Cuba’s ambassador to the U.S., José Cabanas, speaks during end-the-blockade event in Washington. (Bill Hackwell)

My wife and I recently spent a week in Washington, D.C., advocating for an end to the failed, 56-years-and-counting U.S. blockade of Cuba. We were with a group that included American, Canadian, and European activists, a renowned Cuban pediatric oncologist, a North American representative of Cuba’s main people-to-people friendship organization, the head of a Cuban youth group, and five bright young American doctors who’d been trained at Cuba’s famed Latin American School of Medicine and were now beginning their own careers back in the United States.

We visited Congressional offices and attended a series of public events at D.C. universities, churches, libraries, and community centres to raise awareness of the blockade and its impact.

Our focus this year was on health care. We talked about how the blockade affects citizens in both countries. Cuba can’t buy critically important medicines, for example, because the blockade means U.S. companies, including their foreign subsidiaries, can’t sell them to Cuba. At the same time, Americans can’t get access to innovative and proven Cuban-developed, life-saving, life-altering drugs — including ones for diabetes and lung cancer — because the blockade blocks them from being imported into the U.S.

Given that Americans are currently embroiled in their own ongoing, bizarre-to-a-Canadian debate over the future of health care — Obamacare/repeal Obamacare/repeal and replace Obamacare/Bernie Sanders plan/Lindsey Graham’s non-plan… you know the drill — we also spent some time talking about Cuba’s very different approach to the health of its citizens.

What does any of that have to do with Nova Scotia?

I’m coming to that.

At the time of its 1959 revolution, most of Cuba’s 6,000 doctors were concentrated in Havana, and half of them decamped to Miami after Fidel Castro assumed power. There was just one medical school and one rural community hospital for the entire country. Rural infant mortality stood at 100 per 1,000 live births, and Cuba scored abysmally on most accepted population health measurements.

Today, despite the fact it is still one of the poorer countries in the world, Cubans enjoy health outcomes as good as — and often better — than far richer countries that spend far more per capita on health. Cuba has a lower infant mortality rate than the U.S. Cuba was the first country in the world to eliminate polio and measles; it boasts the lowest rate of AIDS in the Americas and was the first country in the world to end mother-to-baby HIV.

That’s in part because Cuba — for practical as well as political reasons — decided to focus on lower-cost, better-outcome preventive medicine instead of on expensive, technology-driven, after-the-fact disease treatment.

Every one of  Cuba’s nearly 80,000 doctors, even specialists, must train first in family medicine. There’s one doctor for every 170 Cubans (compared to one for every 470 in Canada), and the majority of them are family docs who live in the neighbourhoods where they practise, so they know their patients and their problems, social as well as medical. They even make house calls!

But Cuba has done far more than — to paraphrase Donald Trump’s nationalist cant — put Cuba first. Cuban doctors go where they’re needed — from Africa to help with Ebola outbreaks, to Haiti after earthquakes, to, well, anywhere hit by hurricanes. Earlier this month, even as Hurricane Irma was barreling on their own country, 750 Cuban doctors left the island to help out neighbouring nations trying to recover from the same hurricane. Cuba, in fact, sends more doctors to assist in developing countries than the entire G8 combined. Noted former U.N. secretary general Ban Ki-Moon: Cuban doctors “are always the first to arrive and the last to leave.” There are currently 45,000 Cuban medical personnel serving in 60 countries.

But perhaps the best example of Cuba’s medical internationalism is the Latin American School of Medicine (ELAM) — which I like to think of as Fidel Castro’s gift to the world.

After a series of hurricanes devastated Central America and the Caribbean in 1998, killing 11,000 people, Cuba — as it always did — immediately dispatched its medical brigades to help out. But Castro quickly realized citizens in those countries, who already had limited access to even everyday medical care, needed far more than disaster relief.

So in 1999 he turned a suburban Havana naval academy into a medical school — imagine that! — to train Latin American students from those hardest-hit countries to become doctors and then return to their own countries to practise in under-served communities. Significantly, Cuba did not even have diplomatic relations with these countries at the time, but saving lives trumped diplomacy.

That was the beginning. ELAM soon expanded to include students from poor communities around the world. It is now the largest medical school in the world, with 19,000 students enrolled. The school has graduated 26,000 doctors from more than 100 countries.

