
In the medical response to Ebola, Cuba is punching above its weight - megalodon
http://www.washingtonpost.com/blogs/worldviews/wp/2014/10/04/in-the-medical-response-to-ebola-cuba-is-punching-far-above-its-weight/
======
VLM
Decades ago Cuba made training and exporting medical personnel their "thing"
and they ended up owning that part of the world market despite being a small
and very poor country.

There is a direct tech analogy with Finland and cell phones.

From the small country PoV, if you can't compete in the strategic nuclear
bomber world market, or the manufacturing robot world market, you can probably
find some market segment, however small, to focus on and take over. Like
cellphones, or 3rd world medical care.

Other countries could, and probably will, do the same.

There is the interesting analogy that Finland isn't doing so well in the post
Nokia, iphone and android world. Wonder what could happen to Cuba if the
demand for docs dried up (optimistically due to 3rd world advancing into
training their own medical workers, and not by the entire 3rd world dying of
ebola or in ensuing strife after the epidemic)

~~~
Retric
What I thought was most interesting in the Cuba case was how little technology
it takes to train Doctors. Outside of surgery Doctors tend to have other
people doing the high tech hands on work like operating an MRI or Doing blood-
work. But, as they training people to operate in the 3rd world even surgery
tends to be fairly low tech.

In reality it's the opportunity costs that makes training doctors so
expensive. So, in many ways less developed nations have a huge cost advantage
when supplying doctors. The real issue is after exporting them they probably
don't send all that much money back home.

~~~
guard-of-terra
The real issue is that developed countries refuse to import doctors.

Developed countries have medical doctors associations which keep a close eye
on who can become doctor and how, thus limiting the number of doctors in the
country and sustaining their high wages.

From what I've heard, you have to get an expensive education and then live
thru a long and undercompensated and exhausting internship in order to become
a full doctor and get all the perks. Any immigrant will also have to face that
kind of internship (not easy for someone without a source of income) plus they
have to re-learn a lot of things in order to pass the certification.

I might be fuzzy on the details, but still: we're lucky in our IT, we have
comparative small amount of bullshit and entrenching.

~~~
maxerickson
It's just the opposite:

[http://www.ft.com/cms/s/0/9647519c-207a-11e3-b8c6-00144feab7...](http://www.ft.com/cms/s/0/9647519c-207a-11e3-b8c6-00144feab7de.html#axzz3FNWxlNtQ)

Doctors tend to leave undeveloped countries for developed countries.

~~~
guard-of-terra
It's behind paywall.

~~~
maxerickson
Here's the research discussed at the FT link:

[http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fj...](http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001513)

~~~
guard-of-terra
"and by agreeing to provide care in areas that are underserved by US
physicians"

This changes the perspective slightly.

------
cgar
How interesting, just yesterday I watched a TED[1] talk about Cuba's ELAM
(Latin American School of Medicine)[2].

> Established in 1999 and operated by the Cuban government, ELAM has been
> described as possibly being the largest medical school in the world by
> enrollment with approximately 19,550 students from 110 countries reported as
> enrolled in 2013.

[1]
[http://www.ted.com/talks/gail_reed_where_to_train_the_world_...](http://www.ted.com/talks/gail_reed_where_to_train_the_world_s_doctors_cuba)

[2]
[https://en.wikipedia.org/wiki/ELAM_%28Latin_American_School_...](https://en.wikipedia.org/wiki/ELAM_%28Latin_American_School_of_Medicine%29_Cuba)

~~~
616c
I assume it must be the same school, but a undergrad friend and roommate was a
pre-med and came from a very interesting family. His family was all about
immigration in the US, and was very tight with the Latin American community
where they lived (he even grew up for a period in Mexico, and spoke perfect
Mexican Spanish, as was his American father who raised him there).

He clued me into the existence of full-ride scholarships for Americans to
study in medicine. American students with a full medical education in Cuba! I
was very impressed. I guess it is this.

[http://www.ifconews.org/node/707](http://www.ifconews.org/node/707)

This kid was amazing and very altruistic. However, he pulled his application
bc of the sad reality of US medicine; he was told point blank by some med
school mentors he would never practice medicine in the US with that degree,
and it was pointless as he would likely redo all of his medical education and
required certification/boards stateside lest he have any intention of ever
practicing medicine in the States.

I am still glad, despite all the fucked up political harassment by the USG,
this scholarship remains.

