When the eighth leak appeared in the dining room ceiling, you accepted the mission to go to Venezuela as a doctor.  You knew that with each month’s salary you’d never have been able to tear out the paneling and replace the worn out columns.  Also, the resale of some appliances you bought there would help pay for the cost of cement and rebar.  In Havana, your bank account would grow with the fifty convertible pesos you’d receive each month for your stay in Caracas.  Your wife ordered a laptop and your youngest son asked for Play Station.

The first months you slept badly with the sounds of gunfire coming into the small room shared with five other colleagues.  To chase away the nostalgia, you thought about your relatives’ faces when they’d learn about all the nice clothes you had gotten at a discount.  Meanwhile, the small bank account grew in Cuba, under the condition that you could enjoy it only at the end of your mission.

Someone in the group confessed one night that he was going to cross the border and take off for Miami. You listened to him with the trembling of one who can forget about the leak, the new roof, and the requested laptop, and use your savings to start a new life.  Suddenly you remembered the nurse who escaped and has never been able to get her family off the Island.  Deserters are punished with separation, marked by the impossibility of being reunited with their families.

So you spent your two years curing people and saving lives, suffering the separation, the fear and the shared housing.  With relief, you got news that your wife had started to buy the bags of cement to repair the roof.  When it was almost time for you to return, someone announced that an agreement to stay another six months could be made by signing a paper.  “No problem,” you thought, “with the extra money I’ll earn in that time, maybe I’ll have enough to repair the walls of the house.”


  1. National Geographic Magazine had an article on Cuba a few years ago. The bad economic situation of a Cuban doctor and his wife was part of the story. Poor Cuban professionals–and poor Cuban people.

    La revista National Geographic tuvo un articulo tratando de Cuba hace unos anos. La mal situacion economica de un doctor Cubano y su esposa fue parte de la historia. Pobre Cubanos professionales–y pobre gente Cubano.

  2. I understand one becomes a doctor in Cuba after only 4 years of University studies. Is that true????

  3. To: La Verdad,no that is not true.You spent 6 years,of those 2 in basic sciences specifically oriented to a medical carrer an yes 4 in aproaching to clinical sciences after that practice and the a recidency program that may vary between 3 and 4 years.

  4. Is it really that difficult to fix a roof over there? You’re too stupid to make your own clay roofs? Or make your own bricks and mortar? sad sad.

  5. In Canada and the US, many, perhaps most, medical doctors are strongly influenced in their choice of profession by its wealth-building potential.

    Because of the lengthy and costly professional training, they predominantly come from the well-to-do minority of the population, so their empathy for the poor is naturally limited. Upon graduation, almost all of them have a massive debt to pay off, which alienates them even further from the mainstream of society, and orients their thinking towards means of optimizing revenue (the same is true for dentists, and other health professionals, of course).

    When they have finally paid off their student debt, they naturally move in the same social circles as other highly paid professionals – lawyers, accountants, corporate managers, etc.. Their social contacts with the average person, including their patients, become minimal to non-existent. Their interest in the advancement of medical science, if they had any to begin with, takes a distant back seat to consolidating and advancing their financial and social status and/or pursuing their recreational interests.

    As a result, patients with ailments that are difficult to diagnose and/or to treat are often avoided or told to find another family doctor, as they become a financial liability to the medical practice.

    In some Canadian cities, it’s impossible to find a family doctor anymore. There are people who haven’t had a family physician for years, and must go to a walk-in clinic or a hospital emergency room to be seen by whoever is on duty. The result is extremely compromised care, since the attending physician has no knowledge of the medical history of the patient, and little or no personal interest in the long-term resolution of the patient’s complaints.

    In Canada, the vast majority of medical doctors stopped visiting patients in their homes decades ago. Sick people must be brought to the hospital for medical examination, if they’re too ill to visit a clinic. If they have no one to drive them there, they must call an ambulance, and pay for it.

