Cuba's free healthcare

In 1995, Nelson Mandela declared with regard to Cuban international solidarity missions to Africa over past decades:

"Cubans came to our region as doctors, teachers, soldiers, agricultural experts, but never as colonisers. They have shared the same trenches with us in the struggle against colonialism, underdevelopment and apartheid."

The US, of course, had offered a less favourable characterisation of Cuban activities on the African continent, and accused the island nation of exporting revolution. Evidence of diabolical Cuban meddling in the internal affairs of sovereign nations included its substantial assistance in defending newly independent Angola against a US-backed South African invasion that - according to Noam Chomsky - ultimately killed a million and a half people in Angola and Mozambique.

As for more subtly packaged revolutionary exports, the New York Times reported in 2009 that, "[i]n the 50 years since the revolution, Cuba has sent more than 185,000 health professionals on medical missions to at least 103 countries".

While hysteria-prone sectors of the global population have determined that Cuban-inspired health care programmes in Venezuela are merely a front for terrorist training operations, the Times managed to limit itself to citing a Cuban medical presence of 31,000 in the South American country. It also referred to medical endeavours abroad as "a crowning achievement of Cuban foreign policy" - albeit one that was being "effectively… turned on its head" by the curiously titled Cuban Medical Professional Parole Programme.

A joint initiative between the US Department of Homeland Security and the State Department, the parole programme for non-criminals encourages Cuban health care workers deployed internationally to defect to the US, thereby neutralising an apparent PR coup by the Castro regime.

Of course, even if we assume that Cuban medical deployments are nothing but a politically motivated ploy to secure international support via a facade of humane charitableness, it is not difficult to figure out which of the following two scenarios is objectively less harmful to humanity: a facade of humane charitableness that results in free health care for countless numbers of people across the globe who would not otherwise have access to it, or a facade of democracy promotion that has thus far resulted in over a million deaths in Iraq alone since 2003.

Indeed, as a Cuban doctor named Yamile remarked to me at a Barrio Adentro ("Inside the Neighborhood") health clinic on Venezuela's Margarita Island in 2009: "We also fight in war zones, but to save lives."

Yankees welcome

Barrio Adentro, a collaborative effort between Cuba and the Hugo Chávez administration that began in 2003, is a nationwide system offering health care free of charge to all Venezuelans. According to Steve Brouwer's bookRevolutionary Doctors: How Venezuela and Cuba are Changing the World's Conception of Health Care, it includes nearly 7000 walk-in offices and more than 500 larger diagnostic clients. The irony of the situation was not lost on the Cubans - that a national of the country presiding over the embargo that has historically prevented Cuban acquisition of medicines and equipment had now ended up the recipient of gratuitous ultrasounds courtesy of Cuba. In a more severe case of irony resulting from the unconditional dispensation of health care, it was revealed in 2007 that Cuban doctors in Bolivia had performed free cataract surgery on the man who killed Che Guevara.Visiting some of these during a month-long excursion to the country, I was pleased to discover that the system did not discriminate against imperial citizens from the north. Though there was nothing detectably wrong with me, the Cuban and Venezuelan Barrio Adentro personnel graciously accommodated my requests for ultrasounds of various parts of my body, and Yamile donated a free packet of mind-altering allergy pills to my traveling companion. The walls of the clinics were generally festooned with alarming political propaganda such as handmade calendars denoting the birthdays of staff members, Chávez and Fidel Castro.

Yamile, who hailed from the province of Guantánamo, had just signed a 10-year contract in Venezuela following deployments to Angola, Zimbabwe and Guyana.Though she acknowledged the hardships of separation from her four children and the low salary relative to local standards, she insisted that it was her duty to assist the Venezuelans in developing their revolutionary potential. It is this sort of rhetoric that underscores the judiciousness of George Bush's 2005 rejection of Cuba's offer of medical aid in the aftermath of Hurricane Katrina.

