How Cuban medical education helped Pacific countries face the challenge of the pandemic
With the COVID-19 pandemic spreading health systems around the world, countries in the Pacific have taken advantage of their relative isolation to avoid the worst. Border closures and other measures have slowed and stopped the spread of the virus to the point where some countries have done so recorded no case at all.
However, even where the virus has not spread, the implementation of screening, quarantine and mass vaccination programs has already limited health systems stretched. Where community transmission has occurred, as in Fiji and Papua New Guinea, it has put a strain on national health systems.
The good news is that these small countries have been more resilient than they could have been otherwise due to a dramatic increase in the number of doctors employed in the Pacific over the past decade.
In some countries this has seen a double or more doctor numbers. For example, from 2012 to 2019, the number of doctors in Kiribati from 18 to 51. Remarkable increases were also recorded in Solomon Islands (79 to 170), Tonga (44 to 80), Vanuatu (27 to 67) and Tuvalu (7 to 27).
Where these doctors come from may surprise you. Most are recent graduates of the Latin American School of Medicine (ELAM) in Cuba. Over the past decade, more than 250 Pacific students have traveled to Cuba, learned Spanish, and completed six years of medical training with full scholarships from the Cuban government.
Solidarity and compassion
Cuba has a long history of international medical cooperation, and Cuban doctors have served in over 150 countries. In the Pacific, approximately 50 Cuban doctors have served in Nauru, Kiribati and Vanuatu since 2006.
But Cuba also acknowledged that having foreign doctors to staff health systems indefinitely is unsustainable, and that “the ideal provider is a well-trained, local health professional”.
The goal of ELAM is therefore to train students from low-income and medically underfunded communities who will serve their country. Training doctors is an act of solidarity and compassion based on Cuba’s commitment to health as a human right.
Read more: Pacific nations grapple with horrific COVID toll and desperate need for vaccines
Although the program began long before the COVID-19 pandemic, its impact on health system resilience and crisis response has been crucial. Without qualified professionals as the first line of defense, there can be no health security or pandemic response.
Cuban medicine and medical training also emphasizes prevention, public health and community care. It is a model designed for low resource environments, well suited to Pacific needs. As one Cuban-trained graduate from Tuvalu said:
Doctors trained in Cuba have a sense of preventive medicine […] I think our best contribution in health services would be to apply what we learned in Cuba and adapt it to our health system in Tuvalu.
As a result of this pandemic, our resources have become even more limited than before. Thus, prevention and good health promotion would be the main objectives to be achieved in order to limit the use of already scarce resources.
At the same time, the return of these graduates and their integration into local practice has not always been smooth. Their initial integration was threatened by the lack of places in medical internship programs in the region. These had to be quickly created or extended to the Solomon Islands, Vanuatu and Kiribati.
Although they have demonstrated good basic medical knowledge and a solid foundation in preventive health, many Cuban graduates have badly in their entrance exams for internship training.
Read more: Cuban Compassion: Training Doctors for a Time-Running Pacific Island Nation
In part, however, the problems were result of differences between the health systems and needs of Cuba and the Pacific. Numerous diseases prevalent in the Pacific were eradicated in Cuba, which also has a much higher rate doctor / population ratio and therefore more defined professional roles within the health sector. As one medical trainer noted:
Trainees trained in Cuba said that in Cuba you would never take your own blood samples […] You wouldn’t interpret x-rays. You would have a lot of other people to do it for you. So, they would never learn any of these skills. But they wanted it. They were so eager to learn.
Support frontline workers
Transition course and the successful training of trainees helped to overcome these differences. Concerns eased as graduates found jobs, with some also undertaking postgraduate training in Fiji, New Zealand and elsewhere.
Cuba’s direct contribution to the Pacific has slowed due to the pandemic and changes in regional governments, with only one Cuban doctor still in the region (in Kiribati).
Read more: By sending doctors to Italy, Cuba continues its long campaign of medical diplomacy
Corn a virtual meeting last year between Cuban experts and representatives of seven Pacific countries discussed regional responses to the pandemic. Cuba also offered post-pandemic support to Nauru and Palau, and remains open to cooperation with other Pacific countries.
However, it is safe to say that many countries in the Pacific have been able to respond well to the challenges of COVID-19 thanks to past help from Cuba. In particular, the strong sense of service, community and solidarity inherent in Cuban medical education has supported and motivated Pacific health workers on the front lines.
Thanks to Dr Helen Leslie and Assoc. Professor Robert Huish for their advice and support at the start of this research, and to Cristine Werle for her master’s thesis work in Kiribati.