Arriving in Cuba this week for the first time since the release of his new documentary, Sicko, Michael Moore met with an enthusiastic reception from the communist authorities. Cuba’s health minister, José Ramón Balaguer, previously led the way in gushing that Moore has helped “the world see the deeply humane principles of Cuban society.” For a dictatorship that imprisons journalists and dissidents as a matter of course, it was a rare rave for political commentary.
That Party apparatchiks should be so taken with Moore is no mystery. In Sicko, Moore paid the Cuban regime the ultimate compliment, taking at face value its claim to provide superior medical service to Cubans and breathing fresh life into official propaganda that health care is one of the great achievements of the Cuban revolution. Such was the success of the Cuban system, Moore enthused, that the country even dispatched doctors abroad to treat the sick of needy nations.
As with much else in Moore’s manipulative film, this claim is disingenuous in the extreme. To be sure, Moore is far from original in making it. Cuba’s “doctor diplomacy,” through which some 20,000 Cuban doctors travel to provide care in several African and Latin American countries, is routinely cited as a point in its favor, an example of humanitarian outreach that purportedly transcends politics and belies the country’s reputation as a brutal dictatorship.
On the Left especially the notion enjoys popular currency. Thus, the Council on Hemispheric Affairs, a left-wing think tank, has repeatedly hailed the program, most recently in a 2006 policy paper sympathetically titled “Cuban Medical Diplomacy: When the Left has Got it Right.” Michael Moore’s contribution was to stamp this left-wing script with Hollywood’s seal of approval.
To say that such glowing tributes are not vindicated in practice is to understate the tragic reality. In fact, convincing gullible supporters to carry its ideological water is about the only “success” that can be credibly ascribed to the program. Considered closely, “doctor diplomacy” is a farce, one that reveals much about the continuing repression in Castro’s prison state and yet more about the activists and ideologists who turn a blind eye to political malpractice when it accords with their preference for socialized medicine.
Revealingly, the most damning indictment of the program comes from the participating doctors. While the Cuban government’s fellow travelers like to see these doctors as humanitarians going forth to spread the blessings of universal healthcare, many take part for a very different reason: they seek any available way out of Cuba. This April, for instance, the prominent UK medical journal, The Lancet, published an instructive article on the 14,000 Cuban doctors stationed in Venezuela. Hundreds of these doctors have used the opportunity of arriving in a new country to flee to neighboring Colombia, where they seek temporary asylum while waiting on a slim chance to immigrate to the United States. “I didn’t arrive in Venezuela to work; I arrived and deserted right away,” one typical Cuban doctor told the journal.
Stories such as these are all too common. In 2000, some commentators made much of the fact that Cuban doctors were sent to Zimbabwe to help relieve the crisis of the country’s disastrously-run hospitals. Few saw fit to mention the names Leonel Cordova and Noris Pena, two Cuban doctors who used the occasion to, as they put it, “fulfill lifelong dreams of leaving Cuba forever” by defecting.
Precise statistics on defectors are difficult to come by, but there can be little doubt that the numbers are high. In 2006 alone, some 63 Cubans, most of them doctors, sought refuge in the Colombian capital of Bogota; untold others sought asylum at the U.S. embassy. And while defecting entails many complications -- doctors put their life in limbo with no guarantee of reuniting with family members or practicing medicine again -- it is a choice that countless Cubans are demonstrably willing to make.
To stem the tide of defections, the Cuban government has sought to keep doctors under constant guard. Cuban “minders,” most commonly police and intelligence agents, severely restrict doctors’ freedom of movement. Traveling outside of one‘s assigned area is strictly prohibited. In Venezuela, according to The Lancet, doctors are forbidden to engage in any personal contact with natives, let alone journalists or diplomats, and must adhere to a daily curfew. Those who complain about any aspect of the program open themselves up to threats of being sent back to Cuba -- itself a devastating commentary on the political state of the country. Beyond endless surveillance, there are reports that Cuban authorities select only married doctors for missions abroad. The idea is that should the doctors entertain the idea of defecting, their families in Cuba would serve as potential hostages.
Inasmuch as political repression is a core component of the program, it would be hard to credit it even if it produced tangible results. But the most serious flaw in the Cuban program is that it may actually harm more people than it helps. Among other problems, doctors involved with the program report working in unsanitary conditions; many are badly overworked, putting in three or four days straight. That such conditions are not conducive to quality care is obvious. A Cuban nurse in Venezuela was recently quoted saying that “There were many accidents, many injuries” were she worked. If the point of the program is to promote government-run health care, it would be hard to conceive of a less appealing advertisement.
Considering the program’s fundamental flaws, one has to ask: Whom does it actually benefit? Students of Cuban history will not be surprised to learn that the main beneficiary is the Castro regime. It is one of the bigger ironies of “doctor diplomacy” that it is driven less by supposed socialist concern than by a distinctly capitalist desire for profit. According so some reports, the program brings in $2.5 billion annually, a statistic that compactly explains why Cuba prefers to send doctors to oil-rich Venezuela rather than impoverished Haiti -- despite the fact that its Caribbean neighbor, plagued with the highest rate of AIDS infection outside of sub-Saharan Africa, is in dire need of medical aid. By contrast, Venezuela supplies Cuba with nearly 100,000 barrels of oil a day as payment for the program.
Similarly, a 2000 study by the Association of American Physicians and Surgeons estimated the Cuba took in $1.2 million a month from Zimbabwe, of which only a “very small fraction…goes to pay the physicians themselves and their families in the island.” Indeed, Cuban doctors earn a meager $15 a month. “It’s a kind of slavery if you will,” Dr. Antonio M. Gordon, a Miami-based physician and one of the study’s authors, told Front Page. “Say the doctor is sent to Zimbabwe. 95 percent of what he earns in a month will stay in the hands of the Cuban Ministry of Public Health. In effect, his services will be sold [to the government].” Meanwhile, the communist elite prospers.
None of its glaring deficiencies have deterred Fidel Castro from flogging the program for propaganda purposes. In the aftermath of Hurricane Katrina in September of 2005, Castro attempted to capitalize on American tragedy by making a politically calculated proposal to send 100 Cuban doctors to help displaced New Orleans residents, an offer celebrated by many who declined to notice that the health care Cuba provided its own citizens, at least not those connected to the ranks of power, is abominable. Earlier, in 2001, Castro won plaudits from leading newspapers, including USA Today, for his offer of free medical training scholarships for low-income Americans. Far less noticed at the time was that the scholarships were primarily an ideological training program, wherein a recruit would be instructed that he “must become a communist and he or she must pledge to improve his or her skills as a communist.”
Shorn of Michael Moore-style myth making, Cuba’s “doctor diplomacy” appears less a humanitarian achievement than yet another blot on the country’s human-rights record. Where Castro can claim success is in convincing many on the Left to believe otherwise.