Since the late 1990s, Miami residents have likely encountered Cuban-trained physicians in clinics and hospitals, but not only. Also as taxi drivers, old folks homes’ assistants, and facial massage specialists. It would seem that – for many Cuban medical professionals, including those initially bound for Third World countries- the United States is a prized final destination. Could Cuba’s international solidarity program become, for would-be immigrants to the U.S., a means to that end? As an oral historian, I decided to go beyond the competing discourses presented in the press and seek the views of Cuban medical professionals themselves.
While numerous press sources maintain that the healthcare system in Cuba should serve as an international example and praise Cuba for its humanitarian concern for and involvement with other countries in need of medical assistance, other more ideologically-driven publications focus instead on the meager income and working conditions of Cuban healthcare professionals, which they go as far as liking them to slavery, as well as on their so-called defection.
From very early on, the Cuban revolutionary government has considered healthcare a key commodity that could be exported to generate financial, political, and diplomatic capital. In 1963, fifty-five health workers were sent to newly independent Algeria for fourteen months. Cuba has since sent medical personnel to over one hundred countries throughout the world. Like all healthcare professionals, these individuals were for many years subject to travel restrictions. The United States, in its complex relationship with Cuba, has sought to weaken Cuba’s medical diplomacy by offering specific opportunities for Cuban physicians to emigrate to the U.S. In 2006, the Bush administration created the Cuban Medical Parole Program (CMPP), which “would allow Cuban medical personnel conscripted to study or work in a third country under the direction of the Cuban government to enter the United States.” Interestingly, the CMPP made no mention of the obstacles these healthcare professionals would face as they sought license to practice in the U.S. Julio César Alfonso, president of a U.S. organization that helps Cuban physicians in the United States, Solidaridad Sin Fronteras, told El País that about eight thousand healthcare professionals have taken advantage of the CMPP since 2006. Official numbers, however, have never been released.
My long-term engagement with Cuban culture and the island’s political situation as a student and as a researcher has always focused on the concept of giving voice to voiceless people, and the need to contribute to the construction of “a more socially conscious and democratic history,” as historian Paul Thompson put it. During my six-month stay on the island in 2000-2001, I had seen with my own eyes the poor healthcare conditions of the people, and I had heard about the meager salaries of doctors and other medical personnel, but such allegations involving Cuba’s often praised international solidarity missions caught my eye. I needed to hear the voices of the healthcare professionals who, once ambassadors of the Revolution abroad, now found themselves in a very different position. This led me to start an Oral History project three years ago about the life stories of participants of these “medical brigades.” Thanks to a British Council research grant and collaboration established with the University of Miami’s Cuban Heritage Collection, I conducted extensive interviews with Cuban-trained physicians in Miami last summer. Their accounts are worth sharing.
While interviewees refer to the difficult work and living conditions on the missions, not all of them share this type of memories. One of the doctors I interviewed had been working on a mission in a small village in Guatemala. The memories she has from those two years are excellent. According to her, she decided to apply for a mission because the extra salary she would receive would help her deal with the financial situation she was facing after a recent divorce. It was the first time she had traveled abroad and she enjoyed the opportunity to discover another country, its people, and its culture. Her job was interesting and the living conditions were good. Although she was separated from her children, she found the relationship with the people she was serving in the community, as well as the help she was able to provide to them, extremely rewarding. While working on her own for ten weeks, she quickly made friends and became part of the community. People were extremely grateful for her help. She explains, “There was a lot of work to do, but people were kind and respectful towards us. I really enjoyed working there.” As her discourse was so positive, I asked her why she had decided to leave the mission and migrate to the US, to which she answered: “It was never part of the plan, but there was a group of Cuban doctors there, deserters, and, although we weren’t supposed to, we had inevitably become friends. Someone gave us away to the Brigade Leader, and rumors started to spread that we were going to be sent back to Cuba, which is for us the beginning of the end, so several of us decided that it was time to leave and we did.” In many interviews, this forced return to the island was identified as a punishment resulting from the professional being considered a counterrevolutionary.
Many Cuban healthcare professionals decide to participate in the missions because of their financial incentives, but they also enjoy the work. Some have made a career in medical brigades, transferring from one mission to another, while going back to the island only for their one-month annual leave. Nevertheless, the salary earned by Cuban medical personnel on the missions is still extremely low, when compared with that of healthcare professionals from other countries. This ongoing issue was recently revisited in a discussion, reported on by El País, concerning the Mais Medicos Program in Brazil, which employs a high number of Cuban internationalist healthcare professionals.. Many of these individuals believe that moving to the US will allow them to live the “American dream” and earn more money. However, they do not always realize the difficulty of the many challenges and obstacles awaiting them, such as their lack of English, the arduousness and cost of the nursing or medical boards, and the adjustment to a capitalist society which requires being able to afford basic living conditions. Organizations, such as the aformentioned Solidaridad sin Fronteras and the International Institute for Healthcare Professionals offer assistance, but they sadly fall short.
Doctor Eloy González, writer of the Blog de Medicina Cubana , an internationalist oncologist who worked in Nicaragua during the Sandinista government now residing in Texas, has taken on the role of counselor for those who plan to migrate to the US. Since he left Cuba, he has never managed to practice medicine again in the United States, which has been very upsetting for him. When I asked him how his life had been since he arrived in Miami, he answered in a sad tone: “It didn’t go well in fact (pause), it didn’t go well.” He also tells me that he tries to warn the young doctors who contact him for guidance before leaving the mission, often advising them to try to make their start in different country, such as Mexico. There, at least, he had managed to work for a short period — the administration having been less strict regarding the recognition of Cuban medical degrees. He lamented, “I’ve recommended it to various people, but they don’t understand; they don’t. They ask me: Mexico? Mexico?”
Of the twelve doctors and one nurse I have interviewed so far as part of my research project, ranging in age from their late twenties to early sixties, only one person had managed by the end of my project to pass the board of nursing and had obtained a good position at the University of Miami Hospital. Four of the interviewees were preparing for the board, but the others had given up on that possibility. All of them, however, were working, and a few worked in the medical domain, although sometimes in positions that did not make use of their training at all. Several individuals had found positions in construction, catering, cleaning and driving taxis — whatever work they could secure, in order to make ends meet.
This tricky situation of the exiled Cuban healthcare professionals often disappears in the Manichean media accounts. However, listening to the healthcare professionals’ voices themselves shows that the situation is much more nuanced than it seems. Although their lives were not easy before coming to the U.S., not all of them had planned to leave Cuba. Those who did hoping to find a better life that would allow them to provide for their family on the island are confronted with the difficult task of adapting to the capitalist world, separated from their home country, as well as, in some cases, from their medical career. However, few express regrets.
The paramount question now is how/whether the recent changes in U.S./Cuba relations will affect their lives, as well as the lives of the healthcare professionals still working on the island or participating in the missions. One of the next steps that Cuba might require from the US is to revoke the CMPP, which according some sources might already be in the works. The US might also demand that Cuba release the medical diplomas of these professionals -often withheld- and effectively eliminate the eight-year ban on their return (which according to many of them is still in effect). We will soon know if the current diplomatic normalization with the United States will lead to am orderly immigration of Cuban medical personnel as highly-skilled professionals, needed in the United States.
Cover Photo: UN Photo/Sophia Paris (2010)
Caption- Abstract – At Delmas 33, a camp for displaced Haitians in Port-au-Prince, a woman grimaces as a Cuban doctor administers a vaccination provided by the World Health Organization (WHO).