Even more incredible, those students don’t have to pay tuition or living expenses during their six to seven years of medical education, meaning they graduate debt free and therefore able to do the kind of people-focused medicine Cuba teaches. Their only obligation to the Cuban government is a “moral contract” to return to their own communities to practise.

All of which was bound to raise the question one puzzled Maryland woman asked during one of our last meetings. “How is it that Cuba, which is such a poor country, can afford to do all of this?”

One of the Cuban guests, the first secretary of a provincial communist youth union, answered with a long and thoughtful lesson on Cuban history. I won’t try to capture it here, but its essence could be boiled down to one word: priorities. Even before the triumph of the revolution, Fidel Castro understood Cuba’s future depended on improving the health — and education — of its citizens. After he assumed power, those became the country’s economic and social priorities for the last 58 years.

Think about that for a moment.

And then think about this.

Here in Nova Scotia, our health authority says 27,757 Nova Scotians are currently on a waiting list for a family doctor. Statistics Canada says 91,800 Nova Scotians — about 10 per cent of the population — don’t have a regular health-care provider. Despite those realities, the provincial health department last year under-spent its budget by $27.6 million.


So Stephen McNeil’s Liberal government could brag that it had recorded a $150-million budget surplus for 2016-17.

It really is all about priorities.

During the time I was in Washington, new census data was released showing Nova Scotia has — still — the worst rate of child and youth poverty in the country. Quebec, which boasts a significantly lower rate of child poverty than Nova Scotia despite the fact it has lower median household incomes, provides for universal childcare for its citizens.

Asked about that, our provincial community services minister, Kelly Regan, responded: “Of course that would be something we’d love to do but at this time it’s just simply not feasible.”

A $150-million surplus and universal childcare is not “feasible”?

That’s because childcare — like health care, like education — is not our government’s priority. We would rather brag about our budget surplus.

You have to have your priorities.

Stephen Kimber is an award-winning writer, editor, broadcaster, and educator. A journalist for more than 50 years whose work has appeared in most Canadian newspapers and magazines, he is the author of...

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  1. I wish there was a way I could share this article with “family” and friends in Cuba. Been going there for 25 years and am still friends with Cubans we met that first year and with whom we have visited in their homes and communities. Many have family members who are doctors, dentists, nurses who work in their community and have also gone abroad many times. Many of our friends who work in “tourism” are “professionals” in many fields — music, engineering, teachers, mechanics, electricians, farmers.
    Through the years we have learned what it is we can readily access and bring or mail to them — items banned by the U.S. Helms Burton Act — but non-prescription meds. Things like Tylenol, aspirin, children’s vitamins, insect repellent, pet meds, etc.
    I also think about Sherritt International that has been operating in Cuba for over 20 years — mining, resorts, agriculture. This Canadian company’s directors and executives are prohibited from doing business or even travelling in the United States. That’s freedom, eh?

  2. Not authoritarianism. Different values in a Communist economic system. It’s what the Castros and Guevara dreamed of. Things like universal quality health care, education and community engagement are really important and equally rewarding for Cubans. Remember that Batista fled to his big brother America with $400,000,000 of Cuba’s money in 1959. The US tried really hard over the last 60 years to make the Cuban communist system fail by imposing trade embargoes with itself, and other free market countries. The US did not want a proximal socialist society to appear affluent or successful. That would have threatened America’s own free market for profit design. In spite of this, the Cubans pulled together to make ends meet , work their own resources and leave no Cuban in need.They don’t live in monster homes with marble counter-top and two new trendy vehicles in the driveway. Most of them would probably prefer a family evening out with live music and dancing to an evening alone in front of a big screen TV while glancing at their coveted new ipod 7. It’s a different culture that has a different definition of “enough” than we do in North America. This is why they have better social infrastructure. We North Americans, however, are indoctrinated with material greed from the time we can speak. Material wealth in our society is the indicator of success in our lives.We couldn’t possibly lose a tax loophole or pay more in taxes so others may benefit.We have lived in so much excess the entire planet is dying ( and I’m sure Cuba is loving us for the severe weather lately) but still we can’t possibly reduce our waste or support carbon taxes. Cuba has something special that we can never achieve here because our core values are radically different. Or maybe they are just more intelligent.

