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Does Cuba Hold the Cure for America’s Doctor Shortage?

by Mark Hay

June 9, 2015
Illustration by Tom Eichacker

Ever since Barack Obama and Raúl Castro announced their intention to normalize relations between America and Cuba last December, the world has been abuzz with speculation as to what the long-awaited opening will bring the two nations. American businessmen and officials have already launched trade delegations to the island, exploring new import-export markets and avenues for development. But besides all the chatter about American tractor exports and Cuban cigar imports, one of the most exciting new deals has been a plan by a Buffalo, New York-based biotech firm to import, test, and distribute a Cuban lung cancer vaccine, Cimavax. Already widely used in countries with better economic relations to Havana, the drug (which is far cheaper and less toxic than chemotherapy) seems capable of extending the lives of critical patients by four to six months, buying them some much needed time.

The excitement over Cimavax is just the beginning of Cuba’s potential in the biomedical field. Thanks to its long isolation from major medical markets and intense poverty, the island nation has long prioritized innovation and technology. They currently hold about 1,200 international medical patents and market their goods to over 50 nations—Cuba is especially well known for its top-notch meningitis and hepatitis B vaccines, anti-tumor drugs, wound-healing accelerants, ulcer treatments, and cheap, non-invasive brain mapping procedures (used to treat patients in rural, poor clinics without access to bulky and expensive MRI machines). Imagine the potential of Cuban medical innovation, the popular narrative runs, when it gets an infusion of American cash and access to U.S. research facilities.

Yet while much hype has been focused on biomedical collaboration, there’s actually something far more basic, vital, and immediate that Cuba can offer the U.S. medical market. They have the power to potentially solve America’s chronic and growing doctor shortage, as they just happen to have a surplus of exactly the kind of doctors the United States needs, working in conditions similar to our most underserved and economically disadvantaged regions.

As of March 2015, an association of North American medical schools predicted that within a decade America would suffer from a deficit of 46,100 to 90,000 physicians. That’s actually better than their 2010 projection of a 130,600-doctor shortage by 2025, but it’s still a fairly grim assessment. This shortage already affects and will increasingly hurt poor and rural communities, where there’s not just a lack of specialists but also a lack of primary care physicians. Primary care doctors make up about a third of the US medical shortfall predictions, and are necessary to provide preventative treatment and offer regular check-ups to chronically ill or elderly patients. And as we’ve come to understand in the healthcare debates of recent years, failing to provide early and regular medical attention in such communities can have cascading effects of illness, poverty, and medical costs for already overburdened locales.

Not everyone’s convinced of these gloomy shortfall predictions. Some argue that in terms of raw numbers, America has enough doctors to provide for the entire nation. But in truth, most of the excess doctors are clustered around the major cities where these physicians did their medical training. And many of them specialize in fields that are more lucrative than general care. As of now, we have no incentive system or enforcement mechanism to get doctors to equally distribute their expertise to match the needs of the wider public, overriding their self-interest as wage earners and consumers. The arguments of those who believe the issue can be solved with the current crop of US medical practitioners seem to revolve around a near-talismanic belief in the power of theoretical future “innovation”—a die-hard conviction that doesn’t offer specifics or much hope to those lacking the same faith.

A Cuban medical team in Haiti. Image by peoplesworld via Flickr

Meanwhile, just 90 miles south of Key West, across the Florida Straits, Cuba has an abundance of physicians, thanks to Fidel Castro’s strong convictions in the value of developing his nation’s medical capacities. While Cuba had just 750 doctors in the 1960s, thanks to a disproportionate subsequent allocation of state cash to good, free, and universal healthcare, the island now has tens of thousands of doctors with clinics in just about every community. That amounts to up to double the number of physicians per capita than in America, and a far better distribution of medical knowledge. The island’s supply of doctors helps to contribute to Cuban life expectancy (which is tied with the U.S.) and low infant mortality rates (which are better than those in the U.S.) despite their lack of cash and supplies.

