Fidel Worth Millions?

Castro's Medical Mercenaries
While clinics crumble at home, bereft Cuban doctors are dispatched on Castro's goodwill missions. But their purpose, it turns out, is more than just charity care.

By Susan Kitchens | Nov 14, 2005 | 3143 words, 0 images

While clinics crumble at home, bereft Cuban doctors are dispatched on El Jefe's goodwill missions. But their purpose, it turns out, is more than just charity care.

At 4 A.N., hours before a pink sun would climb above the hills near Harare, Zimbabwe's capital, Leonel Córdova was jerked awake. "Get up! Get up, now!" screamed the figure bursting through the door. Córdova, a doctor from Cuba, sat up on the couch. A policeman from the brutish African state, muscles bulging under his jacket and khaki-colored trousers, towered over the medic, pointing a gun barrel in his face. Córdova could hardly breathe. There was at least one other cop in the small, dark room now, with a gun trained on another Cuban, a dentist named Noris Peña.

The two Cubans had committed a potential act of treason: Though promised to faltering Zimbabwe on behalf of the Cuban government, they had left the mission days earlier, escaping to a local's home. That morning, with the door flung open in the predawn chill, Peña shivered in her T shirt and shorts. Her heart pounded as the cops steadied their guns and then motioned for the two to get into a waiting jeep. "I felt like we were going to die," she recalls, five years later.

Córdova, 36, and Peña, 30, are two of at least 60,000 Cubans who have, for decades, been dispatched as part of what Fidel Castro terms his "humanitarian medical missions." Of late this effort has grown more pointed, with new medical degrees being churned out and ever more doctors, nurses and dentists dispatched abroad--even as the state of care in Cuba itself deteriorates. What is El Jefe up to?

Few of the médicos see as much drama as Córdova and Peña did. Most quietly complete multiyear stints, sometimes in remote regions, in dozens of countries in Africa, Latin America and parts of Asia. They then return home, many times to even more poorly equipped hospitals and clinics in Cuba.

But a disturbing picture emerges from the ranks of those who, like Córdova and Peña, never go back. These two "deserters," as Cuba labels them, ultimately managed to slip to freedom, joining perhaps hundreds of others who've taken refuge in Canada, the U.S. or Europe. Most don't want to be located or identified, preferring not to bring further trouble onto themselves or family still in Cuba. FORBES interviewed nine.

Castro dispatched his first medical brigade to Algeria in 1963 and has since boasted that in spite of a U.S. trade embargo Cuba managed to provide these trained missionaries to the world. He delighted in offering 1,500 doctors to help America deal with Hurricane Katrina. (Washington said it didn't need the help.)

The Cuban missions have multiple aims. At some level, certainly in the minds of the medics themselves, this is humanitarianism. It is also a chance to practice their field with resources absent at home.

But for the Castro regime there are geopolitical and financial objectives. Shipping out the doctors bolsters support for Cuba in international circles such as the United Nations, where it faces periodic human-rights censure. And extending social services to the poor assists ideologically aligned despots like Robert Mugabe of Zimbabwe and Hugo Chávez of Venezuela, which has the largest Cuban contingent, some 22,000 at last count.

Physicians have been diverted to presidential palaces in the cases of the ailing, 81-year-old Mugabe and onetime Sandinista boss Daniel Ortega of Nicaragua, according to Alcibiades Hidalgo, a ranking Cuban government official who defected to the U.S. in 2002. Saddam Hussein was treated for a spinal tumor by at least one Cuban surgeon while ruling Iraq, Hidalgo has written.

And then there's the money: Castro's doctors help to keep the Cuban regime equipped with hard currency. While a number of the destination countries are destitute, others make cash or in-kind payments to Cuba, and Castro maintains a firm grip on such inflow, say those who study Cuba's economy.

Doctors exiled from Cuba say that in exchange for their mission work they earned a third or less of what Havana got for their services from foreign governments. The balance may amount to hundreds of millions of dollars for the state till, perhaps destined for handling by foreign banks.

At their clinics for the dirt poor abroad, these medical emissaries get a further shock: They see drugs in use that are manufactured in Cuba--such as ones to treat asthma or heart disease--but are unavailable at home. "People I knew in Cuba needed these medications," says one doctor who recently fled a mission in Venezuela and wouldn't talk on the record. ("Deserter" families still in Cuba are routinely punished, losing apartments or jobs, for example. To retain such leverage, the government prefers not to send unmarried doctors.)

Aside from tourism and nickel Cuba has little to offer the rest of the world in exchange for cash. What Castro lacks in salable goods he can make up for with Cuba's highly literate population of 11 million, especially those in medicine. In the last five years enrollment in Cuban medical, dental and nursing schools has more than doubled to 50,000, according to Cuban state statistics.

Outside of the schooling achievement most promises of Castro's 1959 revolución , including good health care for all, have been shunted aside. "At first I believed in the revolución and everything it stood for," says one Cuban doctor, Alejandro Ramos, 62, who when younger went on a medical mission to Angola. "But when things begin falling apart, you start to see there is no hope, no future, if you stay in Cuba. You become desperate to find a life for yourself and your family." Years later, in 1994, he escaped to Miami by boat with his family. Now a nurse at Coral Gables Hospital, Ramos is part of a group that assists doctors who've fled. (At his age he elected not to obtain certification here as an M.D.)