What would happen if we sent doctors instead of weapons to other countries?

This week, Stephanie and Michael talk with Dr. John Kirk, professor at Dalhousie University and expert on Cuba’s innovative and inspirational approach to public health and its dedication to ‘medical internationalism’. Medical internationalism – the practice of offering healthcare to those in need, wherever they might be – embodies Cuba’s commitment to healthcare as a human right, an idea that is enshrined in its constitution: “the preamble to [the Cuban constitution] says we have an obligation to share what we have. Not to give our leftovers, but to share what we have.” 

This policy of what might seem like radical generosity to those entrenched in healthcare systems fueled by the capitalist prioritization of profit, in fact works: 

"Cuba’s also got a surplus of doctors. The ratio of patients to doctors in Cuba is three times that of what is found in the US. So, Cuba has a tremendous human potential. And Castro saw that and that's why he was the person who sort of directed medical personnel to work in the developing world."

Since 1960, Cuba has played a significant and effective role in emergencies worldwide, from Chernobyl to Haiti. In addition to collaborating with countries who have acute needs due to natural disaster, war or other misfortune, Cuba educates aspiring doctors from all over the world – and medical school in Cuba is free. Additionally, doctors in Cuba are trained to understand patients as “bio-psycho-social beings,” that is, holistically, with lives and contexts that dramatically impact their health.

This interview does more than highlight an isolated and particular case study, a close look at public health in Cuba, which has a 65 year history of success, offers a possible alternative to the broken healthcare systems in the US and elsewhere.

Transcript

Stephanie: Greetings and good morning everybody. Welcome to another episode of Nonviolence Radio. I'm your host, Stephanie Van Hook, and I'm here with my co-host and news anchor of the Nonviolence Report, Michael Nagler. And we're from the Metta Center for Nonviolence in Petaluma, California.

On today's show, we have the opportunity to speak with Dr. John Kirk. He taught for over 43 years at Dalhousie University, and we're going to be speaking with him about Cuban medical internationalism.

We'll explain later in the show how this ties into Nonviolence Radio. You'll be able to hear the connections. But really, in the conversation about health care systems, especially in the United States that have been raised especially since the murder of CEO of UnitedHealth, Brian Thompson. There seems to be a lack of conversation about alternatives to the health care system and more of a question about the justification of that murder or not. So, our goal here in this show is to present some alternative methods and models for health care and try to spark a conversation about that.

So, let me give you a quick background about Dr. Kirk. Besides teaching at Dalhousie University, he has been traveling regularly to Cuba since 1976, and most recently in April of 2024. He is author and co-editor of numerous books on Cuba, most recently Contemporary Cuba: The Post-Castro Era, by Rowman and Littlefield. He has written extensively about Cuban medical collaboration abroad, including his extensive study Health Care Without Borders: Understanding Cuban Medical Internationalism from the University Press of Florida.

In 1994 and 1996, he worked as the interpreter for the premier, who was a liberal family doctor of his home province, Nova Scotia, in two weeks of meetings with Fidel Castro. And he says that he's a man obsessed with public health concerns. We'll find out more. From those meetings came Kirk's interest in medical internationalism. So, I'm pretty excited to have him here. Welcome to Nonviolence Radio, John Kirk.

John: Thank you, Stephanie. Pleasure to be with you.

Stephanie: It's great to have you. You mentioned that you worked as an interpreter for Nova Scotia's Premier in meetings with Fidel Castro really sparked your interest in medical internationalism. So, might you share a specific moment or insight from those meetings that really left an impression on you?

John: Yeah, sure. In January 1994, I went with the premier of Nova Scotia. Canada's got ten provinces. Nova Scotia is a small one on the Atlantic coast. And the premier was a guy called John Savage, who was a member of the Liberal Party, but also was a very small liberal family doctor here in Nova Scotia.

He took a trade delegation of 25 businesses from Nova Scotia to Cuba in 1994 for a week. I went along as his interpreter for meetings that he held with members of the Cuban government, including many with Fidel Castro. We went back in February 1996 to continue discussions about investment in Cuba, trade, things like that.

But what sparked my interest was that John Savage was a very well-known family doctor here in Nova Scotia. And so, I was interpreting and listening to him talk with Fidel Castro, with whom he had an excellent working and personal relationship. And it became very obvious to me just how obsessed with public health Castro was. And so, the two of them talked a lot about public health.

Stephanie: And so, was there a specific thing that was said there? Was it just those conversations that really got you thinking about this topic in particular? Because it says you've been going to Cuba since 1976, so there was some shift in your interest there it seems.

