Cuba does not export physicians but health services - Envoy
A fierce campaign championed by the United States against the Cuban cooperation with the world, especially against the Medical brigades, is well underway.
And, as with what’s become commonly known as ‘Trump tariffs’, if developing countries of the Global South, especially the poor and vulnerable in Africa, are not vigilant, they may find themselves marginalised and their weak health systems thrown to the doldrums, or at worst, vanquished!
This is the context in which the question by Member of Parliament for Kgatleng West Unity Dow was posed recently.
The new US administration has intensified its onslaught against Cuba and is lobbying countries to reject the Cuban medical brigades saying they are nothing else but a ‘human trafficking’ scheme.
But here is the real picture.
Cuba is cooperating in the medical field with 56 countries and territories - a cooperation based on the request of the authorities of these countries and territories and regulated by bilateral cooperation agreements.
None of these countries whatsoever, is coerced into the cooperation. Neither are the participating Health Specialists, Technicians and Medical Doctors arm-twisted into the scheme.
To participate in these brigades is a personal decision, legally supported by the signing of a contract between the professional and the Cuban Unit for Medical Cooperation, an institution that governs the medical cooperation.
The participants keep their working relationship with their labour centres in Cuba through a contract that guarantees them payment of their full salary, the Social Security rights and holidays.
And this is confirmed by Dr Pablo Ricardo Betancourt Álvarez, the National Coordinator of Cuban Medical Team in Botswana. Currently, the Cuban medical team in Botswana consists of 90 specialists. Most of them are medical doctors, but also dentists, radiographers, and biomedical engineers.
Traditionally, the Brigade served for two years, but during the COVID-19 crisis, some specialists were in Botswana for four years or more.
Dr Pablo Ricardo Betancourt Álvarez explains that the newly-signed document between the Governments of Botswana and Cuba, establishes that the provision of services is for two years, which can be extended to four if both parties agree.
But how is the welfare of these Doctors provided for in Botswana and Cuba? Dr Betancourt Álvarez explains that the collaboration is carried out under a legal instrument that is periodically reviewed and updated.
It establishes that each specialist must have adequate well-being conditions both in their accommodations and at their workplace. These conditions are monitored before the collaborators arrive in the country and during tours conducted by the brigade leader, often with the Cuban embassy.
In this regard, horizontal and vertical communication is essential. In Cuba, specialists receive their full monthly salary for the duration of their mission and are guaranteed their return to their jobs once the mission is over.
In Botswana, they receive a stipend that, along with other conditions, guarantees their basic needs.
This is buttressed by two other Doctors – Dr Danet Milán Roca, a Cardiologist based in Francistown and Dr Calidis Matos Lobaina, a Family Physician at Ghanzi Primary Hospital.
Both aver that all collaborators receive a financial stipend in Botswana, defined in the legal document signed by the Ministries of Health of both countries.
“This, along with housing, transportation, basic amenities, and paid annual leave, guarantees our needs during the mission.
“In addition, we receive our full salary in Cuba and our job is secured for our return,” Dr Calidis, who responded with a resounding “No” when asked if she was coerced into participating in the programme explains. She says that Cuban medical cooperation is based on principles such as volunteerism, humanism, and solidarity.
This is the third time she has participated in international collaboration programmes; the first was in Venezuela from 2003 to 2008 and the second in Brazil from 2013 to 2016.
“Of my 33 years as a graduate, I've spent almost a third abroad. It's difficult for any government to force someone without strong convictions to do something like this for so long,” she says.
As for the selection process, she maintains that it is rigorous, first in Cuba, at the workplace, and family also plays a role.
“It's difficult to be away for so long. Selection interviews are then conducted by officials from the Botswana Ministry of Health and the Botswana Health Professions Council, so from a pool the best prepared and most capable are chosen.
“Furthermore, it should be added that anyone can abandon the mission at any time they decide, without any retaliation,” she says.
Dr Danet Milán Roca, the Cardiologist was exposed to Panama in the year 2020 during COVID-19, and Panama did not have enough doctors to face the pandemic. That’s when a group of brave
doctors, under the principles of volunteerism and solidarity, went out to help the people who were dying.
“In this voluntary and supportive manner, we joined the Botswana medical programme. This process of incorporation begins after a call for applications has been launched in the work centres.
“Those who decide to join the medical programme are interviewed by the Botswana Medical Association, which evaluates and chooses the specialists who will join the programme.
“I reaffirm that my participation in the programme, as in any medical agreement, is 100 percent voluntary,” the Doctor said.
Dr Betancourt Álvarez explains that the first group of Cuban medical team arrived in Botswana in 1989, and since then, the brotherhood between “our two peoples has strengthened”.
