To Fight Ebola, Cuba Is Sending Its Biggest Export - Doctors

"They were trying to get us to do the best job we could. We were told that this is very good income for the country," said a Cuban doctor we'll call Dr. Jose Suarez, describing instructions from his government as he prepared, five years ago, to leave Cuba for Venezuela. There he was to join up in his nation's most prestigious, most successful and most lucrative enterprise: its physician-export industry.

Along with his wife and children, Suarez now lives in New York, having defected to the United States in 2009. He asked that his real name and personal details not be used, fearing that family members back on the island would suffer retaliation.

Cuba's export of medical professionals has gained the Communist country much praise, including most recently from the island's neighbor and nemesis, the United States, where top officials have praised Cuba's response to the Ebola crisis in West Africa. The Cuban contingent of medical professionals sent to the epidemic's hot zone was larger than any other country's.

Suarez's story suggests a nuanced picture behind those international accolades, in which these doctors, who bravely combat diseases and treat the poor around the world, are treated as an instrument of the state.

Cuba has trained many more medical professionals per capita than any other developing or developed country. In 2010 it had 6.7 doctors for every 1,000 citizens, according to the World Bank. In the United States in the same year, there were 2.4 doctors for every 1,000 Americans. Unlike America, however, in Cuba the government alone finances medical studies, and it then controls the careers of medical professionals.

Suarez said that when he completed his studies, the government noticed that while he had graduated with honors, he was not interested in politics and never became a member of the Communist Party.

"You have to work where they tell you," he said. The young doctor was sent to Santiago de Cuba, a 12-hour bus ride away from his hometown at the center of the island. The ride is expensive, and each trip home ate away at his salary, the Cuban equivalent of $20 a month. A year later, he was lucky to be assigned to a hospital near his hometown.

Then came the offer to join Cuba's medical mission in Venezuela. It was a relatively lucrative offer, and also very hard to refuse. "They prepare you psychologically," Suarez said. "They tell you this is important for the nation, you know, blah blah blah. It all seems very benign. But if you say no, there will be retaliation. For example, if you work in a very nice hospital in the city, you will be sent back to the countryside."

And the conditions in Venezuela were much better than back home. In Venezuela Suarez was paid $150 a month, while an additional $100 a month was deposited in his name in a bank back in Cuba. "The government evaluates your performance, and if you do a good job, you get that extra money as well," he said.

That is, of course, only if you return to the island. Unlike many of his colleagues, whose travel documents were confiscated and kept by the government, he was considered low risk, so he was allowed to keep his passport. That helped when he finally defected. Now he practices internal medicine at a Brooklyn hospital.

No definitive figures have been published by Havana or Caracas about the financial arrangements between the two countries, which are much more complex than simply "doctors for cash." Without Venezuelan oil, the Cuban economy would have collapsed long ago, and besides physicians, Cuba sends to Venezuela an unknown number of security officials and other professionals.

Cuba's exportation of doctors and other professionals to other Latin American countries, including Haiti, as well as to far-off places such as Pakistan and Africa, has become a source of pride for the Caribbean country.

Last July the general director of Cuba's Ministry of Foreign Commerce and Investment, Dagmar González Grau, told Havana's Popular Assembly that 64,362 Cuban professionals were sent by the state to serve in 91 countries. Three in four of those professionals are in the health sector, González Grau said, according to Trabajadores, a state-run newspaper.

The government, she added, expects those professionals to bring in $8.2 billion in 2014. By those figures, the Cuban government could be earning as much as $6.15 billion from its exportation of doctors alone.

These proceeds far exceed any other Cuban enterprise, with tourism lagging well behind in second place. Sales of Cuban staples like cigars, rum and guayabera shirts are not even close. The sugarcane industry, the pride of the country during the Cold War (though it was heavily subsidized by the Soviet Union), is no longer profitable.