John: Well, yeah. My PhD thesis was on Cuba, and so, I'd been traveling, and I published books on Cuban history and Cuban culture. But I hadn't thought about medical internationalism until then. I'd been to the public hospitals with my students and my daughter, who was studying at the university. She had a very bad reaction to peanuts and so, I accompanied her and spent time with her going through the medical treatment, of paying the bill. And that gave me an interesting insight.

But the medical international came about as a result of the meetings between Castro and the premier. That's when I said, “Whoa, this sounds interesting.” And so, I started to study it.

Stephanie: And so, tell us a little bit more about some of the philosophy of medical internationalism, why we don't call it aid.

John: You know, the Cubans get upset when you call it aid. They sort of say, “No, that's very paternalistic. This is collaboration or it's cooperation.” Medical internationalism is based upon the approach to public health which exists in Cuba and so, it's a continuation or extension of that. Patients are never clients. They're always patients. The emphasis is upon preventive medicine, not curative medicine. 

The patients, they’re seen as bio-psycho-social beings. So, when a doctor interviews a patient, they look at the whole surroundings, like the house they live in, the community they live in, the stresses they're under. So, all of this is part of seeing the patient as a bio-psycho-social being.

The Cuban Constitution also insists that everybody have access to health care as a basic human right. And also, the Constitution, the preamble to it says we have an obligation to share what we have. Not to give our leftovers, but to share what we have, particularly with countries in Latin America and the Caribbean.

So, this basic philosophy, which is so unusual, is in many ways the philosophy, the filter through which medical internationalism is seen.

Stephanie: That's really interesting, John. And you said in your bio that Fidel Castro was a man who was obsessed with health or public health concerns? Can you tell us how that ties into this phenomenon?

John: Yeah. I asked him about this, and said, “Why is public health so important to you? And why specifically in terms of medical internationalism?” And yeah, he smiled, and he said, “Listen, if you look at most of my government ministers, they’re doctors. They're not economists or social scientists, they’re doctors. Why? Because to be a doctor, you have to have compassion. You have to have heart. You have to believe in the potential for people. And so, I firmly believe that the best people to practice government are doctors – if they have the right human values. And I believe that the training we give to our doctors provides that.”

So, that was the basis, Stephanie, from which he looked at and sort of at running any kind of humanitarian government. In terms of medical internationalism, the Cuban Revolution took place in 1959. And in 1960, Cuba sent its first medical delegation abroad. It sent it to Chile after an earthquake. And Cuba was broke in 1960 yet continued to – without charging anything – to a variety of countries in the global south. So, it's part of the DNA, if you like, of the Cuban political system.

Stephanie: And they send doctors from Cuba. Do they send doctors also to train other doctors? I believe there's –

John: Yes.

Stephanie: - the Latin American School of Medicine is part of the training of international doctors. Can you explain that to us?

John: Sure. The Latin American medical school, ELAM is the acronym, was set up after a series of massive hurricanes destroyed – well, it ravaged Central America. Fidel Castro sort of said, “What we have to do is to take revenge on the hurricanes. And so, what we're going to do, we're going to convert the Naval Academy in the west of Havana and turn it into a medical academy for the training of young kids from the regions affected. And we're going to train them, give them six years of medical training at no cost.”

So, that's how ELAM was founded. So, the Naval Academy was closed down, moved out, they were kicked out. And it became the Latin American School of Medicine. Now Latin American School of Medicine has trained 31,800 physicians from 122 countries. ELAM is the largest medical school in the world. At present, there are 1877 students from 100 countries, including from the US. About 200 students from visible minorities, largely, have been educated and trained for free in Cuba at ELAM.

So, it's extraordinary – I have been there many times. I've interviewed many of the students for my research. And it's a fascinating large facility in the west of Havana with, again, with 1800 students registered there.

Stephanie: That's really heartening and hopeful to hear about this. And for those of our audience who have never heard about this before, I'm sure it's quite inspiring. And yet, for those who have heard of it, we definitely want to get into some of the criticisms that have come up in practice. No system is perfect.

John: Yes. Yes. And I'll be happy to get my own criticisms of it as well.

Stephanie: But before we get there, how does it differ from other approaches to medical diplomacy led by other nations? I was, for example, part of the Peace Corps. And I know some of the volunteers in Peace Corps work in medical facilities or other international NGOs like Doctors Without Borders. Can you kind of set us up here to better understand the connection, relationship, and difference?

