Cuban Internationalism in Oceania: South-South Cooperation in the Pacific

By Sasha Gillies-Lekakis

A class at the Latin American Medicine School (ELAM) in Havana, Cuba, on October 14, 2013. Photo: ADALBERTO ROQUE/AFP

The sight of Cuban doctors walking the same streets as Australian tourists in the South Pacific has been a phenomenon since the early 2000s. These medical emissaries from the Caribbean are present even where many NGOs do not tread, from isolated Kiribati to tiny Nauru, some of the least-visited nations on Earth.

Cuba’s internationalist presence in the South Pacific has been little noticed for decades. This is surprising considering that Havana has established a diverse, vibrant, and growing range of projects and cooperation programs with the governments and peoples of the region, improving health and education outcomes dramatically.

Beyond Timor Leste

In the Pacific, Cuba is perhaps most well-known for its medical assistance to Timor Leste where it is credited with establishing the nation’s public healthcare system in many respects. However, internationalist cooperation has subsequently reached across the South Pacific where governments are also continuing to deepen ties.

Cuba’s ‘Henry Reeve’ medical brigades have operated throughout the Pacific region since 2004, including in Solomon Islands, Vanuatu, Fiji, Tonga, and Kiribati. Cuba also trains Pacific Islander medical students on free scholarships at the Latin American School of Medicine (ELAM, to use its Spanish acronym). It is these Cuban doctors, and then Cuba-trained local graduates, that often form the backbone of small Pacific nations’ public healthcare systems.

Beyond medical assistance, a series of high-profile diplomatic agreements currently exist between the governments of Cuba and Pacific Island nations. A notable example of the political will to continue deepening cooperation was the 2008 Cuba-Pacific Islands Ministerial Meeting.

Just four years later, Cuba was made a dialogue partner of the Pacific Islands Forum and has attended the organisation’s summits in some capacity since that time. It is important to note that it is Pacific Island countries taking proactive steps to deepen ties – which Cuba is more than happy to reciprocate.

Extending Cuba’s Home-Grown Medical Achievements

To understand just how Cuba is able to provide critical assistance in healthcare provision and public health workforce development through education, an understanding of the Caribbean nation’s own medical system is necessary. Cuba’s medical internationalism gains its strength from the island’s domestic public healthcare system, which has received international praise since the 1960s, including from the World Health Organisation.

Cuba operates centrally funded medical services and programs, has an excellent medical education program, and boasts the world’s best patient-to-doctor ratio at 155:1. As a result, Cuba is able to commit around 30,000 medical personnel to medical cooperation with other Global South nations in need, without significantly burdening the domestic health system. Moreover, the socialist island’s focus on preventative medicine is a cheap and resource-light approach to medical care conducive to many healthcare systems in Africa, Latin America, Asia and the South Pacific.

The changes engendered through Cuba’s free internationalist cooperation with Pacific nations in education and healthcare have often been understated and escaped the attention they deserve.

A history of medical diplomacy: a mural in Turin, Italy, thanking Cuban doctors who helped during the first wave of the pandemic. Photo: Getty Images

Kiribati, the Solomon Islands and Nauru

The situation of Kiribati, a collection of far-flung atolls grappling with climate change, sanitary, and migration crises instigated by the Global North, is a case in point. Remarkably, since 2007 the intervention of Cuban doctors has led to an 80 percent reduction in national infant mortality rates. Over 300,000 medical consultations were undertaken by Cuban doctors in Kiribati during this same period, as well as 9,530 surgeries. Additionally, 1,460 lives were saved by Cuban medical interventions.

In the Solomon Islands, which is the Pacific nation most engaged with Cuba – including through its embassy in Havana – Cuba-trained students have almost doubled the pre-2007 medical workforce with 82 Cuba-trained medics supplementing the 100 doctors already in the country as of 2020. Cuba’s assistance there has provided critical human development and strengthened public health provision beyond what any other development partner has been able to achieve.

Nauru is another country facing many health crises, including the rapid growth of non-communicable diseases such as diabetes. Collaboration between Nauru and Cuba has been ongoing since 2004, with 52 Cuban medics having served in the country. By 2020, 43,336 patients had been attended to, and 254 lives were saved by Cuban medics. In 2004, the arrival of 11 Cuban medics increased the number of medical professionals in the country by 367%. In Nauru, Cuba has again helped form the backbone of another Pacific healthcare system.

Many other Pacific Island Countries, ranging from Tuvalu and Vanuatu to Tonga and Fiji, have had dozens of medical students trained by Cuban specialists.

Over 80 countries were represented in the ELAM graduating class of 2019. Photo Credit: Eduardo Añé

Deepening South-South Cooperation

Recent, broader expansions in cooperation are encouraging. They indicate that Cuba-Pacific relationships can serve as a model for further South-South linkages free from the power imbalances and impositions that characterise Global North-driven neoliberal development.

A tourism visa exemption agreement signed between Fiji and Cuba in 2020 and cooperation on developing domestic natural medicine production in Solomon Islands which began in 2018, are just some of the most recent milestones demonstrating the growth of this unique bond between small island states.

Cuba’s presence in the Pacific has not come without challenges. The sheer logistical difficulty of organising cooperation between the Caribbean and Pacific presents enormous obstacles, the most obvious being exorbitant flight costs. Language difficulties, with English- and French-speaking students receiving their education in Spanish when in Havana, also need to be overcome.

Domestic opposition from wealthy, private medical associations in countries such as Fiji and Papua New Guinea has also raised its head.  These are threatened by the altruistic and community-oriented mindset of Cuban medics and Cuba program graduates. Nonetheless, cooperation has persisted.

Cuba’s development contributions mean that people in the Pacific are healthier and better educated, whether they be in laid-back Honiara, bustling Suva, or remote Tarawa.

Links established through developing medical and human capacities will bond Cuba and Pacific Island Countries for many decades to come. The remarkable achievements demonstrate what is possible when humanistic priorities are elevated, and nations of the Global South cooperate for the health and wellbeing of their populations.

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