From Das Kapital To Human Capital... Cuba's Doctor Diplomacy Pays Big Dividends For Now

Food security, energy security and environmental security are major policy concerns for nations, international organizations and ordinary people. Now, the World Health Organization has added a new numb to the sum of all fears.  A shortage of 4.3 million doctors, nurses and technicians. Call it health care security.

 

From Human Condition To Human Attrition

There was a time when the quest to combat illness and disease had a humanitarian and philosophical dimension, what French writers and intellectuals called “the human condition.”

When French diplomat Romain Gary (born in Vilnius as Roman Kacew Рома́н Ка́цев) won the Prix Goncourt in 1956 for a novel that discussed human suffering and the exploitation of animals in Central Africa, his work was a reminder of “the human condition.” His second Prix Goncourt, the story of a Holocaust survivor, was about the human condition too.

But in November of 1956, Fidel Castro, his brother Raul, the Argentine “Che” Guevara and around 80 others set off from Mexico in the Granma, a boat they bought from a gun runner with funds raised in Florida, USA, to make a revolution in Cuba. It took around two years after Fidel marched triumphantly into Havana for his regime to declare Cuba a socialist nation that sided with Moscow, and only after the Eisenhower administration rejected a meeting with the Cuban leader.

As a result of Cuba siding with the Soviet Union the struggle to combat disease and human weakness took on a revolutionary dimension.  Once that happened, Fidel quickly provided doctors to Algeria, which was emerging from its war against former colonial power France. Today, ironically, France, experiencing its own doctor shortage, is importing doctors from Algeria, and Romania.

But, it is Fidel, not Frantz Fanon, the black French psychiatrist who lived in Algeria and was the ideological godfather of the FLN, who gets credit for helping the revolutionary movement develop its medical infrastructure.  After the FLN came to power Fanon developed leukemia. He was flown to the Soviet Union for treatment and experienced some remission. But he was beset with psychological problems and wanted to leave.

Fanon left Moscow and traveled to the United States for additional treatment through the help of an American diplomat, Oliver Iselin. Fanon died in December 1961 in Bethesda, Maryland, his death reported under the name of Ibrahim Fanon. Perhaps the Algerian working in France represent his legacy.

Stealing Fanon’s thunder for over half a century now Cuba has provided doctors to poor emerging nations, disaster areas and areas in rebellion (Angola, Mozambique). Nobody in the western media asked directly how Cuba earned the money to finance this assistance. Moreover, due to the U.S. economic embargo of Cuba, the humanitarian side of Castro’s foreign policy received little coverage in the western press. As Cuban “doctor diplomacy” evolved it was ignored by the US media, which went on to illuminate the humanitarian work of Nobel winner Mother Theresa, and aspiring Nobel Prize candidates like rockstars Bono and Sting and the good work of Hollywood superstars and their cause related marketing exploits like Angelina Jolie.

Few Americans or Europeans realize that Cuba operates the Latin American School of Medicine (ELAM), one of the world’s largest, with more than 12,000 students from over 50 nations.  Effectively medical training is open to students from around the world. Thanks to the efforts of U.S. Representative Charles Rangel  and former Secretary of State Colin Powell, and others, US students can attend and receive scholarships, circumventing the convoluted politics of the U.S. Trade Embargo.

Now, Cuba appears to be earning more money annually through the outsourcing of for-profit health care, coaches and sports trainers and educators than it is from tourism, cigars and nickel.

Compared with one of the world’s largest outsourcing companies, Paris-based data giant Capgemeni and its 10 billion Euros annual earnings, Servimed is 60 percent the size of the French firm. But with Servimed employing around 40,000 Cuban doctors and professionals word-wide, it would take a hundred Servimeds to end shortage of 3 million doctors being publicized by the WHO. One wonders if the war to provide health care for all is a war of attrition.

 

How Did Servimed Get So Big So Fast?

It has a lot to do with Cuba’s relationship with Venezuela. Cuba provides health care infrastructure, educators and other skilled personnel to Venezuela. Some medical helpers were active in the oil rich nation during the corrupt administration of Carlos Andres Perez, before Hugo Chavez came to power. For everything Cuba does to promote the Bolivarian Revolution and the infrastructure to keep it stable, and that’s a lot, Caracas “pays” Havana 100,000 barrels of oil each day.

 

Such is the largess of the Bolivarian Revolution and the cult of personality that developed around its leader Venezuelan president Hugo Chavez. Using $100 as the price for a barrel of crude, that equals $300 million each month. Extend that out to 12 months and Cuba receives $3.6 billion each year from Venezuela. More than half the $6 billion amount Agence France Presse, El Universal in Colombia and other mainstream sources claim Cuba “earns” exporting health care and other infrastructure services.   

 

The Revolution and Human Capital Hook Up

Albert Einstein is alleged to have said “if the data don’t fit the theory, change the data.”

Launched by the government of Cuban president Raul Castro in 2011, the state owned Empresa Comercializadora de Servicios Médicos de Cuba S.A. “Servimed” wraps services like public health, sports training and education into a single organization and markets them world-wide. Effectively, the nations who can afford to pay cover the costs of the poor countries who can’t, a theme that harkens back to the ideas that emerged from the Cuban revolution. Under these rules, Venezuela is a “payer.”

