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Salud! Cuba’s Medical Diplomacy

Salud! Cuba’s Medical Diplomacy

Medical diplomacy; doctors for export; altruism; humanism; or plain old politics; whatever you want to call it, Cuba’s massive international health program helps the bottom billion. These are the world’s poorest and most desperate, to whom a little prevention, basic interventions, or vaccines can mean the difference between life and death.

Unfortunately, millions of the bottom billion don’t have access to even basic care. In many cases, there’s simply no one to administer it, aggravating a worldwide crisis that is reaching disastrous proportions. According to the World Health Organization, the global shortage of doctors, nurses, and midwives is a critical 2.4 million. The causes are sinister: brain drain, death, AIDS, and crumbling health systems among them.

Enter Cuba’s with its Herculean effort – 30,000 health professionals volunteering in over 60 poor countries and 20,000 doctors from the Third World slated to graduate form the island’s medical school by 2015. How can such a small, poor, and isolated country do it?

The new feature-length documentary film ¡Salud! tackles the complicated subject. The sticky wicket of global health was new territory for Academy Award-nominated Director Connie Field (Rosie the Riveter; Freedom on My Mind), who traipsed through Venezuela’s barrios, the Mosquito Coast of Honduras, rural Gambia, South African townships, and of course, Cuba, to capture the ¡Salud! story. Luckily Field had formidable backup in Co-Producer Gail Reed, a Havana-based health journalist with decades of Cuba experience, and Vicente Franco, a crackerjack cinematographer and director, best known for his work on the Academy Award-nominated documentary Daughter from Denang, which won the Sundance Film Festival Grand Jury Prize.

There is nothing pedantic about this film. Rather, Field and company sit back, letting viewers experience the Cuban program through heartfelt stories told by the patients and doctors throughout the different countries. And therein lies its brilliance.

There’s Luisito’s mom, a young mother from Cuba’s most rural reaches confronting her young son’s second operation for a congenital heart defect. Nest it’s on to Gambia, where Dr Joel Marzo is reduced to tears describing what it’s like to have a child die in his arms – something he never experienced at home, where under 5 mortality is 7 per 1,000 live births.

Meanwhile, in Venezuela, spitfire Vanessa Hernández inspires with her decision to become a doctor: one day her son becomes entangled in a live cable and gets electrocuted outside her house built into a Caracas hillside. She scoops him up and runs down and out of the slum. She doesn’t stop until she gets to the hospital 40 minutes later, only to confront doctors content to let the poor kid languish in the emergency room. She insists and persists and they finally attend to him, reviving his stopped heart. The doctor’s diagnosis? ‘You’re a bad mother.’ Her son recovered, but it was an unforgettable day. When Vanessa learned the Cuban doctors working in the barrios were recruiting for medical school, she signed up and hasn’t looked back since.

But ¡Salud! touches on the dark side of Cuban cooperation as well. Dr Rolando Ortíz talks emotionally about the very real danger of contracting HIV as head of the Cuban medical team in Lusikisiki South Africa, while compatriot Dr Nancy Suárez in Gambia explains how she feels being so far from her daughter as she blossoms into a young woman.

There are Cuban officials discussing the desertion rate (2% overall, which is absurdly low considering there are 30,000 Cubans serving abroad with about as many temptations), juxtaposed against a Cuban doctor who jumped ship in South Africa and now lives in a McMansion in a Johannesburg suburb. The film also shows local health care providers who are fuming at Cuban doctors who provide free care in some of the most remote regions of their countries, as they readily admit that they wouldn’t serve in those areas even if you paid them a king’s ransom.

Then there’s Dr Aleida Guevara (yes, daughter of Che), explaining why (and how) her team keeps a 40-year-old X-ray machine working. Director Connie Field says this was an amazing revelation for her: “The electro-medicine specialty is brilliant and so quintessentially Cuban – to develop an entire academic discipline, electrical engineering in medical equipment, to fix what’s broken but not obsolete. It’s born from scarcity, but now Cubans are all over the developing world bringing medical equipment back to life and teaching others how to do it too. I love it.”

Cuban ingenuity and spunk run throughout ¡Salud! and are among the most inspiring characteristics of the whole program for co-Producer Gail Reed. “There’s a Cuban saying: ‘no es fácil’ (‘it’s not easy’). But there’s also another Cuban saying: ‘no hay problema’ (‘no problem’). I heard both frequently during filming. And that really sums it up. These people are doing something incredibly difficult, making unbelievable personal sacrifices, but they approach it with such good humor…I suppose because they feel like they’re making a difference, but also because that’s just the way Cubans are.”

¡Salud! is full of such opinions, coming from patients, health authorities, co-workers, and community leaders in the countries featured. Even US health experts weigh in on Cuban biotechnology, the proven results of the country’s prevention-based strategy, and the quality of the medical education. Indeed, nine new doctors from poor, underserved US communities have already graduated from Cuba’s Latin American Medical School and are back home preparing to enter practice.

Look for them, and ¡Salud! showings, in a neighborhood near you. November 2009

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