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The Business of Exporting Cuban Doctors

June 25, 2013 5 comments
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Photo: Cuban doctors showing their diplomas in Havana. From Martí Noticias.

By 1998 Fernando had already spent a year and a half working for free in the civil war in Angola where, to get to a clinic in an isolated hamlet, he had to be accompanied by a landmine deactivation expert. Twenty-five years later he is packing his bags for Venezuela.

This time there is no war. The government of General Raul Castro has turned Cuban medicine into the country’s premier export industry. It is a profitable business. Doctors are to Cuba what petroleum is to Venezuela.

According to figures from the National Office of Statistics and Information (ONEI), in 2011 the depleted state coffers took in around five billion dollars just in the exchange of Cuban doctors for Venezuelan oil.

In 2003 the government of the late Hugo Chavez reached an agreement in which PDSVA, the state oil company, would send 105,000 barrels of oil a day to Cuba for which Havana would pay by sending doctors, sports trainers and military advisers to Venezuela.

When Fernando, a medical specialist, travelled in an Ilyushin Il-62 jet to lend his services in the Angolan jungle, Fidel Castro’s official rhetoric was quite different. Money did not matter. In speeches he reiterated that he was motivated only by altruism and ideological solidarity, known as “proletarian internationalism.”

The Cuban regime did not begin charging for medical services until after 1991, the year Soviet communism said goodbye. Cut off from the wealth of rubles, petroleum and raw materials coming from Moscow, Cuba entered a period of unending economic crisis.

The Soviet Union defrayed the cost of the island’s military expenditures. A phone call to the Kremlin was all that was needed to obtain financial credits. Subversion was not Fidel Castro’s only tool for exporting his brand of revolution. On any given day he might use funds from the national budget to build a school in Kingston, Jamaica or to provide a sugar mill to Nicaragua.

It did not matter; the money was not coming out of his pocket book. But with the precipitous fall of the Berlin Wall and the disappearance of the Soviet Union, subsidized Cuba had to adapt to changing times.

Exports fell 40%. Sugar production some 70%. There was only tourism, which generated somewhat more than two billion dollars annually. And family remittances, which with hard currency, packages from overseas and cash spent by Cuban Americans on trips to the island amounted to almost five billion dollars a year.

But what contributed the most green-backs to GDP was the export of services. Not all the statistics are readily available but Carlos, an economist, believes that “just in terms of the services provided to the ALBA countries (Venezuela, Ecuador, Bolivia and Nicaragua) the figure approaches ten billion dollars annually.

It is estimated that currently some 40,000 doctors, specialists, nurses, technicians and others are working in sixty countries on five continents. Schools of medicine at Cuban universities graduate as many as 5,000 physicians annually. It is an assembly line, a highly profitable one.

Most of them are paid between two thousand and three thousand dollars a month, though some nations such as South Africa pay twice that. The regime retains 95% of their salaries.

Recently, Brazil announced it had agreed to hire about six million Cubans to work in the country’s depressed, rural areas. In a statement Brazil’s Federal Medical Council branded the agreement as “irresponsible and questioned the “technical and ethical quality” of the Cuban professionals.

After Brazil’s physicians exerted pressure, the government of Dilma Rousseff instead decided to hire Spanish and Portuguese doctors, whom it considered to be more qualified.

Cuba’s medical system does not enjoy good health but, so far, this situation is not reflected in the country’s favorable statistics. The average lifespan is 78 years. In 2012 the rate of infant mortality was 4.6 deaths for every thousand live births, the lowest in the Americas.

However, many hospitals are in ruins, their equipment in poor condition and their personnel mediocre. The mass exportation of doctors provokes unease among Cubans. Oneida, a housewife, says that specialists are rare. “At the clinic where I go, the dermatology department is open only one day a week due to a shortage of dermatologists. No hospital in Havana has a staff of dermatologists on duty. Those who treat you are foreign students and their quality leaves something to be desired. Most of the trained physicians are on ’missions’ (working overseas).”

According to the Brazilian Medical Council 94% of Cuban medical school graduates who took Brazil’s medical licensing exam in 2012 failed.

