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Healthcare without Borders: Understanding Cuban Medical Internationalism ‐ by Kirk, John M.

Book Reviews
Kirk, John M. (2015) Healthcare without Borders: Understanding Cuban Medical Inter-
nationalism, University Press of Florida (Gainesville, FL), xv +356 pp. $79.95 hbk.
In his last book, John M. Kirk one of the most prominent Cuba experts in North
America sheds light on what he refers to as ‘the greatest story never told’ (p. 3, my
emphasis). Indeed, even though Cuba’s ve decades of medical internationalism has led
its personnel to treat, free of charge, millions of patients in the 158 countries in which
they were deployed, it has been largely ignored by the mainstream media and, to a lesser
extent, academia. Given this regrettable reality, Healthcare without Borders represents
a most necessary effort to rectify this situation.
The book is divided into two main sections. In the rst one, Kirk examines the origins
of Cuba’s medical internationalism and goes over the different elements that might help
us understand its raison dêtre. Afrming that the island’s outstanding record in this
© 2018 The Author. Bulletin of Latin American Research © 2018 Society for Latin American Studies
110 Bulletin of Latin American Research Vol. 37, No. 1
Book Reviews
domain should not be understood as a mere example of soft power, the author argues
that the political vision and personal involvement of Fidel Castro have been the two
principal driving forces behind Cuba’s medical internationalism.
This policy was motivated, among other things, by Castro’s faith in the importance of
international solidarity and South–South cooperation, which the revolutionary leader
considered as a ‘moral imperative’ (p. 21). This conviction paved the way for the island’s
rst international relief mission in Chile, in May 1960. Following this rst initiative,
Cuba became more and more involved in the improvement of health conditions in the
developing world: by the end of the 1980s, 30 African nations had welcomed Cuban
medical personnel. In the aftermath of the 1998 Hurricane Mitch, which devastated sev-
eral Central American countries openly hostile to Cuba, the island expanded its medical
missions to Latin America and other regions of the world. All in all, this rst chapter is
helpful in reminding us that Fidel Castro’s ideology made him promote initiatives that
might not t the standard cost–benet calculations that seem to govern many of our
Western leaders’ decisions.
The second section is made up of a detailed analysis of ten healthcare programmes
carried out by Cuban personnel all over the world. From the operation Milagro – which
provided consultations and surgeries for free to millions of poor people suffering from
eye deciencies – to the Henry Reeve mission – a permanent emergency response team
which, from the 2005 earthquake in Pakistan to the recent Ebola outbreak has provided
healthcare services to millions of people affected by natural disasters or epidemic dis-
eases; from the setting up of a medical faculty in Timor-Leste aimed at training students
from the region for free, to the treatment, free of charge, of 25,000 children, victims of
the Chernobyl catastrophe, those different examples allow the reader to grasp the diver-
sity and, at times, the obvious lack of self-interest of Cuba’s medical missions. Indeed,
while sending Cuban doctors to Venezuela in exchange for oil looks like a sound policy
based on a cost–benet analysis, one has to wonder what could be the potential ‘return
on investment’ of building a medical university in Timor-Leste, one of the poorest coun-
tries on earth.
By highlighting the sheer benevolence that seems to have guided many of Cuba’s med-
ical initiatives under Fidel Castro, Kirk demonstrates that, for the Cuban government,
healthcare should not be considered as a source of prot but as a basic human right that
should be granted to every human being. This vision found its most striking applica-
tion in the establishment of ELMA, a medical school situated in Havana in which tens
of thousands of students coming from impoverished areas from all over the globe have
been trained for free since 1999.
The book also mentions the change of paradigm that has taken place under Raúl
Castro’s leadership. Engaged in a battle to improve his country’s economy, Raúl Castro
has become more concerned with the potential economic spin-off of the island’s medical
internationalism. Under this new approach, Cuba has become the largest exporter of
medicine in Latin America and the sale of medical services has become the country’s
largest source of hard currency.
While the book does a wonderful job at documenting more than ve decades of
Cuban medical internationalism, it also triggers important questions about its future.
Indeed, Kirk stresses the importance of the personal relationship between Fidel Cas-
tro and Hugo Chávez in recent years – with, roughly speaking, the latter’s petrodollars
funding the former’s international medical initiatives. Yet, while, in Cuba, the ideologue
Fidel Castro has been replaced by his more pragmatic brother, in Venezuela, Nicolás
Maduro Chávez’s successor has been entangled in a severe political and economic
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Bulletin of Latin American Research Vol. 37, No. 1 111
Book Reviews
crisis. Given those fundamental changes, one is left wondering what the future will hold
for Cuba’s medical internationalism.
Hugo Goeury
City University of New York
© 2018 The Author. Bulletin of Latin American Research © 2018 Society for Latin American Studies
112 Bulletin of Latin American Research Vol. 37, No. 1
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