The Success of Cuba Medical Internationalism

Finding solutions to Liberia and the Mano River Union Nations Health Care Delivery Systems

By James B. Jaddah, Sr.

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Liberia our beloved country located on the West Coast of Africa is considered to have the worst health care delivery system in the Mano River Nations and the entire West African Region. Liberia, after 170 years of our sovereignty we are considered to have the worst health care delivery system with the doctor to patient ratio of 1 medical doctor to the population of 86,000 by the time of the Ebola pandemic in Liberia. Liberia and the Mano River Nations were greatly devastated from the outbreak of the Ebola virus. Liberia was mostly affected by the Ebola virus outbreak than any of the four Mano River Union Nations at which time more than five thousand Liberians lost their lives in less than one year. This is a clear indication that Liberia has the worst health care delivery system in the Mano River Union Nations and within the entire West African Region.

Now let’s look at the patients to a doctor’s Ratio within the Mano Rivers Union Nations and the West African Region. According to the World Health Organization (WHO) analysis of the basic health care metric doctor to patient’s ratio, the key in helping identify the most vulnerable West African states to ongoing Ebola outbreak; unsurprisingly Liberia and Sierra Leone, which have remained the epicenters of the pandemic, have the worst patients to doctor ratio in West Africa. Liberia has a ratio of about 86,000 patients to 1 medical doctor and Sierra Leone has about 45,000 patients per 1 medical doctor. Now let’s look at the patients to doctor’s ratio in the entire region.

Country-Total Numbers of doctors -- total population -- Doctors Patient Ratio population per doctor                                                                                      

Liberia	51 doctors	4.4 million people	86,000 persons per doctor
Sierra Leone	136 doctors	6.2 million people	45, 000 persons per doctor
Burkina Fasso	713 doctors	24.3 million people	24,000 persons per doctor
Togo	349 doctors	7 million people	20,000 persons per doctor
Benin	542 doctors	10 million people	18,000 persons per doctor
Senegal	741 doctors	12.8 million people	17,274 persons per doctor
Cameron	1,346 doctors	20 million people	15,000 persons per doctor
Guinea Bissau	124 doctors	1.75 million people	14,113 persons per doctor
Mali	1,291 doctors	15.7 million people	12,000 persons per doctor
Ghana	2,325 doctors	27 million people	11,634 persons per doctor
Guinea	940 doctors	10.6 million people	11,277 persons per doctor
Gambia	175 doctors	1.8 million people	10,723 persons per doctor
Cote D’Ivoire	2,746 doctors	23.2 million people	8,449 persons per doctor
Nigeria	58,363 doctors	168 million people	2,879 persons per doctor
South Africa	39,541 doctors	54 million people	1,320 persons per doctor

Source: Un/WHO Damina Advisors.

The purpose of this project is intended to urgently propose to the Government of Liberia and the Mano River Union Nations the most and cost-effective way to help improve our health care delivery system which is the worst in the region is to urgently begin to negotiate with the Government of the Republic of Cuba immediately to initiate a scholarship program for the education of our medical students in their country. Cuba has the largest medical institutions in the world with over 19,000 medical students from 103 nations around the world.  Liberia and the Mano River Union Nations to begin negotiating with the Cuban Embassies in the region with the possibility of eventually signing an agreement to follow the path taken by other developing nations, including Africa. Many of these nations have had their medical students trained in Cuba as the result of the Cuban’s program of Medical internationalism. This partnership, when established, would help to boast up and develop our health care systems before we encounter another eruption of the pandemic of the Ebola virus or any other communicable disease that may devastate our communities.

For example, such agreement with the Cuban government could be for Cuba to send doctors and other medical personnel to Liberia and the Mano River Union Nations to help improve the health care delivery system, which could save about thousands of lives annually.  The Cuban doctors upon arrival in Liberia could be dispatched and assigned in our rural communities while the medical students are undergoing their studies. Gradually, these Cuban doctors will be replaced as the medical students complete their studies. Medical education in Cuba is free including room and board. The Liberian government will only provide stipends for the medical students while undergoing six years period of studies, which may cost the government not more than 5 to 10 percent of the national budget. Liberia could emulate the government of the Republic of Ghana and other African Nations that have succeeded in training their medical students in Cuba, to help improve their poor health care delivery system. Liberia too could benefit to help improve the health system in the entire West African region.

Now let’s take look at the Cuban Health Care medical internationalism.

History of Cuba’s Medical Internationalism around the World

Preceding the 1959 Cuban Revolution, the number of doctors per thousand of the population ranked above Britain, France, and the Netherlands. Yet there were inequalities because most Cuban doctors were based in the prosperous cities, while citizens of the towns saw few doctors. Health care services deteriorated because of the mass exodus of Cuban due to the United States embargo against Cuba as the result, there was an increase in infant mortality.