      1. Nick: Provide a reference for “does not allow its citizens to leave the country”.

        Whenever I see people saying things like this, I tend to assume that they have no idea how the rest of the world works. Cubans require visas to enter many countries. Many countries refuse or restrict the issuance of said visas. Please explain exactly what you mean by this.

        Canada is somewhat more enlightened, and daily provides visitor visas for Cubans, who come to participate in academic conferences and to visit friends or family. Here in Nova Scotia we receive biannually groups of music students who come on a youth exchange with the fabulous Los Primos project. Here in Mexico, I see Cubans all the time – we have a doctoral student in our programme; there are music teachers working throughout the country.

        1. The trip advisor forum on who can leave Cuba (or how to invite a Cuban friend) is enlightening and appears to confirm that it’s not just a Canadian fear of claiming refugee status but also a Cuban fear of allowing those who might not come back, the chance to leave. I don’t doubt many qualify as unlikely to abandon their lives in Cuba and are permitted to leave.

      2. I can’t legally visit Cuba — not because of Cuba, but because of the U.S. I actually do see this as walking on my freedom.

    1. The revolution did succeed in many ways but failed in many others. They do lead a monastic lifestyle, which turns out to be better for the environment. While that may be admirable or even ideal, it seems archaic to force it on a people. If Cubans decide that’s their preference I congratulate them but so far no one lets them speak. They have tremendous opportunity with their healthy, educated population- to leapfrog many nations. Without new leadership they will remain a (magical) preserve of wasted potential. With the wrong new leadership (ie maduro) their progress will have been for naught. Why wouldn’t the Castros reach out to a country like Canada to see about negotiations to end the embargo? Because they do not want to relinquish total control of Cuba. It’s a great scapegoat. Our values are the same as Cubans, many of us happily give half our earnings to the government to share with others. What Cubans do not have and should not be denied is freedom.

      1. “They do lead a monastic lifestyle, which turns out to be better for the environment”

        The good news is, you’re allowed to do that in Canada, although it’s of course discouraged and there are regulatory and infrastructure issues. Share a bachelor apartment with a roommate (alternatively your partner and possibly kids), eat mostly rice and beans, shop at value village, walk everywhere and you can approximate the developing world lifestyle pretty closely. It’s colder here, but hey, there’s lots of poor people in the ‘stans, Russia and the FSU who do it, not to mention people on reserves in the north. Of course, for some reason almost nobody actually does it unless they have to.

        OFC people in the developing world have community, which basically nobody has in Canada.

        1. Carbon credits/taxes if applied appropriately could reward such martyrdom when carried out willingly in the developed world…

  3. Perhaps this article should be taken off the paywall so that our beloved leader McNeil can read it.

    I’m sure a subscription to the Examiner would put the budget out of whack and he probably has many sources of information more closely aligned to his own ideological bent – AIMS, Chambers of Commerce newsletter, etc.

  4. Thank you for highlighting Cuba’s health accomplishments. What the have achieved really is revolutionary. It’s hard to fathom the sheer number of physicians per capita they have on that island. Imagine is there were 5 times as many doctors in NS as there are currently. We’d certainly all be making house calls! There are definitely lessons to be learned. The average age for starting medical school at Dal is 25. No one would be starting to practice family medicine before age 31 with 150-250k$ in student debt. In Cuba they’re probably starting to practice by age 25-26 with no debt but a lifetime at 30$ a month. The Cuban doctors aiding in emergencies abroad is excellent PR but the Cuban government is known to contract them out to foreign nations making a tidy profit on the difference. There is another word for that… In any event there are many lessons to be learned but the #Cubadecide movement is worthy of as much attention as the #cubavsbloqueo side. There is really no reason they shouldn’t allow democratic change on that island. As you mention, they’re healthy and literate, all they’re lacking is freedom – to trade and to choose.

    1. Cuba is definitely one of the most humanely-run authoritarian states – but yeah, a young(ish?) doctor making $150,000 a year in Nova Scotia makes 100 times as much after-tax income as a doctor in Cuba.

