The Militant (logo)  

Vol. 72/No. 38      September 29, 2008

 
‘Well stay as long as needed’
Cuban medical cooperation with Equatorial Guinea: the
internationalist example of a socialist revolution
(feature article)
 
The following is the third of three articles based on a two-week fact-finding trip to Equatorial Guinea in July and August by supporters of New York-based Pathfinder Press. The previous two articles, “Equatorial Guinea: Changing economic and social realities facing millions in Africa,” and “Young Guinean doctors are key to building public health system in Equatorial Guinea,” appeared in the September 8 and 22 issues of the Militant.

BY MARTÍN KOPPEL
AND MARY-ALICE WATERS
 
BATA , Equatorial Guinea —“It took a lot of effort and willpower. We had to learn how to study, and how to study long hours. But today we’re graduating as doctors. We will be working to improve the health of the Guinean people,” said Benjamín Ntutumu Mbá.

His remark captured the pride and confidence of the 21 doctors who graduated August 5 from the medical school here. They were among 102 students in the class of 2008 at the National University of Equatorial Guinea (UNGE) who received their diplomas. Now they are starting their first jobs as MDs at hospitals and clinics across the country.

The university’s medical school in Bata, led and staffed by Cuban doctors for almost a decade, opened in 2000 as part of a program of medical cooperation between the governments of Equatorial Guinea and Cuba. Cuba committed itself to send brigades of doctors, nurses, and lab technicians—today they number 160—to help staff hospitals and public health centers throughout this Central African country. The medical school is training hundreds of Guinean doctors and nurses whose goal is to progressively replace the Cuban personnel currently providing almost all primary health care.

The training of Guinean doctors, committed to improve health conditions in their country, is no small achievement in one of the least industrialized countries in sub-Saharan Africa. Equatorial Guinea shares with the rest of the region a centuries-long legacy of colonial and imperialist domination. As in much of Central Africa, malaria is endemic, typhoid fever, tuberculosis, intestinal parasites, and sleeping sickness are widespread, and the incidence of HIV/AIDS infection, while lower than in much of the region, has been increasing.

The health-care crisis inherited by Guineans is magnified by the very workings of the world capitalist system. Drawn by the lure of much higher salaries, better living conditions, and promises of “career” advancement, medical personnel migrate to imperialist countries from Africa and other parts of the semicolonial world. The head of Ghana’s public health service, for example, reported in 2005 that the country had lost 30 percent of doctors trained there to the United States, Britain, Canada, and Australia. Some 5,300 physicians from sub-Saharan Africa were practicing in the United States alone, according to a 2004 study by Human Resources for Health.

The training offered by the Cuban-run medical program, like the Cuban Revolution itself, imbues students with a different class perspective. Instead of promoting personal “advancement,” it encourages social solidarity and health care as a human right. It seeks to instill a determination to provide medical services to working people in isolated rural areas and small towns for whom such care has previously been inaccessible and unaffordable.

The medical school program is organized in close cooperation with the Ernesto Che Guevara medical school in Pinar del Río, Cuba. When the program was first launched, a group of Guinean students studied five years in Pinar del Río and their sixth under supervision of the medical school faculty in Bata. Simultaneously another group studied five years in Equatorial Guinea and spent their final year in Pinar del Río.

Today all students attend the school here and then complete their sixth year in Cuba, reported Dr. Tebelio Concepción, dean of the facility in Bata. Concepción, a Cuban dentist who previously taught at the Ernesto Che Guevara school, noted that since the founding of the institution in Bata, its dean has always come from Pinar del Río as part of that university’s long-term commitment to the program of cooperation.

In the 2007-2008 term, 170 Guinean students were enrolled in the Bata medical school, including 23 in a five-year nursing program. More than half the students—89—are women, a statistic greeted with enthusiasm and pride at the Bata graduation ceremony when announced by María Jesús Nkara, UNGE director of academic affairs.

With the August 5 graduation, 122 Guinean medical students have received their diplomas here since 2006.  
 
High retention rate
“The big majority of all the medical students complete the course,” Concepción told us. This contrasts with many other university departments in Equatorial Guinea, where, for a variety of reasons, a large percentage of students drop out in the first or second year.

