Clarifying Confusions # 2:   Cuban physicians’ drain or waste, captivity, slavery, and use as international mere merchandise and agents of propaganda and subversion.

 

 

 

The solidary WONCA Melbourne Manifesto was mentioned in the responsible closing words of the AAFP Global Health Workshop on September 11, 2010 held in the Hyatt Regency Hotel of Coral Gables, Miami, Fl.  There, I learned that it was created at the 5th WONCA World Rural Health Conference in Australia on May 3, 2002.  In it the developed countries agreed in their moral obligation to be more auto sufficient in training its own physicians for their underserved areas, and to do not promote the “physicians drain or stealing” from the developing countries with poor health and few physicians, although allowing the liberty of any physician to emigrate from developing or developed countries with enough or excess of physicians. 

In this AAFP workshop it was signaled sometimes by a participant that the “brain drain” to the northern countries comes many times preceded by a “brain waste” in the southern countries. This is because physicians, dentists, scientists, and other university professionals in their native countries without employment or with miserable wages, to survive decently have to work in jobs less qualified but better remunerated as bellboy, barman, taxi driver, car mechanic, photographer, etc.

This waste of physicians and more specifically of family physicians has happened in Cuba due that the average physician has earned from 1991 to 2010 the equivalent in Cuban pesos to $20-25.oo US dollars monthly. This together with the fact that from 1985 to 1998 advanced the family physician program up to a density of one family physician per 125 or 250 families (with an average of 4 individuals per family), giving a density of one family physician and nurse per 500-1000 inhabitants, having the less density in the distant rural areas. In this family medicine program the physician it was supposed to work from 9 am to at most 1 or 2 pm consulting his population, and in the afternoon it was supposed that he should work in the field, but usually the physician did not work in the afternoon, and did not study enough too. He was surviving in the greatest economic crisis that has had Cuba in the 20^th century. With the special missions to Venezuela, and after to Bolivia, Nicaragua, Ecuador, etc. from 1999 to 2010, the amount of generalist family physicians, internists, pediatricians and obstetricians decreased in the health areas of all Cuba, reducing the family physician program to the half of generalists and family physicians in the primary health care.

In 1959 the Cuban physicians’ emigration and exile to the US and other countries began escaping from the communist abuses. The Cuban government has usually misinformed this to the international public opinion as “physicians’ stealing.”

I would like to clarify here the case of the Cuban physicians’ emigration and political, social and economical exile, called by the Cuban socialist government: “immoral emigration” and “betrayal and desertion from humanitarian medical missions”. The latter missions have been always more ideological, political and even military than guided by high values and solidarity between 1959 and 2010.

The Cuban socialist government has distorted the role of the Cuban physicians in the old universal concept of international health and medicine missions in the last 200 years. The physicians are wasted, repressed, imprisoned and enslaved in Cuba. They are forcibly used as international agents of more political repression, more socioeconomic misery, and more equity at the bottom in the Third World countries against to their democratic ideas and institutions, and against their medical colleges and native physicians living levels and standards, as Trojan Horse Brigades.

The Cuban government has tried to cover the physicians escaping from Cuba and this socialist distortion of the physician roles in international health and medicine, with the pejorative term of “physician stealing”, including only a causal background of economic nature, excluding the political and social causes, which would reveal these other greatest failures of the Cuban socialist system.

In red Cuba, the most political dictatorial and demagogical government of the twenty-century in the Third World, the excess of Cuban physicians repressed, captive, and enslaved, since the early 1960s have been used as mere political sergeants of politicking ideological campaigns in pro of the most brutal socialist conquer, repression and impoverishing of the Third World developing countries.

In 1958, Cuba was already a country with excess of physicians. They were more concentrated in the urban centers than in the rural areas as it was the standard in the rest of the countries in the world then. Cuba had since then higher physicians’ density per population than Sweden, the UK, Finland, Portugal, Malta, Singapore, Hong Kong, Taiwan, Malaysia, Thailand, Indonesia, and the same physicians’ density that Norway and Ireland. In 1958, Cuba had already advanced in its democratic period to the fifth country in America after Argentine, Uruguay, the US and Canada, and the 26^th country in the whole world, in highest physicians’ density per inhabitants evidenced by the United Nations statistical yearbooks since 1946.

In 1959, Cuba had created most of the modern urban living and health material infrastructure created. The red government has used and deteriorated it in 51 years, but deteriorating most of the health human resources and population as well.  

However before 1959, the physician and people emigration was not an important issue. Cuba was from 1492 to 1958 a country of immigrants with practically no emigration as was the US and Canada. Only, in few moments, during the Wars of Independence from Spain in 1868-1878 and 1895-1898, there were short periods of few years of political exile with dictatorial governments in 1929-1933 and 1956-1958, but the people always maintained the right to return to their fatherland when the democracy prevailed again. Most of the world governments used to respect all the private properties of the people living abroad, except the red governments.

In the last 200 years, the Cuban physicians used to study the medicine career, exchange in meetings, and make fellowships in Europe and the US, returning most of them, because the living conditions in the island in all the matters were good to live decently and to practice good medicine, even in the late Spanish colonial times. The Cuban physicians as well as the people had all the rights to stay any length of time living abroad and return to Cuba as in any other advanced country.

Example of this was Carlos J. Finlay, MD, our discoverer of the mosquito as the transmission agent of the yellow fever from 1881 to 1901, who studied in the Jefferson School of Medicine in the University of Pennsylvania, Philadelphia.