More than 5,000 Cuban doctors have deserted the international medical missions. Due to a lack of rigorous training for many of Cuba’s medical professionals, some doctors and specialists who decide to leave their homeland opt to work as medical assistants and nurses in the United States.

“Acquiring an American medical license is an arduous task. The exams are very rigorous. Once you live here, you realize there are a lot of gaps in our medical training. For me it’s not bad. While I am learning English, I work in a private clinic as a nurse. It pays well,” admits Eduardo, who has lived in Miami for two years.

Fernando, the doctor who 25 years ago was stationed in Angola, acknowledges that quality these days is not the best. “The reasons vary. From not having immediate access to specialized information, in spite of the national network Infomed, to low salaries and lack of technology. But I don’t think that the world is full doctors willing to work for two years in remote locations for subsistence wages.”

In 2012 sixty-eight Cuban doctors died in Venezuela. The Chavez government memorialized them, unveiling a plaque in their honor. “To heath care workers killed in Bolivarian lands while carrying out their duty,” reads the bronze inscription in a Caracas hospital, as though they fell in combat.  Most were killed in street violence, which last year alone claimed 12,000 lives in that country.

“Then why are you going,” I ask Fernando.

“It’s the only way to acquire hard currency — performing abortions, doing small-scale business transactions and saving what little money they pay you — so that, when you go back home, you can fix-up your house and provide a better living for yourself and your family,” he says.

Some doctors with whom I spoke said it was economic necessity and not altruism that was leading them to work in out-of-the-way and dangerous locations, even at the risk of losing their lives.

Iván García

19 June 2013

Olive Green High Society / Ivan Garcia

June 18, 2013 3 comments

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They have few reasons to envy of their capitalist counterparts. The differences between them are ones of rhetoric and philosophy. The anti-capitalist islanders having studied Marxist manuals and speak on behalf of the poor.

But many are living at full throttle. At the workplace they wear sweltering uniforms designed by some sadistic tailor from the former Soviet Union. Twenty-five years ago they used to get around in Russian-made Ladas with capitalist tires and stereo systems. They called attention to themselves.

The top officials were untouchable. Officers used to place their caps in the rear of their vehicles so that police would not stop them for traffic violations. Laws were for other people to obey.

The only ones who could dismiss them, punish them, jail them (or shoot them) were the Castros. They lived in the former residences of Havana’s upper and middle classes in the Siboney, Miramar, Nuevo Vedado, Fontanar or Casino Deportivo neighborhoods.

They had more than one car and houses with Ikea furniture, electric kitchens, “made in USA” refrigerators, Sony televisions, South Korean air conditioners and Philips audio equipment.

They enjoyed three succulent meals a day and once a week they read articles from the western press that had been condensed for the directors of the Department of Revolutionary Orientation or the Communist Party. For vacations they travelled  to one of the USSR’s Baltic republics or strolled carefree through Prague’s Wenceslas Square. And they went to Varadero whenever they felt like it.

The drank Czech beer and Yankee whiskey. They smoked cigars for export and carried American dollars in their wallets back when doing so was forbidden. Ministers and military brass were fond of dressing up like Madrid’s posh elite or New York’s jet set, with Levi’s 501 jeans and polarized Ray-Ban sunglasses.

In the difficult years of the “Special Period,” while the masses whom they lauded suffered from hunger, became ill from malnutrition, put up with blackouts lasting twelve hours and got around on bicycles, the revolutionary upper class maintained its same lifestyle. They had electrical generators in their homes, celebrated with loud parties and never had to put up with the lousy food — ground beef from soy, meat paste and Cerelac — devised by Fidel Castro for the average Cuban.

In the 21st century they have become successful entrepreneurs. The various businesses established with capitalist partners as well as the “industry” which arose after the increase in remittances sent by Cubans living overseas nourish members of the armed forces and interior ministry.

An absurd captive market, which forces Cubans to pay for everything from a bottle of cooking oil to a ventilator in another currency, is managed by a holding company set up by the military.