At the heart of this success, Concepción said, is the individualized attention given to each student as they transform their study and work habits. The Cuban instructors provide tutoring to all students who need assistance. To make this help more effective, “the professors, grouped according to each year of study, meet monthly to discuss how their students are doing and to determine who needs special attention,” he said. The students select a representative to take part in these discussions and help uncover problems needing attention that the teachers may not be aware of.

A student, for example, may be living in a neighborhood without electric service and cannot study at home in the evenings. “Or sometimes a student whose first language is Fang has a more limited knowledge of Spanish, and has a hard time understanding a Cuban professor who talks very fast.” Several dialects of Fang are the main indigenous languages spoken in the region of the African continent that includes Equatorial Guinea.

“This kind of individualized attention has been decisive in giving us a high retention rate,” noted Dr. Juan Carlos Méndez, head of the Cuban medical brigade here, who previously directed the ministry of public health in the Cuban province of Ciego de Avila.

Graduates of the medical school we talked with said the help and encouragement they received from their teachers had been decisive in their ability to overcome myriad obstacles and complete their studies. Such obstacles are often outside the experience and assumptions of even sympathetic observers from countries dominated by class relations shaped by capitalist production and trade.

Equatorial Guinea does not have a class of small landowning agricultural producers struggling to grow a surplus to sell on the market in order to pay off debts and not lose their land. An industrial working class is only now barely beginning to emerge. These historical realities mean that the habits of work imposed on the toilers by the capitalist whip of debt slavery for the peasantry, and job competition and wage slavery for the working class, exist in embryo at most in large parts of Central Africa.

Dr. Florentino Abaga Ondó, a Guinean who is today medical director of the hospital in Mbini, a coastal town on the continent, is one of the 2006 graduating class who studied five years in Cuba and returned here for the sixth. What he found most difficult when he began his studies in Cuba, he told us, was not the food or cultural differences, or being far from family and friends. It was “learning to work, learning to work hard. That’s what real study is.” He also felt the pressure of being one of the few African students in his class at the Latin American Medical School, he said—feeling he had to prove he wouldn’t wash out as some of his fellow students expected. He succeeded, and attributed this in large part to the backing and encouragement of his teachers.

“The most difficult thing in my first year was to adjust to the method of study,” said Tecla Mangue Mitogo, who graduated August 5. “We had to get used to reading and studying at least five hours a day.

“The Cuban professors helped us a lot. They taught us to study and to work.”  
 
Extension program
Today dozens of Guinean physicians are working at health-care centers across the country, alongside Cuban doctors, nurses, and technicians. At every public hospital we visited the medical director, often still in his 20s, was a Bata medical school graduate. That is now true throughout the country, we were told.

Starting this year, another important step is being taken. A full medical school program is being offered in five more cities for young people who could not otherwise overcome barriers to living and studying in Bata, whether financial and housing limitations, family responsibilities, or whatever.

Dr. Méndez reported that 13 students are enrolled in the program so far: 2 in Ebebiyin, 3 in Mongomo, 1 in Mbini, 5 in Malabo, and 2 in Luba. Next year the program is projected to expand to additional towns, with an increased number of students in each.

On a visit to several towns in the continental region, we met several of these students and their instructors. We accompanied the rector of the National University of Equatorial Guinea, Carlos Nse Nsuga, and a group of professors and administrators on a tour of the university extension centers in Ebebiyin, Mongomo, and Mbini. The university personnel were assessing the first months of the new program.

The medical courses are taught by Cuban doctors working in those districts. Many have extensive teaching experience in Cuba as well as years of medical practice. In Kogo, for example, the nurse recently arrived from Cuba, with more than 30 years of experience, had previously been head of nursing administration for all of Havana.

In Mongomo three students are enrolled in the extension program, which began in May with a three-month preparatory course. Dr. Luisa Gómez, one of the Cuban doctors leading the program there, told us the preliminary studies include chemistry, biology, an introduction to medicine, and computer training. Beginning their practical education right from the start, the students accompany the doctors each morning as they make their rounds and treat patients at the hospital clinic. Classes are held in the afternoon, after the doctor-instructors finish their hospital consultations for the day.

José Fernando Monsuy, 24, a student in Mongomo, said he had already learned a lot from going into the community with Cuban doctors to educate local residents on basic hygiene and preventive health care.

