Publications
Partners
The furore surrounding the arrival of over 200 Cuban medical doctors in South Africa to fight the coronavirus has highlighted a failure on the part of the South African government to explain the nature and drivers of our country’s relationship with Cuba.
The arrival sparked a sharp reaction from the South African Medical Association (SAMA). Although SAMA is not opposed to the deployment of Cuban doctors, it felt it was premature for the government to do so before it could consult the association and exhaust internal resources, especially given that there were many retired local doctors and interns who could have been brought in to help with combating the virus.
The controversy has been heightened by reports that the government has forked out at least R400 million for the services of the Cuban doctors.
This triggered public disquiet which, in turn, prompted the Cuban embassy to South Africa to take the unprecedented step of issuing a public statement proclaiming that "Cuban internationalist doctors are not looking for luxuries or big payments as it is usually the case with highly qualified specialists around the world".
The whole affair has been managed ineptly and created the impression that the South African government has not been transparent and forthright about the trade-offs involved in recruiting the Cuban medical personnel.
What happened?
To underline why this is the case it is important to understand the pillars that have anchored Cuba’s foreign policy since the start of the country’s revolution. For more than sixty years, Cuba has pursued a foreign policy of medical diplomacy.
The policy has entailed sending Cuban healthcare professionals abroad both as an icon of socialist solidarity with countries in need, and in an effort to generate financial revenues to counter the debilitating effects of American sanctions.
Former Cuban leader Fidel Castro identified universal healthcare and internationalism as vital to the country’s global strategy. Starting with its first mission of Cuban doctors to Algeria in 1963, the country has exported its programme across the world, with more than 400 000 health workers having been sent to 164 countries.
Reputation
The global coronavirus outbreak has created opportunities for the Cuban government to burnish its reputation as a medical power. The government has shored up its overseas medical programme, dispatching health workers to combat the virus in the Chinese city of Wuhan, where the pandemic originated, as well as Italy, Andorra and, lately, South Africa.
Income
The programme provides desperately needed money for the Cuban state, while also allowing it to engage in diplomatic power plays. In the case of its assistance to Italy, for example, Cuba has sought to drive a wedge between the United States and Europe.
Medical service exports account for Cuba’s largest source of foreign exchange and, in 2018, they earned the country $6.3 billion. Raking in $3 billion annually, tourism is the country’s second biggest earner of hard currency and has kept the country’s embryonic private sector afloat.
The combination of American sanctions and the spread of the coronavirus has crippled the tourism industry. Cuba has reeled from decades-long economic sanctions imposed by successive American administrations. However, the country enjoyed a respite during a short period of détente with the US under the Obama administration.
Since it came to office, the Trump administration has intensified the US embargo against Cuba and enacted new draconian measures around travel, oil shipments, third-party business and remittances from abroad. The Trump administration has especially punished Cuba to force it to relinquish its support for the Nicolas Maduro government in Venezuela.
In recent years Cuba has relied on support from foreign allies to sustain its struggling economy. It has capitalised on its oil-for-doctors deal with Venezuela. It has also benefited from its strong relations with China and Russia, both also staunch backers of Venezuela.
Russia, in particular, has tried to rekindle a previous era during which the former Soviet Union was Cuba’s benefactor, pouring massive subsidies into Cuba to prop up its economy. Moscow has, among others, boosted its exports to Havana, provided substantial cheap credit and government guarantees, as well as invested in a $2bn upgrade of the railways over the next decade and in a $1bn project to build and install four 200 megawatt generators by 2024.
Pure altruism?
Against this backdrop, it is clear that the Cuban government’s external policy is driven not only by the revolutionary ideals of international socialism, but also by a dire need to secure foreign capital to bolster a domestic economy under siege.
Casting the presence of Cuban doctors in South Africa as purely altruistic, as the Cuban embassy suggests, is therefore disingenuous.
Further, contrary to the embassy’s statement international research, for example the work of Stephanie Panichelli-Batalla from the University of Warwick, has shown that revolutionary conviction and humanitarian passion are no longer the only motivations why doctors participate in foreign missions. Economic interests and an opportunity to quit Cuba also play a part in their decisions.
The hard reality is that commercial interests are as vital as the need to forge international solidarity in Cuba’s foreign policy. This is the message that should permeate South African public diplomacy in respect of the country.
Cuba occupies a special place in South African history. One of the first things the late former president Nelson Mandela did after his release from jail was to visit Cuba to thank the late president Castro and the Cuban people for their immense and courageous contribution to South Africa’s freedom.
The presence of Cuban doctors on our shores symbolises a continuation and strengthening of the strong bilateral relationship. It is a relationship that must be actively encouraged, but this must be done so on the basis of transparency and frankness.
Mills Soko is Professor of International Business and Strategy at Wits Business School. Views expressed are his own.
