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Cuban Doctors in Pakistan: Why Cuba Still Inspires

Aasim Sajjad Akhtar (amajid [at] is a political activist associated with the People’s Rights Movement (PRM), a confederation of working-class struggles. He also teaches colonial history and political economy at the Lahore University of Management Sciences.

The signs point to the fact that the symbol of the Cuban revolution is reaching the end of his road. Even if it does not formally mark the definitive end of almost fifty years of undisputed leadership at the helm of the island republic, Fidel Castro’s handing over of power to brother Raul in late July is surely a precursor to what will happen sooner rather than later.

A hypothetical post-Castro Cuba has been promoted by the U.S. power structure for a long time. In the initial decades after the 1959 revolution, the hope persisted that the revolution could be undermined, in spite of the fact that the incessant efforts of the CIA to assassinate Castro never met with success. More recently, new conjectures on what will become of Cuba after Castro have started to make the news as it has become clear that Fidel’s health is slowly failing.

The Bush administration has started to wax lyrical about the “plan” that it has in place to help Cubans move quickly toward “freedom” after Castro departs the scene. Of course given its preoccupations elsewhere, the administration is not likely to spend too much time and effort worrying about Castro’s health, unless his passing starts to look imminent. In general, and to many people’s surprise, the Bush administration has been unable and/or unwilling to respond to Castro’s recent resurgence in popularity across the Americas due to the electoral victories of a growing number of populists—some may call them genuine socialists—in countries to Cuba’s south.

Yet the imperialist propaganda machine still operates at full tilt. Misinformation about Cuba in the United States remains startlingly widespread. The term “dictator” is bandied about liberally in referring to Castro. In mainstream accounts about the island, there is no mention of Castro’s overwhelming popularity among the Cuban people. Some of the more warped and gory propaganda pieces suggest that criticism of Castro invites the wrath of death squads. In actual fact, as time has passed, Cubans have become more uninhibited in expressing their displeasure about unpopular decisions and openly criticize Castro’s past and present indiscretions.

In the final analysis, there is little said about Cuba in mainstream U.S.—and therefore many international—accounts that does not somehow come back to Castro and his “monstrous dictatorship.” There is no mention of the solidarities that characterize post-revolution Cuba, only misrepresentation of the social cleavages that Cuba continues to face. There is no mention of the incredible gains that the Cuban people have made in health, education, and other sectors of society, only an insistence that the majority of them are terribly unhappy and constantly on the look out for an escape route to Miami. And there is absolutely no connection made between the ongoing difficulties that the revolution encounters and the crushing embargo that has been championed by every U.S. administration for forty years.

For all of the talk of Cuba being wedded to the failed communist experiment and the obsolete ideals of the Cold War period, it is mainstream America that still uses the language that was commonplace at the height of the superpower conflict. Cubans who come over to Miami are “defectors” and are treated as liberated prisoners of war by the exile community. Just how preposterous such portrayals actually are is reflected in the fact that Cuba’s biggest income-earning industry is tourism—millions of Europeans, Asians, and Africans (and even a fair share of Americans) visit the island every year, none of whom are considered by their own governments to be “spies” or possible “defectors.”

Cubans’ remarkable commitment to internationalism is also down-played globally due to the smear campaign that Washington and the U.S. dominated corporate media spearheads. Cuba has sent its troops around the world in support of numerous liberation struggles, including many in Southern Africa and Asia. Perhaps even more significantly, Cuban doctors are found in the remotest of areas worldwide, serving populations that may never have seen doctors before. The most recent such episode was in the aftermath of the devastating earthquake in Pakistan’s mountainous region in October 2005. The Bush administration has consistently referred to Pakistan as a “front-line state” in the post-September 11 period, and one would think that the earthquake would have presented an opportunity to reward the military regime of General Pervez Musharraf for its extremely unpopular support for the “war on terror.” But it was at this time of great suffering of the Pakistani people that imperialism’s hollow slogans of neoliberal internationalism were exposed, while the virtues of socialist internationalism were plain for all to see.

Over 2,500 Cuban doctors lived and worked in the earthquake-hit zones for six months after arriving in late October 2005. For many of these doctors, this was the first time that they had been exposed to any kind of winter, let alone a relatively harsh one in an area with very little in the way of protection, particularly after the devastation of the earthquake. The Cubans developed intimate relationships with thousands of those they treated, even though they were very careful not to engage in too many discussions and debates on politics, particularly relating to the discontent that is rife against the army’s domination of public life.

For many Pakistanis, the Cuban experience was a revelation. In the first instance, there was a stark sense of disbelief that these individuals came to Pakistan of their own free will and that they stayed well beyond the point that most global relief efforts had wound down. Pakistanis found it very hard to understand the picture that the Cubans painted of the dynamics of Cuban society. They could not relate to the idea that the majority of Cubans believed in and were committed to a profound sense of social equality, especially when they compared this to the deep-rooted hierarchies that permeate Pakistani society. Perhaps more unbelievable was the notion that the state actually promoted this shared solidarity—Pakistanis know the state to be committed only to undermining such processes.