University rector Nse Nsuga urged the students to speak not only about the progress they are making but the problems they confront. “If you don’t raise them, we can’t together address them,” he said.

The students described various practical obstacles. Their new classroom is still under construction, as part of the hospital’s renovation. In the meantime, two computers, which they use to watch instructional DVDs, are temporarily set up at the modest residence of the Cuban medical personnel. They can use these computers only after 6:00 p.m., when electricity comes on for the evening. (For more on the challenges of electrification, see the previous two articles.)

Students pointed to other problems, as well. There is a lack of textbooks. The room serving as a school library is often locked during hours they are able to use it. After some discussion, the rector encouraged the students to take some control in busting through these impediments. He urged them to make a proposal on library hours and then arrange with hospital administrators to assign someone to have a library key. He told them to organize themselves to photocopy and share reading materials.

The medical director, Dr. Nicéforo Edjang, a Guinean graduate of the school in Bata, also responded to the three students. There is a basis to their complaints, he said. But the heart of what underlies them is that they are unaccustomed to the discipline of study, which takes work.

“You have to adjust to what it means to study,” Edjang said. “That’s your biggest difficulty. All of us who went to the medical school faced the challenges you are going through. In fact, the conditions we confronted in the first year were even harder,” Edjang said. For example, that very first class, we learned on a previous visit to Equatorial Guinea in 2005, had no textbooks at all for the initial six months.

The students agreed to take the suggestions of the rector and initiate solutions to the obstacles they were raising.

Medical personnel in several cities we visited pointed out that training students in their home towns, as opposed to a distant city, let alone another country, strengthens their commitment to work in their own communities. Educating doctors ready to work in areas most in need of health-care facilities is a cornerstone of the medical training they receive.

In Kogo, for example, an isolated town in the southwest corner of the country, the small hospital now has one Guinean doctor who is also the director—an important gain. He grew up in a different region, however.

“We need to train more doctors who are from here and who will stay here,” Dr. Hilario Nguema told us. It makes a big difference to have doctors who grew up in the community and are known. In the Kogo area it helps to have personnel who speak Ndowe, the first language for most in the coastal region.

Méndez said students training in their home towns “know their own communities and are committed to them. Seeing what others like them have been able to achieve will speed the process of winning more medical students to the program and training even more doctors. And it will strengthen the public health system, especially in areas that have had little access to trained medical personnel.”  
 
‘We’ll stay as long as needed’
At the end of our two-week tour, Méndez and Concepción took time from their busy work schedules with the medical brigades posted throughout the country and at the school in Bata to tell us a little more about the work Cuban volunteers are carrying out.

The medical cooperation between the Cuban and Guinean governments, they emphasized, aims to train Equatorial Guinean doctors and nurses who will work to transform public health care in their country. This is a principle guiding all Cuba’s medical missions in every country where they are invited to work, they noted.

To accomplish this goal, Méndez said, “we are committed to stay as long as necessary.”

Such medical collaboration is an expression of the proletarian internationalist course that has marked Cuba’s socialist revolution for half a century.

In 1963 the very first Cuban medical brigades volunteered to go to Africa. They went to newly independent Algeria less than a year after the French colonial regime had been defeated by the Algerian National Liberation Front in a long and bitter war.

That same year, and acting with the same solidarity, Cuba responded to a request by Algeria’s workers and peasants government to send weapons and volunteer combatants to help deter an imperialist-backed assault by the Moroccan regime. Over the decades, Cuban internationalists have fought alongside anti-imperialist forces throughout Africa—from the Congo to Guinea-Bissau to Angola—as well as in Latin America.

That tens of thousands of Cuban medical personnel are today providing health care in the most hard-to-reach parts of countries the world over is one of the most demonstrative expressions of the socialist character of the revolution that Cuban workers and farmers carried out, overturning capitalist property relations and transforming the consciousness of millions. No other country in the world is capable of anything remotely comparable, nor does any other government want to do so.

As Cuban revolutionary leader Ernesto Che Guevara, himself a physician, explained and demonstrated by his own example, “To be a revolutionary doctor, you must first make a revolution.”

In Cuba not only has health care—an expensive commodity under capitalism—become free and available to all as a basic right, but those who become medical workers are educated in that spirit.