Cuba has over 82,000 doctors, giving it a ratio of one doctor to every 137 inhabitants. Doctors who work in Cuba’s free public health system earn less than the equivalent of $50 a month. Thus, there is an incentive to work abroad and earn more money in the scheme operated by Servimed.  Brazil pays Cuban doctors around the equivalent of $4500 each month, with most of that sum repatriated to Cuba where it is held in escrow and the doctor or technician is compensated by the government on the completion of his or her assignment.

But while official Cuban publications praise the mega-project as a continuation of the revolution, Servimed also employs management processes in alignment with the “human capital” model that operates under rigid conditions that detach individualism from the process and seeks to add value to services by harnessing labor directly to the economic enterprise.

In this context, the Servimed bureaucrats have created a hybrid, aligning human capital with the evolving model of Cuban-style communism.  Cuban doctors are contracted to work in situations that would be considered “whistle blower” opportunities for American or European personnel. But they are instructed to say nothing to the media and usually live in dormitory conditions isolated from the general public. Doctors and other medical personnel are not allowed to bring their families with them; they remain back in Cuba.

 

Saudi Arabia and Qatar, Wild Cards In The Game

A generation ago the Saudi royals were heavily involved in funding the Iran-Contra project which attempted to eliminate Cuban-style revolutionary movements and proponents of Roman Catholic “liberation theology doctrines”, in El Salvador, Guatemala, Honduras and Nicaragua.

Today the house of Saud and their rivals, the ruling Al-Thani family of neighboring Qatar,who have ruled their nation longer than the House of Saud has ruled what is now known as Saudi Arabia, are welcoming Cuban doctors and technicians, and building new hospitals dedicated to them. Many of the Cuban doctors working in these and other Arabic speaking nations are fluent in Arabic.

Already acting independently of some of the diplomatic objectives voiced by the United States and Russia in Syria, Saudi Arabia and Qatar back Islamist groups who seek a footprint in the Venezuela dominated ALBA trade bloc, which includes Venezuela, Ecuador, Bolivia, Cuba, Nicaragua, Antigua and Barbuda, Dominica, St Vincent and the Grenadines and St Lucia. Trinidad and Tobago, just off the coast of Venezuela, has oil and an Islamist presence and is not an ALBA member.

This, and the fact that the Maduro legacy government in Caracas is providing a media platform for Iran in Latin America is already drawing the attention of the U.S.-Israel lobby affectionately referred to by some U.S. media as “J Street.”   

 

Cuba Without Venezuelan Oil, The Bolivarian Revolution On Borrowed Time?

While Cuba continues its decade long client relationship with China Russia is seeking to renegotiate debts and develop trade relationships with Havana looking to the future. But the future is clouded by the $3 billion oil subsidy Caracas continues to provide the Castro regime and the political-psychological situation inside Venezuela and the Maduro legacy regime itself. Add to that the inevitable succession issues that will play out when Raul and Fidel Castro leave the house and you’ve got rolling instability throughout Latin America and the Caribbean.

A cut off of three billion dollars annually would be destabilizing to Cuba, much as the cut off of assistance from Moscow was with the end of the Soviet Union.

Opinions voiced by bloggers and commentators on the Valdai Club blog view the future relationship between Russia and Venezuela with extreme circumspection, suggesting that the Maduro government will remain in power for just a “few more years. The relationship, between Moscow and the Chavez regime in Carcas was based on military cooperation, and experts of all stripes agree agree that the Venezuelan market for Russian defense exports has dried up.

In an essay published here at RIAC, Zbigniew Iwanoski, Head of the Current Political Situation at the Institute for Latin America of the Russian Academy of Sciences was even more circumspect over the future of Venezuela, suggesting that it is “split apart.”  He voiced his concern with the political and economic situation of ALBA members Ecuador and Bolivia, and the quality of leadership of both nations.

 

The Meltdown In Maracaibo

U.S. media has been buzzing up the paranoid scenarios voiced by Venezuelan president Maduro. His references to groups led by old Iran-Contra hawks Otto Juan Reich and Roger Noriega seeking to destabilize his regime. Maduro, switching out the Chavista red sweater for a colorful warm up jacket and showing up with a goon squad at a leading toilet paper factory to enforce price controls in the name of the people. Cancelling a speech at the United Nations due to dark forces organizing a plot to assassinate him.

If Washington-backed contender Henrique Capriles Radonski assumes power in a free election or a brokered transition there will be tremendous pressure on him to cut off the annual $3 billion oil “payment” Caracas provides to Cuba.  Should this happen, more than soft power diplomacy will be required by the United States, and Russia (since Venezuela is a client of Moscow) and to some extent China (due to Havana being its client for a decade) to stabilize the transitions in both nations. This could mean Washington lifting its embargo to provide food, oil and other items to Cuba. In spite of the embargo the United States remains one of Cuba’s top ten food suppliers. And the world needs the more than 40,000 Cuban doctors and medical professionals working around the world.

According to the UN World Health Organization, the United States will have a shortage of 52,000 primary care doctors and nurses by 2025. Will the United States be a client of Servimed in 2025?