      1. It only works in Cuba because it’s an authoritarian state where no one can leave. They’re fed, housed, taught, cared for but all at the whim of the ruler. They have achieved so much but they won’t trust their own population with freedom. I really think Canada should play a strong role in transitioning them to the 21st century. We too have socialist tendencies without all the Florida/Castro baggage. We’re the Americans’ largest trading partner so I’m sure they wouldn’t object if we eased the transition. A merging of our two health care systems would provide Canada with more physicians and an insured warm weather destination for retirement. We can help Cuba preserve their socialized medicine/education while entering the free market.

        1. You might want to do a bit of contemporary research to better inform your cold-war era comments. “no one can leave”? Jeepers! I wonder who all those Cuban imposters are who I see at conferences in Canada and Mexico, where I work. I wonder if my Cuban friends who are posting photos of themselves in front of the Eiffel Tower, or Big Ben, or Teotihuacán are really just state propaganda agents pounding away at computers in the Ministry of Security’s basement? And what about all those Cubans on the flight I took from Havana to Mexico City a few years ago? Lifelike mannequins? :-O

          “Freedom” is in the eye of the beholder. The Cubans who have been in my life for over 20 years are free to not worry that their children will be abducted by kidnappers or shot in the street in a conflict between narcos and federales, as it is here in Mexico. Cuban parents never need to worry about whether they can afford to see a doctor (though due to the U.S, embargo, they do often worry whether the government pharmacies can secure medicines via third countries). Saving tens of thousands of dollars for a university education? Something else Cubans don’t need to worry over.

          And if you want to talk democracy, there’s a lot to be said for a system in which the communist party is forbidden by law from supporting candidates; where candidates are proposed by and elected by the people in their own neighbourhood; where only children are needed to guard the voting booths (and proudly participate as proud defenders of their democracy); and where no corporation nor ideological political party is able to buy regulations or influence policy. The debates around government policies are interminable by Canadian standards, but it’s their system, it’s as legitimate as any other, and it’s worked for them for a very long time now. Any Cuban who ever thought that U.S.-style multiparty democracy was the pinnacle of freedom need only look at the current occupant of the White House to see just how f*****d up that system really is.

          1. I don’t think anyone would hold up the American or even antiquated Canadian system up as the ideal democratic form of government. I am not criticizing the revolution’s goals or accomplishments particularly compared to other Latin American states. What I am criticizing is the familial rule and totalitarian control over many people’s lives. This isn’t unique to Cuba. Turkey is probably the biggest disappointment globally right now for freedoms lost. And yes I realize some Cubans can travel. I have no doubt select individuals are free to leave under specific circumstances. Thousands still flee the socialist utopia on rafts every year. You could argue this is a result of the American embargo or their wet foot dry foot program, or even not disproportionate to the region. Perhaps their tolerance for dissent had improved as el Sexto was freed and Rosa Maria Paya travels abroad. It seems Raul is more lenient than his brother. I think we can learn many things from Cuba and I think the embargo should end. With few concessions I think Canada could facilitate those negotiations or even force an end to it. What I would like to see is freedom of the press and for them to decide their own form of government. If it is as ideal as you describe I’m not sure what the ruling power has to fear.

  5. 100 years ago in North America doctors were middle class workers – they made okay money but there were better things to do if you were a socially mobile middle class man and wanted to make money. Today, the average salary for a doctor in Canada is $225,000. To add enough doctors at that pay grade to get to 1 doctor per 170 Canadians would cost 27 billion dollars, which is 150% of the defence budget or half the education budget. Of course a lot of the money would come back as taxes.

    It’s hard to find information about Cuba that isn’t ideologically bent towards or against communism, but one way Cuba got their infant mortality numbers down is abortion of fetuses who were not likely to do well. Given the circumstances I don’t think that this was unreasonable – but the numbers aren’t as great if abortions are included.

    Authoritarian regimes often get stuff done really well – for instance, Putin has made Russia nearly self-sufficient in food for the first time in decades – making it the only large developed country to be self sufficient in oil, natural gas and food (by 2023). Canada technically meets this requirement but lacks the infrastructure to supply the eastern third of the country with oil, and we also aren’t really independent of the USA – a large oil importer.