Cuba's health care alternative

March 20, 2010

On March 15, Australian Prime Minister Kevin Rudd, spruiking his plans to revamp Australia's ailing health care system, was told by Queanbeyan Doctor Jeannie Ellis, who has spent some time in Cuba, that he should look to the Caribbean island for ideas on how to develop a decent public health system.

Rudd replied: "You're the first one to advocate the Cuban healthcare system to me."

It is understandable that most Australians don't know much about Cuba's remarkable achievements in health. The corporate media says little about Cuba that is not full of malice.

Indeed, the same corporate monopolies that rail against socialist Cuba have campaigned quite effectively against a decent public health system for the richest country on Earth — the United States.

Rudd's claimed ignorance, however, is less understandable. If genuine, our prime minister neither reads his mail nor pays much attention to our region.

In January 2008, I and more than 30 other academics, health professionals and aid workers sent Rudd a letter asking the Australian government to "match" Cuba's offer of 1000 medical scholarships to East Timor.

We wrote: "We urge your government to begin a large scale public education program for the East Timorese, matching the Cuban offer of 1,000 scholarships, in areas in which we have great capacity, such as teacher training."

I was the spokesperson for the group and have never received a reply.

In early March, I met my friend Juvencio Dias in Dili. I have known his family for several years, and visited him in Cuba while he was studying medicine. We spent a couple of days together, discussing health and development issues.

Late last year, Juvencio was part of the first group of 18 students to return home to East Timor to complete their sixth and final year. At the moment, they are practising in Timor's districts under the one-to-one supervision of Cuban doctors.

They are set to graduate in September 2010.

I asked Juvencio if he had delivered any babies — yes, eight, he said. At the primary health care level, he has his hands more than full with the typical demands of his country: treating malaria, dengue fever, tuberculosis, pulmonary infections, intestinal parasites and one of the highest childbirth rates in the world.

Juvencio left for training in Cuba in 2003. He was followed to Cuba by further 700 young, smart East Timorese students — all had completed year 12 with better than 70% marks in science subjects.

Another 200 have been studying exclusively in Timor, under Cuban supervision.

Over the next year, 500 of the students in Cuba will return home, in small groups, to complete their fifth and sixth year studies — and join a health system that never previously had more than 50 doctors.

They will practice as they study and a number will begin to teach very soon after they graduate.

Among Timorese doctors, there is something of a culture clash. Those trained in Indonesia (like doctors in Australia) see medicine as a profession where private practitioners charge for services.

However, those trained by the Cubans see themselves as salaried public servants, treating people as a matter of social obligation.

The Cuban medical training program in East Timor is the most dramatic, yet most under-reported, development in health aid in our region.

Cuba is also training another 150 students from the Solomon Islands, Kiribati, Vanuatu, Nauru, Tuvalu and Tonga.

An Australian PM with an interest in aid and foreign affairs should have been paying attention to the emergence of the largest health aid program in the Asia-Pacific region.

Cuban health aid to our island neighbours is now more substantial than all other countries' health aid programs put together.

Why would Rudd not know this?

Among the lessons that can be learned from Cuba's health programs at home and abroad is that a large expansion in the training of health workers is a step in the right direction.

Of course, this has to be matched by resources for the medical faculties and by new positions in the hospitals.

Salaried positions in hospitals and regional health centres will be the key to a wider and more equitable spread of health services, especially in rural areas. Private practitioners can never meet the needs of rural or disadvantaged communities — in rich or poor countries.

The Cubans know and have been working with this simple fact for some time.

One reason medical training in Australia has fallen is pressure from a strong private profession that does not want competition. Another reason is reliance on imports.

On the one hand, we have an aid program that pretends to share training with poorer countries. On the other hand, we "poach" professionals from those countries with our "skilled migration" program.

The Cubans recognise the "brain drain" of health professionals is a major problem for developing countries. Their response is to massively expand training, promote health as a right and focus on building a large group of salaried professionals with a public service ethos.

East Timor's former health minister Dr Rui Araujo considers this ethos to be the most distinctive feature of Cuban medical training. He says the Cubans train health workers "to serve the public and not trade the services".

Is that the sort of ethos we would like to see in Australia?

[Tim Anderson has produced two short documentaries on Cuban health programs in our region: The Doctors of Tomorrow and The Pacific School of Medicine. A fuller article by him on the Cuba-Timor Leste program entitled "Solidarity aid: the Cuba-Timor Leste health programme" can be found at

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