By Christopher Marquis. The Inquirer, March 9, 2000. Knight Ridder News Service.
HAVANA - After relying for decades on guerrillas and guns to export his Marxist model, Cuban President Fidel Castro has found another tool to win international support: "doctor diplomacy."
The Castro regime, which touts high-quality health care as a pillar of the 41-year-old Cuban revolution, has long sent its doctors abroad, welcomed health "tourists" to the island, and developed drugs to attack some of the most stubborn blights of the developing world.
Now, although the country's medical system is so hard-pressed that patients must show up for surgery with their own sheets and soap, Castro has opened a medical school exclusively for students from across Latin America. Free of charge, Havana plans to train thousands of new doctors from
neglected, impoverished populations of the region.
In a whitewashed former naval academy by the sea, the gleaming school has provided Castro with a needed burst of goodwill from his Latin and Caribbean neighbors. At the Ibero-American summit in Havana in November, Latin leaders who strongly criticized Castro's human-rights record were dazzled by
the school and clamored for more spaces for their students.
Castro obliged, expanding plans to teach as many as 7,500 Latin American medical students over five years, 10 times the original number, school officials said. In so doing, the Cuban leader may hope to inoculate himself from further regional attacks and play the humanitarian in a part of the
world where Washington slashed economic aid by 83 percent between 1990 and 1996.
Officials deny that the school has a political purpose.
"We don't teach politics, just medicine," said Nancy Nunez, director of the school's foreign affairs department. "We hope they come out of this course with the same human sensibility as the Cubans who spend time in other countries. We hope they don't see medicine as merchandise,
but as humanitarian."
With one doctor for every 170 Cubans - one of the best ratios in the world (the United States has about one doctor per 352 people) - the country has exported its medical talent for decades, usually in the service of socialist solidarity.
After Hurricane Mitch in 1998 wiped out entire towns in Central America, though, Cuba deployed medical brigades across the region. Cuban doctors now work for free in some of the region's most remote hamlets, some of which have never had regular medical attention. Cuba has more than a thousand
doctors in Guatemala, Nicaragua, Belize, Honduras and Haiti.
The Latin American School of Medical Sciences opened last year, after 18 Latin American governments selected and sent 1,929 of their most promising students - evenly divided between men and women - from mostly rural, disadvantaged backgrounds.
Most came from Central America, which has been tormented in recent decades by ideological proxy wars fueled by the United States on one side and the Soviet Union and Cuba on the other.
Students live at the school, which has a theater, dormitories, 28 teaching laboratories and a post office. They get uniforms, food and a small stipend for expenses on weekends. They will remain there for 21/2 years, then be integrated into the Cuban system for the rest of their medical
education.
School officials say they do not know yet how much all this is costing the cash-strapped Cuban government. Costs elsewhere are curbing basic medical services.
The largest hospital in Cardenas, a city of 150,000 in the Matanzas province, for example, closed its operating room to all but emergency surgery for a year (it recently reopened) for lack of proper equipment to provide general anesthesia, doctors there said.
Cuban doctors earn as little as a dollar a day, and many are forced to moonlight by selling trinkets or homemade rum to make ends meet.
Yet, Cuba's health record remains impressive, with infant-mortality rates that rival those of the United States (7.8 deaths per 1,000 live births in Cuba, compared with 7.2 deaths per 1,000 live births in the United States). It has eradicated diseases such as malaria that continue to plague the
region.
Indeed, Cuba's reputation for capable doctors, experimental treatments and personal therapy draws people from around the world. Dubbed "health tourists," they shell out dollars to stay in clinics designed for foreigners or on designated floors of general hospitals.
One of the most prominent health tourists in Cuba today is Diego Maradona, the legendary Argentine soccer player, who is being treated for cocaine addiction. Maradona, an idol of many Latin American children, checked himself in after expressing admiration for the Cuban revolution.
With so much medical talent, Cuba turned to its doctors and researchers for cash when its economy crashed after the Soviet Union withdrew its support a decade ago. Cuba pumped more than $1 billion into developing new medicines using biotechnology, and charted some successes. They include the use
of interferon to combat hemorrhagic dengue and a therapeutic vaccine for certain cancers. Its meningitis B vaccine is so promising that SmithKline Beecham, with U.S. headquarters in Philadelphia, obtained approval from the Clinton administration to test the drug, despite a U.S. ban on trade with
Cuba.
Cuban officials say their fledgling biotech industry supports itself with more than $30 million in profits, although it is a long way from recouping its huge initial investment. Researchers say they are targeting Third World markets that are overlooked by U.S. and European pharmaceutical firms.
Jorge Gavilondo, a top researcher at the Center for Genetic Engineering and Biotechnology in Havana, says that U.S. restrictions on trade forced Cubans to excel and provided a boon. Congress in 1996 allowed for some medical sales to Cuba provided the materials were not used for reexport, the
military or the biotech industry.
"The embargo allowed for Cuban scientists to create their own space," Gavilondo said. Without the sanctions, Cuba might have been turned into a pill factory, rather than a source of innovation. "We would have been absorbed by the big [American] production companies," he said.
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