John: Sure. The basic philosophy is not that different. What is different is the political commitment of Cuba. Cuba has been sending medical personnel to countries since 1960, regardless of the ideology of the country. In other words, they've sent medical personnel to countries that didn't have diplomatic relations with them.

And again, it comes back to Fidel Castro's personal humanitarian philosophy. And having spent two weeks with him, very close, long working days, it became very obvious that this guy was obsessed with public health and with the need to extend what Cuba has to other countries that don't have it, particularly in the global south.

You mentioned ELAM, but Cuba has also set up medical faculties and 7 or 8 countries in the global south. Most recently in Timor-Leste, East Timor, where after a horrendous civil war, there were about 70 physicians left in the whole country. The president of Timor-Leste asked for Cuban help, and Cuba sent 200 doctors. And then sort of said, “Rather than send medical personnel, send us your brightest kids, and we will train them in Cuba.”

So, from 70 physicians 20 years ago, there are now a thousand trained by Cuba at no cost to the Timorese students, who are now practicing in Timor. And I think it's the humanitarian necessity felt by the Cuban government when Castro was the president to provide, at no cost, medical assistance to countries that most needed it, regardless. And even most recently with Covid, Cuba had 5000 medical personnel working in 50 countries.

So, Cuba's got this remarkable record of having been in the medical trenches since 1960. They've got a finely honed system. And they have a basic philosophy that you need to share what you have.

Now, at the same time, this also is a means of financial support for Cuba. Cuba provides medical training and medical care at no cost to Haiti, but it charges a fairly good rate to countries like Qatar or Saudi Arabia.

So, it is not only a humanitarian gesture, but it also is a main source of hard currency for the country. So, it's a complex, but rewarding approach to sharing what you have, not giving you leftovers.

Stephanie: Oh, absolutely. This is, as I'm thinking of a recent headline of the US preparing a package of $8 billion to send to Israel in the form of weapons. 

John: Yes.

Stephanie: Right. So, imagine what $8 billion in terms of medical assistance could do for Israel- Palestine, or any conflict zone. It's so frustrating to see that there's other models that exist and money is being used in better ways. And yes, there is such a contrast to what the US is offering the world.

John: Yeah, I agree. I agree completely. There are, by the way, over 200 Palestinian students studying at ELAM. You might not know, but after the nuclear meltdown in Chernobyl in Ukraine, Cuba sent a large medical delegation and then started receiving kids. So, this is in the late 1980s when Cuba was a basket case.

Cuba depended upon the Soviet Union for trade and for aid. 85% of its trade was with the former Soviet Union. And precisely as the Soviet Union was falling to pieces and the subsidies to Cuba were ending, Cuba took 23,000 kids who had been affected by the Chernobyl meltdown, and into Cuba and treated them for free, as well as bringing along a parent or a relative with them.

You know, so you talk about what the US has been doing in Gaza – and you look at what Cuba did in so many countries – it's the exact opposite of what should be done.

Michael: John, if I may, this has been, not only fascinating, but a corrective in a sense for me because when I was in medical school – and let's not ask how long ago that was – we, you know, there was a scuttlebutt, a rumor, but I think it was substantiated that if you failed in an American med school, you could always go to Cuba. And so, that left me with a kind of impression of very second rate.

On the other hand, I went to visit my son in Nicaragua when he was there for the Peace Corps. And I heard such heartwarming good things about Cuban doctors. That this, and what you've been now sharing with us, is such a corrective to what I guess must have been propaganda, about the value of Cuban medicine.

John: Yeah. Michael, I think you got that right. I think the US media does a terrible job in analyzing the reality of Cuba. It's always the negative stuff which comes out, and the health care and the education are religiously ignored. The Cuban health care system is at the moment undergoing tremendous problems, and we can talk about them, basically because of the government’s own mistakes and because of pressure from the US. Biden was, in many ways, was Trump lite, did very little to help Cuba. As opposed to the Obama years, when there were major changes that were very positive in Cuba.

But in terms of what you were saying, it's sort of sad because prior to the revolution there were 6000 doctors in Cuba. By 1961, two years later, 3000 had voted with their feet, mostly going to the US. So, Cuba started off with 3000 doctors, now has 98,000 doctors. And the philosophy that medicine has got to be free. There are no private clinics. You have a basic necessity, an obligation, to provide this most basic human right.

Cuba’s also got a surplus of doctors. The ratio of patients to doctors in Cuba is three times that as what is found in the US. So, Cuba has a tremendous human potential. And Castro saw that and that's why he was the person who sort of directed medical personnel to work in the developing world.

