Monday, August 16, 2010

Cuba's Cash-for-Doctors Program

Cuba's Cash-for-Doctors Program
Thousands of its health-care missionaries flee mistreatment.

For decades, Cuba has "exported" doctors, nurses and health technicians
to earn diplomatic influence in poor countries and hard cash for its
floundering economy. According to Cuba's official media, an estimated
38,544 Cuban health professionals were serving abroad in 2008, 17,697 of
them doctors. (Cuba reports having 70,000 doctors in all.)

These "missionaries of the revolution" are well-received in host
countries from Algeria to South Africa to Venezuela. Yet those who hail
Cuba's generosity overlook the uglier aspects of Cuba's health diplomacy.

The regime stands accused of violating various international agreements
such as the Trafficking in Persons Protocol and ILO Convention on the
Protection of Wages because of the way these health-care providers are
treated. In February, for example, seven Cuban doctors who formerly
served in Venezuela and later defected filed a lawsuit in Florida
federal court against Cuba, Venezuela and the Venezuelan state oil
company for holding them in conditions akin to "modern slavery."

They claim the Cuban regime held the funds Venezuela remitted for their
services and then paid them—an arrangement they say is a form of "debt
bondage." They also say they were forced to work extremely long hours in
dangerous areas, including urban zones with high crime rates and the
jungle. (The Venezuelan government and its oil company are challenging
the court's jurisdiction to hear the case; Cuba hasn't responded.)

Starting in 2002, Hugo Chávez agreed to pay—mostly with subsidized,
cheap Venezuelan oil—for Cuba to provide health care to marginalized
populations in Venezuela at no cost to patients. But in the past several
years he has expanded the effort to other countries, helping to build
support for his regional Marxist agenda while keeping the Cuban economy

Cuba won't release its agreements with host countries, but details have
emerged in open sources, including in Cuba's official media. These show
that typically the host country pays Cuba hard currency for each health
worker and provides accommodations, food and a monthly stipend generally
between $150 and $350. Cuba covers airfare and logistical support, and
it pays salaries to the health-care workers out of the funds it holds.

Cuba's global health projects also receive support from the developed
world. In 2005, at least $27 million was donated to Cuba's Haiti
mission, including from France and Japan. International goodwill also
translates into direct aid. In 2008, Cuba received $127 million from
OECD countries. These transfers explain the recent rise in Cuba's export
of services, to $8.6 billion in 2008 from $2.8 billion in 2003.
Representing 75% of GDP, they generate far more income than any other

Cuban doctors go abroad because at home they earn a scant $22-$25 a
month. When they work in other countries, they typically get a small
stipend in local currency while their families back home receive their
usual salary plus a payment in hard currency—from $50 to $325 per month.

But with the state as sole employer and the citizens forbidden from
leaving the country without permission, the system is tailor-made for
exploitation. Several Cuban doctors who have served abroad tell me that
in addition to very long hours they may not drive a car, leave their
dwellings after a certain hour, or speak to the media. In some countries
they are only allowed to associate with "revolutionaries." Thousands of
Cuban health professionals have deserted world-wide. Almost 1,500 have
made it to the U.S. alone since 2006, according to a Department of
Homeland Security report in March.

Cuba's profitable global business has ramifications for its own
health-care system. It's been extensively reported, by Cuba's
independent journalists as well as by the occasional Westerner who ends
up in a hospital for the common people, that Cubans face a chronic
shortage of doctors and dilapidated health facilities. Patients or their
families must even bring their own food and linens to the hospital.

Meanwhile, the mass production of Cuban doctors for export has led
medical associations in host countries such as Bolivia, Paraguay,
Uruguay, Brazil and Portugal to question their experience and
credentials. Some Venezuelan doctors have complained of being fired and
replaced by Cuban missionary physicians. And a few years ago the
Bolivian press reported that the country's medical association was
complaining about thousands of unemployed health professionals who were
earning considerably less than what Mr. Chávez was paying for Cubans.

Humanitarianism cannot be selective. Cuba's health workers deserve full
protection of local and international laws, its citizens deserve access
to adequate health care, and patients everywhere deserve accountability
from their health-care providers.

Ms. Werlau is executive director of nonprofit Cuba Archive, a human
rights organization.

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