By Tom Whitney, January 19, 2009

Speculation grows as to reordering of Cuba's economy and relaxation of U.S. hostilities. Yet basics get short shrift in that discussion no less than they do amidst dispute over first-offender responsibilities for war in Gaza. Graciela Guerrero Garay identified one essential in both situations: "There is nothing more important than the life of a child."

She points to Cuba. There, infant mortality last year was the lowest ever. Out of every 1000 live births, only 4.7 babies died during their first year, a rate down from 60 in the 1950's, 10.7 in 1991, 6.5 in 1999, and 5.3 in 2007. Decline during the nineties coincided with severe economic hardships. The United States registered 6.3 in 2008 (estimated), other industrialized nations, around five.

Effective social support, adequate food, high educational levels, supportive families, prioritized prevention, and ready access to health care all contribute to Cuba's achievement. Guerrero Garay testifies to special networks of nutritional and medical care available to pregnant women; competent, accessible pediatric care; and "the love of parents, doctors, nurses, and any Cubans having to do with [children's] quality of life."

In contrast to the money–driven U.S. society where political dialogue seems to center on jostling for advantage, the needs of all come first in Cuba. In that regard, the story of Cuban health care is worth revisiting.

Only 3000 physicians remained in Cuba in 1962. By 2007, there were 72,417. Medical schools expanded from one to 22. The physician per population ratio is 1/155 now, compared to 1/330 for Western Europe, 1/417 in the United States. Nearly 30,000 practitioners of "comprehensive general medicine" team with a nurse to provide preventative and curative care in neighborhoods for 99 percent of the population. Cuba's GDP dropped 34 percent after 1991 and stayed low. But over seven years the health care portion of the national budget rose from 7.4 to 13.1 percent. The recent economic upswing has brought renewed construction and refurbishing of clinics, hospitals, and medical equipment.

An astounding venture, decades in the making, has recently come to fruition. Steve Brouwer reports on Cuba's worldwide export of health care and medical education in "Cuba's Revolutionary Doctors" appearing in Monthly Review, January, 2009.

As of November, 2008, 38,544 Cuban health workers, 17,697 of them physicians, were caring for patients or teaching in 75 countries. Over 7000 physicians and 3000 dentists from Cuba, plus hundreds of specialists, work in Venezuela, and 1500 more physicians, in Bolivia. In Venezuela, Cuban doctors accounted for one primary care doctor per 17,300 people becoming one per 3,400. Disaster relief teams of hundreds, even thousands, of Cuban doctors served in Pakistan, Bolivia, Guatemala, and Indonesia.

The education segment of this project is unprecedented. Presently 24,000 foreign students are studying medicine free in Cuba. Since 2005, The Latin American School of Medicine has graduated 1500 – 1800 students annually. Students in that six year program have come from 40 Latin American, Caribbean, and African nations. Cuban and Venezuelan educational specialists pioneered in developing a separate curriculum in "comprehensive community medicine" aimed at students learning medicine in their own communities and staying there to practice.

Some 12,000 Cubans study medicine that way now in addition to 17,000 others enrolled in traditional medical schools. In Venezuela, over 20,000 medical students attending the "medical school without walls" have completed two to three years of a six year course. Cuban doctors do most of the teaching. According to Steve Brouwer, students interact with patients from the start, hear lectures daily, utilize innovative audio-visual modalities, and rely on resourceful, world-experienced physicians serving as tutors.

Brouwer visited medical students in and around Sanare (pop. 39,000), an upland, northeastern Venezuelan city where 42 inhabitants were studying medicine. Nearby Monte Carmelo (pop. 800) was home to eight young people studying locally and one in Cuba.

Cuba and Venezuela's total medical school enrollment approximates the 65,000 total of students attending U.S. schools. They, on graduation, will be looking for work lucrative enough to pay off individual medical school debts averaging almost $200,000. By contrast, their Cuban and Venezuelan counterparts will work where they are needed – at home, in poor neighborhoods.

Greeting the Cuban people on May 1, 2000, former President Fidel Castro had set the stage: "Revolution means…being treated and treating others like a human being."