The Cubans too found many aspects of what they saw around them to be somewhat unbelievable, perhaps most of all that so many of their patients were actually seeing a medical doctor for the first time in their lives. The Cubans also distinguished themselves from the rest of the relief effort by either living in tents under the same conditions as those displaced by the earthquake, or when in Islamabad, renting rooms at the most modest hotels that they could find. This was in stark contrast to the staff of most of the international aid agencies, who not only contributed to the creation of an extremely harmful and artificial parallel economy in the earthquake areas by paying for everything in foreign exchange and doling out huge amounts of money to meet their basic “subsistence” needs, but who also tended to spend an enormous amount of time in five star hotels in Islamabad and other big cities. As with all major donor funded operations, a healthy chunk of the monies committed to earthquake relief was channeled toward the overhead costs of the relief teams themselves. Not so with the Cubans who were provided a fairly meager allowance even by Pakistani standards and shopped and ate in the working-class areas of Islamabad (hidden as they are from view by a very sinister planning process), interacting extensively with ordinary people in these areas in a spirit of great camaraderie.

The Cubans have since committed to providing training services to Pakistani doctors for free, admitting Pakistani medical students to universities in Cuba, and continuing to send Cuban doctors to Pakistan to work in under-serviced areas, a practice that was much more common when the socialist bloc still existed, but is now slowly being experimented with again in friendly Latin American countries. In some cases, such as those of Venezuela and Bolivia, the Cubans are receiving cheap oil and gas in return for their medical expertise, but in the Pakistani case, the Cuban offer of assistance was made (and accepted) without demand for something in return. There has been talk of a broader preferential trade agreement between the two countries, although there has been no explicit progress on this initiative as yet, ostensibly because General Musharraf would rather not annoy his more prized ally ninety miles to the north of the little island.

Perhaps unsurprisingly, Pakistanis who came into regular contact with the Cubans were kept under strict watch. In cases where there was a suspicion that the interaction had moved beyond basic conversation about health-related issues, and particularly when the Cubans met local political activists with even a slightly leftward tilt, the intelligence agencies wasted no time in asserting themselves. A number of people were questioned about their exchanges with the Cubans and implicitly warned not to meet them again. Pakistan has long been a bulwark against communism—and is now ostensibly a bulwark against terrorism—hence the tolerance for any “communist” influence is virtual nil. It is a testament to the nature of the Pakistani state that it constantly complained about its lack of capacity in dealing with the earthquake, particularly in terms of a shortage of civil servants, and yet still had enough state functionaries to collect intelligence on the activities of a team of Cuban (read: communist) doctors who were arguably the most effective of the many foreign relief teams that came to Pakistan after the earthquake. Like its patron the United States, the Pakistani state clearly has not moved beyond the hang- ups of the Cold War, while, to their credit, the Cubans avoided any controversy and dedicated themselves totally to their work, making sure to engage publicly only on matters related to their medical tasks.

U.S. involvement in the earthquake areas was also very conspicuous. Apache helicopters that were graciously excused from duty in Afghanistan made numerous daily trips with various aid supplies from air bases in Islamabad and Rawalpindi to the earthquake-affected areas. The helicopters were, without doubt, extremely valuable because the road network was badly disrupted: many roads were simply unusable while those that were intact had to deal with a massive increase in traffic that seriously undermined the relief effort, which effectively became a race against time. But what was not well known to the general public was the cost that was being incurred for limited use of the aircraft. It was initially reported that the Americans were “renting” the helicopters to the Pakistanis, their most prized of allies, although this was quickly denied and the original story discredited. A relatively small number of American troops were also sent over from Afghanistan to conduct sporadic missions to the remotest of peaks where it was impossible to transport medical help or supplies by road. On the whole the Bush administration committed $150 million in congressional aid to Pakistan for the earthquake, in comparison to over five times that amount for the tsunami relief effort in 2004–05. As with most such aid however, only a fraction of it has been disbursed as of this time, and, as is also the common practice with foreign aid, the vast majority of the funds committed is in the form of loans—albeit low interest. This means that the interest owed will end up being greater than the value of the principal loaned. In fact, of the more than $6.5 billion committed to Pakistan by the international donor community, only a fraction was committed in grants. The government has actually received a little over $1 billion.

