Valdez, 37, a physician from Pinar del Rio, is one of 379 Cuban internationalist doctors who are working in South Africa.

"The poorest of the poor want us here," said Antonio Otelo, 34, an orthopedic surgeon, who also worked in Zambia from 1990 to 1992. "We are working in rural areas basically where no one else wants to work."

Otelo and six other Cuban doctors are posted at Philadelphia Hospital in Dennilton, a rural black township in Mpumalanga province. Valdez and René Aguinaga, also a family physician, work about 20 miles further north at Groblersdal Hospital, which was formerly a private facility. In apartheid South Africa, that meant it was for whites.

"Whites felt the hospital had always belonged to them, then after 1994, it became a state hospital and blacks started coming in from the villages," said Aguinaga. At first the whites' hostility was palpable, "but now they're getting used to it because it's time already."

Aguinaga previously worked at Philadelphia Hospital. "Before 1994 all the doctors (three to five) were white South Africans, and they were not touching the patients" in the 500-bed facility. "You should have seen the way they were treating the nurses. When the first Cubans arrived in 1996 the nurses were scared of us. Now it is totally different."

Expressing a common view among the nurses, Mildred Namane said of the Cubans: "They must not go."

Of South Africa's 11 official languages, Zulu, Northern Sotho, and Ndebele are predominant in the area, and the Cubans have picked up quite a bit of vocabulary. "South Africans give us new names," said Otelo. "They call me Thabo."  
 

Land and nation

Nearly all patients at Philadelphia Hospital are black. Many are farm workers employed on capitalist farms, and still more are unemployed. The state-owned hospital charges the equivalent of about $2 for admission and treatment, which includes medication. That is a steep fee for many people. Treatment for women who are pregnant and children is free under laws established by the African National Congress government since 1994.

According to nurse Maria Sewela, working people throughout this area successfully fought off attempts by the apartheid state to incorporate them into the KwaNdebele "homeland"--the white regime's euphemism for reservations that millions of blacks were forced to live on and made "citizens" of under racist rule. However, blacks had no citizenship rights, and were prevented by law from farming, selling their labor freely, or even living in cities.

Conditions in Dennilton are little different from the homelands. The limited work that exists is on farms in the area. As a result, more than a thousand people make the daily commute to jobs in Johannesburg--a trip that takes two to three hours each way. Dozens of buses start leaving at about 3:00 a.m., returning at about 7:00 p.m.

Rural South Africa in particular illustrates the continuing challenges of forging a nation here: there is only a shadow of modern class development and wealthy white farmers still control the great majority of productive land. However, the democratic conquests registered by workers and peasants since the early 1990s have opened up all sorts of possibilities.

"I can see changes even in the last three years," said Otelo. "People here could not talk freely, think or act as human beings," by law under apartheid. "They now have the possibility to express their ideas, to act and to fight."

"It's going to take a long time," said Valdez. "There is no official racism but in practical experience racism is still there. Both blacks and whites need to change, but to change the mentality of people is not something you can do in a year."  
 

The Cuban mission

The first Cuban doctors began arriving in South Africa at the request of the ANC government in 1996. Initially they were on three-year contracts. Then the South African government asked the Cubans to extend their stay. "We accepted on one condition: that South Africa has to decide if they want us here," said Otelo. Today, the doctors are on one-year renewable contracts.

According to Jaime Davis, who coordinates the work of the Cuban doctors in South Africa at the government-to-government level, there are about 1,200 Cuban doctors working on the African continent, including in Angola, Botswana, Cape Verde, Côte d'Ivoire, Equatorial Guinea, Gambia, Ghana, Guinea, Guinea Bissau, Mozambique, Namibia, Seychelles, Zambia, Zimbabwe, and in the Sahara in areas controlled by the Polisario Front.

Valdez worked in Namibia from 1991 to 1993. He proudly relates the spirit of the internationalists who came to that country, which won its independence after Cuban troops played a decisive role in defeating the apartheid army in 1988 at the battle of Cuito Cuanavale in Angola.

When the first doctors arrived in 1996, the big-business press and opponents of the democratic revolution launched a hue and cry over their presence, not only attacking the Cuban government but also questioning the qualifications of the doctors. They ignored the fact that all the Cubans had to pass a comprehensive test administered by South African medical authorities--in English--before traveling here.

That hostility has subsided, doctors say, as they have demonstrated their work habits and medical ability--and conducted themselves with revolutionary dignity.

