They say that they fulfill their mission when they serve in countries that have signed agreements with the Cuban regime. "Mission." It is a term that supposes a zeal to spread the faith, and entails a set of diplomatic shenanigans. And, indeed, there is a lot of indoctrination and diplomacy involved in the work of Cuban medical personnel on "missions," as they do not only care for their patients, but often seek to influence, in accordance with the Government's interests, patients who are also voters.
In this way Castroism cultivates the reputation that has won it good press around the world (ah, the Revolution's health system, the Revolution's education...), without meddling in the internal affairs of other countries. But public health can be the continuation of guerrilla campaigns, by other means.
It is no coincidence that when doctors and medical experts abandon their missions and seek refuge where there are no agreements with the regime, they are officially branded as deserters. They flee from their roles as political pawns, the restrictions on their movements and contacts, the surveillance they are under at all times. They reject being soldiers. So they are deserters.
They carry out missions in regions where even their local counterparts refuse to go. And they do so for salaries that, according to other doctors, are not worth the sacrifice. This is where supposed Castroist altruism comes into play, and where the World Health Organization (WHO) sings the regime's praises: there go Cuban doctors and experts to make up for the selfish locals, to succor the poor in this world...
But before, in order to lure them towards those places, they are subjected to a impoverishment. Their salaries in Cuba are insufficient to lead dignified lives. They have no TV, or car, house or vacations. They eat poorly, unable to give their children certain basic sources of nourishment. All this ensures that they end up serving on missions, in an effort to scrap to get a little a bit ahead. If the authorities view these health missions as proxies for guerrilla campaigns, for Cuban doctors they are alternatives to emigration and exile.
When Barack Obama, in his last days in the White House, canceled the asylum program for Cuban medical personnel, in place since 2006, he cited humanitarian reasons: he did not want to jeopardize health care in Cuba, and did not want to steal doctors from patients on the Island. Great intentions, in practice, but the end result will only be to exacerbate the enslavement of medical personnel implemented by the Castros.
It is essential to address this practice as a kind of neoslavery: mission staff receive only 10% -30% of what international governments and institutions pay for their work. The rest of the money ends up in the hands of authorities who are unaccountable for their exploitation. It is a system that rewards the worker as little as possible in order to keep him in a vicious circle that ensures his perpetual availability. A system designed employing pimp-like stratagems.
The Castros, in this way, resemble another Caribbean Dynasty: the Duvaliers, who rented out Haitian cane cutters and seized a good portion of what the Dominican Republic paid for each of them. Outdoing the Duvaliers, their Cuban counterparts manage to enslave doctors with the approval of the WHO, and many grateful Latin American presidents, who turn deaf ears to the details about their exploitation. Then Castroism seeks to shame any government that threatens its human merchandise, accusing it of stealing brainpower belonging to it.
There is talk now of some 1,200 former members of Cuban medical missions who, without being on US soil, were able to qualify for asylum before Obama's new measure. There is talk of thousands more who fled but will not have an opportunity like this one. There is talk of petitioning President Donald Trump to revise the country's immigration policy.
The Cuban regime warned that this year would be a tough one for the nation's economy, so it will be ratcheting up exploitation in one of the areas most profitable for it: the renting out of health personnel. The number of Cubans per available doctor is likely to grow. And there will probably continue to be a shortage of specialists at hospitals in Cuba. The revocation of the US asylum program will not help people on the Island, and will do nothing either for the liberation of its enslaved doctors and medical experts.