Cuban Health Care: The Ongoing Revolution, by Don Fitz (Monthly Review Press, June 2020), affirms a view of the Cuban Revolution offered to me by C.L.R. James in 1970: While there is much to criticize, it broke the stranglehold of the Monroe Doctrine, even if just a little, and gave the region a chance to shape its own destiny—including its remarkable health care system.
Cubans adapted as best they could, by encouraging tourism from the United States and elsewhere. Health tourism also became possible, even at a time when the United States managed to cut off Cuba’s access to medical equipment and medications.
Fitz, a socialist and social psychologist from St. Louis, Missouri, learned from his daughter, Rebecca Fitz, a health care professional, that he could add technical knowledge to his own insights into Cuba history. Cuban Health Care not only tells the story of how Cuba developed universal health care, but of how it became a model for other countries in the Global South. Fitz, for example, offers a detailed account of the Cuban contributions to African health care, something even the Cuban people are only now starting to openly discuss.
The book begins with the “brain drain” flight of doctors and other professionals from Cuba, long before the bonds of neo-colonialism were officially cast off in 1959. Doctors fled the countryside for the cities during the outbreak of Yellow Fever in the second half of the nineteenth century. This created divisions between doctors who refused to see the necessity of treating disease in the rural areas and doctors who demanded better medical care for the whole population of the island.
Cuba’s revolution was, as much as anything else, a revolution in health care. Fifteen hundred doctors and nurses had been sent to rural Cuba by 1963, for the first time providing populations with preventative cures, including vaccines of various kinds.
Meanwhile, working class students in Havana were recruited into medical schools for the first time, and teaching hospitals ramped up. The sharp decline in the final pre-revolutionary years—Fulgencio Batista, the U.S.-backed dictator who was overthrown in 1959, responded to student protests by closing the University of Havana in 1957-58—was reversed, with classes resumed and expanded.
The 1961 literacy campaign marched ahead even as Batista sympathizers, lurking in the countryside, assassinated some of the most idealistic young volunteers.
As the revolution settled in for the long haul, the development of systematic preventative and curative care accelerated. Teaching advanced greatly, as did university-based research. But a stumbling block remained: the need for physicians to become a true part of their surroundings.
In other words, Cuba needed family doctors in the local neighborhoods, not just in medical centers. The charismatic Fidel Castro visited communities throughout the island, giving inspirational speeches to audiences large and small. The resulting doctor-and-nurse teams lived in the neighborhoods where they worked, seeing every patient at least twice each year.
The number of doctors that Cuba produced, including those who practiced in other countries, expanded rapidly, but never as fast as desired.
In 1963, Cuba sent a small medical brigade to Algeria. A gripping description of its activities across Africa is seen in the pages of Fitz’s book for the first time.
Each commitment, wrapped up in a specific guerrilla war, presented its own difficulties. The Congo, and Guinea-Bissau brought the deepest commitment, and the material presented by Fitz has been adapted from interviews with several military doctors. As Fitz explains, the paradigm of white doctors and Black soldiers was a crucial and inescapable fact, especially for the doctors, who had to travel and work secretly in war-torn regions.
So secret were these missions that the recruits often didn’t know where they were going. Once embedded, they often had to treat and help each other adjust to new environments.
In Angola, after the departure of the Portuguese colonial government in 1961, various factions competed against each other for power. Only the National Front for the Liberation of Angola, led by poet and doctor Agostinho Neto, had a clear view of the social transformation that was needed.
The CIA staked its claim on the rival National Union for the Total Independence of Angola, led by the charismatic but brutal Jonas Savimbi, who had worked closely with the Apartheid government of South Africa.
The end of colonialism had brought Angola’s medical system to a halt; barely a dozen doctors remained behind, for a population of 6.4 million. In 1987-88, Cuban troops played a decisive role in defeating Savimbi’s forces, but sustained terrible injuries, making the medical situation even worse. Cuban doctors also had to cope with malaria almost continually.
Fitz presents many details crucial to this story. Savimbi, backed by millions of U.S. dollars for weapons, was welcomed into the anticommunist alliance of Lane Kirkland, head of the AFL-CIO. Meanwhile, Savimbi sent his forces to bomb schools and hospitals, burn wives and children of his village opponents alive, and assassinate Cuban medical workers. Ronald Reagan, meanwhile, repeatedly emphasized to Congress the necessity of protecting Angola’s white minority.
As late as 1988, there were 55,000 Cuban troops in Angola, with the U.S. claiming that peace had become impossible until the Cubans left. They departed, knowing that too little had been done for the Angolans.
The collapse of the Eastern Bloc in the early 1990s caused Cuba great distress. The Soviet Union had pressured the Cubans to produce even more sugar, a characteristic mistake, as this one-crop export economy impeded plans for sustainable development. When the world price of sugar fell, hardship ensued.
Cubans adapted as best they could, by encouraging tourism from the United States and elsewhere. Health tourism also became possible, even at a time when the United States managed to cut off Cuba’s access to medical equipment and medications.
Astonishingly, Cubans were also able to provide free education to international students. The Latin American School of Medicine, for example, attracted students from across the world. Mixing traditional medicines with modern practice, it also invited students from the United States (Fitz’s own daughter took advantage of this program). Students lived modestly, with many items rationed. But they could rightly feel part of something larger than themselves, and certainly larger than their own medical careers.
Fitz profiles a dozen students that he met. They were courageous and determined young people from Africa, Asia, the Caribbean, and even some small Pacific islands, who joined in what they understood to be a new global approach to world health.
The very presence of these students highlights the gains of the Cuban Revolution, against almost unimaginable odds. It continues to have limitations and flaws. But it still has much to teach to those in the most overpriced health care system in the world—that is to say, ours.
The book closes with a long postscript titled “How Che Guevara Taught Cuba to Confront COVID-19.” The essay explains how the notions of a community-based health care system that served the needs of all people first inspired the legendary guerilla fighter during his 1951 motorcycle trip across South America. “Che’s imagination went from doctor to doctor,” Fitz writes. “Or perhaps many shared their own visions so widely that after 1959 Cuba brought revolutionary medicine anywhere it could.”