Decades ago Cuba made training and exporting medical personnel their "thing" and they ended up owning that part of the world market despite being a small and very poor country.<p>There is a direct tech analogy with Finland and cell phones.<p>From the small country PoV, if you can't compete in the strategic nuclear bomber world market, or the manufacturing robot world market, you can probably find some market segment, however small, to focus on and take over. Like cellphones, or 3rd world medical care.<p>Other countries could, and probably will, do the same.<p>There is the interesting analogy that Finland isn't doing so well in the post Nokia, iphone and android world. Wonder what could happen to Cuba if the demand for docs dried up (optimistically due to 3rd world advancing into training their own medical workers, and not by the entire 3rd world dying of ebola or in ensuing strife after the epidemic)
How interesting, just yesterday I watched a TED[1] talk about Cuba's ELAM (Latin American School of Medicine)[2].<p>> Established in 1999 and operated by the Cuban government, ELAM has been described as possibly being the largest medical school in the world by enrollment with approximately 19,550 students from 110 countries reported as enrolled in 2013.<p>[1] <a href="http://www.ted.com/talks/gail_reed_where_to_train_the_world_s_doctors_cuba" rel="nofollow">http://www.ted.com/talks/gail_reed_where_to_train_the_world_...</a><p>[2] <a href="https://en.wikipedia.org/wiki/ELAM_%28Latin_American_School_of_Medicine%29_Cuba" rel="nofollow">https://en.wikipedia.org/wiki/ELAM_%28Latin_American_School_...</a>
Off-topic, but I had the opportunity to have several cuban PhDs teach some of the final classses in college (Multi-agent systems, computer intelligence, etc) ... All of them were incredibly good in their fields, better than any other professors I had in school, and as good as some of the brightest I've met in this field.<p>There were also some docs in other disciplines and they were all incredibly good. Based on that experience I think cuba is hardly "punching far above its weight", but reflecting great care, passion and responsibility as they do in other fields... We just assume a lot of things about cuba. I sure did before.
Cuba was the world's best experiment in total communism. Unfortunately the US ruined the experiment by imposing an embargo for decades out of spite. Still, when you compare Cuba to neighboring Dominican Republic they're doing better under many measures, including health, education and a GNP per capita of $5890 vs DR's $5620.
Would these Cuban doctors be likely to escape to the US via Liberia? Normally it's illegal for them (doctors) to travel outside of the country:<p><a href="http://www.bbc.com/travel/blog/20130116-cuba-lifts-travel-restrictions" rel="nofollow">http://www.bbc.com/travel/blog/20130116-cuba-lifts-travel-re...</a><p>(edit) Apparently the US explicitly permits Cuban doctors working abroad to emigrate to the US -- in contrast with most refugees, who have to physically set foot in the country to gain asylum.<p><a href="https://en.wikipedia.org/wiki/Cuban_medical_internationalism#Defection" rel="nofollow">https://en.wikipedia.org/wiki/Cuban_medical_internationalism...</a><p><a href="http://www.state.gov/p/wha/rls/fs/2009/115414.htm" rel="nofollow">http://www.state.gov/p/wha/rls/fs/2009/115414.htm</a><p><a href="http://online.wsj.com/articles/SB10001424052970203731004576045640711118766" rel="nofollow">http://online.wsj.com/articles/SB100014240529702037310045760...</a><p><i>"...a wave of Cubans who have defected to the U.S. since 2006 under the little-known Cuban Medical Professional Parole immigration program, which allows Cuban doctors and some other health workers who are serving their government overseas to enter the U.S. immediately as refugees. Data released to The Wall Street Journal under the Freedom of Information Act shows that, through Dec. 16, 1,574 CMPP visas have been issued by U.S. consulates in 65 countries."</i>
Can we end the stupid sanctions now? The USSR is gone and we trade massively with China for F's sake. Cuba doesn't have the best human rights record on Earth, but neither does China or Saudi Arabia to give two other examples with which we trade extensively. All this does is harm the Cuban people and paradoxically actually strengthens the existing regime there.
A chronically under-recognized point is buried in the article:<p><i>It's not a simple picture. Critics have complained that Cuba has begun to sacrifice the health of its citizens at home to make money sending medical workers abroad, and the conditions for these medical workers themselves have been criticized</i>
Their contribution will save thousands of lives. Ebola is a slow moving tsunami that we, as a world, can stop. If we don't step up and contribute the needed resources, literally hundreds of thousands of people will die. The sooner the better. Hats off to Cuba, but for the rest of the world, especially countries that can contribute, this should be a wake up call.