~~~
jessaustin
Preventing foreign physicians from practicing in USA is kind of the whole
point of having a "profession" with lobbyists like the AMA. If they had to
compete with H-1B'ers, they couldn't afford to spend so many years and dollars
in training. Also health care would be much cheaper, which would step on a lot
more toes than just those of the M.D.'s.

~~~
616c
I completely agree with you. But this was a group of doctors dissuading them.
It was more an argument about stigma (that other US doctors would never hire
them, regardless of him re-studying and re-boarding might not save the
potential of a career).

I would love such an opportunity. I think we should also open up medicine in
the US as you describe, but I also must be honest: expect the quality and
knowledge of doctors _on average_ going down. I live abroad in the MENA
region, and most of the doctors here are from abroad (the first medical school
in country is part of the educational complex I work in; the first graduating
class will be this year or next year). Even at good hospitals, people check
nationality of the doctor as a result and you always go only to doctors you
friends have visited and recommend if not an emergency. Whether it is general
fear or racism whatver you call it is another debate. You will notice some
doctors meet minimal standards here but I would be afraid to call them doctors
(one told me you have to be careful which kind of fish you eat because the
Quran explains so; religion has its place but I will not tolerate that from a
doctor, and I never visited her again).

Allowing doctors all over the world while maintaining a minimally required
level of education and skill with such different education systems and
credentials will be awful. I live that every day I visit the hospital with my
son, even for a simple doctor's visit.

------
benbeltran
Off-topic, but I had the opportunity to have several cuban PhDs teach some of
the final classses in college (Multi-agent systems, computer intelligence,
etc) ... All of them were incredibly good in their fields, better than any
other professors I had in school, and as good as some of the brightest I've
met in this field.

There were also some docs in other disciplines and they were all incredibly
good. Based on that experience I think cuba is hardly "punching far above its
weight", but reflecting great care, passion and responsibility as they do in
other fields... We just assume a lot of things about cuba. I sure did before.

~~~
crpatino
I don't think the "above its weight" in the title refers to the quality of
Cuban education, but the size of its economy.

So, if you look at the number of qualified personnel committed to the epidemic
by country, and divide over their per capita GNP, indeed Cuba is punching way
above its weight.

------
guelo
Cuba was the world's best experiment in total communism. Unfortunately the US
ruined the experiment by imposing an embargo for decades out of spite. Still,
when you compare Cuba to neighboring Dominican Republic they're doing better
under many measures, including health, education and a GNP per capita of $5890
vs DR's $5620.

~~~
drzaiusapelord
> Still, when you compare Cuba to neighboring Dominican Republic

What kind of comparison is that? The DR is practically a failed state. By any
rational metric Cuba is an economic and human rights disaster and continues to
be. Its other, capitalistic, neighbor Mexico has 2x that GDP per capita. Heck,
its only because of Western pressure that Cuba is only now, after decades of
spite against its own people, started releasing political prisoners.

[http://www.hrw.org/world-report/2014/country-
chapters/cuba](http://www.hrw.org/world-report/2014/country-chapters/cuba)

>Unfortunately the US ruined the experiment by imposing an embargo for decades
out of spite.

Pardon me if I think my nation should tolerate nuclear missiles 90 miles off
our coast from a country aligned with our enemies who have a stated doctrine
of first strike and tactic nuclear usage with zero warning in advance, held by
a dictator who wanted nuclear war.

[http://townhall.com/tipsheet/meredithjessup/2009/09/24/nytim...](http://townhall.com/tipsheet/meredithjessup/2009/09/24/nytimes_castro_wanted_soviets_to_nuke_usa)

I'm all for lifting of sanctions, but Cuba needs to up its game first.
Rewarding the autocratic and oppressive Castro regime makes no sense.
Democratic reforms, regime change, freedom of ownership, open elections,
multi-parties, the right to sue, the right to travel, a free press, the right
to petition, etc must all be respected. You're not automatically entitled to
my money.

~~~
trhway
>Pardon me if I think my nation should tolerate nuclear missiles 90 miles off
our coast from a country aligned with our enemies

Don't you think people of other nations may have the same intolerance to their
enemies' nuclear missiles deployed right on their borders? The Cuban missiles
were symmetric response to deploying the Jupiter missiles in Turkey - which is
right on the border with USSR
[http://en.wikipedia.org/wiki/PGM-19_Jupiter](http://en.wikipedia.org/wiki/PGM-19_Jupiter)

"They were all removed by the US as part of a secret agreement with the Soviet
Union during the Cuban Missile Crisis."

Do onto others what you don't want others do onto you :)

~~~
joeclark77
The USSR was a totalitarian communist empire openly determined to conquer and
enslave the entire world. The USA was a champion of liberty that pursued
strategies intended only to defend the free world against the USSR. Your moral
equivalency game indicates you're either ignorant of recent history, or that
you're _on the other side_.