At the moment, the last figures I saw from a few months ago, there are 25,000 Cubans working in 52 countries, mainly in the global south. But in Italy, there are 500 working, in Portugal as well. So, they're all over the global south. And again, going back to Covid, you know, there were 5000 working in 50 countries.

But to go to your point, Michael, I think that the US media tends to disregard any good news stories coming from Cuba, which is unfortunate because you don't get the balance.

Michael: Certainly is unfortunate, as all propaganda is, you know. And this is reminding me of something that I'd like to get your comment on. You no doubt know about it. There's a special class of physicians in India who are called Visha Vaidyas, which means poison doctors. Their specialty is to help people who have been bitten by a cobra and might have hours to live. And one interesting feature of the Visha Vaidyas is after their training, they swear an oath never to charge money. Because, you know, someone comes staggering into your office, been bitten by a cobra, you could charge them anything.

John: Yes, yes. Of course.

Michael: So, this is like, in an extreme form, I think, that Castro ideology, that healthcare is a human right and should not be charged for.

John: Yeah. I think that the basis for the Cuban approach to medicine, that I mentioned before, seeing the patients as bio-psycho-social beings and seeing them as patients, not clients, and emphasizing preventive medicine, makes so much sense. And the family doctor is the key person in Cuba. There are over 11,000 family physicians working in offices. And I've been to some. I mentioned how my daughter had a horrible reaction to a peanut. This is going back ten years, but we rushed her to the local polyclinic. And she was given right away an EpiPen and then a sort of Benadryl and tranquilizer. And you’ll never guess what the bill was.

Michael: Tell us.

John: Well, for the physician who we saw in Emerge said, “I'm awfully sorry, I’ll have to charge you for this.” And so, I said, “Okay.” So, I got out my cash, wondering how much it was going to be. And he said, “I have to charge you $25 for a physician's visit. And for the drugs and for the time here, the bill’s going to be $70.”

Michael: By the way, I am allergic to peanuts, so I'm really – fascinating.

John: Oh, yes. Yeah, yeah. So, the approach is so very, very different. The family doctors, who are the – they are the guardians of the system. They spend half a day in their clinic and half a day visiting their patients, usually in the afternoon. By law, they have to visit each of their patients in their homes at least once a year.

And of course, you know, they see themselves as detectives because they can see who's got sort of rodent problems or who's got hypertension. It's a remarkable system. And of course, another difference is that most of the physicians live in the same area where their patients are. So, their kids go to the same schools, they play baseball together, they go to the same stores. So, they have a really good understanding of the patients and of the community in which they live. Again, part of the preventive emphasis on them. And it makes an awful lot of sense.

Stephanie: That does make an awful lot of sense to understand the environmental factors that cause illness or stress. Yes.

John: Yeah. And what's also interesting is that the patient is seen as having an obligation to know about health. So, in other words, I've been several times to Cuba with hospital administrators from Canada. One was a world-famous specialist in vaccinations, and I remember she didn't believe me when I said about how Cubans were. They had a very, formal, a profound sense of the medical needs and what was available to them than the Canadian counterpart. So, she stopped and said, “Excuse me. Tell me about vaccinations,” to a woman with a young kid. And the mother said, “Well, yes, we have these vaccinations.”

So, Cubans are obliged to be part of the solution to any medical problem. So, the medical team that lives in the community will do a lot of educational work, and the patient has to be a partner in that. They have to know when to see the physician and when to see the nurse and when to go to Emerge. And also what medications they need to take. So again, it's a very different system from what we have in Canada. And I presume in the US as well.

Stephanie: It sounds like that fundamental shift in perspective of having a system do everything for you, and therefore you become dependent on it and those who give it to you. Versus a mutual reciprocal relationship that empowers the individual as much as it supports a healthy functioning system.

John: Yeah, exactly, Stephanie. They’re partners with the physician in their treatment.

Stephanie: I just want to pause here for a second because throughout this interview you've said something that I just want to hear you say it again. I'll say it. We can all say it. But that medical care is a human right. And in Cuba, medical care is free.

John: Yes.

Stephanie: It's so foreign. It's so beyond the – you know, it feels so uncomfortable to realize how deeply controversial that can be within the kind of capitalist framework for earning money on people's poor health.

John: Yeah.

Stephanie: Yeah, I just want to let that sink in a little bit. Medical care is a human right.

John: Yes, it’s a human right. It's guaranteed in the Cuban Constitution. Also, all medical education is totally free in Cuba. So no doctor ends up with a massive student debt. Cuban doctors also have to take an oath, exactly what you were saying, Michael, saying that they will never charge anyone because it is a human right.