Aside from the condescending title, we also have this, in the first sentence:<p><i>Cuba, a country of just 11 million people that still enjoys a fraught relationship with the United States</i><p>To describe Cuba's position with regard to the U.S. (entering its 6th decade of basically vindictive and pointless economic sanctions) as a "fraught relationship" is certainly an interesting circumlocution. It's kind of like saying that the skinny kid in junior high who keeps getting pushed into lockers "enjoys a fraught relationship" with his peers.
Brazil got a program that imports around 10 thousand cuban doctors. And they are nearly slaves to the cuban regime.<p>Brazil pays around 4k USD for each doctor, but he only keeps 1,2k. Everything else goes to the Castro's regime.<p>And that's because our oposition made a huge noise about that, because they used to receive about 400 USD, and the rest of the money to castro.<p>They have a good health program? Maybe. But I won't swap my freedom for that.
It is easier to create new drugs if you are not subject to strict regulations and if you are not afraid of lawsuits from people that participate in trials.<p>What slows down the research in USA is the safety mechanisms imposed by FDA. This is almost the same for every country that is not a dictatorship.<p>source: worked a decade for pharmaceutical companies.
Don't be unduly impressed. It's common for a totalitarian state to focus its resources and "punch above its weight" in a specific area or two, but it's at the expense of the rest of their economy and the general well-being of its people. Its also a common tactic used to shore up support at home and win superficial plaudits abroad.<p>The Soviets were able to keep pace with the US militarily and in space. The also had world-beating athletics, chess and classical arts (ballet, orchestra etc). All this came at the high price of individual freedom and <i>basic</i> human prosperity. Milton Friedman aptly observed this gap between "public affluence and private squalor" as the defining outcome of centralized socialism. Christopher Hitchens, at that time a committed socialist, described his disillusionment w/Cuba while volunteering there in 1968 as follows:<p><i>Cuba was torn between grim austerity for its people and flamboyant hedonism for its revolutionaries, and one’s elementary socialist principles managed to register the gross injustice of this even while hoping (perhaps) that the engine of history would make up the deficit.</i>
- <a href="http://www.city-journal.org/2008/18_2_spring_1968.html" rel="nofollow">http://www.city-journal.org/2008/18_2_spring_1968.html</a><p>It is, I guess, better that Cuba has chosen to focus on healthcare rather than war-mongering, but it doesn't recommend their method of government as preferable to our own. It doesn't recommend their hundreds (perhaps thousands) of political executions or their death squads or their forced labor camps. It doesn't recommend their complete suppression of free speech and their prosecution of Cubans wanting to <i>leave</i> this self-proclaimed "paradise".<p>And it seems quite unethical to praise Cuba for it's export of medical expertise while ignoring the fact that relatives of these experts are essentially <i>held hostage</i> to ensure they won't defect. If you don't see something <i>extremely</i> sinister and disgusting about this, I'd posit you don't have the capacity for suspicion and disgust.<p><i>.. the government "bars citizens engaged in authorized travel from taking their children with them overseas, essentially holding the children hostage to guarantee the parents' return. Given the widespread fear of forced family separation, these travel restrictions provide the Cuban government with a powerful tool for punishing defectors and silencing critics."</i>
- Human Rights Watch, <a href="http://en.wikipedia.org/wiki/Health_care_in_Cuba" rel="nofollow">http://en.wikipedia.org/wiki/Health_care_in_Cuba</a><p>I'd posit that a fair (and fairly obvious) measure of a political system is the market for voluntarily migration. The fact is that <i>almost no one</i> migrates into Cuba and millions have braved, and continue to brave, incredible costs and dangers to migrate <i>away</i> from Cuba.<p>American style democratic capitalism is not without its flaws, and we must be eternally vigilant to resist and reverse attempts by both state and corporate power to impinge on our rights & freedoms in their own selfish interests. But, unlike Cubans (and former East Germans etc), we have the political infrastructure and basic human freedom to improve our system for the better. We shouldn't sacrifice these hard earned and extremely rare circumstances in the vain hope of securing <i>marginally</i> better health outcomes (or marginally better security, chess skills, literacy rates etc) by means of totalitarian socialism.