As of 2008, more than 36,000 Cuban doctors, dentists, nurses, and medical technicians are working as volunteers in 81 countries, according to Cuba’s ministry of health. That includes 1,500 doctors in 35 African countries. Cuban personnel are responsible for medical schools not only in Equatorial Guinea but in Gambia, Guinea-Bissau, and Eritrea.

The Cuban medical brigade has been in Equatorial Guinea since 2000 as part of the Comprehensive Health Program for Central America, the Caribbean, Africa, and Asia, Méndez told us. That initiative had been launched by the Cuban government two years earlier in response to the destruction caused by Hurricane Mitch in Central America. “We sent emergency medical brigades to the region struck by the hurricane,” he said, and from there the program expanded to other parts of the world.

Today the 160 doctors, nurses, and lab technicians who make up the Cuban brigade in Equatorial Guinea are working in 18 of the country’s 21 districts—57 of them on the island of Bioko and 103 on the continent. Except for those with special leadership responsibilities, who sometimes serve longer, brigade members generally work here for two years, with a one-month vacation at the end of the first year.

“The Cuban doctors go to every corner of the country, even to the most remote areas,” the president of Equatorial Guinea, Teodoro Obiang Nguema, told us in an August 7 interview. “You can see the discipline and morale of those doctors.”

The living expenses of the Cuban medical workers are paid by the government of Equatorial Guinea. “We provide them with a stipend, housing, transportation, and other necessities,” Obiang said.

In addition to the minimal stipend—the same for all personnel, irrespective of qualifications—the Cuban government pays the Cuban medical volunteers their regular monthly salaries in Cuban pesos, giving that amount directly to their families in Cuba or depositing it in a bank account held for them until their return. Medical workers who have completed international missions receive $50 a month in hard currency for the rest of their working lives in addition to their salary in Cuban pesos.  
 
Conquests of Cuban Revolution
In a discussion with more than 30 Cuban medical brigade members in Bata one evening, several talked about the deep impact the experience of working in Equatorial Guinea has had on them.

Some had previously served in Angola, Iraq, Western Sahara, Ethiopia, or other countries—one was on her fourth internationalist assignment. For most of them, however, it was their first time living and working outside Cuba. While they vary widely in age and work experience, most are in their 40s or early 50s.

“Here we discovered a reality we ourselves had never encountered in Cuba,” said Dr. Laura Cobo. “We’ve seen preventable diseases we had previously only read about in books. We’ve seen children dying of malaria or dying of hunger.” Some of the doctors noted that many diseases common in Equatorial Guinea had ravaged working people in Cuba as well, before the socialist revolution conquered in the early 1960s and began transforming social relations. Even the oldest of the brigade members, however, are generally too young to have experienced those capitalist conditions firsthand.

In Equatorial Guinea, Cobo said, Cuban medical personnel often treat patients for polio. “In our country it’s been years since we’ve seen a case of polio. In Cuba children receive 13 vaccinations in their first year.”

One of the hardest experiences here, several doctors told us, was seeing children with malaria or other curable illnesses who were brought to the hospital too late to be treated and died.

At the same time, Dr. William Pérez added, “there are cases of children in critical condition who, despite our limited resources, we are able to restore to health. That gives us tremendous satisfaction.”

Dr. Rubén Romero told us he has been teaching in Bata two years. “This medical school is a big step forward. Now the third class of students is graduating,” he said. “We can begin to see the fruits of our labor.”

Cobo said the hardest thing she’s had to get used to is that “health care here is a commodity.” In Cuba high-quality medical care is free for everyone. But here “patients have to pay for everything, from medicine to emergency operations. If they can’t pay we’re not supposed to treat them.”

Some doctors told us they find this so difficult to carry out that they not infrequently forget to tell patients they have to pay.

“This experience prepares us to work better on behalf of the Cuban Revolution,” Cobo said. “When we return home, we’ll be able to use these experiences—despite all the material shortages we face in Cuba—to explain the gains of the revolution,” to explain what a socialist revolution means.

The conditions the Cuban doctors describe are the reality millions confront in Africa and other parts of the semicolonial world. Most satisfying of all, they say, is the opportunity to be part of changing this reality.

Brian Taylor and Omari Musa contributed to this article.
 
 
Related articles:
Background on Central African nation  
 
 
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