Don Fitz. Cuban Health Care: The Ongoing Revolution (Monthly Review Press, New York, 2020). 303 page, $26.
Vijay Prashad has recently written about a movement to nominate a group of Cuban doctors for a Nobel Peace Prize for their work in battling COVID-19, Ebola and other diseases on the African continent, and treating catastrophic injuries incurred from hurricanes and landslides in Central and Latin America (People’s Dispatch, August 25, 2020). Predictably, the Trump administration, along with Human Rights Watch and Trump’s small group of Latin American allies, has been pressuring the World Health Organization and the Norwegian Nobel Institute to block these front-line doctors from receiving such an honor simply, it seems, because they are representatives of the Cuban government.
The doctors are members of the Henry Reeve Brigade. This group is regularly dispatched to catastrophic hotspots by the Cuban government. The group is named after a New Yorker, Henry Reeve, who died fighting for Cuba in its First War of Independence from Spain from 1895-98.
Monthly Review Press has recently released a timely book, Cuban Health Care: The Ongoing Revolution, by Don Fitz. Fitz tells an intriguing and valiant story of a Cuban health care system that has grown largely in isolation and from humble beginnings, largely due to a brutal financial and cultural embargo imposed by the US government since 1959.
Fitz is on the editorial board of Green Social Thought, is a newsletter editor for the Green Party of St. Louis, and a frequent contributor to Monthly Review. He developed his interest in Cuban medicine after his daughter made a decision to attend medical school in Cuba. She had heard that a school in Havana was attracting students from throughout the world, and that the Cuban government was subsidizing the education of these aspiring doctors. Fitz encouraged his daughter to attend the school, also known by the acronym of ELAM (Latin American School of Medicine).
He describes his initial thoughts on medicine in Cuba as he prepared to write the book: “Delving into Cuban medicine” he writes, “led me to realize that it beautifully demonstrates how fulfilling the goals of the 1959 revolution brought forth novel institutions which, interacting with forces both inside and outside Cuban society, led to innovations that could not have been conceived prior to the revolution.”
Fitz provides a short history of how medical revolutions in Cuba helped the country become aware of the strong relationship between poverty and disease, and how training health care workers to think and act differently from their peers in wealthy countries has elevated the health status of people in poverty. The health care system that has evolved in Cuba since 1959 could not have been achieved through capitalism. In Fitz’s words, “racist and classist discrimination required confronting the contradiction that egalitarian health care could not be attained within systems that were inherited from capitalism.”
Cuban Health Care: The Ongoing Revolution, is well researched and accessible with 16 pages of notes and 30 pages of index. It is very readable to those not generally inclined to pay attention to the development of a robust innovative global health/medical system springing from a country that is not the United States. The book is worthy of use as a textbook for medical students throughout the world. Pre-med students would profit highly from digesting its contents. The message of the book is: There are small, socialist countries that know how to lead the way to better health and medical services than capitalist countries can provide.
ELAM, first formed by the Cuban government in 1999, had enrolled over 21,000 students from more than one hundred countries by 2010. Many of the students who have attended the school are from low-income families who have been tortured and otherwise brutally mistreated under Latin American and other authoritarian governments throughout the world. The mission of the school is to help students, upon graduation, to return to their countries to serve those most needy among them. Importantly, the students are taught to be listeners as well as healers during their medical educational process. Countries with large GDPs could learn from this model.
Cuban doctors, as they are assigned to countries that are suffering high rates of contagion from potentially lethal diseases such as Ebola, HIV, and COVID-19, are set apart from disaster relief teams from countries like the US. Medical teams from the US and other western countries, as a rule, live in luxury hotels and are often flown into disaster zones by helicopter. In contrast, their Cuban counterparts live alongside those most affected by the disasters. In the parlance of Dr. Paul Farmer, a US physician who has spent most of his professional career working with HIV and TB in Haiti, and who is an exception to the US disaster relief model, this is a bottom-up approach to the practice of medicine. By listening to those who serve and getting to know them on a personal basis, the Cuban medical system has created a unique medical culture that should be emulated worldwide.
Fitz uses the method of oral history to tell this story of a small country that is revolutionizing health care. This is a key to the success of the book: real life stories are told firsthand by those who provide this unique form of health, medical and disaster relief in Angola, Kenya, Honduras, Brazil, Algeria, Saint Lucia, Sierra Leone, South Africa and other countries. Importantly, Fitz interviewed many ELAM students to record stories of their own education and experiences in this innovative system.
Readers may recognize the contents of some chapters from the book. Fitz had previously published some of the chapters as articles in Monthly Review and other publications. They have been edited and updated for this volume.
While the attempted quashing of the Nobel Peace Prize nomination for the Henry Reeve Brigade may seem trivial, it is indicative of a long-term pattern of the US government: regular interference with the effective health care and disaster relief system that Cuba has built. George W. Bush rebuffed help from Cuba in August of 2005 even as the governor of Louisiana begged for additional medical personnel after Hurricane Katrina devastated the Gulf States. Fitz observes that “Bush’s silence reflected the attitudes of many wealthy Americans who would prefer to see their poor countrymen suffer and die rather than admit that Cuba had a disaster response capability superior to that of the United States.”
Based on Fitz’s superb book about how Cuban health care has evolved, support for the nomination of the members of the Henry Reeve Brigade for a Nobel Prize seems a worthy endeavor.
Allan Ainsworth
University of Utah and retired CEO of the Fourth Street Clinic
Salt Lake City, Utah
allanain@me.com