When Cuba sent 256 health workers to combat Ebola in West Africa in October, Havana was universally applauded. The World Health Organization (WHO) is "extremely grateful for the generosity of the Cuban government and these health professionals for doing their part to help us contain the worst Ebola outbreak ever known," said Margaret Chan, the WHO's director general.

"Although I did not encounter them personally, I have to commend Cuba," the American U.N. ambassador, Samantha Power, said after making a fact-finding trip to West Africa in late October. She noted that the Cuban government planned to send 200 physicians to the Ebola-stricken zone in addition to the initial group. "That is a big gap and a big need," Power said.

Maria Werlau, a former vice president at Manhattan Chase Bank and founder of the Free Society Project, a nonprofit, has researched the finances of Cuba's health system and its services-export industry. The Cuban government, she says, did well for itself by sending doctors to West Africa.

"It's brilliant," Werlau says. "They get money from it. They get attention. They make the impression that Cuba is a medical power," and as a result, the government will get a lot of future contracts to send medical and other professionals "in servitude conditions" to many other countries as well.

According to Gregory Hartl, a WHO spokesman, each doctor working in Western Africa in the fight against Ebola receives from the organization a per diem grant of $200 to $240 a day, depending on the location of service. He said that the money is deposited in a local bank in Africa so that it can be withdrawn by each physician upon presentation of a WHO-supplied approval slip.

A former health professional who still lives in Cuba and asked to remain anonymous said that she recently saw a contract that is typically presented to doctors on their way to the Ebola zone. In it, she said, a doctor is promised $1,500 a month while working in Africa, and an additional $1,500 to be deposited in a Cuban bank account, where it can be withdrawn upon return and evaluation of the work.

It is not clear whether that money comes from the per diem from the WHO—and is distributed by Cuban officials who collect it on behalf of the doctors in Africa—or is separate from the WHO money.

Cuban doctors are "sent by their government, so we do not know how that money is distributed," said a U.N. official familiar with the international efforts in Africa, who spoke on condition of anonymity, as he was not authorized to discuss the matter with the press.

"So what," said another U.N. official said. "It's just like U.N. peacekeepers. Their governments send conscripts, and they get paid for each soldier. But the troops get very little of the proceeds. Developing countries use the U.N. as a source of national income."

Attempts to reach by phone the spokesman for the Cuban mission to the U.N. were unsuccessful, and he declined to answer an emailed question about the distribution of WHO funds. But as Cuba's exportation of doctors and other professionals grows, there has been some pushback.

Ramona Matos Rodriguez, a Cuban doctor who was sent to Brazil, defected last summer and sued the Cuban government for damages. She said in a deposition that the government presented her with a contract promising a salary of $400 a month, with an additional $600 that would be deposited in a Cuban bank on the island, to be withdrawn by her later.

When she arrived in Brazil, however, Matos Rodrigues discovered that Brasilia pays an average of $4,200 a month for each of the 11,000 Cuban doctors working in Brazil. That arrangement leaves most of the money Brazil allocates for the doctors in the hands of the Cuban government.

The case became contentious, as the government defended the importation of thousands of Cuban doctors to serve in remote areas where "Austrian doctors, for example, wouldn't work," said then foreign minister Antonio Patriota. But a Brazilian union, the National Federation of Physicians, said in a statement that the arrangement resembles "slave labor," serving no one but the Cuban government.

And this month Brazil's federal prosecutor Luciana Loureiro Oliveira said that paying Cuban doctors a mere quarter of what the Cuban government collects for them is "downright illegal" under Brazilian law.

Cuban blogger Orlando Luis Pardo Lazo, who is a student at Brown University in the United States, says he believes the exportation of medical staff is having a detrimental effect on Cuba's own health care system. Lazo says last year he had to tend to his ailing mother back in Cuba. "Every time I went to a hospital in the middle of the night, I found Venezuelan doctors, Bolivian doctors, students from Latin America," Lazo said. "Where are the Cuban doctors?"

He added, "I'm not trying to make politics out of this. I would just like Cuba to help Cubans [and others] in a better way."

Follow Benny Avni on Twitter @bennyavni.