Stephanie: And the question – I mean, that's so beautiful. And on the question of the internationalism, again, with the focus at home, on preventative care, but with medical internationalism and going into conflict zones or post-conflict zones where people need immediate care, emergency care. That's a little bit different. So, is there any tension there in terms of the preventative work at home that the Cuban doctors work on and then sending them abroad to do more emergency work?

John: Well, Cuba's got, 9000 specialists in emergency care who are part of what's called the Henry Reeve Brigade. Henry Reeve was an American from New York who fought for the Cubans seeking their independence against Spain. Castro took this name as part of the internationalist brigade.

Now, they were formed in 2005. And, in many ways, the US was responsible. Because in 2005, Hurricane Katrina devastated New Orleans. The Cuban government offered 1300 specialists in emergency medicine and, like, 20 tons of medicine. The planes were ready to go from Havana, the doctors and the nurses and the technicians were sitting, waiting with their backpacks ready to go. And George W. Bush decided to play politics rather than save lives.

Castro decided shortly afterwards that what they should be doing, what Cuba should be doing with this larger number of physicians and emergency technicians that it has. Again, it's like having a standing army of 9000 specialists in emergency medicine and disease. They were the first to volunteer in West Africa when Ebola broke out. They stayed to deal with the cholera outbreak that was caused. Covid, as I mentioned, there were 5000 Cubans. Now, Cuba's only got a population of 10 million people. So, to send these large numbers of physicians and nurses and technicians is quite extraordinary.

The very first mission after George W. Bush decided that he didn't want to receive Cuban doctors, was to Pakistan. And 2000 were sent to Pakistan, set up 32 field hospitals. And it was quite extraordinary.

And so, since then, they've been in dozens of countries. Everything from tsunamis to hurricanes to whatever. And in some ways, this would be a remarkably small thing for the UN to do. To pay a basic fee to have this standing army of medical specialists for emergencies ready to go at the drop of a hat, anywhere in the world.

And I think that unfortunately, because of the bad press that Michael mentioned earlier, most people are not aware of this. But Cuba has got tremendous potential to help other countries in the global north as well as the global south.

Michael: That is such a wonderful vision. And I'm wondering what the relationships might be politically, ideologically or other, between Cuban medical internationalism and Médecins Sans Frontières, you know, Doctors Without Borders.

John: It’s a very similar philosophy. The basic difference, Michael, is that the physicians, the people who go with Médecins Sans Frontières, they basically go on short-term contracts, whereas the Cubans, when they go, they go until they're no longer needed. So, they don't have, usually, an end to their contract. They are there while they are needed. And so, 2000 went to Pakistan after a massive earthquake in 2005.

But apart from that, its a very similar approach, you know, that medical care has got to be provided to all, regardless of any limiting factor.

Michael: That is somewhat similar to a problem that we often face doing third-party interventions in conflict zones. That we do the best we can, but we are often troubled by the fact that we're parachuting in and taking the first exit out when we're “no longer needed” versus long-term interaction.

John: Yeah, yeah. And Cubans never go anywhere unless they've been invited in by the government. So, you know, there are so many countries with which, as I mentioned earlier, Cuba didn't even have diplomatic relations. But when they were requested for support, they sent them in. And not only that, but again, the role of ELAM is so important because not only does Cuba provide medical assistance, but as is the case with Timor-Leste, they train people, they train their bright young kids to come to Cuba to study medicine so they can then go back.

And again, everyone who goes to ELAM has to take an oath that they have to pay back, after six years of living for free in Cuba and receiving medical care and training for free, the only obligation is to help people, either in their community or in some other community, where their services can be useful.

Stephanie: And again, I just want to emphasize how the United States is very willing to train young people around the world in, you know, in violent militia activities. And just that, ELAM, shut down the Naval Academy and started training doctors. It really is a shift in values and a shift in and what we care about.

John: Yeah. Castro once said, “We don't send bombs, we send doctors.”

Stephanie: And yet, I can imagine a few counterpoints here that I'd like to –

John: Oh, yes.

Stephanie: One is, you know, sending medical personnel after or during conflict, it doesn't – does it help to end conflict, or does it just clean up the mess for other countries? What are some of the structural implications there that might shift that the power dynamic at all in that situation?

John: Yeah. Stephanie, the Cubans don't go after conflict. They go where they're invited in to deal with a medical emergency. So, it's very, very different. So, they are invited in precisely because of an outbreak. Ebola is the best example recently, or cholera, or Covid. 5000, you know, went to 50 countries. 