    Many of the tasks medical doctors are unwilling to do (such as home visits) could be performed as well, or better, by nurse practitioners, but the medical associations of Canada are very successful at blocking any infringement on their professional monopoly.

    Is this the kind of health care the Cuban people want?

  6. The volunteer Cuban doctors who serve in some of the most wretched places imaginable are heroes who deserve the utmost gratitude, not back-handed insults. They earn a lot of money for the Cuban people and have helped millions receive care they would not have gotten otherwise.

    The US knows the program is having a massive success and so they devised a truly sinister program to try to sabotage it. Last year, Bush signed an order intended to lure Cuban doctors to the US with a generous offer of financial and social assistance as well as immediate US Residency. All the Cuban doctors have to do is show up at the nearest US Embassy ready to defect. What a sickening idea – stealing doctors from the poorest to score political points. It would not surprise me if Yoani supports this too.

  7. av2ts, Yoani doesn’t insult Cuban doctors practising abroad. Quite the opposite. She points out the real life dilemmas they face and the hardships they endure. And while I strongly oppose the Bush Administration’s counter-productive Cuban policy, the Castro government is by no means blameless. There’s a reason why Cuban doctors are not allowed to bring their families with them when serving overseas. As Yoani points out, “deserters” are punished by separation from their families.

  8. John Two, maybe condescend was the more correct word, not insult. She basically presents everything in the dreariest light possible, her political motive unrelenting. Fine. She is a very good propagandist. But to find blame in the program because spouses can’t accompany doctors on their short-term missions abroad is not serious. Again, these are volunteers. The program simply would not work if families had to be accommodated. The program is heroic and awe-inspiring. Literally thousands of lives have been saved from the millions of medical consultations in the most disadvantaged places. To write a piece like this, ignoring anything positive, is a deep disappointment to read. When the US drops its stomach-turning stealing of doctors and general luring of Cubans (wet foot/dry foot) I will be the first to ask Cuba to change their migration policies.

  9. av2ts said: But to find blame in the program because spouses can’t accompany doctors on their short-term missions abroad is not serious.

    Two or 2-1/2 years is NOT “short term”. Imagine you are a child asked to live without one of your parents for two or more years. You will have practically forgotten them by that time. 40,000 Cubas work in Venezuela… traded for oil… bringing in $9.2 billion a year to Cuba (See ER’s post on another entry)… if those numbers are correct… that Chavez guy is giving his buddies Fidel and Raul $230,000 a year FOR EVERY CUBAN. WOW! I wish I was worth $230,000 a year to somebody — heck, I’d take half of that! (OK… maybe some of the $9.2 B comes from other countries, but even so… what if Chavez is “only” paying $150,000 a Cuba? Well according to what I could find on the web, the salary for a doctor in Venezuela is about $600 a month… so that’s $7,200 a year… so how is this working out for Chavez? Let me see… he could have ONE Cuban doctor or SEVENTY permanent, home grown, Venezuelan doctors. No wonder communism never works out all that well for these countries. Their leaders can’t even do simple arithmetic!

  10. #5, you are FOS. My kids’ pediatrician works at an HMO. He came recommended to me. He does an excellent job with all kids and will see them anytime he can. He will email me if I ask him a question in the same format. When he goes on his yearly leave, he goes to the northern reaches of Thailand to help kids in very small, under-served villages far away from the big city of Bangkok. It’s most unfortunate that people like you spew falsehoods like that and aren’t grounded in reality. But that’s your choice. Medical practice in the US and everywhere else could be better. You have socialized medicine if you are really in Canada. You can go to a clinic any time you want. I find it funny to see you slamming this system, because this is pretty much the system found in Cuba. So you end up arguing against yourself and your own ideology in your own post. People like you make me sick. If you really believe in your crap, you should move to Cuba. I came across a manager in a public health clinic in Portland, Oregon, USA who was spouting the virtues of socialism and Cuba’s medical system. She didn’t know what she was talking about, so I invited her to get the hell out of here and move. I guess her $84k/year salary for doing a whole lot of nothing in a socialist-wannabe state like Oregon was just too much to pass up.