~~~
mercurial
I hope this is sarcasm.

Sure, the USSR was a totalitarian state. That said, both sides pursued an
aggressive, expansionist policy via proxy. The "champion of liberty" installed
thoroughly repressive regimes all over South America which had little to envy
to the Soviet Union. It didn't prove itself above manufacturing border
incidents to trigger the Vietnam war, either. Was the USSR worse? Certainly.
But this doesn't make the US the good guy in the story.

~~~
redacted
The propaganda of the Cold War is breathtaking in its effectiveness. The USSR
are the bad guys, comic book villains out to destroy the world. The US are
plucky do-gooders, fighting to save the world from evil yet again (after
single handedly winning WWII). There is no room for nuance. There is no grey
area in perhaps the greyest of all conflicts since the Great Game. Both the US
and USSR inflicted terrible damage to nations all over the world through proxy
wars, intelligence agency coups. The ramifications of those conflicts are
still felt throughout Latin America, the Middle East, and South East Asia.

And that all gets swept aside by "The USA was a champion of liberty that
pursued strategies intended only to defend the free world against the USSR."
Read the Wikipedia article on "Covert United States Foreign Regime Change
Actions" [0], and see how many of those nations benefited in the long run, and
how some incredibly brutal regimes were installed or propped up throughout the
third world, simply because they weren't communists.

[http://en.wikipedia.org/wiki/Covert_United_States_foreign_re...](http://en.wikipedia.org/wiki/Covert_United_States_foreign_regime_change_actions)

~~~
joeclark77
You should have said "the anti-American garbage that leftist teachers are
feeding to grade-school kids is breathtaking in its effectiveness" but in
order to do that, you'd have to have some understanding of the true (not the
_political_ ) version of history.

What's really amazing is that you think your 1960s, nihilistic, self-loathing,
theyre-all-the-same cynicism is _thoughtful_ and _original_ , and you assume
that the reason I disagree with you is that I haven't heard of such a notion
before, and must not be as educated as yourself...

~~~
mercurial
Well, even without opening a history book (sadly, "leftist teachers" did not
get rid of Allende all by themselves), one would think that the US military
adventurism of the last decade would have equipped US citizens (I'll go out on
a limb and assume you are one) with a healthy dose of skepticism.

Governments have most often been waving various pretenses to make their
actions look good. Manifest destiny, the white man's burden, the necessity to
bring the socialist paradise... "Championing liberty" is just one of them. But
you don't "champion liberty" by setting up something like the School of the
Americas[1], or selling arms to Iran to fund Contras terrorists[2]. This is a
different concept, which is "protecting your interests by whatever means
available".

1:
[http://en.wikipedia.org/wiki/Western_Hemisphere_Institute_fo...](http://en.wikipedia.org/wiki/Western_Hemisphere_Institute_for_Security_Cooperation)

2:
[http://en.wikipedia.org/wiki/Contras](http://en.wikipedia.org/wiki/Contras)

------
throwaway_yy2Di
Would these Cuban doctors be likely to escape to the US via Liberia? Normally
it's illegal for them (doctors) to travel outside of the country:

[http://www.bbc.com/travel/blog/20130116-cuba-lifts-travel-
re...](http://www.bbc.com/travel/blog/20130116-cuba-lifts-travel-restrictions)

(edit) Apparently the US explicitly permits Cuban doctors working abroad to
emigrate to the US -- in contrast with most refugees, who have to physically
set foot in the country to gain asylum.

[https://en.wikipedia.org/wiki/Cuban_medical_internationalism...](https://en.wikipedia.org/wiki/Cuban_medical_internationalism#Defection)

[http://www.state.gov/p/wha/rls/fs/2009/115414.htm](http://www.state.gov/p/wha/rls/fs/2009/115414.htm)

[http://online.wsj.com/articles/SB100014240529702037310045760...](http://online.wsj.com/articles/SB10001424052970203731004576045640711118766)

 _"...a wave of Cubans who have defected to the U.S. since 2006 under the
little-known Cuban Medical Professional Parole immigration program, which
allows Cuban doctors and some other health workers who are serving their
government overseas to enter the U.S. immediately as refugees. Data released
to The Wall Street Journal under the Freedom of Information Act shows that,
through Dec. 16, 1,574 CMPP visas have been issued by U.S. consulates in 65
countries."_

~~~
megalodon
That's funny, the US are keen on maintaining the embargo against Cuba but at
the same time don't mind welcoming their doctors and thus admitting their
superiority in medical education.

~~~
freehunter
I'm not sure that welcoming Cuban doctors necessarily means admitting superior
medical education. Most countries like well-educated immigrants, no matter
what their former nation was. The US welcomed Nazi scientists to help build
rockets and bombs, too. That wasn't a commentary on the Nazi regime other than
that they had good scientists that were willing to defect.

