Cuban Medical Diplomacy: A model for American Foreign Policy or Medical Propaganda

Cigars, sugar, and doctors: the most desired Cuban exports. And the medical exports especially have won over the hearts, minds, and UN votes of many low and middle income countries. When disaster strikes, Cuban healthcare providers are some of the first to arrive on scene to provide aid. According to a Financial Times article in 2010, “In the past half century, some 130,000 have worked abroad, and today, 37,000… are spread across more than 70 countries.” This story is repeated by many of the major news organizations such as the BBC and USA Today (from a quick Google search). So much for only being a repressive Communist regime, right?

Other rather isolated countries have benefited from the goodwill garnered from medical diplomacy. Israeli doctors, and therefore Israel itself, received significant international praise for their quick and organized response following the Earthquake in Haiti. The United States was there providing extraordinary medical services too, but somehow with soldiers on the ground as well, the same narrative did not come across.

Cuba has a long tradition of linking medical assistance with revolution and foreign policy. With an enormous medical workforce, strictly managed practice at home, and higher salaries abroad, there is no shortage of volunteers to execute this “soft power.” In the US, however, using government backed medical diplomacy as a direct arm of foreign policy is not as clear-cut.

A 2008 report by the National Intelligence Council describes, “States such as Cuba and Venezuela garner a disproportionate amount of international influence thanks to their provision of health services worldwide. More and better-publicized developed world medical diplomacy efforts… could mitigate such influence while improving the health of citizens of poor countries [italics added by blogger].” The report highlights the tour of the USNS Comfort as a good start.

However, not everybody agrees. The Financial Times article illustrates how Cuban medical missions create resentment from local doctors for undercutting local health systems by providing free care and then leaving without improving healthcare infrastructure or human resources. Furthermore, many decry the physicians, who get intimate access to their patients’ lives, as nothing more the pawns to legitimize the government’s ideology.

So should the US take a lesson from its small adversary to the south? I’d say not completely. Unlike in Cuba, the US has a long tradition of an independent medical profession, for which its ethics, practices, and trust with patients is based. US government agencies that employ healthcare providers, especially the military, are doing remarkable medical work abroad, and should do more and better publicize those actions. However, the vast majority of healthcare providers are independent and should independently address the world’s medical needs. US providers are doing this through universities and non-profit organizations, and are engaging the world through technology such as telemedicine. After all, Americans doing good abroad, even if not explicitly under the direction of the US government, is good for the US and good for the global community.

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