Meanwhile, the number of maneuvers intended to counter a supposed Yankee invasion have diminished. Aging Russian armaments, built in the 1980s when the government was mobilizing the population for “imminent enemy aggression,” lie rusting in underground bunkers.

Today the new Creole upper class is betting on the world of business. It advises Venezuelan comrades and secures positions in European embassies. The old Russian Ladas are no longer fashionable. Now they show off with Audis and Hummers.

Cuban baseball bores them. They prefer to watch Big League games, championship football matches and NBA playoffs live on satellite. The like to play golf or go hunting in exclusive game reserves. They dine as though they lived in London or Paris. They have internet access at home and use Skype for video conferencing or for chatting with their children in Florida.

Offspring of the nouveau riche have studied or are studying at universities in the United States or Europe. Others, more in tune with the times than their fathers, prefer to live in exile.

At night this elite bourgeoisie dines at Havana’s finest restaurants and frequents its hottest nightclubs. They dress in designer clothes, perhaps made in dismal garment factories in Bangladesh. They sport French perfume and Swiss watches. By day they take part in revolutionary actions while wearing white guayaberas.

They demand productivity and sacrifice, speak of a prosperous and sustainable socialism, condemn Yankee imperialism and ask that the people work with them to end rampant corruption. This new Cuban upper class loves to foment revolution from the soap box.

Photo: Banquet and show from the XV Festival del Habano 2013, which took in more than a million dollars. These festivals has been taking place in the Cuban capital since 1994 and bring together hundreds of celebrities, specialists and cigar lovers from all over the world. Parents and children from communist military high society regularly attend these exclusive, opulent events. From Diario de Yucatán.

Iván García

16 June 2013

Venezuela: Maduro Digs In

June 10, 2013 4 comments

The PSUV (Partido Socialista Unido de Venezuela) brothers have divided the country into two trenches. Their followers — in petrocasas (mass-produced small houses) and medical practices painted in red and white with images of Chavez hanging from the roof — if they show absolute loyalty, gain the right to a position as a minor official, where they can earn thousands of bolivars extra.

Those who are against — half the Venezuelan population — are treated as enemies. Nicolás Maduro is governing in virtually a state of siege. The army in the streets. And his comrades turn up in Parliament with gauntlets hidden in their pockets in case they need to hit their opponents.

Maduro has drawn the short straw. The man has a short fuse. He has little room to manoeuvre. As a statesman, he leaves a lot to be desired. His public speaking is a disaster.

He pulls three or four phrases out of the drawer and repeats them to the point of tedium about his love for Hugo Chávez . It doesn’t look as if the old Caracas bus driver is able to more Venezuela forward with his government drawn from the street, where only his own followers turn up.

A country is not a party. You should govern for everybody. Listen to the others. And respect their opinions in the parliament. Many people believe that the advice that Fidel Castro is whispering from Havana is seeking to polarise and radicalise a Bolivarian revolution which is deflating.

That’s how Castro governed in Cuba. The bearded guerilla humiliated the priests and any religion which was not Marxist. He nationalised all property. And provided an air bridge which allowed his enemies and the middle class to flee to Miami. But that was in the time of the cold war.

In the 21st century, to put together an almost scientific autocracy, with a parliament in the Cuban style in which they vote unanimously, is impossible. Following Castro’s strategies is the shortest route for the PSUV to dig its political grave. For many reasons. One of them: Castro’s government is a monument to inefficiency.

It survives on exile dollars and passing the collection box in Venezuela. Productivity is at rock bottom. Salaries are laughable. The infrastructure is dysfunctional. Even the much-trumpeted successes of the revolution in public health, education and sport are going backwards.

Politically, guaranteeing basic rights and employment while sacrificing liberties will never be worthwhile. Those rights and duties which a modern state must fulfil. Without asking for votes in exchange.

Maduro isn’t Chávez. The man from Barinas had charisma. Ability to manoeuvre, and, in spite of his major screw-ups, with his oratory he was able to convince his supporters.

Maduro creates distrust even in typical Chavistas. The position of President is too big for him. Rushing forward is not the right decision.