~~~
mercurial
I don't know, hearing stories of immigrants with good degrees having to do
menial work in Europe isn't that uncommon.

------
api
Can we end the stupid sanctions now? The USSR is gone and we trade massively
with China for F's sake. Cuba doesn't have the best human rights record on
Earth, but neither does China or Saudi Arabia to give two other examples with
which we trade extensively. All this does is harm the Cuban people and
paradoxically actually strengthens the existing regime there.

~~~
joeclark77
Cuba is a brutal communist slave state. But so is China. I think the shameful
thing is not that we have sanctions against Cuba, but that we do _not_ have
sanctions against China and some of the other barbarian regimes out there
(e.g. Vietnam, Saudi Arabia).

~~~
api
If Cuba is a brutal communist slave state, so is China. Do you own any Apple
products or anything else manufactured by Foxconn?

~~~
joeclark77
What are you going for, here? The old, "if you benefit from something, you're
not allowed to criticize it" angle?

------
ctdonath
A chronically under-recognized point is buried in the article:

 _It 's not a simple picture. Critics have complained that Cuba has begun to
sacrifice the health of its citizens at home to make money sending medical
workers abroad, and the conditions for these medical workers themselves have
been criticized_

~~~
guard-of-terra
Cuba now has roughly the same life expectancy as the USA - a bit more than 79
years.

I.e. it doesn't seem that they sacrificed a lot.

~~~
ecocentrik
The US isn't exactly setting the bar for healthcare.

~~~
funcSoulBrother
It's not about the United States being the best, it's about them being the
"reference standard" for life quality in developed nations. Everybody compares
themselves to the US from economic metrics to quality of life, as one will do
when a superpower has dominated geopolitical dynamics for as long as the US
has.

~~~
danohuiginn
In many areas, yes. But from Europe at least, the US healthcare system seems
so obviously broken that it's relatively rarely used for comparisons. Sweden
is more common, I'd say.

Now if we're talking about innovation, technology, culture -- THEN there will
be wistful comparisons to the US

------
brohoolio
Their contribution will save thousands of lives. Ebola is a slow moving
tsunami that we, as a world, can stop. If we don't step up and contribute the
needed resources, literally hundreds of thousands of people will die. The
sooner the better. Hats off to Cuba, but for the rest of the world, especially
countries that can contribute, this should be a wake up call.

~~~
jessaustin
Is there any doubt that "hundreds of thousands will die" of ebola in the next
year? The reports I've seen are a bit more pessimistic.

------
dreamweapon
Aside from the condescending title, we also have this, in the first sentence:

 _Cuba, a country of just 11 million people that still enjoys a fraught
relationship with the United States_

To describe Cuba's position with regard to the U.S. (entering its 6th decade
of basically vindictive and pointless economic sanctions) as a "fraught
relationship" is certainly an interesting circumlocution. It's kind of like
saying that the skinny kid in junior high who keeps getting pushed into
lockers "enjoys a fraught relationship" with his peers.

~~~
Someone1234
Seems like you got offended just for the sake of getting offended. The title
isn't THAT condescending, they're giving Cuba props for weighing in more than
another country of its size and GDP.

As to the "fraught relationship" issue, what? I'm not sure what terminology
you would have prefered they used but most of the alternative words choices
are just 'fraught' synonyms anyway.

The Cuba sanctions are well known and a lot of people (myself included) think
they're unwarranted. I'd definitely call what Cuba and the US have a fraught
relationship.

Do I think the US bullies Cuba a bit? Yes. Do I think that the word choice was
bad? No.

~~~
dreamweapon
Anyway, the point about the "fraught relationship" depiction is that it's
basically an elephant-in-the-room thing. Such language might work to describe
the relationship between the U.S. and Russia (or China), because those
countries are essentially peers on the global stage. But to use it in the
US/Cuba case pointedly ignores the fundamentally one-sided and, in the view of
many inside (and essentially everyone outside) the U.S., petty-minded and
abusive nature of that country's treatment of its much more vulnerable
southern neighbor.

There's also an unpleasant blame-the-victim tinge to it.

The Post could have stated the obvious, of course, and acknowledged the
elephant in the room. But it knows very well that in order to maintain its
image as the (lessor of two) "papers of record" within the center of Federal
power, that just would not do.