What is remarkable about these amounts is how they actually compare to the tens of billions that the United States is spending annually in nearby Afghanistan, the first major front of the “war on terror.” Further, the total U.S. defense budget for 2007 is $447 billion. It should be borne in mind that there are over two hundred Apache helicopters in Afghanistan of which only eleven were deemed expendable enough to be sent over to Pakistan. The U.S. strategy in Afghanistan is not improving things in that terribly unfortunate country. In fact it is further exacerbating an already dire situation. Meanwhile, the U.S. munitions industry continues to make billions of dollars by selling weapons to warring factions in Afghanistan and earns even more from its sale of F-16 aircraft and weapons technologies to Pakistan. On the whole, the United States has directly contributed to the militarization of Pakistani state and society, and it shares responsibility with the Pakistani military for the political process being a shambles. Even as the sheer magnitude of the devastation caused by the earthquake became clear, the American intervention remained dwarfed by its unending desire to dominate the region.

All in all, the differences between little, embargo-stricken Cuba’s contribution to earthquake relief and that of the world’s richest and most powerful country, the United States, were stark. Pakistanis have been bitterly opposed to the present government’s naked policy of alignment with imperialism, yet they are typically only exposed to the hateful sloganeering of the religious right as an alternative to the Musharraf junta’s adoption of a radical neoliberal policy framework. The religious right claims that it is the only principled opposition to the military’s pro-imperialist stance even though it too has a very similar political philosophy (read: Islam vs. the infidel West) to the U.S. with-us-or-against-us war on terror. Since the religious right’s takeover of power in the North-West Frontier Province and signing of the constitutional amendments package that legitimized the lame-duck arrangement that allows Musharraf to retain almost absolute power, the majority of the Pakistani people have had their long-held suspicions about the religious right confirmed—that it offers no alternative to neoliberal capitalism at all, and that, in fact, its politics mirror that of its alleged sworn enemy, the imperialist United States.

It was therefore very significant that Pakistanis—particularly working people, including those in serious need—were able to spend time with the Cubans and learn about a genuine alternative to the soulless and exploitative social order that exists in Pakistan and the vast majority of societies around the world. Naturally, by virtue of it being part of the capitalist world economy, no matter how comprehensive the efforts to insulate itself, Cuba, particularly after the collapse of the Soviet Union, is also beset by numerous inequities and injustices that are the defining features of the capitalist social order. Yet it remains a society that has undergone profound revolutionary changes, arguably the most significant of which is the shift from “material” to “moral” incentives, as Che famously insisted would be the crux to the building of a genuine socialist society. This is not to say that “material” incentives have been vanquished from the Cuban social order, but the very idea that an entire society could conceive of things in this manner truly inspired the many working Pakistanis that had the chance to hear about it.

Indeed, it is facile to postulate that the Cuban revolution will suddenly vanish into the past as soon as Fidel Castro dies, or that the White House-championed perversion of “freedom” will suddenly prevail. There is no doubt that tensions between the older generation of Cubans who have witnessed the revolution unfold before their eyes and the younger generation that is drawn to the flashy gimmicks of twenty-first century capitalism have been intensifying steadily over the past decade and a half. And not without reason either—after all, Cubans have experienced a quite dramatic decline in living standards following the fall of the socialist bloc and the tightening of the U.S. embargo. And it is this latent conflict between successive generations of Cubans that will define the post-Castro era. But it is also worth remembering that even amongst Cuban youth, as much anger as they might harbor against Castro for trying to insulate Cuba as much as possible from the United States and the penetrative effects of capitalism at large, there is still a value for life, equality, and the other tenets of the revolution that will not easily be replaced by the crass individualism and hunger for self-aggrandizement that keep capitalism ticking.

Cuba still has much to teach the world, particularly the third world, about how to resist the dictates of imperialism and how the will of a self- conscious and united people can build an alternative to capitalism. This is particularly so in this era when neoliberal ideology dominates in so many parts of the world (although conspicuously less so in Latin America) with the result that the very notion of an alternative means of organizing society has become a marginal idea. With the spread of globe-encompassing information technologies that are easily manipulated by the corporate media and complicit states, it is difficult for genuine information about progressive, and even revolutionary, social processes to reach many parts of Asia and Africa. But as the wave of upheavals in Latin America proves, it is no longer possible to get away with grand proclamations such as the “end of history.” The crisis of neoliberal capitalism is becoming more and more acute, even if the alternatives to it will take time to emerge.

In the meantime, the Cuban revolution will continue to unfold and be a source of inspiration for the third world, or at least those in the third world who know even a little bit about it. There is no doubt that imperialism will continue to seek to undermine the revolution and that the most crucial period in the almost fifty years since the revolution will follow Castro’s passing. But revolutions are not made by individuals, even if in this case Castro’s impact has been disproportionately large. In the long run, it will be up to Cubans themselves to decide how things proceed. No matter how serious an effort is made by the United States to penetrate Cuba with its corporations and cable television, the Cuban people will strongly resist any path that they have not chosen themselves. This is the independence and democratic control that all of the third world aspires to, and that many Latin American peoples are now actually starting to achieve.