  11. #6, you are sick as well. The system is not working. Doctors were defecting long before any “inducement” to do so. Remember Angola? At any rate, Cuba enslaves people and consigns them to duty stations for the purpose of bringing in hard currency to los hermanos Castro. Bush’s inducement, rightly or wrongly, is designed to undermind that ability for the country to bring in hard currency using human capital. Anyone knows that just because you are certified as a doctor in X country doesn’t mean you become one here. You have to go through a lot of trouble to get a license in an American state, so please, spare us of your political BS and post something more useful to us all.

    #8, Yoani is a propagandist? I think not. She is living under the repression of the “revolution.” Where are you living? You are the propagandist and it is easy for any reasonable person here to see. You are the kind of person that will defend each and every action of this government. Perhaps you live in Cuba as well and act as a counter to Yoani. If not, then you are just another sick individual who needs some serious repression at the hands of government to cure you of your little problem.

  12. Ardra, I know it is hard to be without one’s family. It is a sacrifice for sure. Just like serving in the military. The $9.2 billion revenue earned in 2008 for services includes all tourism to Cuba ($2.7B), their pharmacutical sales abroad, all other professional services, their training of doctors on the island, as well as the Doctor program. So the idea that Venzuela is paying hundreds of thousands of dollars per doctor is not at all correct. Venezuela has a shortage of doctors, which is why Cuba is training thousands of them to replace the Cuban doctors. The trouble is that no Ven doctors want to work in the slums and rural areas. The figure of a Ven doctor making $7,200 a year is incorrect as well. The average income in Venezuela is now above $13,000 a year and I doubt doctors make nearly half that.

    11, Amazingly very few Cuban doctors have in fact defected from their missions, despite the sick “inducements.” Like I said, the inducements include a provision to get Cuban doctors accredidated more quickly than otherwise.

  13. No they don’t. Cuban doctors in the US have to go through a state certification process. A process that is not run by the feds who are otherwise running such “inducement.” you are spewing propaganda. At least we are free here to tell you to STFU. I just wish Yoani could do the same to the government and their supporters in Cuba. If you are not writing from Cuba, you are a disgrace and should strongly consider moving there.

    First, you make it sound like the inducement is stealing a lot of your doctors. Yes, I said your doctors. Then you say that very few are going. Which is it? At any rate, it appears to be in the hundreds to thousands just in a period of months…


    What’s wrong with doctors and health professionals looking out for their families and themselves? Answer: NOTHING. If everyone looked after themselves, the world would actually be a better place.

    What’s wrong with the US offering an inducement? It takes away a resource from Cuba? Yeah, a resource that has been enslaved in order to keep los hermanos Castro afloat. These people are being used as political pawns. As you say, they are very intelligent people and intelligent people may come to resent being used by a bunch of ideologue government officials. I know I would be. Like them, my preference is to tell the government to get f*****. I know, I know, you can’t stand the thought, but that’s what is so great about freedom. I can tell my government and your government to go get f***** and there isn’t a damn thing either one of them can do about it. Enjoy, coullion.

  14. # 10.patricio dice:

    “#5, you are FOS. …It’s most unfortunate that people like you spew falsehoods like that and aren’t grounded in reality.”

    what “fasehoods”? – potty language and vague accusations don’t constitute an argument.

    “…You have socialized medicine if you are really in Canada. You can go to a clinic any time you want. ”

    In Canada, any doctor and any clinic can refuse to treat you. Some years back, in the small town of Pincher Creek, Alberta, not far from my home (by Canadian standards), a woman sued her doctor for botching a medical procedure, and as a result, was refused treatment by every doctor in the town.

    I don’t know what you mean by “socialized medicine”, but what we have here is a combination of the worst aspects of bureaucratization and monopolistic exploitation. Immigrant medical specialists spend years as floor cleaners and night watchmen so that incompetent homegrown doctors can continue to abuse the public with impunity and without competition.

