Even before the government required rural medical service, on November 29, 1959, medical students assembled to pledge their willingness to go to provincial Cuba. Soon after López Benítez graduated from medical school, he said, “a friend asked me why doctors were being sent to Santiago when there were not enough in Havana and I said that there were even fewer in Santiago. We’re all Cubans.”
As Cuban society polarized, students were entering medical school with the expectation that they would be trained not for personal gain but according to the needs of society. Renouncing private practice, students often commented that they would go “wherever the revolution needs me.” By 1963, it was very clear to those entering medical school that they were different from earlier generations of students.
Eagerness to go to the countryside likewise caught fire with practicing physicians. Fleites was profoundly affected by his chat with the new minister of health: “That minister knew me and he talked to me about going with them. They needed many physicians to go to various places in the Sierra Maestra, to provide care for the peasants. And I said ‘Yes, I will go!’” López Benítez observed that “Fidel had a huge influence after the literacy campaign. He asked for people to study medicine and many who answered the call were teenagers.” One of those teenagers was Dr. Oscar Mena Hector, who spoke to me when he was sixty-two. He heard Fidel’s call when he was in middle school. He took the science entrance exams for medical school when he was fourteen years old. He did not pass then, but he did in 1970 and became a doctor in 1976. Medical campaigns in rural Cuba deeply affected those who participated. Fleites “will always remember the particular case of a dehydrated little boy. We gave him intravenous infusions because he had diarrhea. I remember that boy well because he would have died of dehydration if we hadn’t been there.”
MEDICAL INTERNATIONALISM
Cuba’s medical system interacted with other countries in many ways. As early as April 1961, Cuba signed a cooperation agreement with Czechoslovakia. The next year it sent technicians to Bulgaria to study preventive medicine. East Germany made an agreement in 1964 to send orthopedic supplies. Cuba also sent doctors abroad. In March 1960, only fifteen months after the revolution, an earthquake hit Chile, and Cuba sent a small number of doctors for a brief period. The next year Cuba sent arms to Algerians fighting for independence from France. The boat returned with seventy-six injured Algerians and twenty child refugees.
A medical brigade sent to Algeria in 1963 had fifty-five Cubans, including twenty-nine doctors. There were forty-three men and twelve women. Details of this mission were not widely known until Hedelberto López Blanch published Historias Secretas de Médicos Cubanos (Secret Stories of Cuban Doctors), a collection of oral histories of Cuban medical workers serving in Africa in the 1960s and 1970s.19 One of the doctors going to Algeria was Dr. Sara Perelló, who was eighty-four years old when interviewed by López Blanch. She had just graduated with a specialty in pediatrics. Her mother had heard Fidel saying that the flight of doctors to France left Algerians even worse off than Cubans: “There are 4 million more Algerians than Cubans but they have only a third of the doctors we do.”20 After her mother came home and told her that she needed to help them, Perelló went to MINSAP to volunteer. She was worried about leaving because her elderly mother was suffering from Parkinson’s disease. Her mother responded that Sara’s sister and husband would help her as would the government: “Now the thing to do is go forward and don’t worry about your mother, who will be well taken care of.”21
When Dr. Pablo Resik Habib was seventy-six years old, he told López Blanch that he was chosen to head the Algerian mission largely because of his Arab heritage. He had worked as an anesthesiologist, first in a hospital and then in a mutualist clinic. He left his three-month-old daughter in the care of his wife, who supported the international efforts. Brigade members were promised a small stipend, with their salaries going to their families. Resik described the precarious plunge into Cuba’s first international mission: “We found ourselves in an Arabic country, Muslim, with habits, customs and cultures very different from ours.”22
Dr. Zoila Italia Suárez would have completed her pediatric specialty, but due to Batista’s closure of the university, her graduation was delayed until 1960. She went immediately to Granma province for her rural services. Her recruitment to the Algerian brigade exemplifies the transition from campaigns to end the rural-urban dichotomy within Cuba to medical internationalism. Her initial willingness to leave Havana for rural Cuba easily transformed into a willingness to help meet medical needs in Africa. Italia emphasized that language was her main problem. During treatment she would have one translator for Arabic to French and a second for French to Spanish. When one woman brought in a child but spoke a form of Arabic that the translator did not understand, the mother took her hand and placed it on her son’s abdomen. Upon feeling a tumor, she sent him to the hospital immediately. She learned to diagnose based on where the mother touched the child or if she imitated sneezing or coughing.
The mission taught staff valuable medical experiences. Italia witnessed “many sicknesses that were rare or nonexistent in Cuba. I saw a lot of tuberculosis, malnutrition, malaria, parasitic diseases and bacterial infections…. In Constantina, a military hospital was completely empty because the French doctors had left.”23 Ernesto “Che” Guevara left a deep mark on this formative mission. Italia recalled: “Che visited us when we had only been in Algeria a month. He asked if we were having any difficulties and how we were able to interact with patients without knowing their language. Che only spent a few hours with us; but we were distributed in various provinces and he went throughout the country.”24 Dr. Perelló reminisced, “One afternoon we were told that Che would meet us the next morning at 7 a.m. We didn’t think that would happen because no one travels at night in Algeria. But when we arrived at the government house on April 13, 1963, Che was waiting for us at the door.” Che impressed her as serious to the point of being ascetic: “Che told us to forget the greenery and palm trees of Cuba and dedicate ourselves to our work.”25 Algerian experiences left Cubans with stories that would inspire medical students for decades. Resik emphasized, “I received much more from this mission than I gave to it…. I am proud to have been one of the pioneers of this enormous example that the small island of the Caribbean has given to the world.”26
THOSE WHO LEFT
Many Cuban doctors had no desire to go to the provinces, much less to the Algerian desert. Multiple waves of doctors left Cuba after the revolution. The first accompanied the huge changes in health care delivery during the first couple of years. Many were owners of private clinics, directors of mutualist centers, and doctors who enjoyed high incomes from private practice. The second wave was provoked by the April 1961 Bay of Pigs invasion and the October 1962 missile crisis. López Benítez pointed out that “in William Soler Hospital there were fifty-nine doctors. In one day in February 1961, twenty-six left. This was a month or so before the Bay of Pigs. They must have known that it would happen and left before.”
Many departed with the advent of rural service, which would take them to locations lacking the comforts of Havana. Cárdenas stated: “It was similar to Brazil where many doctors do not want to go to areas where they are most needed.” He added, “Most of the doctors who left were not rich but identified with them.” The literacy, medical, and other campaigns that brought contact with Cuba’s poor, working, and farming classes were an affront to middle-class lifestyles. It went beyond the disruption of medical school—when Batista closed the university during the years 1957 to 1958, there was no great exodus of medical faculty. Dueñas suggested, “They knew that doors were open to them in the United States. Many doctors went to Miami not because they were counterrevolutionaries but because they could have so many things in the United States.”
I asked four doctors—López Benítez, Cárdenas, Dueñas, and Mena—if the difference between those who left and stayed was primarily a generation gap, and they all replied no, age had nothing to do with it. They also agreed that it was not possible