Cuba nurses East Timor to health and gives Australia a medical lesson
- Submitted by: manso
- Editorial Articles
- 07 / 23 / 2011
July 23, 2011.What do Hugo Chavez, the President of Venezuela, and Richard Marles, the parliamentary secretary for Pacific island affairs in the Gillard government, have in common?
Answer: both are visiting Havana, Cuba, at the moment for reasons of a medical nature.
The leader of the Bolivarian revolution is getting follow-up cancer treatment in a Cuban hospital, courtesy of his friend and guiding light, Fidel Castro.
Julia Gillard's junior minister is there to talk about linking up the health assistance programs of Cuba and Australia in the small countries of our region, including East Timor and the Pacific island states.
There is a considerable irony here. Older readers will recall that preventing "another Cuba" popping up in the middle of south-east Asia was cited in 1975 as a reason Australia and its allies tacitly supported the Indonesian annexation of the abandoned Portuguese colony of East Timor.
At the time, Cuba was actively supporting armed communist movements elsewhere in Latin America and in several African countries, notably the former Portuguese colony of Angola, and East Timor came under control of the Fretilin movement.
Fretilin was indeed imbued with the liberation ideology of the times, its leaders getting around in jungle green uniforms, giving the clenched fist salute, and talking about sending out brigades of its cadres to transform the countryside.
Thanks in part to the interventions of those well-known revolutionaries John Howard and Alexander Downer, East Timor became independent from Indonesian rule in May 2002 with a new government run by Fretilin, and a military-fatigues-wearing former guerrilla leader with a beard, Jose Xanana Gusmao, as president.
About nine months later, Gusmao got talking to Castro at a non-aligned nations meeting in Kuala Lumpur. Hearing about the new nation's appalling social indicators (life expectancy, infant mortality etc) and gathering population explosion, Castro immediately offered "a thousand doctors".
This has turned out to be no empty promise. Cuba has built up its medical "brigade" in East Timor to 278 Cuban doctors, some in the central hospital in the capital, Dili, but most in the 12 districts where they are deployed at sub-district clinics.
In addition, the first of about 700 Timorese sent to medical schools in Cuba under scholarships provided by Havana graduated last year, after six years of study, and also have been sent out to local medical units. A further 150 Timorese have been studying in the faculty of medicine set up with Cuban assistance at the National University in Dili in December 2005.
It has become the biggest Cuban health assistance program outside Latin America. East Timor has never had an intensity of medical services across its population like this, and the example has been copied by the Solomon Islands and Kiribati, which also have sent medical students to Cuba.
Doctors are Cuba's best-known exports, along with cigars and rum. This is a money earner with larger, resource-rich partners such as Venezuela and Bolivia. In places like Timor, students are trained free, and meagre home salaries kept up for the Cuban doctors assigned abroad (with local governments providing a monthly allowance of $US150 [$139] to $US200, plus board and lodgings).
On the face of it, Fidel Castro seems to have done a miraculous thing: delinking the medical profession from the goal of making large amounts of money.
At the same time, Cuba itself has improved some of its social indicators to a better level than those in the United States.
Compared with other Third World countries with good universities like India and South Africa, it has a relatively small brain drain of trained medicos and nurses to rich countries.
Cuba is losing only about 2 per cent of its doctors a year to migration, and that is not for lack of opportunity to escape. About 28,000 of its 70,000 doctors are assigned or working abroad. Its medical qualifications are recognised in the United States and many other countries - it even has about 100 Americans studying in Cuban medical schools, which are much better respected than the various "Caribbean" schools favoured by some Americans who can't get into US medical colleges.
For a country like East Timor, the particular attraction of the Cuban assistance is not just the provision of large numbers of low-wage doctors. The Cubans come and work under the local health department, not in separate clinics reporting to a foreign aid agency. The foreign expertise is a holding operation until the local personnel are trained up over six years to replace them.
Western government aid agencies such as Australia's AusAid are often criticised for setting up expensive systems that fall apart when the foreign experts are withdrawn. Indeed our whole aid program is under fire for essentially awarding large contracts to Australian-based consultants, often former aid officials themselves, who know how to process the huge amount of paperwork and compliance detail the system generates.
Our investment in human talent is quite meagre: about 20 scholarships for East Timorese, compared with the hundreds from Cuba (admittedly on very lean individual costs).
Tim Anderson, a lecturer in political economy at Sydney University, suggests the answer is co-ordinating our programs with those of Cuba, rather than ignoring them or trying to compete. Marles seems to have joined the revolution. Viva Gillard!