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¡Salud! tells the story of Cuba's medical internationalism

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Issue: 49 Section: Ideas Geography: Latin America cuba Topics: film, health, doctors

September 14, 2007

¡Salud! tells the story of Cuba's medical internationalism

Film Review

by Derrick O'Keefe

Images from the film ¡Salud!

[This article originally appeared in Seven Oaks Magazine]

Michael Moore’s Sicko, an incendiary expose of the for-profit health care system in the United States, generated some predictable backlash from right-wing pundits. More than anything else in the film, what tended to get them especially enraged was the role of Cuba in the documentary.

After comparing and contrasting the US system with health care in Canada, Britain and France, Moore delivers the coup de grace by taking a number of 9/11 rescue workers to Cuba to get treatment for work-related illnesses that the U.S. system would not cover. These scenes feature friendly Cuban medical professionals providing free, quality care to the sick 9/11 heroes so shamefully neglected by their own government. Contrary to the hysterical claims of Moore’s critics, these acts of generosity were not mere propaganda set-ups; in reality, the provision of free treatment for the 9/11 workers only scratches the surface of Cuba’s exemplary medical internationalism.

Director Connie Field’s Salud! picks up from Moore’s Sicko with a documentary that examines Cuba’s long and elaborate history of exporting the gains of socialized medicine. In addition to telling an inspiring story that has received next to no mainstream media coverage in the western world, Salud! also presents an important debate, counterposing two very different philosophies as to what it means to be a physician.

Field’s documentary begins with some of the basic history of the Cuban revolution. The dire state of health care, especially in the countryside, was a factor in bringing about a mass movement and fuelling support for the guerrilla army that toppled Batista in 1959. In the early 1960s, free health care became a right for all Cubans, and a rapid process of training new health professionals was undertaken. Within only a few years, Cuba began to send brigades of medical volunteers to allies and various needy Third World countries. The extent of Cuba’s “doctor diplomacy,” as it has been called, is truly staggering. Over the past five decades, more than 100 000 Cuban medical professionals have served abroad, often in the most remote, isolated and impoverished locations.

Salud! covers a lot of ground for a medium-length documentary, highlighting the accomplishments of Cuba’s doctors in The Gambia, South Africa, Central America, and Venezuela. To its credit, the documentary lets the story unfold primarily through the observations of the doctors and patients themselves, supplemented by some experts in the field, such as the innovative and tireless internationalist Dr. Paul Farmer.

The segments in Africa are particularly poignant. We see experienced Cuban doctors literally reduced to tears by the extreme poverty and suffering of their patients. In The Gambia, the Cubans have helped to build a basic health care system from the ground up, beginning with simple measures to reduce the scourge of malaria. In many cases, following their community health model, Cuban doctors live in small villages that have never before had the benefit of medical attention.

In South Africa, while many of the local doctors and private practitioners live like kings, the country’s health care system is stressed beyond its limits by the AIDS crisis and a lack of personnel and funding. In one scene, we see a Cuban physician who has “defected” from his compatriots’ team in South Africa. Now in private medicine, the born-again capitalist happily shows off his mansion and boasts of his new lifestyle in “a white neighbourhood”. A Cuban medical official explains that only roughly 2% of all of their internationalist physicians have left to pursue this more lucrative type of medicine. South African and other African health officials, for their part, complain of a much higher percentage of “brain drain” with their graduates, as they watch helplessly as doctors are lured by contracts from North America and Europe.

In Venezuela, too, the film demonstrates the clash of medical philosophies between the Cubans and the local physicians. When the government of Hugo Chavez initiated community health clinics in the poorest barrios, Venezuelan doctors refused to sign on, so the government called in thousands of willing Cubans to do the job. Now, for the first time, the barrios around Caracas have doctors living and working in poor communities.

The last segment of Salud! covers the incredibly ambitious efforts of Cuba to offer free medical training to students from throughout Latin America, Africa, and – believe it or not – even the United States. Some of the most delightful interviews in the film are with these young students. In two notable cases – a young man from rural Honduras and a dynamic young woman from a barrio in Caracas – the students tell of being inspired to become doctors after witnessing the selfless efforts of Cuban doctors in their communities.

The thousands of students receiving medical training in Cuba represent a real hope for developing a ‘New Doctor’ for the 21st century, not driven by a desire for money or social status, but instead motivated to serve those in need and live as an equal with those in his or her community.

Salud! is an important documentary, and not just because it deals with one of the great and almost unknown accomplishments of the Cuban revolution. The film also confronts crucial issues about our collective right to health care in a world where so many still die needless, preventable deaths because of the greed or indifference of others.

» ¡Salud!: Official Site

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