    Ordinary people suffer disabling, painful, and often for live-threatening conditions for months and even years waiting in line for medical procedures, while select groups and the rich jump to the head of the line.

    For the hoi polloi It can take three to six months to get a consultation with a specialist, another three months plus to set up a surgery or a diagnostic test. People die on waiting lists for heart surgery, and yet, for the privileged, the door is always open.

    BTW – in France you can still get a home visit from a medical doctor, even in Paris!


  15. otropogo, you haven’t even begun to see a potty mouth from me, but I am more than willing to dump it on you if you like. I don’t know what your angle is, but if you like it so much in Cuba, you should move there. As for Canada, I could barely give a rip. I think that country sucks as well, just not as bad as Cuba or North Korea, I suppose. You people have a real bad case of Political Correctness disease. There is no healthy debate of the issues up there as your “sensitivites” will not allow it. If you get one thing from my message, it should at least be this: not everyone marches in goose-step with your left-wing brand of politics and a lot of people, in fact, are angry about it. Either way, we don’t want that crap where I am from and I can assure you it won’t take hold here (New Orleans). Try spewing this crap down here. No one will pay any attention. Try to institute that crap down here and you will simply get your ass kicked. It is that simple. I love my freedom. The end. Have a nice day, coullion. lol

  16. @patricio: Give me a break. You have your own Castro apologists in the good old USA (including a few who like to post here – av2ts and Walter Lippmann immediately coming to mind), so please don’t use an overly broad brush to attack Canadians in general. Folks like otropogo who act as apologists for the Castro brothers are a tiny minority up here in the great frozen North just like they are in your country.

    That said, it is a bit tiresome to see posters running down the Canadian health care system (despite its many failings) for the sole purpose of defending the “uniqueness” of the Cuban model. As if that somehow excuses Cuban tyranny. As for the purported lack of healthy debate in Canada, try typing ‘Canadian Medicare’ (or any other political issue) into a search engine, and I will guarantee you will find it debated by Canadians from every imaginable angle.

  17. “it is a bit tiresome to see posters running down the Canadian health care system (despite its many failings) for the sole purpose of defending the “uniqueness” of the Cuban model.”

    I don’t know where you got that “uniqueness” quote, but it wasn’t from anything I wrote. And my purpose was not to defend anything except truth, fairness, and a reasonable perspective.

    The fact is that Cubans have been blessed with precious benefits that most people in this hemisphere could only hope for. And accessible health care is certainly prominent among them, as are higher education and a vibrant cultural environment. It sickens me to see those achievements belittled out of envy for the “rich” relatives in Miami.

    If any people in the world has the power to overthrow an oppressive government, it’s the Cuban people.
    So why haven’t they? I like to think that it’s because they know better than to jump out of the frying pan into the fire.

  18. Posted by otropogo:
    “If any people in the world has the power to overthrow an oppressive government, it’s the Cuban people.”

    The above statement exposes your naivete regarding authoritarian governments such as Cuba’s. You don’t have to believe me, but I’m hoping you might be more open to reading what the respected international human rights organization Amnesty International has to say. According to a September 2008 report, here is what Cubans who want to change their government are up against:

    * Unlawful restriction of fundamental freedoms. The Cuban legal framework places restrictions on human rights guaranteed in international law (such as right to assembly, association or expression). Freedom of expression is very restricted in Cuba because of the complete control by the government, provided in the Constitution, on all media outlets.

    * Lack of freedom of association. All human rights, civil and professional associations and unions in Cuba outside the state apparatus and mass organizations controlled by the government are barred from gaining legal status.

    * Limitations on the right to fair trial. The right to a fair trial is limited in Cuba, with courts and prosecutors firmly under government control. At least 58 prisoners of conscience– including teachers, journalists and human rights defenders detained for their peaceful activities – are currently held in prisons across Cuba, following trials that failed to uphold international standards for fair trial.

    * Harassment and intimidation of dissidents and critics. Amnesty International continues to be concerned at reports of harassment and intimidation of critics and political dissidents and their families by quasi-official groups in so-called acts of repudiation (“actos de repudio”).

