This was published in the journal The Lancet, one of the oldest and most widely read medical journals, while it does not reveal anything terrible new it still makes for an interesting read. While it is unfortunate that Cuban doctors defect to the US when they are providing a valuble servie to the poor in poor countires, it is only natural for them to want to. Who would want to be exploited and imprisoned the way these doctors are by their own government.
Michael Ceaser
Growing numbers of Cuban doctors sent overseas to work are defecting to the USA, following a change in US immigration policy. Critics say the policy is immoral because it takes medical professionals away from some of the world's poorest nations. Michael Ceaser reports.
Andres—a 36-year-old Cuban physician—decided to get out even before he had got fully in. When Cuban medical authorities tapped him for a medical mission in Venezuela, he did not see an opportunity to help the poor of an allied nation, but rather an opportunity to make his way to the USA. “I didn't arrive in Venezuela to work; I arrived and deserted right away”, he said while waiting for his US visa in Bogota, Colombia.
Cuba has sent tens of thousands of medical professionals to serve in poor communities in the developing world. And while doctor and nurse defections have long bedevilled these overseas programmes, they now seem to be accelerating, in part because of a US immigration policy announced last August that makes it easier for these Cuban medical professionals and their families to obtain visas.
The policy offers the Cubans a tempting opportunity. Back home they face a life of poverty under a Communist regime that offers few political rights, whereas in the USA, because of their professional skills, they have a chance to move quickly into a comfortable middle class life.
In addition to undermining Cuba's foreign policy efforts, the visa policy benefits the USA because many foreign-trained physicians go to practise in underserved poor, minority, and rural communities. But critics see the US policy as immoral because it is taking medical professionals from some of the world's poorest nations, where they are needed, to one of the world's wealthiest nations.
Smita Baruah, a specialist in AIDS and health-care systems at the Global Health Council based in Washington, DC, said she supported people's right to migrate. But she also criticised the USA for encouraging medical professionals to leave poor nations. “That's not the way to solve our long-term [doctor] shortage, by taking away doctors from countries that need them more than we do”, Baruah said.
But some disagree with the criticism. “The idea that we're going in to try to lure away Cuban doctors who are trying to administer to poor people in Latin America is cynical and I think is counter productive”, said James McGovern, a Democratic congressman from Massachusetts. “A lot of poor people who did not have health care now have health care. What's wrong with that? Why should we be trying to undermine that programme? We should have a similar programme.”
A large number of the defectors have fled from Venezuela, which has received some 14 000 Cuban medical professionals, more than the rest of the world combined. Currently, dozens have sought refuge in neighbouring Colombia, often living in precarious conditions, while they await permission to enter the USA.
Andres paid a price to get to Colombia. He and his wife had been assigned to the city of Punto Fijo on the northwestern coast of Venezuela, not far from the border. Their escape went smoothly until they reached the frontier, where Venezuelan guards refused to permit them to cross because the visas on their passports were valid only for travel within Venezuela. Only after Andres bribed the agents with nearly all their possessions did the guards let them leave Venezuela. “We gave them all the money we had, cellular phones, watches, and they let us cross”, he said. “We were in Colombia and we had reached freedom. We felt free.”
Andres and his wife were fortunate because not all defecting Cubans get across the border but are, instead, arrested and shipped back home. Once across the border, however, Andres and his wife found themselves stranded in north east Colombia's harsh Guajira desert without contacts or money to continue travel. Eventually, however, they were given a lift by truckers, who carried them to the capital, Bogota.
In Bogota, Andres has lived with two other defectors in an unused storage room provided by a church group. They have also received assistance from the UN High Commission for Refugees. But, as they wait for their US visas, many of the Cubans are fearful because of their uncertain legal status in Colombia, whose government has given few of them refugee status.
Several Cuban defectors interviewed in Bogota said that they fled not only because of oppression in their own nation, but also because of unreasonably poor and demanding work conditions in Venezuela. Andres said that he could not stand the conditions in Venezuela, where he lived in a crowded house with a leaky straw roof which he shared with fifteen other Cuban doctors waiting to be put to work.
Yane, a 29-year-old Cuban nurse, said she had to work in Venezuela with little support. “There were many accidents, many injuries”, said Yane, who worked in a clinic in Falcon State, northwestern Venezuela. The clinic had “a maternity section, observation room, [and] trauma section. There were just two of us, me and a doctor, and sometimes we had to stay there 3 or 4 days at a time without going home.”
The doctors also said that in Venezuela, Cuban minders monitored their movements, prohibiting non-work contact with Venezuelans. When not at work, the Cubans were required to be at home after 6 pm. One couple said that after they pointed out some problems with the programme, officials threatened to send them back to Cuba in retaliation.
The Cubans said that the programme they worked in, called “Inside the Barrio”, was also plagued with mismanagement and inefficiency. Although many clinics were severely understaffed, newly-arrived medics sometimes sat for months waiting for assignment to a post, they said, and often conditions in the clinics were rudimentary lacking even basic medicines.
Still, the Cubans agree that the programme provides a valuable service to many poor Venezuelans. Although some Cuban clinics were under-stocked, most were well supplied, often far better than Venezuelan facilities. Yane said that she once took a young girl with respiratory problems to four hospitals before finally finding one with a working, if old, respirator.
Defectors have also been reported from Bolivia, another country that Cuba has sent physicians to. 41-year-old Amauris Samartino Flores, a doctor and an anti-Castro activist, defected from Cuba in 1998, fleeing first to the US Naval Station on Guantanamo Bay on the southeastern end of the island, then to Bolivia in 2000. There, he worked as a supervisor in natural gas operations.
Samartino said he became politically active after Evo Morales, a socialist and a close ideological ally of both Venezuela's President Hugo Chavez and Cuba's President Fidel Castro, was elected Bolivia's president in 2005 and Cuban doctors began arriving. Samartino said he feared Bolivia was going to be turned into a second Cuba so he began speaking out in the media about the Communist island's human rights violations and helping Cuban medics who wanted to defect.
Cuba's overseas medical programme is more political than humanitarian, Samartino argues, pointing out that Cuba has sent many more medical personnel to oil-rich Venezuela, ruled by a close ally, than to Haiti, the hemisphere's poorest nation, and which is wracked by an AIDS epidemic.
Bolivian police arrested Samartino last December and were preparing to send him back to Cuba, but UN refugee officials took him into their custody and flew him to Bogota.
In an interview in his Bogota hotel, where he was awaiting a flight to a new life in Norway, Samartino said that despite his concerns about the political impact of the Cuban programme, the Cuban doctors and nurses do provide a valuable service to Bolivia, where many work in isolated, impoverished communities.
“The truth is that medics are needed in those places, giving free services and handing out medicines, which is much more than they had before”, he said.
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