On November 17th the New York Times published another editorial in its series urging changes in U.S. policies regarding Cuba. Under the title “A Cuban Brain Drain, Courtesy of the U.S.,” the editorial targets the U.S.’s Cuban Medical Professional Parole Program (CMPPP).
In order to understand the editorial, we first must look at the Cuban government’s policy and program of sending Cuban medical personnel to other countries and then at the CMPPP’s response to that Cuban program. Thereafter we will examine the Times’ rationale for its recommendation along with the arguments for the Wall Street Journal’s support of the CMPPP before we voice our conclusions.
Cuban Policy and Program of Sending Medical Personnel Abroad
According to a 2011 article in the Wall Street Journal, since 1973 Cuba has been sending medical ‘brigades’ to foreign countries, “helping it to win friends abroad, to back ‘revolutionary’ regimes in places like Ethiopia, Angola and Nicaragua, and perhaps most importantly, to earn hard currency. [The] Communist Party newspaper Granma reported in June  that Cuba had 37,041 doctors and other health workers in 77 countries. Estimates of what Cuba earns from its medical teams—revenue that Cuba’s central bank counts as ‘exports of services’—vary widely, running to as much as $8 billion a year.”
Again, according to the same Wall Street Journal article, Cuban doctors often desire such overseas assignments because they provide opportunities to earn significantly more money than at home. “When serving overseas, they get their Cuban salaries [of $25 per month], plus a $50-per-month stipend—both paid to their dependents while they’re abroad. . . . In addition, they themselves receive overseas salaries—from $150 to $1,000 a month, depending on the mission.” Many on-the-side also engage in private fee-for-service medical practice, including abortions. As a result, many of the Cubans are able to save substantial portions of their overseas income, which they often use to purchase items they could not have bought in Cuba like television sets and computers. Other desirable purchases are less expensive U.S. products that they can sell at a profit when they return to Cuba.
The Wall Street Journal article adds, “Since Hugo Chávez came to power in Venezuela in 1998, Cuba has been bartering its [medical personnel] . . . for Venezuelan oil. The U.S. Energy Department estimates that in  Venezuela ships Cuba 90,000 barrels of oil a day—worth more than $2 billion a year at [then] current prices. In addition, Venezuela pays Cuba for medical teams sent to countries that Mr. Chávez considered part of Venezuela’s “Bolivarian” sphere: Bolivia, Honduras, Ecuador and Paraguay.”
As a result of this quid pro quo, Cuba has over 10,000 medical personnel serving in Venezuela. According to the Los Angeles Times just this past September, the working conditions in that country for the Cubans are horrible. Many of the clinics lack air-conditioning and functioning essential medical equipment. The Cubans’ workload is often “crushing.” Common crime is rampant, and the Cubans are often caught in the middle of Venezuela’s civil unrest between followers of the late Hugo Chavez who want the Cubans to be there and more conservative forces that oppose the Cuban presence. As a result, as we will see below in the discussion of CMPPP, many Cuban medical personnel serving in Venezuela have chosen to defect to the U.S. under CMPP.
The Times editorial says, “This year, according to the state-run newspaper Granma, the government expects to make $8.2 billion from its medical workers overseas. The vast majority, just under 46,000, are posted in Latin America and the Caribbean. A few thousand are in 32 African countries.”
Facts Regarding CMPPP
A U.S. Department of State website says this program was announced on August 11, 2006, “by the Department of Homeland Security in conjunction with the Department of State, [as a program] that . . . would allow Cuban medical personnel conscripted to study or work in a third country under the direction of the Cuban government to enter the United States.”
Under the program “Cuban Medical Professionals” (i.e., health-care providers such as doctors, nurses, paramedics, physical therapists, lab technicians and sports trainers) are eligible if they meet the following criteria: (1) Cuban nationality or citizenship, (2) medical professional currently conscripted to study or work in a third country under the direction of the Government of Cuba, and (3) not otherwise ineligible for entry into the U.S. Spouses and/or minor children are also eligible for such parole.
According to the Times’ editorial and the Wall Street Journal, the program “was the brainchild of Cuban-born Emilio González,” a former U.S. Army colonel, the director of the U.S. Citizen & Immigration Services from 2006 to 2008 and a “staunchly anti-Castro exile.” “He has characterized Cuba’s policy of sending doctors and other health workers abroad as ‘state-sponsored human trafficking.’” The Cuban doctors, he says, work directly for health authorities in other countries and have no say in their assignments.