Now, to be fair, as I mentioned earlier, the Cubans do this, there's a sliding scale of charges. So, for a poor country in the global south, there's no charge. For a rich country, several Arab countries with money, the Cubans charge not what a European or American – North American trained physician would charge. But about two thirds of that. So, that's still a lot of money for a country which is in desperate economic shape.

I've been going to Cuba since 1976, and I've never seen the country in as bad shape as it is at present. And so, the exportation of medical supplies, which is done for the best of intentions – humanitarian intentions, for free, also is a means of bringing in substantial amounts of money from countries. Italy is another good example. 500 physicians in Italy that will pay a fair amount of money for those medical services that will be plowed back into the medical system in Cuba.

Stephanie: And your more recent book, “Contemporary Cuba: the Post-Castro Era,” so how is medical International? It seems like it's still doing okay, given that Ebola – that's 2014, right? Covid, that’s 2020. But with tightening of US sanctions or other domestic challenges, I imagine, how sustainable does this model seem? Do you see it continuing?

John: Well, the Cuban public health care model, which we talked about in very positive terms, the philosophy is great. The problem is that when you've got a bankrupt country, with – there’s been four total shutdowns of power, total blackouts for the entire country in the past two months. There's a shortage of some basic foods. A shortage of medicines.

Prior to Covid – Covid dealt a death blow to Cuba in many ways, between Covid and the Trump administration. First of all, the Trump administration cut off all tourism to Cuba. And tourism was in the ascendancy. There were 5 million tourists going to Cuba. Now, 5 million tourists in a country of 10 million, that's a lot of people. And that was a real cash cow for Cuba. The Trump administration stopped that and all cruise traffic was stopped. All educational travel was stopped. There were hundreds of hotels where Americans were not allowed to stay in Cuba. Some incipient foreign investment, US investments were stopped by the Trump administration.

Four hundred Western Union offices were closed down as policies of the Trump administration. Between that and Covid, which did a number on tourism, Cuba has not recovered. So, Cuba is in dire economic circumstances. And that has a major knock-on effect on the medical system. 

Now Cuba produces, in pre-Covid times, 62% of its own medicines. So, my daughter, who received medical treatment after a reaction to a peanut allergy, was using Cuban medicines. Now, that's been — so, the 62% is now being cut in half because the Cuban government doesn't have the money.

Again, physicians, a lot of physicians about – it's an estimated 12,000 physicians of the 100,000, have left the public health care system. Why? Because the monthly salary of $50 to $80 USD monthly salary doesn't pay the bills at a time when the country is in economic freefall. So, the system is facing major, major challenges. The infant mortality rate, which was 4.1 per 1000 live births ten years ago, is now 7 per 1000 live births.

So, the economic situation is in desperate straits. The Cuban government has been putting all sorts of money into hotels, to build hotels. But tourism has not recovered. And so, the money which the government had invested in tourism has been very unwisely invested.

So, the country is in bad shape. The medical system has deteriorated. And as I'm sure you know, 700,000 Cubans have arrived in the US in the past 18 months. And so, to give the rosy situation I pictured, the basis of it is still there. The philosophy is still there. But it's very difficult to live in a society which is facing economic difficulties like Cuba’s.

But that said, the Cuban medical internationalism continues both in poor countries which pay nothing, and also rich countries which pay because that there's a substantial source of hard currency for the Cuban government.

Stephanie: I also wonder if you have any research on how they are able to adapt, or any plans that they might have for economic recovery under these kinds of difficult circumstances?

John: I think the Cuban government has played it very badly. I think that they put all the eggs into the tourism basket and that hasn't panned out. The incentives for people to produce food are not there. So, the top-heavy government system with a very large bureaucracy means that there are not incentives for people to produce enough food. So, 80% of food in Cuba is imported. And there's no reason why Cuba could not be self-sufficient in food production. But again, the government has not provided the incentives for people to produce enough food. So, I think the government has lost the plot.

Stephanie: I see. And another critique of the Cuban medical internationalism, that I don't know if it's just propaganda trying to tear it down, and tear down the intention of it, but that some testimony from doctors themselves who say that it's a kind of modern slavery. Can you speak to that?

John: Yeah, absolutely. I interviewed 270 internationalists for the book that I wrote on medical internationalism. And the most common explanation that they gave – I said, “Why are you here? You know, because you've come for a two-year contract.” And they said, “Well, because I'm paid so little in Cuba that here I'm paid five times my salary.”