    * Restrictions on human rights monitoring. Amnesty International remains concerned, however, that human rights monitoring in Cuba continues to be very restricted. Local non-governmental organizations have great difficulty in reporting on human rights violations due to restrictions on their rights to freedom of expression, association and movement. At the same time, international independent human rights organizations are not allowed to visit the island, which contributes to the limitation of human rights monitoring.

    * Impact of the US embargo. Amnesty International also believes that the embargo has undermined freedom of movement between Cuba and the US and restricted family reunifications. However, the organization is also concerned that the Cuban government uses the embargo, and the political antagonism with the US government, as a pretext for violating the human rights of the Cuban people.

    The entire Amnesty report is available on their website:

    I would strongly encourage you to read it before continuing to make such uninformed statements.

  19. John: @patricio: Give me a break. You have your own Castro apologists in the good old USA (including a few who like to post here – av2ts and Walter Lippmann immediately coming to mind), so please don’t use an overly broad brush to attack Canadians in general. Folks like otropogo who act as apologists for the Castro brothers are a tiny minority up here in the great frozen North just like they are in your country.

    I hear you. We do. There are a lot of oddballs here. No doubt about it. But at least in my part of the USA, we can still say what we want without repurcussion from it. We can dialogue and work the problems. We don’t have to cower to ideology. My home state of La. takes a lot of heat for a lot of things, yet we were the only state to send new Republicans to national office in November. We have our problems and I will freely admit them. Apparently you can’t even admit that your country has been over-run with left-wing nuts where you can’t even have a fair discussion about anything. Canada is a beautiful country, but it has gone nuts and lost it’s way. But so has some of the US, so I don’t see this as purely a Canadian problem. What I do see is a lack of balance or the ying to the yang. Maybe I am wrong about that. In either event, I really don’t care about Canada or what kind of near-socialism your country wants to create. We have a saying down here that there is only one thing worse than a Yankee – A Canadian. That said, I still like hockey, so don’t take it personal. As for debating national healthcare in Canada, opinions are like ***holes, everyone has one. All I have to do is look at what is actually going on up there. It’s in place and it isn’t coming out of place. Canadians are running to the US to get what they want or need. We have our own health problems here, but I certainly don’t want a system like yours to screw things up over here.

  20. I just want to add that I don’t have a problem with Canada and really don’t want to get into it with any of you Canadians. I have seen a lot of anti-American rhetoric come out of Canada, especially over the last 8 years. I have been rather confused and confounded by that as I don’t see Americans doing that to Canadians. But that is neither here nor there for me. I live 600 miles north of Havana while you Canadians live a few thousand miles away. Canada just isn’t on our radar, with the possible exception of Montreal and Quebec City, which I hear are beautiful. Cheers. I’d rather stick to Cuba, so I’ll heed your advice and not discuss Canada further. Es mejor que siguimos con la tema de este blog.

  21. I will be eternally grateful to the Cuban doctors that are in my homeland, Haiti. They are really doing the Lord’s work there, they will live in truly wretched conditions serving the truly poorest of the world’s poor. Talk to any Haitian who have lived in Haiti during the past decade or so and they testify to that effect. Politics aside, We (I take the liberty to speak on behalf of poor Haitians here) would rather have this kind of relationship with Cuba than the so called ‘foreign aid’ we get from the US, Canada, EU.

  22. Patricio,

    I am a Cuban living in the U.S., so I sort of know both sides of the story, and before calling you an idiot, which I plan to do later on in my post I just want to explain the readers a few things. Freedom in America? really?, jajaja, let me laugh for a while first.

    Here you are a slave of the system too, but the mechanisms used are far more effective. They are so effective that idiots like you don’t realize it. That is the real success of the system.

    One more thing, let us Cuban fix our country our way; and get the f* out of this block and start spending your time writing to the insurance, banking and oil companies (i.e the real power in your country), and stop selling the bullshit of freedom in America which is just unrealistic smoke.

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