At the Park of African Heroes in Havana, Cuba, the bust of former President Jomo Kenyatta is one of the attractions. Unveiled in March 2018 by Uhuru Kenyatta, it marked the solidification of diplomatic relations with the Caribbean island, which uses medical diplomacy to gain political friends. One of the outcomes of Uhuru’s mission was a bilateral agreement that saw Cuban doctors sent to Kenya.
But as President William Ruto continues to undo some of his predecessor’s projects – and as he continues to appease Washington – the fate of Cuba’s ‘army of white coats’, as the doctors are globally known and who had been hired to offer services in the rural counties, is now in limbo. It is known that the US exerts pressure on countries that hire Cuban medical doctors and views them as victims of “trafficking”.
At what point the Cuban doctors will become casualties of the dalliance between Kenya and the US is not clear – though there are various pointers. The National Assembly’s Health Committee Chairman, Dr Robert Pukose, has already said that the 100 Cuban doctors, who have been in the country for six years, “have done their job and must now return home”. Parliament will soon be asked to vote on the issue – though there is more to it than the presence of doctors.
The arrival of the Cuban doctors coincided with Kenya’s campaign to have the Caribbean nations support its bid for the United Nations Security Council (UNSC) non-permanent seat from 2021 to 2022.
President Kenyatta had not only opened a new embassy in Havana but had also toured several Caribbean nations and met with the leaders of the Organisation of Eastern Caribbean States in Barbados. Later, he would open the Caribbean Community (Caricom) embassy in Nairobi as part of his pan-African campaign. Cuba provides medical doctors to several Caricom members as part of bilateral agreements, and they played a critical role during the Covid-19 crisis. They have also resisted pressure from the US.
The presence of Cuban doctors in Kenya has been opposed by the local labour unions, which say that the government should have employed the jobless doctors first. But the former president had said that the 100 Cuban doctors were specialists in areas like nephrology, cardiology, and neurosurgery and that their mandate included training local specialists to provide standards of care similar to those in Cuba.
Two years ago, some Caribbean nations were under US pressure to stop hiring Cuban doctors. For instance, Barbados Health Minister Jeffrey Bostic told off Washington, which had threatened to target countries benefiting from Cuba’s medical missions. Bostic told the local press: “Barbados is a sovereign country and we make decisions in the interest of the country…and we are not going to buckle under the pressure of any other nation.” That was at the time when Florida Republican Senator Rick Scott had introduced a bill to target countries that hire Cuban doctors through medical missions.
Although the Cut Profits to the Cuban Regime Act, which required the State Department to publish the list of countries that contract doctors through the Cuban government to be listed in the human trafficking list, did not receive the vote – it is believed that it pointed to a future policy direction. Whether Kenya could silently be bowing to pressure is not clear.
Comprehensive medical cover
During the Corona crisis, the US Secretary of State Mike Pompeo criticised the South African government for accepting doctors from Cuba. The US argued that Havana was exploiting its medical workers. “Governments accepting Cuban doctors must pay them directly. Otherwise, when they pay the regime, they are helping the Cuban government turn a profit on human trafficking,” the US said.
Early this year, the Council of Governors chairperson Anne Waiguru supported sending the doctors back to Cuba, arguing that they were costing millions of shillings. They allegedly signed extravagant contracts paid by national and county governments. The doctors are guaranteed comprehensive medical coverage under the National Health Insurance Fund, security, and air transport for their holidays.
The county government pays for their electricity, water, and gas, and furnishes their homes. This is not provided for local doctors with similar expertise. It has been claimed – and denied – that each Cuban doctor earns a monthly salary of Sh125,000, while the Cuban government receives Sh500,000 for each doctor. In total, the government of Kenya pays at least KSh625,000 per Cuban doctor.
When they arrived, the then-Cabinet Secretary for Health, Sicily Kariuki, said they had been placed in Job Group S, where the top salary is Sh882,180. Ms Kariuki denied that Kenya would spend Sh2 billion on the 100 doctors within the contract period. The Cuban government gets part of this money.
In some countries where Cuban doctors are engaged, critics say they provide the local authorities a window to avoid overhauling the domestic healthcare systems and engage the local workforce. This argument is the same that Kenya Medical Practitioners and Dentists Union members have put forward. Though Cuba, as part of the agreement, was to train 50 Kenyan doctors, the KMPDU Secretary General, Dr Davji Bhimji Atellah, told a Senate Health Committee in March that the deal was a “waste of human resources”.
KPMDU members had in 2018 tried to block the employment of the Cuban doctors, but their petition was dismissed. Justice Onesmus Makau said it lacked “precision in material particulars” and “sufficient evidence” to prove that recruiting Cuban doctors to work in Kenya discriminated against local doctors.
If President Ruto terminates the Cuba contracts, he will not be the first to do so. In 2018, Brazilian President Jair Bolsonaro severed the Cuban cooperation agreement and sent away 8,000 doctors hired from Havana.
For the last 60 years, Cuba has engaged in the medical export business and offered solutions to developing and developed nations eager to implement universal healthcare, much to the chagrin of the US. Following the 1959 Cuban Revolution, the Fidel Castro government trained healthcare professionals and leased them to foreign countries. As a result, health diplomacy earns Cuba more than $10 billion (Sh147 billion) and is bigger than the country’s tourism sector.
Many countries seek to learn from Cuba’s best practices and overlook the country’s ideology to get medical experts from Havana. At any point, Cuba has more than 50,000 doctors sent to various countries through bilateral agreements. Also, countries facing a shortage of doctors in public hospitals contact Cuba to help, and it is estimated that today, Cuban doctors operate in more than 60 countries. So successful is the Fidel Castro experiment that life expectancy on the island is higher than in the US. With more than 100,000 doctors in practice, Cuba, which has a population of 11 million people, has one of the best doctor-patient ratios in the world – one physician per 110 people. Compare this to Kenya, which has (as of 2021) 13,376 registered medical doctors, resulting in a ratio of one doctor for more than 6,000 people.
Whether President Ruto will overturn and terminate the agreement remains to be seen. What is clear is that developing nations that hire Cuban doctors have to decide on who to please or offend – Havana or Washington. With President Ruto playing ball with the US – after the Chinese coffers dried – there are heavy chances that the Cuban doctors would be the first casualty. But only time will tell.