So, I didn't find one single physician, nurse, or technician. Now, this is going back ten years. It's changed a lot because the economic crisis – and I use the term crisis advisedly – is so much greater now so that a lot of physicians have left to go to the United States and even more have left to work in the private sector in Cuba because they can make more money. $50 to $80 a month is not very much.

So, in terms of slavery, I think that that has been blown out of all proportion. I think that every person I spoke with understandably said, “Listen, I'm here because I can make so much more money than if I were back in Cuba.”

So, the way it worked was that for most contracts, a Cuban internationalist would go for 11 months and then go back home for a month's vacation. Then they go back for the second year of their contract. A lot of people volunteered to stay on. And so, it was quite common to have people doing two, three, four terms abroad, which is, you know, goes against the idea of modern slavery. They did it because they could make more money.

But also, they also – many of them would tear up. And this might be difficult for your audience to understand, but Cubans have been socialized from daycares, that they have a role – they have an internationalist role. Fidel Castro was a leader of a small third-world country, but was regarded, and in new international news terms, as a first world powerhouse. You know, Cuba's role in Latin America and Africa, when Castro was alive, was quite extraordinary for such a small country.

In schools, Cubans have been socialized to recognize that they have an obligation to – and again it’s in the Cuban constitution. And the Cuban education system emphasizes the need that people have to share what they have to develop other countries. And this is before the crisis. So, I'm sure that the current crisis has had a major impact in sort of making people more skeptical and more cynical. But I think that for most of the Cuban revolutionary process, that's been the official way. I say the official and also the natural way. People were proud to have their kids working abroad.

You know, I spent a lot of time in Nicaragua as well, doing a book on religion and politics in Nicaragua. I met many Cuban physicians and nurses and technicians who had a great reputation precisely because they were there to help. And I think it's when they go, they go to make money, but also because it's been drilled into them that they have a role to help other people in less positive circumstances.

Stephanie: I have one last question for you. I know that these are big questions. And you probably wrote papers on every single topic that we've addressed here. So, thank you again for your time. My last question is about, and lessons for the world, what other nations might be able to learn from Cuba's model of medical internationalism. And are there any aspects that could really realistically be adopted elsewhere?

John: Yes, I think so. I think the capitalist system, and sort of high pay for medical personnel make it difficult. I think a high level of medical care can be provided at a fraction of the cost. I think that might be very difficult for American medical personnel to accept, as it is for Canadians.

I think that a great deal can be achieved with very little. But you need political will, and you’ll need long-term investment. And you also have to have a humanitarian basis to accept the fact that you are – we are so fortunate. You know, I look at what's happened in Gaza, and I feel like crying. I have a student who is doing a master's degree who is Lebanese who went back to help his – after Lebanon was invaded by Israeli forces. And when I see the cruelty that has been unleashed in Gaza and following on in Lebanon, it seems so, so cruel.

The Cuban approach makes so much more sense, to have both domestically, and also internationally. So, with political will, with long-term investment, with good leadership. Not politicians who are elected for two years and then need two years to fight to get re-elected. You need people with vision, people who have a conscience. And that's hard to find in a society in which money and prestige and power are lionized.

Stephanie: John Kirk, thank you so much for joining us today on Nonviolence Radio. We appreciate your time so much, and thank you for your research.

John: You're very welcome. Thank you, Stephanie. And thank you, Michael.

Stephanie: For those of you just tuning in, you're here at Nonviolence Radio. I'm Stephanie Van Hook, I'm here with Michael Nagler, and we were just speaking with Dr. John Kirk. He is the author of “Contemporary Cuba: the Post-Castro Era,” as well as an extensive study, Health Care Without Borders: Understanding Cuban Medical Internationalism.

And we were speaking with him in particular because of the debate around health care that has been raised by Luigi Mangione, in particular with the murder of CEO Brian Thompson of UnitedHealth.

And it's important in these conversations that people are having around the politics of this, is to think about the nonviolent angle. Not just in terms of resistance, but in terms of constructive action, and what models exist out there that can be understood and drawn from and recreated or expanded upon in some way. And I really felt that the Cuban medical internationalism plays a big role in that.

Michael, I'm thinking about Gandhi in this and how much he would love medical internationalism. As much as he was a home rule kind of person, that you definitely have to start at home, this idea of peace brigades, of nonviolent brigades. Gandhi, as a young person, you know what his first job that he wanted was to be?

Michael: A nurse.

Stephanie: A nurse. Exactly. So, I think that this is very much following in a vision of nonviolent action. And I also came across a quote from Martin Luther King Jr. from a speech that he gave, I think, to medical personnel in Chicago in the ‘60s. And that quote is, “Of all forms of inequality, injustice in health is the most shocking and inhumane.” For all the reasons that we covered in today's show.

