Cuba has begun to withdraw more than 8,300 Cuban doctors from Brazil, potentially leaving millions of Brazilians, particularly its indigenous communities, without access to basic healthcare.
The new right-wing, neoliberal government of President-elect Jair Bolsonaro in Brazil demanded a change to the contract initially signed in 2013 under the socialist government of his predecessor President Dilma Rousseff as part of a programme known as “More Doctors”.
Since that time, more than 20,000 Cuban doctors have tended to more than 113 million patients in Brazil.
Bolsonaro demanded that contracts with the doctors should be individually signed, they should keep 100 percent of their wage and their families should be able to join the doctors. Last Thursday as a result of Bolsonaro’s demands and Havana’s refusal to renegotiate has meant the first of many Cuban doctors have started to return.
The sheer number of Cuban doctors operating in Brazil and the millions of people they were looking after is one of Cuba’s best-kept secrets, a nation better-known for Castro, cigars and Cadillacs.
C uban healthcare is free for its citizens and constitutionally enshrined. Life expectancy rivals those of rich countries and is comparable to its richer neighbour to the north, the United States, which has imposed a blockade on the small island ever since it dared to move out of its political and economic orbit of control.
The tiny communist country has presented what some have called a paradox unique to Cuba, an ostensibly poor country whose tertiary and preventative healthcare rivals that of many advanced economies.
However, Cuba’s healthcare is not just a point of pride or a visible success story for the country. It’s also an economic lifeline and a powerful tool in its foreign policy.
The country has more than 70,000 doctors operating abroad which earn the country's treasury more than $8 billion in hard currency. For a country that continues to face a 50-year economic embargo at the hands of the US, it’s also an important economic lifeline. The Cuban government takes a portion of the doctors’ wages as part of licencing agreements that provide more money than tourism and other associated exports.
The importance of Cuba’s health diplomacy cannot be overstated. Cuba has exchanged thousands of Cuban doctors for discounted fuel from Venezuela, a close regional ally.
Its relationship with Brazil, which has Latin America's largest economy, is also of significant importance to Havana as it forms a part of Cuba’s economic and political relationship aiming to offset American isolation.
Early anti-colonial beginnings of health diplomacy
Shortly after the success of the 1959 Cuban socialist revolution, the new government made it a priority to improve the miserable living standards of its impoverished population.
Yet, the internationalist socialist ideology of the Fidel Castro government also meant that even though half of Cuba’s 6000 doctors left the country, the government still managed to free up resources to send doctors to countries fighting colonial powers.
Algeria was Cuba’s first foray into the African continent. It helped the National Liberation Front fight against France’s 132-year brutal colonial occupation, by offering military and also significant medical assistance. To this day, Cuba sends doctors to Algeria with more than 1,000 doctors operating in a fuel for doctors deal.
By the 1960s to 1970s, Cuba began to send medical assistance to other African countries fighting colonialism as far afield as Guinea Bissau and Angola.
Assisting like-minded revolutionary movements formed one part of Cuba’s soft power outreach to the Global South. Yet, the most significant assistance it offered was for humanitarian purposes, either assisting countries with poor medical infrastructure or providing quick medical relief. In the aftermath of 2005 earthquake in Pakistan that left millions homeless and in need of medical assistance Cuba was quick to dispatch more than 2,000 doctors. Similarly when there was an Ebola outbreak, Cuban doctors were at the forefront of tackling the health crises.
The political leadership in Havana has honed in on health as a basic human right and as an instrument of influence and prestige in the process winning the hearts and minds of millions around the world.
Political survival in the 21st century
When the Cold War ended, Cuba lost its most significant and powerful benefactor, the Soviet Union, and many expected the country to crumble.
Yet, the Castro government survived by capitalising on Cuba’s historic relations with the global South.
Cuba deepened ties, especially, with Latin America. And by 1999, it had struck an “oil for doctors” deal with Venezuela, an economic partnership that only deepened with Hugo Chavez’s coming to power and providing the cash-strapped nation with a crucial economic lifeline.
After more than fifty years of expertise in disaster relief and offering practical and inexpensive medical expertise in impoverished countries, Cuba formed relationships with NGOs and international aid agencies such as the World Health Organization in the 21st century, which have only helped to extend the soft power of Cuba’s diplomacy and as a result reduce international isolation.
The election of the far-right Bolsonaro in Brazil has coincided with a hardline Trump administration that seeks to further isolate Cuba and rollback the brief thaw in relations under the Obama administration.
Earlier this month Bolsonaro threatened to cut diplomatic ties with Cuba over its human rights record. And in the run-up to the Brazilian elections last month Venezuela and Cuba were painted as threats that awaited Brazil should the opposition win.
The returning Cuban doctors, therefore, are part of a wider regional strategy that is emerging to contain and isolate Cuba and Venezuela under the now hardline leadership in Washington and Brasilia.
Cuba’s health system is far from perfect, it lacks crucial pharmaceutical drugs and specialised equipment to deal with complex diseases due to US sanctions. However, its focus on preventive healthcare combined with the global reach of its doctors has meant that Cuba has been able to punch far above its weight in global diplomacy – a fact that cannot be missed as thousands of Cuban doctors leave Brazil an economy 20 times larger and in need of Cuba’s health expertise.
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