------
PauloManrique
Brazil got a program that imports around 10 thousand cuban doctors. And they
are nearly slaves to the cuban regime.

Brazil pays around 4k USD for each doctor, but he only keeps 1,2k. Everything
else goes to the Castro's regime.

And that's because our oposition made a huge noise about that, because they
used to receive about 400 USD, and the rest of the money to castro.

They have a good health program? Maybe. But I won't swap my freedom for that.

------
scardine
It is easier to create new drugs if you are not subject to strict regulations
and if you are not afraid of lawsuits from people that participate in trials.

What slows down the research in USA is the safety mechanisms imposed by FDA.
This is almost the same for every country that is not a dictatorship.

source: worked a decade for pharmaceutical companies.

~~~
jdimov
There's a more general and more interesting pattern at work here. As humanity,
we have grown too fond of our safety and comfort over the past 50 years to the
point of being unwilling to take the risks that are necessary for us to grow
further. The levels of risk-aversion we have reached, especially in developed
countries is actually akin to a terminal disease that is already ensuring the
demise of most "western powers". It's paradoxical in a very beautiful way..
that will eventually serve to remind us that life isn't really about being
safe and secure. Safety, security and privacy are unnatural values that have
been drilled into us, quite elaborately, over generations. They are fake
values that only serve to hold us back and inhibit our innate greatness.

------
argumentum
Don't be unduly impressed. It's common for a totalitarian state to focus its
resources and "punch above its weight" in a specific area or two, but it's at
the expense of the rest of their economy and the general well-being of its
people. Its also a common tactic used to shore up support at home and win
superficial plaudits abroad.

The Soviets were able to keep pace with the US militarily and in space. The
also had world-beating athletics, chess and classical arts (ballet, orchestra
etc). All this came at the high price of individual freedom and _basic_ human
prosperity. Milton Friedman aptly observed this gap between "public affluence
and private squalor" as the defining outcome of centralized socialism.
Christopher Hitchens, at that time a committed socialist, described his
disillusionment w/Cuba while volunteering there in 1968 as follows:

 _Cuba was torn between grim austerity for its people and flamboyant hedonism
for its revolutionaries, and one’s elementary socialist principles managed to
register the gross injustice of this even while hoping (perhaps) that the
engine of history would make up the deficit._ \- [http://www.city-
journal.org/2008/18_2_spring_1968.html](http://www.city-
journal.org/2008/18_2_spring_1968.html)

It is, I guess, better that Cuba has chosen to focus on healthcare rather than
war-mongering, but it doesn't recommend their method of government as
preferable to our own. It doesn't recommend their hundreds (perhaps thousands)
of political executions or their death squads or their forced labor camps. It
doesn't recommend their complete suppression of free speech and their
prosecution of Cubans wanting to _leave_ this self-proclaimed "paradise".

And it seems quite unethical to praise Cuba for it's export of medical
expertise while ignoring the fact that relatives of these experts are
essentially _held hostage_ to ensure they won't defect. If you don't see
something _extremely_ sinister and disgusting about this, I'd posit you don't
have the capacity for suspicion and disgust.

 _.. the government "bars citizens engaged in authorized travel from taking
their children with them overseas, essentially holding the children hostage to
guarantee the parents' return. Given the widespread fear of forced family
separation, these travel restrictions provide the Cuban government with a
powerful tool for punishing defectors and silencing critics."_ \- Human Rights
Watch,
[http://en.wikipedia.org/wiki/Health_care_in_Cuba](http://en.wikipedia.org/wiki/Health_care_in_Cuba)

I'd posit that a fair (and fairly obvious) measure of a political system is
the market for voluntarily migration. The fact is that _almost no one_
migrates into Cuba and millions have braved, and continue to brave, incredible
costs and dangers to migrate _away_ from Cuba.

American style democratic capitalism is not without its flaws, and we must be
eternally vigilant to resist and reverse attempts by both state and corporate
power to impinge on our rights & freedoms in their own selfish interests. But,
unlike Cubans (and former East Germans etc), we have the political
infrastructure and basic human freedom to improve our system for the better.
We shouldn't sacrifice these hard earned and extremely rare circumstances in
the vain hope of securing _marginally_ better health outcomes (or marginally
better security, chess skills, literacy rates etc) by means of totalitarian
socialism.

~~~
Dewie
Don't worry. If agencies like NASA and Elon Musk manage to get anywhere with
their Mars ventures, we can go back to praising America and free enterprise
soon enough (since it apparently is a choice between that and
communism/totalitarianism).

------
spiritplumber
Cuban doctors are incredible for doing much with little.