The urgent needs for better health care services prompted the new government to embark upon the idea of a universal health care delivery system. Based on an essay, “On Revolutionary Medicine” written by Che Guevara, a physician who was one of the architects of the Cuban Revolution in 1960; came up with a program plan which will provide public health services for a greater number of the population. The intended goal of the program was preventive health services. The entire population was taught to practice basic hygiene, like handwashing; before the new government enshrined its belief within the Cuba National constitution, it launched the medical internationalism. To be precise, it was done in 1963. Cuban medical internationalism began sending medical personnel overseas, particularly to Latin America, Africa, etc. By 2007 Cuba had 42,000 workers in international collaborations in 103 different countries of whom more than 30,000 were health personnel including, no fewer than 19,000 physicians. Cuba provides more medical personnel to developing nations than all G8 countries combined; this comparison does not consider what G8 development spent on developing nations’ health care. More important, the Cuban missions have had substantial positive impact on the population it served. It is widely believed medical workers are Cuba’s most important export commodity.

Cuba Medical Humanitarianism around the world   

The Cuban Government driven by their foreign policy and humanitarian objectives dispatched Cuban doctors who worked alongside other local and foreign doctors to achieve their goals. For example, in 1972 and 1990 Cuba dispatched emergency assistance teams to Chile, Nicaragua, and Iran following the earthquakes. Similarly, in the wake of the December 1999 mudslides in Vargas State, Venezuela, which killed 20,000, Cuban government sent medical emergency assistance.

In Honduras, the medical personnel had a substantial impact. In the areas they served, infant mortality rates were reduced from 38.8 to 10.1 per 1000 live birth and maternal mortality rates from 48.1 to 22.4 per 1000 live births between 1998 and 2003. However, the idea of a nation saving lives and improving the human condition is alien to the traditional statecraft and is therefore discounted as a rationale for the Cuban approached. In 2004 the 1700 medical personnel in Guatemala received the order of the Quetzal, the country highest state honor. In the year 2000 an attempt by Honduras to expel the Cuban mission on the basis that it was threating Honduras jobs was successfully resisted by the trade union and community organizations.

The success of Cuban Doctors in Ghana

In 2013 the government of Ghana invited about 350 Cuban medical doctors in the country to support the national health care under a medical service and educational agreement between Cuban and Ghana. The Cuban doctors according to Ghana Ministry of Health were not to be paid salaries but rather receive monthly allowances and free accommodation during their stay in the country. As per the Ghanaian Ministry of Health, the Cuban doctors worked in the rural areas where typical Ghanaian doctors will not accept the assignment. Medical assistance from Cuba formed part of the efforts by the Ghana government to enhance the doctor patient’s ratio and accordingly improve on accessibility to health care delivery. In 2013 there were 2,843 doctors for the population of over 25 million, giving a ratio of one medical doctor to 10,000 patients a situation which affected the delivery of quality healthcare. On the training of Ghanaian doctors in Cuba, medical students are selected from deprived districts and communities, would be made to serve in their respective areas after graduation from medical school. The government of Cuba and Ghana signed a partnership agreement few years ago; that agreement allowed Ghanaian doctors to be trained in Cuba while Cuban would come to Ghana to offer health care services. Cuban doctors who were currently in Ghana worked mostly in public hospitals. For almost 20 years Cuban doctors had been working in Ghana to support the efforts of the government to improve the health care delivery system. So far as of 2014, Cuba had trained more than 1,100 Ghanaian doctors in different fields of medicine. When it comes to health care, it is the government responsibility to provide and improve the nation’s health care delivery system.

South African Medical Students in Cuba and Cuban doctors In South Africa

South Africa has a high-profile program which involved training of medical students in Cuba; it is part of an urgent national drive to increase the number of doctors produced. Meanwhile, the government of South Africa is also pushing for the national Universities to boost the number of homegrown medical graduates. South Africa’s high-profile program involved the training of medical students in Cuba which is part of an urgent national drive to increase the number of doctors being produced to augment the shortage of doctors in the country. One of the main draw cards the Cuban system use is placing emphasis on primary health care and prevention in the country with a large rural population like in most African countries. According to the South Africa Ministry of Health, South Africa’s eight medical schools produced roughly 1,200 doctors annually. Since the occurrence of HIV/AIDS together with the loss of qualified doctors to developed countries has exacerbated the shortage of Physicians in the country. The 2010 World Health Organization statistics identified South Africa’s doctor to patient ratio at eight medical doctors for every 10,000 people, which is much better than most African countries.

Since the inception of South Africa and the Cuba Health cooperation agreement in the mid-1990s which selects students from the rural areas to study for six years in Cuba and return to South Africa to take an assignment in the rural areas have made a tremendous impact in health care service delivery in the rural areas. Since 2010 nearly 246 graduates have been produced specially for South Africa Public health sector, another 388 are in the pipeline and will be graduating soon and more are still undergoing studies.