He says that the local population that they serve recognises the quality of care and the humility and humanity of their professionals, while their colleagues in the healthcare sector benefit from the specialists' experience, which “we have learned to share”.
Dr Christopher Nyanga, the Spokesperson of the Ministry of Health and Wellness affirms this assertion when asked if the new Umbrella for Democratic Change Government will keep or abandon this programme.
The new Government will continue with the arrangement because it believes that there is value for money in the relationship, he says.
This, he says, is because the cooperation helps improve access to quality and specialised health care services for Batswana as the Cuban Medical personnel are placed at referral hospitals and district hospital across the country.
“Given the acute shortage of medical personnel especially specialists, the Cuban medical team augment the numbers to ensure delivery of health care services,” Dr Nyanga says.
Dr Betancourt Álvarez says that in over 35 years, they have never received a single complaint of abuse or violation of the collaborators’ labour rights.
“Each specialist works under the labour laws of Cuba and Botswana and under conditions similar to those of locals or other foreigners,” he says.
What about any member of the team expressing a desire to open a private clinic, is this allowed?
Dr Álvarez says the current agreement prevents specialists from engaging in any other professional activity while fulfilling their mission.
“However, there are cases in which, after a period of time, some have decided to return to Botswana, settle here, and practice medicine on their own,” he says.
Asked what will become of the Cuban Doctors posted to Clinics now that Local Government is taking over Clinics, Dr Nyanga stresses that they will continue servicing clinics as before.
“Patients seen at Clinics will continue to access specialist healthcare services through the referral system,” he says.
The Ambassador of Cuba to Botswana, Alvarez Alvarez explains to Botswana Guardian that Cuba does not export physicians but health services. He says that from the very beginning, the Cuban Revolution, was deprived of thousands of physicians, due to a criminal campaign organised by the Government of the USA.
“As a response it dedicated huge efforts and resources to the Health Sector and the formation of highly qualified professionals. Today, Cuba can show one of the highest proportions of doctors per inhabitants,” he says.
As for accusations that the programme is human trafficking in disguise, he explains that Cuba is party to the Palermo Convention on Organised Transnational Crime and its Protocol regarding Human Trafficking.
He says that the national legislation allows them to prevent and face Human Trafficking. Cuba also sustains a Tolerancia Cero (Zero Tolerance) policy regarding human trafficking, and cooperates
with the related international organisations, the Interpol, the United Nations system and European and regional countries in order to “guarantee the prevention and the combat of human trafficking”.
And, as with what’s become commonly known as ‘Trump tariffs’, if developing countries of the Global South, especially the poor and vulnerable in Africa, are not vigilant, they may find themselves marginalised and their weak health systems thrown to the doldrums, or at worst, vanquished!
This is the context in which the question by Member of Parliament for Kgatleng West Unity Dow was posed recently.
The new US administration has intensified its onslaught against Cuba and is lobbying countries to reject the Cuban medical brigades saying they are nothing else but a ‘human trafficking’ scheme.
But here is the real picture.
Cuba is cooperating in the medical field with 56 countries and territories - a cooperation based on the request of the authorities of these countries and territories and regulated by bilateral cooperation agreements.
None of these countries whatsoever, is coerced into the cooperation. Neither are the participating Health Specialists, Technicians and Medical Doctors arm-twisted into the scheme.
To participate in these brigades is a personal decision, legally supported by the signing of a contract between the professional and the Cuban Unit for Medical Cooperation, an institution that governs the medical cooperation.
The participants keep their working relationship with their labour centres in Cuba through a contract that guarantees them payment of their full salary, the Social Security rights and holidays.
And this is confirmed by Dr Pablo Ricardo Betancourt Álvarez, the National Coordinator of Cuban Medical Team in Botswana. Currently, the Cuban medical team in Botswana consists of 90 specialists. Most of them are medical doctors, but also dentists, radiographers, and biomedical engineers.
Traditionally, the Brigade served for two years, but during the COVID-19 crisis, some specialists were in Botswana for four years or more.
Dr Pablo Ricardo Betancourt Álvarez explains that the newly-signed document between the Governments of Botswana and Cuba, establishes that the provision of services is for two years, which can be extended to four if both parties agree.
But how is the welfare of these Doctors provided for in Botswana and Cuba? Dr Betancourt Álvarez explains that the collaboration is carried out under a legal instrument that is periodically reviewed and updated.
It establishes that each specialist must have adequate well-being conditions both in their accommodations and at their workplace. These conditions are monitored before the collaborators arrive in the country and during tours conducted by the brigade leader, often with the Cuban embassy.
In this regard, horizontal and vertical communication is essential. In Cuba, specialists receive their full monthly salary for the duration of their mission and are guaranteed their return to their jobs once the mission is over.