Whipping up the political differences between Venezuelans is putting out a fire with gasoline. Entrenching himself in institutions which respond to the interests of his party is not the correct solution.

He should offer political breathing room and participation to the opposition. It represents 50% of the electorate. It’s not a small thing. If you could grade Maduro’s performance in his first month of government on a scale of one to ten, he would get a zero.

As President he has not been up to scratch.

Iván García

Translated by GH

4 June 2013

Welcome to Havana, Willy Toledo / Ivan Garcia

June 9, 2013 1 comment

RYANAIR-Willy-ToledoAlthough virtually unknown in Cuba, the Spanish actor Willy Toledo — to paraphrase one of his icons, Argentina’s Che Guevara — at least intends to put his money where his mouth is.

In an interview with the pro-Chavez Venezuelan broadcaster Telesur, Toledo declared his intention to live full-time in Cuba. Guillermo Toledo Monsalve, his full name, was born in Madrid on May 22, 1970.

He is the son of José Toledo, a prominent surgeon and a pioneer of thoracic surgery in Spain. Willy grew up without food rationing, power outages or water shortages. As well as being an actor, he is a theatrical producer and a left-wing political activist.

He received a Goya, the Spanish equivalent of an Oscar, for his performance in the TV series 7 Vidas (Seven Lives). After the death of Cuban dissident Orlando Zapata Tamayo on February 23, 2010, Toledo declared him to be “a common criminal, not even a political dissident,” echoing the official stance of the Castro regime.

The actor is a fervent supporter of the Cuban revolution, the late Hugo Chavez’s policies and the 15-M movement in his own country. Unlike his comrades-in-arms who voice support for Cuba’s military government from Europe or the United States while living in nice houses, driving late-model cars and enjoying broadband internet access, Willy has decided to move permanently to Cuba.

Perhaps he is fleeing the economic crisis afflicting Spain. Or perhaps he is moving to the “Caribbean paradise of workers and peasants” out of real political conviction.

I like this kind of guy. It is easy enough to support a cause from thousands of miles away while staying in five-star hotels, but it is better to be in the thick of things.

But I have my doubts about Willy Toledo living in Cuba if he is coming to stay in a guest house in the upscale Laguito neighborhood run by Cuba’s Council of State, or paying out of his own pocket for an exclusive duplex apartment for foreigners.

Toledo will gain the respect of many affluent, progressive people if — once he is on the island — he moves to a poor neighborhood. In Havana there are more than sixty.

I can see it now. I imagine him carrying jugs of water through the impoverished Colón neighborhood, with a hooker, a marijuana dealer, an unemployed worker and a bookie for the bolita, or illegal lottery, as neighbors.

And if he is really a dyed-in-the-wool communist, then he would prefer to be in a llega y pon, a shantytown of cardboard and aluminum shacks. In these unsanitary neighborhoods there are no electric lights or sanitation services. People eat little and poorly, and drink too much distilled alcohol.

If he is coming to work and earn his wages in Cuban pesos without turning to the black market while taking the city buses and private taxis, and feeding himself from the ration book like any other Cuban, then we could say that Willy Toledo is preaching by example.

What disappoints me is when a leftist remains above it all, when he stays in special houses when travelling through the country, or accepts luxurious perks such as those given to generals and government ministers by the Council of State.

I would be disappointed if this European leftie ended up living in an old bourgeois Creole villa – one of those remodeled by the government with air-conditioning, a pool and private security .

I would not like to see Willy Toledo driving an Audi or Mercedes Benz from the flotilla of cars used by Castro’s guests. Or visiting the CIMEQ* clinic, with its latest advances in medical technology.

I would be disappointed if someone wore a Ho Chi Minh T-shirt to accept a Goya. Or if he ran around town at night, paying hard currency for drinks at the newly renovated bar Sloppy Joe’s, surrounded by mulatto beauties.

Or dined in expensive restaurants with the creme de la creme of “Castro’s aristocracy.” Presumably he would in no way resemble Beyoncé or her husband Jay-Z by declaring himself to be anti-capitalist.