Let’s look at the Cuban Medical institutions the largest in the world

In 1999 the Cuban government established the Escuela Latino Americana de Medicine (ELAM) in Spanish and in English Latin America School of Medicine (LASM) formerly the Latin America School of Medical Sciences. This is the major international medical school in Cuba and a prominent part of Cuban health care system. ELAM is operated by the Cuban government and considered the largest medical school in the world by enrollment with about 19,550 students from 110 countries including the USA reported to enroll in 2013. All those enrolled are international students from outside Cuba and mainly Latin America, the Caribbean as well as Africa and Asia. The school accepts students from the United States, 107 enrolled in 2007. Tuition accommodation and board are free, and a small stipend is provided for the student by the Cuban government.

The mission of ELAM is to make competent and cooperative doctors with the degree of MD (Doctor of Medicine) the same degree that is offered to medical schools’ graduates all over the Americas. The educational commission officially recognizes the Latin America School of Medicine for Foreign Medical Graduates (ECFMG); this includes the World Health Organization. It is fully accredited by the Medical Board of the state of California which has the strictest US standard; it means that qualified US graduates of the Latin America School of Medicine are eligible to apply for residency placement in the state of California and the entire USA.

Admission to the Cuban Medical institutions

The Cuban government offered new students annual entry to the Latin America School of Medicine. The application is processed through the accredited Cuban diplomatic missions in the student’s home country. It is necessary to contact the Cuban Embassy or Cuban interest section to request for accurate information. The application process has been designed especially for young people from economically disadvantaged families or communities.

Scholarship Program

The scholarship program includes full tuition, dormitory housing, three meals per day at the campus cafeteria, textbooks in Spanish for all courses, school uniform, basic toiletries, bedding and small monthly stipend of 100 Cuban pesos, the scholarship does not include travel expenses to and from school which is not necessary in the first three years out of the six years as all classes during those years are walking distance from the dorms, the scholarship also does not include travel to and from Cuba.
Conclusion and Recommendations
I would like to recommend to the government of Liberia and the Mano River Union Nations to urgently begin negotiating with the Cuban Embassies in their respective nations for scholarship agreement from the Cuban government for our medical students to be trained in Cuba. This is the only cost-effective way to help boast and develop our health care delivery system. The government of Liberia, the incoming government should take advantage of this opportunity by immediately initiating the negotiation process with the Cuban government for a scholarship for at least 250 Liberian medical students to study in Cuba for six years, and after which another batch of 250 medical students will replace the first graduates. This relationship could be established with the Cuban government for the period of 12 years, at the end of which, Liberia would have trained about 500 five hundred medical doctors. Part of the diplomatic and humanitarian agreement should include bringing in about 200 Cuban Medical doctors to Liberia to help with capacity building that will improve the needed health care delivery system to the masses of the Liberian people.  

I will suggest for the government of Liberia and the Ministry of Health to consider relocating the A.M. Diglottic College of Medicine to Fendell Campus from the present location at the Catholic Hospital Campus. The Fendell location has adequate infrastructure, which includes dormitories, better classrooms, well-modernized laboratory with high-speed internet services. This would help boast and increase the number of medical students and graduates annually. The Liberia government should also annex the Tubman National Institute of Medical Arts (TNIMA) to the University of Liberia. Students who intend to enroll at the TNIMA should be recruited from the University of Liberia and other universities who have completed at least 60 credits in Liberal Arts and Natural Sciences. Students that are enrolled at TNIMA would complete the balance 68 credits in the various disciplines such as Nursing, Medical Laboratory Technology, Physician Assistant, Radiology and Environmental Health will be awarded a BS degree. In addition to TNIMA, the government should also consider the possibility of investing in the community colleges around the country to help establish paramedical departments such as Nursing and Medical Laboratory Technology to be taught on the associate degree level. 

For the continued improvement of our medical facilities and institutions, the government should recruit retired A.M. Diglottic College of Medicine medical personnel and others from the Southeast Asian Nations like the Philippine’s India, Pakistan, Bangladesh, Srilanka and China to serve as instructors at our universities and medical specialist at our healthcare institutions. Also, the government should promote the establishment of the school of midwifery and Nursing Assistant training program in all the 15 Counties to help contribute towards capacity building on the local levels.

Finally, I honestly believe that with the establishment of the diplomatic partnership with the Cuban government to help train our medical doctors, the relocation of the University of Liberia Medical School to Fendell with the construction of new infrastructure to accommodate and boast the number of our medical school graduates with improving other paramedical institutions around the nation and the recruitment of retired medical specialists to work in our healthcare institutions will help to improve the quality of our healthcare delivery system and save many lives.

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About The Author: Mr. James B. Jaddah, Sr. has BS & MS degrees in Health Services Administration. Diploma Physician Assistant, TNIMA, JFK Medical Center; former Director of Liberia Drug Enforcement Administration, Ministry of Justice, Liberia; he can be contacted at: jamesjaddah@aol.com