Cuba sets sights on colony in Haiti

Having failed to export the revolution to Louisiana, Cuba's elite Henry Reeve medical brigade spent seven months fomenting communist insurrection in Kashmir under cover of earthquake relief. As Brouwer notes: "Before they departed, they trained 450 Pakistani doctors in the procedures necessary to operate the [medical] equipment and field hospitals they left behind".

As for the brigade's contributions to earthquake relief in Haiti in 2010 - largely excised from news reports on the event - Brouwer asserts that, over the same seven-week period in which the staff of the US Navy's USNS Comforttreated 871 patients and performed 843 operations, the Cuban medical teams treated 227,443 and performed 6,499.

There are numerous other telling bits of trivia in Revolutionary Doctors. For example, we learn that the Cuban Naval Academy was spontaneously converted into the Latin American School of Medicine (ELAM) in 1998 to provide free education to students from dozens of other countries. We later learn of a reverse conversion during the US-orchestrated coup against Haiti's Jean-Bertrand Aristide in 2004, when "[t]he US Marines overran the new [Cuban-staffed] Aristide medical school, chased out the doctors and students, and used the facility as their military headquarters".

Though seemingly unrelated, these two instances might be seen as symbolic of opposing approaches to existence, especially when juxtaposed with a 2007 article in the Washington Post reporting the American Friends Service Committee's calculation that the money spent by the US on a single day of war in Iraq would fund health care for 423,529 children.

One could also contend that devising 638 ways to assassinate Castro - such as by placing brightly-decorated, explosives-rigged molluscs along the Cuban coast in the hopes that he would be drawn to them while scuba diving - was perhaps not an overly practical use of US resources.

Health care as dangerous freedom

A December 2010 article by Nina Lakhani in the British Independent describes the domestic effects of Cuba's "prevention-focused holistic model" of health care:

"This model has helped Cuba to achieve some of the world's most enviable health improvements, despite spending only $400 (£260) per person last year compared with $3,000 (£1,950) in the UK and $7,500 (£4,900) in the US, according to Organisation for Economic Co-operation and Development figures.

Infant mortality rates, one of the most reliable measures of a nation's healthcare, are 4.8 per 1,000 live births - comparable with Britain and lower than the US. Only 5 per cent of babies are born with a low birth weight, a crucial factor in long-term health, and maternal mortality is the lowest in Latin America, World Health Organisation figures show".

Lakhani also notes that "[a] third of Cuba's 75,000 doctors, along with 10,000 other health workers, are currently working in 77 poor countries" but that "this still leaves one doctor for every 220 people at home, one of the highest ratios in the world".

Former World Health Organisation director-general Halfdan Mahler has declared that "[n]o other country has been as consistent in taking measures towards achieving the goal of 'Health for All' as Cuba", while the New York Times hasacknowledged that "many expatriate [Cuban] doctors say their dealings with patients in Cuba were more humane and less rushed than they are in the United States".

Given this reality, it is impossible not to bash one's head against the wall when confronted with US proponents of the notion that health care as a right rather than a commodity constitutes an unparalleled horror that must be combated at all cost. The danger, of course, is that human health will one day supersede corporate health in importance, an eventuality that has most recently been staved off with the passage of the Affordable Care Act - summarised as follows by Harvard Medical School's Marcia Angell in The New York Review of Books:

"[The act] requires people to buy a commercial product from investor-owned companies at whatever price the companies choose to charge. In short, people are required to contribute to the profits and corporate salaries and marketing costs of companies like WellPoint and UnitedHealthCare".

Brouwer meanwhile concludes with regard to the US health care system:

"The fact that this very wealthy country is willing to deny the opportunities that could effectively deliver health care to its own people, while also sabotaging the efforts of poorer nations to build new kinds of public primary care medical systems, is one of the great scandals of twenty-first-century capitalism".

Though it is crucial to avoid romanticising Cuban and Venezuelan political systems, which naturally contain their own repressive aspects, it's totally healthy to romanticise what Brouwer describes as Che's "original aspiration - combining the humanitarian mission of medicine with the creation of a just society".