The physicians were forced to minimize their use of modest resources. When Delgado reached his assigned eastern front in Guinea-Bissau, he found that the hospital grounds consisted of “four huts: one for the wounded; one a kitchen; one for supplies; and one, a little farther away, for the doctor.”51
Another low-profile and low-resource mission was the one in Tanzania. Juan Antonio Sánchez participated in the military mission there from 1969 to 1970 as a “medical internist at Pemba Island. Cuba had permission from the Tanzanian government as long as their presence was secret. There were no Cuban troops, only three doctors.” Their “operating room had been a garage.”52
The priority for Cuban doctors was always the health of combatants. They were treated for bullet wounds, fractures, and health issues such as hernias and tropical diseases. There were many surgeries, including one in which Héctor Vera participated. “Four men who had been injured by a grenade arrived,” Vera recounts. “The one who was seriously injured was operated on at night and survived. We put him on a table; Che held a lantern; Oliva gave him anesthesia; Tabito operated; Lagomasino worked as an assistant; and I observed.”53
Camacho served in the southern front of Guinea-Bissau where the Portuguese frequently ambushed civilians who helped supply the military. Several Cubans died or were injured in these attacks.54 Delgado describes the difficulties of surgery during combat:
We operated whenever there were battles. Small reconnaissance planes passed overhead frequently, and, when they returned multiple times, we moved the camp because an attack was almost certain to follow. The hospital was burned four times. Every time a plane flew overhead twice, they attacked us…. We were between two rivers. Planes and boats kept coming by and destroyed almost all the canoes we could use to flee…. Most of the time we operated in places where we could set up a tiny hospital. They brought us people who had stepped on a mine or were wounded in an ambush. Almost always, the wounded arrived at night and we had to operate by the light of bundles of grass. I did about fifty operations like this, including several amputations. We cut dry grass, folded it over, tied it with straw, and used it as a candle. Sometimes we couldn’t see what we were operating on, even with eight or ten wicks like this.55
OTHER THAN MILITARY MEDICINE
Cubans felt obligated to treat civilians injured in attacks, which meant that there was an overlap between military and non-military medicine. Delgado became acutely aware that a lack of specialists had its costs. He describes one experience in Guinea-Bissau:
A bomb fell very close to a woman and injured her abdomen. Since I didn’t have my assistant with me, I had to read from a booklet to find out how to apply anesthesia. I had to open her abdomen to see if she had peritonitis. I gave her local anesthesia, and just as I was about to give her general anesthesia, a plane dropped a bomb very close to us. The woman jumped up with her wound half open and ran away. I never saw her again. Later I learned that she had been found dead four kilometers from the tiny hospital.56
Díaz had a more positive experience in the northern front:
One day in Saará, they brought us a boy about four years old named Kumba, who had a large wound in his left leg. His good spirit impressed us; he didn’t shed a tear or show pain. A few hours before, the Portuguese attacked a nearby village that had no combatants and no protection. Luckily, they were able to bring this little boy to our small rural hospital. We cleaned the very dirty wound and partially sutured it because we didn’t want future complications, such as gangrene. During all the treatment without anesthesia, Kumba continued as before, without a tear or expression of pain.57
Cuban officials knew that the behavior of doctors toward civilians was as important for diplomatic relationships as troop discipline was for military advances. When Cuban physicians first went to Algeria in 1963, Raúl Castro issued a strict code of conduct that included a prohibition of alcohol and intimate relations with women, and demanded absolute respect for Algerian traditions. Che spoke to physicians in Zaire of the moral aspect of their mission: “I don’t want any scandal. Anyone who is undisciplined will have to be counseled or sent back to Cuba.” A couple of years later, the Cuban command in Guinea-Bissau replaced a doctor accused of not showing respect for local customs.58
The importance of this respect grew as Cubans and Africans became closer. Unlike Catholic and Protestant missionary doctors, who stayed at fixed locations and required Africans to come to them, Cubans went on long walks to isolated villages to provide care. As Zaireans learned of the arrival of Cuban doctors, “peasants from the surrounding area flocked in.” Before the Cubans arrived, only nine doctors had provided care for almost a million Congolese. Hugo Spadafora, a Panamanian who was the only foreign doctor with the PAIGC, wrote that when the Cuban physicians arrived with medicine and equipment “the quality of the hospital’s care increased exponentially.”59
The guidelines laid out by Raúl and Che served Cuban efforts well. While their military allies in Zaire were often accused of mistreating local people, there were “no reports of the Cubans perpetrating any crimes or acts of violence against the population.”60
Instead, the Cubans won people’s trust by doing countless simple procedures. These included tooth extractions, operations for hernias and cataracts, and treatments for high fever, diarrhea, confusion, stomachaches, and shoulder pain. In Tanzania, Piñeiro recalled that “most patients were civilian and a few were military. The most frequent problems were malnutrition, malaria, pneumonia, and parasites.”61
Delgado learned to treat parasitic diseases he had never seen in Cuba:
I saw whole villages with trachoma, an infection of the eyes and eyelids that leaves people blind. I visited villages where almost everyone was blind. I saw people with advanced leprosy, without fingers. There was a sickness, miasis, produced by a fly bite that causes an abscess from which worms grow. Another produces boils on the body, called onchocerciasis, which is a type of filaria. This disease has a special treatment. There is a worm that gets under the skin and the Guineans use a little stick to which they fasten a palm thread and put it in the boil and roll it around until they pull out an enormous worm called “the worm of Guinea.” There are many parasites and harmful insects, such as the jigger flea (nigua), which gets under people’s skin in dry weather and causes boils. You have to extract the parasite, which looks like a tick.62
Perhaps one of the most unexpected tragedies was a Cuban soldier dying from eating a strawberry. He had a perforated ulcer and no idea how acidic the fruit could be. “By the time he reached me,” Díaz remembers, “he was in agony. We did all we could to stop the bleeding, and since we didn’t have surgical instruments, we tried to move him to the small hospital in Boké. But he died on the road.”63
Though the Cubans tried to attend to civilian medical needs, operations had to be authorized by the PAIGC area director due to shortage of materials. This required creative searches for alternative materials, such as using coconut water (which is sterile) in intravenous fluids. On multiple occasions, Camacho “had to suture patients with domestic sewing thread,” which led to deal-making with local thread vendors.64
TRULY INTERNATIONAL MEDICINE
The riches of Africa were being drained as its peoples lay crippled or dying from curable diseases, which did not pique the interest of wealthy Western investors. This was the case with polio. Álvarez Cambras gives a picture of what he witnessed when he arrived in the Congo:
Many suffered from polio. I visited an asylum attended by a single nun that was full of children with the disease. The children were crawling across the floor in very bare surroundings. The nun didn’t have supplies or staff to deal with them. I operated on dozens of these children…. The French had left nothing of the infrastructure; there were no lawyers or engineers, and only two native doctors.65
Dr. Puente was the manager and one of the principal advocates for a polio vaccination campaign. He ran into two Soviet medical staff who were vaccinating