50,000 employees in more than 60 countries, and revenue of around 11 billion dollars a year. These are not the figures of a multinational, but of the services exported by the Cuban State.
In the image and likeness of a capitalist empire, in recent decades the Government of the island has adopted a policy of global implantation in the niche markets where it has expertise and a large workforce.
This strategy is often overlooked when people talk about Cuba's doctors sent abroad. It is primarily an economic maneuver, for profit, and not (as is usually claimed by official propaganda) a gesture of solidarity.
Although during the decades of "proletarian internationalism" the socialist regime did cover the costs of education and health programs in Third World countries, since the disappearance of the USSR (and its huge subsidies) the experience and reputation acquired by Cuban professionals in these areas have become fundamental assets to open up new markets.
The business of solidarity, beyond the semantic confusion, entails a set of perverse effects. The Government insists that the "missions" contribute to financing the achievements of the Revolution, but given the opacity clouding the administration of national budgets and resources, it is worth asking whether the revenues collected through this channel are actually being invested towards said aims.
Old facilities and a lack of personnel and of resources for patient care are among the persistent complaints of the Cuban people regarding their health system. The deterioration of public services (education, health) is evident in the country, and it does not seem that exports in these areas are remedying this decline.
It would seem, therefore, that the regime is just robbing Peter to pay Paul. The provisioning of services abroad is being carried out to the detriment of Cubans. But this is nothing new, as putting propaganda before the needs of the population is one of the keys to the regime's survival.
The image of a small and poor country that, nevertheless, shows solidarity, ensures it valuable symbolic capital on the international scene.
The other risk involves the hastened turning out of professionals to meet international demand, which has a negative impact on the level of medical personnel. In recent years, in countries such as Brazil, Costa Rica or Chile, Cubans' preparation has been placed in doubt when they have tried to have their degrees validated abroad.
It would hardly be surprising if on the island economic factors were prevailing over educational requirements. And in the short term it will be, once again, the Cuban people who will pay for this regression.
The blackmail strategy
Another thorny point is the massive withholdings on wages (between 50% and 75%) applied by the Government. The justification that these professionals still have incomes above the national average is unacceptable.
It is precisely the paltry salaries the Cuban State gives its employees that spur doctors to participate in the "missions," to compensate for what is a deplorable economic situation.
But it is abroad where the plight of Cuban doctors becomes really shameful. The fact that decades of collective sacrifice have created a population capable of putting up with all kinds of hardships, such that Cuban professionals manage to survive on the salaries they receive in their host countries, does not make them any less disgraceful.
One Brazilian judge did not hesitate to define this type of contract as a "form of slave labor".
This systematic spoliation is based, in the first place, on the absence of any independent trade unions recognized by the State and capable of defending workers’ interests, and negotiating agreements with the Government (or contractors) with respect to pay and working conditions.
In addition, there is the absence of a transparent and clearly regulated national tax system. The appropriation of most of the salary is not really a tax, but rather an arbitrary requisition.
A two-fold blackmail grips Cubans sent abroad: the precarious conditions of life on the island, and potential reprisals (being barred from returning to the country for eight years, for "desertion") if they fail to fulfill their obligations toward the government.
This is indicative of a power that has consolidated its power through militarization and the instrumental manipulation of society.
A final note
To question the tactics of an authoritarian regime that boasts of altruism is not to exalt chauvinistic selfishness. Nor is it to oppose the different forms of solidarity that are established between individuals or societies.
Due to the collective and continuous sacrifice entailed by the old revolutionary guard in Cuba and its perpetuation in power, it would be only logical to consult the population regarding the sending of doctors abroad (how many, and in what sectors).
This would mean the government demonstrating accountability for the current situation of, for example, the health system: surplus medical personnel, in what fields, the infrastructures that need immediate attention (and those that do not), and how the funds accumulated thanks to the export of medical services are being spent.
As this, public health, is a social issue of the greatest importance, a debate that encompasses society as a whole (and not only regime higher-ups) would be in order.
None of this would clash with the charitable impulse that the regime supposedly embodies. But it would be done according to what a society that does not rank among the most prosperous on the planet can actually afford.
Unfortunately, even proposing this idea is to indulge in a political pipe dream, as it presupposes exactly what Cuba lacks: a state subject to the rule of law, and that guarantees its people's freedoms.