In Botswana, they receive a stipend that, along with other conditions, guarantees their basic needs.
This is buttressed by two other Doctors – Dr Danet Milán Roca, a Cardiologist based in Francistown and Dr Calidis Matos Lobaina, a Family Physician at Ghanzi Primary Hospital.
Both aver that all collaborators receive a financial stipend in Botswana, defined in the legal document signed by the Ministries of Health of both countries.
“This, along with housing, transportation, basic amenities, and paid annual leave, guarantees our needs during the mission.
“In addition, we receive our full salary in Cuba and our job is secured for our return,” Dr Calidis, who responded with a resounding “No” when asked if she was coerced into participating in the programme explains. She says that Cuban medical cooperation is based on principles such as volunteerism, humanism, and solidarity.
This is the third time she has participated in international collaboration programmes; the first was in Venezuela from 2003 to 2008 and the second in Brazil from 2013 to 2016.
“Of my 33 years as a graduate, I've spent almost a third abroad. It's difficult for any government to force someone without strong convictions to do something like this for so long,” she says.
As for the selection process, she maintains that it is rigorous, first in Cuba, at the workplace, and family also plays a role.
“It's difficult to be away for so long. Selection interviews are then conducted by officials from the Botswana Ministry of Health and the Botswana Health Professions Council, so from a pool the best prepared and most capable are chosen.
“Furthermore, it should be added that anyone can abandon the mission at any time they decide, without any retaliation,” she says.
Dr Danet Milán Roca, the Cardiologist was exposed to Panama in the year 2020 during COVID-19, and Panama did not have enough doctors to face the pandemic. That’s when a group of brave
doctors, under the principles of volunteerism and solidarity, went out to help the people who were dying.
“In this voluntary and supportive manner, we joined the Botswana medical programme. This process of incorporation begins after a call for applications has been launched in the work centres.
“Those who decide to join the medical programme are interviewed by the Botswana Medical Association, which evaluates and chooses the specialists who will join the programme.
“I reaffirm that my participation in the programme, as in any medical agreement, is 100 percent voluntary,” the Doctor said.
Dr Betancourt Álvarez explains that the first group of Cuban medical team arrived in Botswana in 1989, and since then, the brotherhood between “our two peoples has strengthened”.
He says that the local population that they serve recognises the quality of care and the humility and humanity of their professionals, while their colleagues in the healthcare sector benefit from the specialists' experience, which “we have learned to share”.
Dr Christopher Nyanga, the Spokesperson of the Ministry of Health and Wellness affirms this assertion when asked if the new Umbrella for Democratic Change Government will keep or abandon this programme.
The new Government will continue with the arrangement because it believes that there is value for money in the relationship, he says.
This, he says, is because the cooperation helps improve access to quality and specialised health care services for Batswana as the Cuban Medical personnel are placed at referral hospitals and district hospital across the country.
“Given the acute shortage of medical personnel especially specialists, the Cuban medical team augment the numbers to ensure delivery of health care services,” Dr Nyanga says.
Dr Betancourt Álvarez says that in over 35 years, they have never received a single complaint of abuse or violation of the collaborators’ labour rights.
“Each specialist works under the labour laws of Cuba and Botswana and under conditions similar to those of locals or other foreigners,” he says.
What about any member of the team expressing a desire to open a private clinic, is this allowed?
Dr Álvarez says the current agreement prevents specialists from engaging in any other professional activity while fulfilling their mission.
“However, there are cases in which, after a period of time, some have decided to return to Botswana, settle here, and practice medicine on their own,” he says.
Asked what will become of the Cuban Doctors posted to Clinics now that Local Government is taking over Clinics, Dr Nyanga stresses that they will continue servicing clinics as before.
“Patients seen at Clinics will continue to access specialist healthcare services through the referral system,” he says.
The Ambassador of Cuba to Botswana, Alvarez Alvarez explains to Botswana Guardian that Cuba does not export physicians but health services. He says that from the very beginning, the Cuban Revolution, was deprived of thousands of physicians, due to a criminal campaign organised by the Government of the USA.
“As a response it dedicated huge efforts and resources to the Health Sector and the formation of highly qualified professionals. Today, Cuba can show one of the highest proportions of doctors per inhabitants,” he says.
As for accusations that the programme is human trafficking in disguise, he explains that Cuba is party to the Palermo Convention on Organised Transnational Crime and its Protocol regarding Human Trafficking.
He says that the national legislation allows them to prevent and face Human Trafficking. Cuba also sustains a Tolerancia Cero (Zero Tolerance) policy regarding human trafficking, and cooperates
with the related international organisations, the Interpol, the United Nations system and European and regional countries in order to “guarantee the prevention and the combat of human trafficking”.
