Alberto Tico Arenas, University of Arizona, Tucson
Luis Gerena, Universidad Autónoma del Estado de Morelos, Cuernavaca
In mid-March 2020, when the devastating effects of the COVID-19 pandemic where being felt in several European countries, the transatlantic cruise ship MS Braemar—with 682 tourists, mostly British, and 381 crew members—was desperate to find a port to dock (Knobloch, 2020; Reynolds & Oppmann, 2020). After it was revealed that dozens of passengers and crew members were sick with the virus, one Caribbean nation after another shut down its ports to the ill-fated ship. The governments of Dominican Republic, Curaçao, Barbados, Bahamas, Colombia, and Jamaica refused the ship entry out of fear it would place their own populations are risk. Cuba, on the contrary, allowed the 1000-plus people to disembark at Mariel, a port west of Havana. A key question this action poses is: what allowed the Cuban government to display such solidarity when other nations refused to extend an open hand?
To answer this question, we must understand the larger historical context of Cuba’s health care. Prior to the 1959 revolution, the health care system was predominantly private with limited and low-quality public services, with an emphasis on curative as opposed to preventive care, and with an enormous imbalance in terms of access and quality between urban and rural areas (Liebowitz, 1969; Valdés, 1971; WHO, 2008). While Cuba’s urban areas enjoyed a relatively high level of health care for those who could afford it, poverty and inadequate health care were the norm in rural areas, where over 40 percent of the population lived. With the rise of the revolution, the implementation of a free and comprehensive health care system dramatically improved the health conditions for both urban but especially for rural residents. The Cuban socialist government enshrined in its national constitution that “everybody has the right to health protection and care. The State guarantees this right.” To be sure, this did not happen overnight; it took about two decades for the Cuban health care system along with other social services to eventually be heralded as one of the most efficient and advanced in the world. By the 1980s, Cuba had created a social service apparatus that led to universal health coverage, universal literacy, the eradication of many diseases, widespread access to potable water and basic sanitation, and among the lowest infant mortality rates and longest life expectancies in the region.
The centerpiece of Cuba’s health care is a system of primary care that employs both consultorios and community-based polyclinics (O’Hanlon & Harvey, 2017; WHO, 2008). Consultorios include a doctor and nurse team that work at their office and in people’s homes; polyclinics act as organizational centers with enough doctors and nurses to address the needs of up to 35,000 people per clinic. This primary care system, based on preventive care, focuses on the interrelationship between the physical, mental and social well-being of individuals and communities. It should be noted that one of Cuba’s national heroes, José Martí, a 19th century poet and philosopher who greatly influenced the Cuban revolution, defended the importance of preventive health care, when he wrote in 1883, “True medicine is not one that cures, but that prevents: Hygiene is the true medicine” (in Elizarde Gálvez et al., 2016).
It is precisely this system that allowed Cuba to take action even prior to the arrival of the first COVID case to the island. As one report indicated, “Before the first reported case, Cuba’s government dispatched teams of doctors, nurses and medical students door-to-door asking about respiratory symptoms and educating the public on the disease. It sent suspected covid-19 cases to state-run isolation centers and traced all their recent contacts” (Taylor, 2020). Evidence of Cuba’s success is viewed by its limited number of deaths due to the pandemic: by mid-August 2020, Cuba had less than 100 deaths (one of the lowest per capita in the world), whereas its colossus to the north was witnessing 165,000 deaths.
And it’s not a matter of over-romanticizing Cuba’s public health system. In part due to the U.S. embargo as well as poor socio-economic conditions in general, there is a huge lack of medicines, x-rays, and other material resources; sanitary conditions in hospitals have deteriorated; there is widespread corruption due to low salaries received by doctors; and there is a talent drain with many doctors in overseas missions staying abroad (O’Hanlon & Harvey, 2017). Despite this reality, Cuba has demonstrated true international solidarity with countries in need: there are Cuban medical brigades currently battling the pandemic in 30 different countries. Whereas wealthier and more developed countries have shut down their borders and kept their resources for their own populations, Cuba has demonstrated that, despite its own scarcity, it is possible to extend an open hand to those in need.
As coronavirus cases soar in countries around the world with no end in sight, Cuba is teaching the world a moving tribute to human solidarity. As the Cuban Ministry of Foreign Affairs stated in relation to the cruise ship MS Braemar, “These are times of solidarity, of understanding health as a human right, of strengthening international cooperation” (Knobloch, 2020). Or, as José Martí put it more succinctly in 1895, “motherland is humanity” (in Elizarde Gálvez et al., 2016). For Martí, motherland was the capacity of one nation to integrate with others without prejudices or selfishness. Motherland viewed the other as an extension of the self, as the constitution of one single, altruistic, benevolent family. Cuba has shown us that only in this way is solidarity truly effective. The search for a vaccine, which is now the mission of powerful nations, undoubtedly would offer an immediate solution and would allow societies to return to ‘normality,’ but it would not prepare us for the next pandemic. We would only be ready if, as Cuba has demonstrated, science and technology—along with parallel economic and social policies—have interests different from those that currently prevail, for which enormous damage to the environment and society has been caused, and which left most nations worldwide defenseless in the face of this catastrophe.
Tucson, Arizona and Mexico City, August 12, 2020
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Knobloch, Andreas. (2020, March 17). Cuba pone fin a la odisea del crucero MS Braemar. Deutsche Welle. https://www.dw.com/es/cuba-pone-fin-a-la-odisea-del-crucero-ms-braemar/a-52810027
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O’Hanlon, Claire E., & Harvey, Melody. (2017, October 6). Doing More with Less: Lessons from Cuba’s Health Care System. The Rand Blog. https://www.rand.org/blog/2017/10/doing-more-with-less-lessons-from-cubas-health-care.html
Reynolds, Emma, & Oppmann, Patrick. (2020, March 16). Coronavirus-hit cruise ship in diplomatic scramble to find somewhere to dock. CNN. https://www.cnn.com/travel/article/cruise-transatlantic-coronavirus-gbr-intl/index.html
Taylor, Luke. (2020, July 3). How Cuba and Uruguay are quashing coronavirus as neighbours struggle. New Scientist. https://www.newscientist.com/article/2247740-how-cuba-and-uruguay-are-quashing-coronavirus-as-neighbours-struggle/#ixzz6USpsqByB
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