Doctors With Borders: Caribbean Countries Angry After US Threatens Cuba’s Physician-For-Hire Scheme

For decades, Cuba has been exporting doctors to heal the sick and fill in gaps in healthcare around the world, often in rural and remote communities.  

But now its version of “doctors without borders” is coming under threat from the United States – which is increasing pressure on Caribbean countries to eliminate the program because it sees it as “human trafficking.”  

Caribbean leaders have reacted with outrage.  

“I will be the first to tell you that we could not have gotten through the (Covid) pandemic without the Cuban nurses and the Cuban doctors,” the prime minister of Barbados, Mia Mottley, told parliament, visibly angry. “I will also be the first to tell you that we paid them the same (salary) that we pay Bajans, and that the notion, as was peddled not just by this government in the US, but also by the previous government, that we were involved in human trafficking by engaging with the Cuban nurses, was fully repudiated and rejected by us.” 

Since its 1959 revolution, Cuba has exported health professionals to wealthy nations like Italy and poorer ones in Africa and the Caribbean.  

Currently, Cuba has about 24,000 doctors working in 56 nations, including about 1,500 in the Caribbean, filling in where local communities don’t have enough medical professionals and helping to contain outbreaks of diseases such as Ebola.  

Proponents of the program say that Cuban doctors receive excellent medical training, help communities, and stay in them for long periods, even years.  

“Their presence here is of importance to our health care system,” said Jamaican Foreign Minister Kamina Johnson Smith, adding that the island has more than 400 Cuban doctors, nurses, and other medical staff who have filled a gap left by emigrating Jamaican health workers.  

Critics, including the Trump administration, say the program is promoting “forced labor”: They accuse Cuba of confiscating most of the revenue the doctors and nurses earn and holding their families back home hostage to ensure the doctors don’t defect. Some also contend that the medical care received by host communities is sometimes substandard.  

Others accuse the doctors of being spies. 

Now, the US is threatening to sanction countries that participate in the program with restrictions on visas for their leaders and repercussions on trade. 

Cuba’s ambassador to Saint Vincent and the Grenadines, Carlos Ernesto Rodríguez Etcheverry, called the move “shameful,” as the loss of Cuban health workers would deprive millions of people around the world of care. 

“We really reject the idea that Cuban doctors and nurses are slaves and that the Cuban government is involved in any trafficking issue with regard to our medical brigades,” he said. “That’s because we respect our doctors, our nurses.”  

Since February, there has been a growing sense of urgency over the issue in the region. Caribbean leaders brought it up when US Secretary of State Marco Rubio visited Jamaica, Guyana, and Suriname in late March. That followed a meeting in Washington between the 15-member Caribbean trade bloc known as Caricom and the US Special Envoy for Latin America, Mauricio Claver-Carone. 

The issue, analysts say, is deeply important to Caribbean countries, which say Cuba supplies some of their top doctors and that their healthcare systems are dependent on them. They also dispute US accusations.  

In March, Trinidad and Tobago’s then-Prime Minister Keith Rowley, before being replaced by Kamla Persad-Bissessar, said those medical professionals were paid the same as local doctors and nurses. “We’re now being accused of taking part in the program where people are being exploited,” he said. “Out of the blue now, we have been called human traffickers because we hire technical people who we pay top dollar.” 

Writing in World Politics Review, James Bosworth, a fellow at the Wilson Center, says that both sides are partially correct. “It is true that well-trained Cuban doctors often provide a needed service for poor countries that otherwise struggle to afford quality medical personnel,” he wrote. “It is likewise true that Cuba abuses this program to the full extent possible, treating doctors poorly, making money off the poorly compensated doctors, and using the program for espionage while benefiting from the positive public relations image it generates.” 

“Perhaps most important, however, is the fact that these doctors are literal lifesavers,” he added. “Criticizing the negative aspects of the program is easy to do for the US, but far harder for governments whose populations’ health hangs in the balance.” 

Some Caribbean leaders, including the prime ministers of Trinidad and Tobago and of Saint  Vincent and the Grenadines, said they would keep the program in place and gladly forgo their US visas. 

“I just came back from California, and if I never go back there again in my life, I will ensure that the sovereignty of Trinidad and Tobago is … respected by all,” Rowley said in March, according to the Daily Express, a local newspaper. “We rely heavily on health care specialists whom we have obtained from India, the Philippines, and mainly from Cuba over the decades.” 

However, defying the US isn’t so simple for some countries. 

In Guyana, about 240 Cuban doctors and nurses help fill the gap for medical personnel, especially in remote areas, Kadasi Ceres of the University of Guyana told The Economist. At the same time, the small state needs American security backing to protect its oil and gas reserves off the coast of Essequibo against Venezuelan claims to them.  

Some Caribbean leaders are trying to remind the US that they preside over “sovereign countries,” which have a relationship with Cuba. “Their enemies are not our enemies,” said Antigua and Barbuda’s Prime Minister Gaston Browne. “We are friends of all, enemies of none.” 

He added that the absence of Cuban doctors would “literally dismantle our healthcare services and put our people at risk.” 

Others are trying to change the minds of US officials. Saint Vincent’s Prime Minister Ralph Gonsalves said he has provided proof to the US that Cuban health workers in the country are not victims of human trafficking. He added that it is not possible for the country to give up this program. 

“If the Cubans are not there, we may not be able to run the service,” he said, referring to critical care patients including 60 who receive dialysis treatment. “I prefer to lose my visa than to have 60 poor and working people die.”