Cuba has achieved this success—they’ve been hailed by the World Health Organization as a global medical model—thanks to a reversal of the priorities seen in American’s medical system. Because of a lack of funding for specialized care, Cuba focuses on developing comprehensive, world-class training in preventative and primary care medicine. And as Cuban doctors will usually wind up working in low-income areas, they are trained to work with limited resource and in slum conditions, often with patients who may be reluctant or unable to leave their homes or seek help.

Cuban doctors are quite used to working abroad as well, as the state long ago realized that its well-trained excess medical personnel could be used as an asset to build diplomatic soft power and generate much-needed income for the state. As far back as 1963, revolutionary leader Ernesto “Che” Guevara took 50 doctors with him to the newly independent Algeria as a sign of Cuba’s solidarity with post-colonial nations. In the following years, they managed to strike deals to provide nations like Brazil, Ethiopia, and Venezuela with thousands of doctors in exchange for agricultural aid, cash, and oil, respectively—and even offered to train doctors from the developing world at their facilities for a nominal fee.

Insignia for ELAM (Latin American School of Medicine) in Cuba, which might be the biggest medical school in the world.

Between 1963 and 2013, it’s estimated that upwards of 140,000 Cuban doctors have worked in over 60 nations, treating over 100 million patients and performing millions of life-saving operations. As of 2014, they were training thousands of doctors in over 120 nations. By 2006, this global medical action was netting the Cuban state billions of dollars a year, composing up to a quarter of the state’s earnings and thus comprising its primary export and economic resource. And throughout the 2000s, they’ve also usually been some of the first, most numerous, and most effective boots on the ground in natural disaster zones (they were actually the ones staffing American medical facilities in Ebola-stricken Liberia in late 2014, for instance). To put it simply, Cuban doctors know how to work effectively in the worst conditions all over the earth.

Yet in the past, despite half-hearted exemptions for medical services, our embargo has prevented America from taking advantage of Cuba’s medical expertise. In 2005, for instance, Cuba had 1,600 primary care physicians boning up on the epidemiology of Louisiana and Mississippi, their English language skills, and the proper medical response to hurricane situations, ready to deploy to the hardest hit and most desperate regions struck by Katrina. But the George W. Bush administration waved them off, saying that the Cuban government should offer its people freedom before they offered Americans aid, a decision that now seems more than a little foolish.

In fact, instead of using medicine as an olive branch, like Richard Nixon did with the USSR in the 1970s, the Bush administration adopted the Cuban Medical Professional Parole program, facilitating the defection of Cuban doctors working overseas. To date, this policy has poached over 10,000 doctors from Cuba in a pretty underhanded way. This move demonstrates an American desire for Cuban medical expertise, but a lack of willingness to seek those resources in an aboveboard fashion.

But now that this hostility is slowly sloughing away with the normalization of relations between the United States and Cuba, there’s a chance that we could welcome in thousands if not tens of thousands of Cuban doctors. These doctors can be distributed across America’s most underserved communities, helping to provide the primary and preventative care we so desperately need. Their experience working in cautious, low-income, low-resource environments would make them apt choices for aiding the communities that suffer the most in the United States. Hardliners will oppose such a plan, saying that this will just net new income for the Cuban state and prolong a hated regime. But the ship of that argument has well sailed now, thanks to the wider business collaborations in the works. Plus, if Cuban doctors are already netting billions for their government, there’s no reason America shouldn’t start to benefit from their medical excess. They could probably fill almost exactly the numbers of primary care physicians we need in this country, if the right kind of deal were negotiated. So the potential cooperation seems like a no-brainer, if not almost outright providential.

Professor Peter A. Muennig of Columbia University’s Mailman School of Public Health put it rather simply and elegantly back in December 2014, when he wrote the following to Fox News:

“There is a surplus of medical personnel in Cuba and a shortage in the US. This will therefore be hugely beneficial to both countries.”

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Does Cuba Hold the Cure for America’s Doctor Shortage?