So, hopefully this helps push that conversation a little bit further toward a constructive discussion. And I wonder if you have any follow up?

Michael: I'd like to start by underscoring what you just said and bringing out an angle of it. If you know the history of Gandhi, it's interesting to compare this tragic murder of Brian Thompson with a character from the early years of the Indian freedom struggle, whose name was Bhagat Singh. And he and a couple of accomplices actually lobbed a bomb into the British parliament. And he actually did murder one British policeman.

And as a matter of fact, it turns out he picked the wrong guy. He wanted to, you know, murder somebody who had done something, you know, quite atrocious. But he actually picked a young person by mistake. So, all of that is a way of saying that the Bhagat Singh / Luigi Mangione approach is exactly the wrong way to fix health care. It could not be more wrong.

There's a tiny little silver lining that you may want to see in all of this. And that is it might raise the question, “Okay, what is the right way?” You know, at least we now know that there's a problem there that must be addressed. And we now know that that's the wrong way to address it. So, what is the right way? And of course, that right way would be through nonviolence, broadly speaking, in all of its various parameters.

Stephanie: Yeah. We have to get beyond just protest actions. And I think that that's when people limit nonviolence to this one small frame of reference that they say, “Well, nonviolence doesn't work. So, I have to escalate into violent action because I had no other options.” But as we see, there's constructive alternatives out there. What would it take to build those constructive actions? And it's more participatory, and it's more democratic because you get more people's input on that.

Michael: Yeah. I think what it would take is a change of vision, a change of understanding of what a human being is and how often we get insight into the fact that we actually are beings that not only like to but thrive on helping one another.

I'm thinking of a really heartbreaking episode that is reported by Viktor Frankl in his book, Man's Search for Meaning. He was in Auschwitz for more than two years. And he describes how one prisoner in Auschwitz somehow got his hands on a little bit of chocolate. And the first thing he did was cut it in half and share it with another prisoner.

And people said to him, “My gosh, what an astounding thing to do. And he said, “It is critically important to help others. And the more deprived and oppressed you are, the more important that becomes.”

So, that really struck me also in what Dr. Kirk was saying, about how Cuba is, in some ways, strapped financially. They have, I think, suffered from the aftermath – I guess that's the word – suffered from the aftermath of a violent revolution. You know, after all – I mean, we idealized Cuba when at the time of Castro and his brother. But the fact is, as Gandhi said, this is an inviolable law, “Violent revolution will bring violent swaraj.”

Stephanie: Explain swaraj for our listeners.

Michael: Oh, I'm sorry. Swaraj means literally self-rule. And it was the term for liberation, for freedom. You know, Hind Swaraj, a document that Gandhi wrote in 1909.

Stephanie: Just a quick answer.

Michael: It means revolution. It means freedom. It also means regime. What kind of regime do you have? And Gandhi's principle was that you cannot have a purely nonviolent regime if you have created it through an act of violence. So that's the dilemma.

Stephanie: And so, the term swaraj, so again, the formula is violent revolution brings violent swaraj. Violent home rule, violent –

Michael: Yeah. Regime.

Stephanie: – a violent regime. And, you know, I think it is important, as people who are idealists, obviously we are idealists, not to over idealize any good idea either. Just see that there's this – that the idea is out there. It exists and there's something that we can learn from it.

Michael: Well, Stephanie, you used to teach French, so you're more aware than I am of the fact that Albert Camus said that any idea, I don't care how good it is, carried to its logical conclusion becomes wrong. So, we cannot get away from the need for discrimination.

Stephanie: And not to toss it out without learning about it. “Oh. Well, yeah. Let's. I don't even want to hear about the Cuban International system because there's this critique of it,” or X critique or Y. You know, just let's have a conversation and being willing to allow new information to inform new ideas – I think is quite beautiful.

So, thank you, everybody. You've been here at Nonviolence Radio. Our interview today with was with Dr. John Kirk. And so, we want to thank him. We want to thank, Matt and Robin Watrous for helping to edit and transcribe this show, to Annie Hewitt and our team at the Metta Center for Nonviolence, including Sophia Pechaty, thank you very much for your work.

And to you, all of our listeners out there, we're very grateful. Especially our listeners through the Pacifica Network, through our mother stations, KWMR, KPCA. Thanks so much for learning about nonviolence on our show. You can find out more at NonviolenceRadio.org. And until the next time, please take care of one another.