In 2009, Cuba showed the 1^st place in the world in UNICEF and UNPD statistical yearbooks, but in reality it has the 30^th place caring for the Cuban people, because half of them are state-contracted abroad in humanitarian and disaster missions.

From 1959 to 1961 there was an important emigration of Cuban physicians escaping from the socialist abuse, repression, misery and equity at the bottom. It has been estimated that did not was so great as of the half of the physicians, as the red government has tried to sell to the international public opinion, beginning its international role of victim of the US and European free world countries.

Analyses in depth have shown that the exiled physicians were replaced by physicians that were not employed as doctors before. It was also increased the progressive trend from 1900-58 in graduation of physicians per year from 1962-68 with 500 graduates that year. Since the 1960s the physicians began to be forced by a government law to serve in the rural areas for at least 2-3 years after graduated.

In these same years, began the Cuban medical civil missions abroad, for example in Algeria in 1964, after medical secret military missions advancing behind the army tanks and infantry, helped to establish a 50-year socialist dictatorship.

The secret medical military missions had begun since 1959 to all the developing countries around Cuba trying to subvert the democratic order with rural and urban guerrillas. In all these military and civil missions, the physicians were paid a little better than in Cuba due to the temporal access though limited and under high security surveillance to visit other countries overseas. They stayed abroad all the time without passport, but enjoying the higher levels and standards of life than the impoverishing levels that the Cuban physicians were having at home. It was like a temporal emigration of physicians, but captive and highly charged by the red government, giving to the physicians a miserable wage higher than in the island.

But there was an extra task that was the most important for the red government. These physicians were recruited among the most revolutionary and socialist to serve ideologically to the red government to compose the Trojan Horses Brigades with socialist propaganda and campaign against the democratic ideas and institutions and also against the native physicians’ interests in those countries. Others were recruited to do espionage work for Cuba to destabilize democratic governments or to neutralize the opposition to Cuban promoted dictatorships.

Of course, progressively, the interest of most medical graduate promotions began to be to have access to any medical missions overseas, in any jungle, mountain or dessert out of the island, instead that to serve their own countrymen into their own Cuban abandoned plains and mountains were there were the worst conditions.

In the meantime that the medical graduate promotions were increasing the physicians’ density yearly, the average quality of the cultural instruction and education of the population and of the same medical education of the graduates were decreased. The latter fact was accepted by the own government in 1981. The solution was to reinforce the quality of the medical indoctrination and education program with ideological flags, but with the goal to reach the double of physicians needed in the year 2000, planning 3,000 graduates annually.

At last this maintained the decrease in the average medical education quality especially in the most impoverished period in Cuba from 1990-2010, when the former Soviet Union let to subsidize its “health paradise show” for the Third World at 90 miles of the US. Most Cuban failures in everything were endorsed to the US embargo, when it was the 51-year soviet model embargo the main responsible.

From 1959-2010, Cuba showed the lowest participation of its history, including the Spanish colonial 19^th century in scholarships, fellowships, scientific meetings and exchange abroad of its health care workforce, especially their general practitioners 1959-85 and family physicians 1986-2010 in all developed countries and the US.

The most important thing that the Cuban physicians as the whole population have lost with the soviet socialism is not so much their freedom, possibility to prosper as human being and quality of the medical education to care their poorest populations in Cuba and other developing countries abroad. They have lost primarily from 1959 to date the western advanced living culture and education the Cubans had, and the ability to discriminate with objectivity the truth of everything from the intensive red government propaganda fiction. They have been disabled mentally for 51 years of forced socialist brain de-cortication and dehumanization.

At the same time they have lost the most important ability for a contemporary physician doing international health and medicine: the possibility to have a leader role in the primitive communities where they work, to enhance socially them to foster their modern economic development in living levels and standards with the bioecono-psychosocial conception of the Millennium Village Projects since 2004.

Since the year 1981 the medical career was completely transferred from the Institute of Basic and Pre-Clinical Sciences, to the big national and province hospitals along the countries converted in schools of medicine. Since 2002 the medical career was transferred from the schools of medicine in big hospitals to the community polyclinics following a British model of the 1990s.

In the university community polyclinic the medical education level of the family physicians is lower because of the natural decantation of family physicians specialists with the second specialty from 1991 on (internist, pediatrics, cardiologist, radiologists, etc.) that are done in hospitals and institutes. These university community polyclinics have produced already the last promotions of graduated physicians with improvised professors without experience and some even without conditions to be teachers. They have even produced the last masters in different matters of primary health care with classes by videos and facilitators to the family medicine specialists with a low quality of postgraduate medical education.

Besides this, the Latin American School of Medicine continues with a special school of medicine with basic and preclinical sciences at the classic style and with hospital-based medical education, with all the resources needed in faculty, internet, materials and funds given directly by the State Council of Cuba to create the show for the international public opinion. Of course that its faculty is the most selected and has higher rigor in medical education and ideological indoctrination, as the Cuban best school of medicine. It is very far of the massive native Cuban medical education program of much lower quality. This continues the 51-year discrimination between foreign and Cuban natives in all levels and standards of living, education, working, health care, etc, of the Soviet-Cuban model in pro only of the international political propaganda of red Cuba.

Unfortunately, the today Cuban indigent university physician model as their previous models worse prepared as the Soviet feldsher and the Chinese barefoot, also lacks the modern western cultural and education background, level and standard of living, to be able to do much more than to live and care with solidarity indigent people in the poorest rural villages and slums, but without knowing enough to open their eyes to get them out of the poverty trap by a real way.

 

 

 

Rodolfo J. Stusser, MD.  Miami, Fl., September 14, 2010.