If Willy Toledo is coming to experience first-hand what socialism under Fidel Castro is really like, then welcome to Havana.

Iván García

Photo: Willy Toledo creates an incident when he tries to board a Ryanair flight without proper identification.

*Translator’s note: Spanish acronym for the Center for Medical and Surgical Research, a hospital dedicated to treating senior government officials, their families and foreign dignitaries, but inaccessible to ordinary Cubans.

28 May 2013

Cuba: Internet, in Slow Motion and Hard Currency / Ivan Garcia

June 2, 2013 2 comments

Cuba-Internet-150x150Facing the India fountain, next to Fraternity Park and close to the Capitol, in the center of Havana, is nestled the Hotel Saratoga.

Its ancient facade, painted lime green, has an architecture of curved arches and tall columns. The interior is a modern frame with iron structures and plasterboard. According to the relaxed norms of Cuban hospitality, the Saratoga is a 5 star hotel.

Like almost all hotels, has an Internet cafe. Going up a wide staircase with iron railings, after crossing the piano bar in a small room and pool, one can connect to the internet.

If you have a tablet (iPad), laptop or smartphone, you can do it from anywhere in the hotel, thanks to a wireless network. Otherwise, the Saratoga has three computers. The speed of transmission is a maddeningly slow.

Opening a Yahoo email can take up to 6 minutes. Forget Gmail. The connection runs at 100 kilobytes. Downloading videos and photos that exceed a megabyte is not advisable.

The service is too expensive, even for a foreigner. Half an hour for 6 CUC (over $6 US). One hour for 10. Two hours for 15. In the same hotel where a month and a half ago the singers Beyonce and Jay-Z stayed, the internet works in slow motion.

In 2010 the Castro government, opting for a full ’digital sovereignty’, decided to open its wallet to the investment and together with Venezuela and Jamaica, financed a submarine cable of several thousand kilometers. Its birthplace was the Venezuelan region of La Guaira and termination, Siboney Beach in the eastern province of Santiago de Cuba, about 550 miles from Havana.

Little is known about the cable. It is a kind of ’ALBANET’, with filters and control mechanisms. Behind the famous cable there is an Olympic framework of corruption.

Some put out their hands along the way and lost several million dollars. It’s rumored — in Cuba the rumors are more reliable than the news from the official press — that several people could go to jail.

State media reported euphorically that when the cable is connected, the  data transmission speed would be multiplied by 300. While technical issues are resolved, 97% of the Cuban population still sees the Internet as the stuff of science fiction.

In its absence, a USB flash drive serves as transmitter of information for those computers not connected to the network. The regime considers the internet a ’hegemonic control tool of U.S. imperialism’.

Since the island links to the information superhighway via satellite, the tropical ’think tanks’ wear themselves out trying to design and effective cyber police that can tame the democratic worldwide web.

So far they have not succeeded. What they have achieved is to block sites deemed ’subversive’ and in the workplaces ’big brother’ is watching the footsteps of those disobedient people who decide to take a look at a digital newspaper from Miami or Madrid.

In ETECSA, the State telecommunications company, staff with access to the web had to sign a statement agreeing not to read ’enemy pages or visit pornographic sites’.

Nor may they have international email account (Yahoo, Hotmail, Gmail). Zero Twitter, Facebook or other social networks. But in such closed societies, people applaud a speech with the same emphasis that they blatantly steal from their job or violate established rules.

Raisa, 24, has never surfed internet. That has not stopped the girl from having a Facebook account and a page where she advertises herself as a photographer for weddings and quinceañeras — girls’ 15th birthday parties.

All thanks to a computer savvy friend, charged with editing and updating her site. And those who have State accounts on the internet don’t miss a trick. They sell access for 2 CUC an hour.

But I don’t recommend it. At its best, the connection is 50k. It can take you up to 30 minutes to get to the online edition of the Journal of The Americas.

Even though the Castro regime has established a drips-and-drabs internet, some censored information reaches the average Cuban. Late, of course.

Ivan Garcia

Photo: Several people access internet in a room in Havana. Taken from Infolatam.

1 June 2013