Anabel Rodríguez, 31, an anesthesiologist, arrived here two years ago and works at Boitumelo Hospital in Kroonstad in the Free State province. This is her first time working outside of Cuba, and it has been an eye-opener. "In Cuba there are times we ask why we can't have this or that. Now I see that in Cuba, the government worries over providing everyone the basics. Here, if you don't have money, you have nothing. Winter can kill you if you are poor."

Most of the doctors in her area were Afrikaans speakers; many refused to speak English. "They asked me a lot of bothering questions about Cuba. I said, 'Hey, I'm here and it's the first time I've ever seen TB [tuberculosis] in a kid. I can't have a Mercedes in Cuba but my kids will not get TB.' They didn't ask me any more questions."

The composition of the Cuban brigade, which includes men and women of all skin colors, also comes as a surprise to both black and white South Africans. "We are black, white and yellow--and we are brothers and sisters. They don't understand," said Otelo, how the Cubans work so well together. "They also see that the doctors do not act superior. When we walk through town, people say, 'doctor, how are you? I'm walking because of you.'"  
 

Impact on health

"Philadelphia Hospital used to be seen as a butchery," said a health official who asked not to be identified. "The view was that if you got in, you weren't going to get out. It's much better since the Cubans came."

"South Africa is a country of two worlds. In the world of whites, hospitals have everything; in the world of blacks, rural hospitals like this one are very different," said Otelo. "We face all the results of apartheid. There are very poor social conditions and there is great ignorance. For instance, there are patients that come for treatment only after spending two to three weeks after they are injured, like with a dislocated shoulder."

TB, respiratory infections, malnutrition, diarrhea and hypertension are among the most common ailments in the area--along with severe trauma and HIV/AIDS. Shortages of medication are chronic, particularly in community clinics.

"We cannot solve the problems of centuries in five to 10 years," said Otelo, but the impact of the Cubans' work is noticeable. "The doctors working in primary health care in community clinics are trying to translate Cuba's family doctor principle here to prevent disease before it strikes. There are improvements in these areas."

A Cuban doctor now serves as the acting medical superintendent of Philadelphia Hospital and the Cubans' working methods have helped to raise the level of discipline.

"We initiated morning meetings of the doctors," said Aguinaga, where the cases of those most seriously hurt or ill admitted during the previous day are discussed. "It used to be a total disaster. Doctors here could come to work whenever they wanted. Patients and nurses were treated improperly." Otelo added that "every Thursday we have another scientific meeting with a lecture by a specialist."

A question about the level of HIV/AIDS infection elicits a pained expression on the look of each and every Cuban. "It is very high," comes the answer.

Ulises Machado said that where he works, in the Philadelphia pediatric ward, "10 babies a week test positive for HIV/AIDS," and those are only the ones that are tested. "I think AIDS is going to wipe out a generation," says Aguinaga.

"Education is the big thing," said Otelo. "Most people do not know what AIDS means. There is now a big effort on this by the government, but the number of patients is increasing every day.

Aguinaga said, "The conditions in which people live here means that if they contract AIDS they will die." As contributing factors he cited levels of malnutrition, especially in children, and poor hygiene.  
 

Improving skill levels

Cuban doctors are paid an average of 10,000 rands (about $1,525) a month by the South African government. This is taxed, and 30 percent of the amount is sent to the Cuban government. Otelo said most doctors take home about 5,000 rands a month, roughly $760.

"With the money sent from the pay of the doctors in South Africa, last year Cuba bought half of the vaccines it needed for children," Otelo said.

"Our pay here is better than in other countries in Africa," said Valdez. "But I've worked in Namibia and it was not for money. If a little money comes in, okay. We're revolutionary but we're not stupid. We've lost doctors here. How do you pay for that?" Pointing to criticism of the Cubans when they first arrived as being privileged in comparison to the pay they would receive at home, he said "Thousands of Cubans died in Angola. That was right. There is no privilege. We are here already with the blood of our people."

Silvio Morales, 33, is a family physician from Pinar del Río posted at Philadelphia Hospital. Of the 20 doctors in total at Philadelphia, a minority are South African. The numbers are slowly starting to shift. Under legislation passed by the ANC government, graduating medical students are now required to do one year of "community service," mostly in rural areas.

The Cubans, some of whom have computers and are linked to the Internet, stay abreast of developments, such as the fight to have Elián González returned home. Otelo monitored the response of the imperialist powers to the recent floods that devastated neighboring Mozambique. "All the riches of North America and Europe come at the expense of poor countries," he said. "In Mozambique they talked of help but they are not helping. They can help by eliminating the Third World debt."  
 
 
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