The Times’ editorial includes the following table showing the official numbers of CMPPP visas that have been issued:
Given the large numbers of Cuban medical personnel that are sent to Venezuela to help pay for Cuba’s importation of Venezuelan oil, it is not surprising that the largest number of defections of Cubans has been from that country. As of the end of FY 2010, according to the previously mentioned Wall Street Journal article, the total defections by country were the following: Venezuela, 824; Colombia, 291; Bolivia, 60; Dominican Republic, 30; Ecuador, 28; Guatemala, 25; Brazil, 21; Namibia, 21; Peru, 19; and Guyana, 14.
Apparently the largest number of defections from Venezuela continues in light of the previously mentioned difficult working conditions. For FY 2011-2014 there were an additional 1,181 Cuban defections from Venezuela to the U.S. under CMPPP for a grand total of 2,005. In addition, many of the Cubans in that country fear being seen going to the U.S. embassy in Caracas and instead fly to neighboring Colombia and apply there for CMPPP.
Another obvious reason for such defections under CMPP is the desire of the Cubans to earn more income in the U.S. I have met a Cuban neurologist whose wife was a skilled nurse, but who worked as a waitress in a nearby resort in order to earn more income and obtain tips in hard currencies. Like almost all Cubans, they did not earn enough to afford to have their own automobile and told me about Cuban television announcements that people who had an automobile or other vehicle had a special obligation to give rides to anyone in a white coat. Later while on a mission in Central America they defected to the U.S. under CMPPP. At least as I heard their story, they were merely looking for a way to improve their lives financially.
The Times’ Reasons for Ending CMPPP
The editorial starts by noting, “Secretary of State John Kerry and the American ambassador to the United Nations, Samantha Power, have praised the work of Cuban doctors dispatched to treat Ebola patients in West Africa. The Centers for Disease Control and Prevention recently sent an official to a regional meeting the Cuban government convened in Havana to coordinate efforts to fight the disease. In Africa, Cuban doctors are working in American-built facilities.The epidemic has had the unexpected effect of injecting common sense into an unnecessarily poisonous relationship.”
Therefore, says the Times, “it is incongruous for the [U.S.] to value the contributions of Cuban doctors who are sent by their government to assist in international crises like the 2010 Haiti earthquake [and the current Ebola crisis in West Africa] while working to subvert that government by making defection so easy [under CMPPP].”
Moreover, says the Times, “Cuba has been using its medical corps as the nation’s main source of revenue and soft power for many years. The country has one of the highest numbers of doctors per capita in the world and offers medical scholarships to hundreds of disadvantaged international students each year, and some have been from the United States. According to Cuban government figures, more than 440,000 of the island’s 11 million citizens are employed in the health sector.”
The creation of CMPP was really motivated by a desire by anti-Castro Americans “to strike at the core of the island’s primary diplomatic tool, while embarrassing the Castro regime.” This is hardly a worthy motivation for the U.S.
For a poor country like Cuba, it makes sense to use one of its few economic strengths to bolster its foreign exchange earnings. Is this not an example of the concept of comparative advantage first formulated by classical economists Adam Smith and David Ricardo? The program also helps Cuba garner good will around the world for helping to improve the health of others. There is no legitimate reason for the U.S. to be opposed to such a program.
Adds the Times editorial, “American immigration policy should give priority to the world’s neediest refugees and persecuted people. It should not be used to exacerbate the brain drain of an adversarial nation at a time when improved relations between the two countries are a worthwhile, realistic goal.”
In 2006 when CMPPP was commenced, Cuban medical personnel could not obtain their government’s permission to leave the island for any reason, and this was asserted as one of the reasons for the U.S.’ creation of CMPPP. Last year, however, the Times says, “the Cuban government liberalized its travel policies, allowing most citizens, including dissidents, to leave the country freely. Doctors, who in the past faced stricter travel restrictions than ordinary Cubans, no longer do.”
Moreover, the Times asserts, “The Cuban government has long regarded the medical defection program as a symbol of American duplicity. It undermines Cuba’s ability to respond to humanitarian crises and does nothing to make the government in Havana more open or democratic. As long as this incoherent policy is in place, establishing a healthier relationship between the two nations will be harder.”
Finally, according to the Times, “Many medical professionals, like a growing number of Cubans, will continue to want to move to the United States in search of new opportunities, and they have every right to do so. But inviting them to defect while on overseas tours is going too far.”
The Wall Street Journal’s Reasons for Supporting CMPPP
The Wall Street Journal’s opinions on this subject are frequently uttered by its columnist on Latin American issues, Mary Anastasia O’Grady. The headline for her November 9, 2014, column makes clear her ultimate conclusion: “Cuba’s Slave Trade in Doctors.” She asserts that Cuba’s policy and practice of sending some of its medical personnel to other countries is an “extensive human-trafficking racket now being run out of Havana.”
