannot stop Ebola virus transmission,” Margaret Chan, director-general at the WHO said late last month.

“We need most especially compassionate doctors and nurses … working under very demanding conditions.”

The US is the biggest financial donor to the fight against Ebola, pledging $400 million in aid and sending some 4,000 troops to the region. But in terms of trained healthcare workers, its contribution has been 65 uniformed officers from the Public Health Service Commissioned Corps, reports The Wall Street Journal. 

Cuba is "punching above its weight," when it comes to the fight against Ebola, reports The Washington Post. The island nation of 11 million isn't wealthy; its GDP per capita is less than one-sixth that of Britain's. 

"The little we have, we share. Our principle resource is human capital,” Dr. Jorge Perez Avila, the director of the Pedro Kouri Institute for Tropical Medicine in Havana, told CNN.

Deploying doctors 

This is the first time Cuban doctors have mobilized to fight Ebola, and Cuban state media reports that some 15,000 health professionals have expressed an interest in traveling to West African nations to help.

Under Castro, Cuba nationalized its healthcare system and inserted a constitutional guarantee of free healthcare for all. As a result, health indicators on the island have greatly improved, reports The Washington Post.

Havana regularly sends medical aid and teams of healthcare workers to nations suffering natural disasters. The Post writes that health workers are “up there with rum and cigars in terms of Cuban exports.”

• Soon after its revolution, Cuba sent doctors to Chile to help the nation recover from a deadly 1960 earthquake.
• Cuba sent 2,500 health workers to Pakistan after an earthquake in 2005.
• 1,500 Cuban health professionals traveled to Haiti after its 2010 earthquake.
• Some 30,000 Cubans currently work in Venezuela’s health system; Cuba is partially paid in oil for its contribution. 
• An estimated 4,500 Cuban doctors are currently supplementing Brazil’s public health system in rural parts of the country or undesirable city neighborhoods.

“We work on malaria, cholera, dengue, a disaster situation, floods in Venezuela, floods in Guatemala, floods in Belize,” Jorge Delgado Bustillo, head of the Cuban Medical Brigade to Sierra Leone, told The Wall Street Journal.

Mixed response to Cuban doctors

Although Cuban doctors are known around the world for their service, their reception abroad is not always warm.

According to The Christian Science Monitor, when Brazil announced its Mais Medicos program, which brings thousands of foreign doctors – including many Cuban – to work in areas lacking medical personnel, there was resistance from Brazilian health professionals.

When the program was announced, the Brazilian Medical Association argued that the country didn't need more doctors and unsuccessfully sued to stop the program, which it called "electioneering." And some warned that the foreign doctors – particularly the thousands arriving from Cuba – were unqualified and coming to take Brazilian jobs….

Criticism is harshest around the arrival of Cuban doctors. Though Cuba has a record of exporting top-notch medical care to places like Venezuela, Honduras, and Haiti, some say the quality doesn't live up to its reputation. They are also seen as victims of the program: "slave laborers" in thrall to the Cuban government.

The program pays foreign governments 10,000 reais (about $4,500) per month per doctor. In most cases that money is then transferred directly to the professionals. However, Cuban doctors working in Brazil have reportedly received a small fraction of this salary, and ended up living on an income below minimum wage. Some Cuban doctors in Brazil have even defected from the program and sought asylum.

In Venezuela, criticism of Cuban care often falls along class lines, with wealthier citizens sharing tales of botched procedures or faulty diagnoses. However, Cuban doctors and nurse mostly practice in slums where the poorest live. In 2005, a reporter for the Monitor saw “first-hand why the Cuban doctors working in Venezuela [were] so effective at creating goodwill between the two countries.”

"I was very impressed by the Cuban doctors and gym teachers and what they are doing for the poor neighborhoods," says Danna [Harman].

Critics charge that the doctors are not really doctors but only medics or nurses, she says. "That may be true, but they are right there in the neighborhoods, they know the community, and they are paying attention to people's problems, which is enough, in many cases, for people to feel better," she says.

For example, Danna was feeling ill and went to a private hospital in Caracas this week. "I waited for almost two hours and was confronted by a rude receptionist and an unfriendly doctor, who told me I needed to go see a specialist - and then charged me a lot of money.

"I wished I'd just gone back to the barrio and checked in with the Cuban medic I'd interviewed for today's story. At least she would have made me feel better psychologically, even if she didn't actually solve the problem.

To be sure, fighting Ebola will take more than a friendly doctor. Doctors were trained by WHO-standards in Cuba before arriving in Sierra Leone. But there were still some cultural issues that needed to be checked upon arrival. 

“They’re a very cuddly people,” Katrina Roper, a technical officer with the UN told The Wall Street Journal. The Cuban professionals were shaking each other's hands and hugging at their welcome ceremony. Ebola is transferred through bodily fluids, including sweat; public health campaigns in West Africa have tried to discourage hugging and embracing. “Tomorrow will be me explaining why they have to stop shaking hands and sharing things,” Ms. Roper said.