Her argument centers on the Cuban government’s being paid for these services by other countries like Venezuela or by international organizations like WHO and the government’s paying its medical personnel only some of the Cuban government’s revenues for their services. But this ignores the fact that any corporation or other business entity that sells services, pays the people who actually provide the service less than what is collected by the corporation because there are other cost factors that have to be covered plus a profit.
While she admits that “Cuban doctors are not forced at gunpoint to become expat slaves,” she argues they “are given offers they cannot refuse.”
When the CMPPP was created in 1966, Cuba’s government prohibited its medical personnel from leaving the island, and one of CMPP’s original rationales was providing a legitimate way to provide them with a way to leave Cuba and go elsewhere. Now, however, the Cuban government permits such citizens to leave. This change, in this blogger’s opinion, eliminates the only arguably legitimate basis for CMPPP.
The allegation by some supporters of CMPP that Cuba’s practice of sending medical teams to other countries is a form of human trafficking is absurd, in this blogger’s opinion. The Cuban government has paid for all of the education of its medical personnel, and sending some of them to serve in foreign countries is a way for them to compensate the state for their free education. This Cuban practice is like the U.S. practice during some wars of having a selective service system and drafting some people to serve in our armed forces. Similarly we in the U.S. from time to time have debated having some kind of required national non-military service program for younger citizens without anyone arguing that it would be illegal human trafficking.
The U.S. State Department issues annual reports on the status of other countries’ human trafficking, which the reports define as “umbrella terms for the act of recruiting, harboring, transporting, providing, or obtaining a person for compelled labor or commercial sex acts through the use of force, fraud, or coercion.” This compelled service requirement uses “a number of different terms, including involuntary servitude, slavery or practices similar to slavery, debt bondage, and forced labor.”
Although the latest U.S. report on this subject unjustly casts Cuba into the report’s Tier 3 status, as argued in a prior post, that report rejects the argument that Cuba is engaged in human trafficking when it sends its medical personnel to other countries. Here is what that report says on this issue:
- “Some Cubans participating in the work missions have stated that the postings are voluntary, and positions are well paid compared to jobs within Cuba. Others have claimed that Cuban authorities have coerced them, including by withholding their passports and restricting their movement. Some medical professionals participating in the missions have been able to take advantage of U.S. visas or immigration benefits [under the CMPPP], applying for those benefits and arriving in the United States in possession of their passports—an indication that at least some medical professionals retain possession of their passports. Reports of coercion by Cuban authorities in this program do not appear to reflect a uniform government policy of coercion; however, information is lacking.”
This blogger, therefore, supports the Times’ calling for an end to CMPPP.
 Under the overall title of “Cuba: A New Start,” the prior editorials (all of which are simultaneously published in Spanish) have urged overall reconciliation between the two countries, including ending the ending of the U.S. embargo of the island, the U.S. designation of Cuba as a “State Sponsor of Terrorism” and re-establishing normal diplomatic relations; U.S.-Cuba collaboration in combatting Ebola in West Africa; recognizing changing U.S. public opinion on relations with Cuba; U.S.-Cuba exchange of prisoners; and ending USAID covert programs to promote regime change in Cuba.
 Another issue unrelated to CMPPP is whether or not the services provided by the Cuban medical personnel meet the professional standards of the country where they serve. A South American ophthalmologist has told this blogger that she frequently has been called to fix problems created by Cuban doctors on such missions, but this blogger has no information about any comprehensive study of this issue.
 The program’s stated statutory authorization is INA section 212(d)(5)(A), 8 U.S.C. 1182(d)(5)(A) (permits parole of an alien into the United States for urgent humanitarian reasons or significant public benefit); 8 CFR 212.5(c) & (d) (discretionary authority for granting parole), whereby the U.S. Citizenship and Immigration Services (USCIS) may exercise its discretionary parole authority to permit eligible Cuban nationals to come to the United States.
 This calculation is based upon a November 9, 2014, article in Venezuela’s El Universal newspaper.
 Tier 3 is a U.S.-created category of countries that the U.S. asserts “do not fully comply with [a U.S. statute’s] minimum standards and are not making significant efforts to do so”.
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Comment: U.N. Has Positive Report on Cuba’s Anti-Trafficking Efforts
On November 23, 2014, the U.N. Office on Drugs and Crime released its “Global Report on Trafficking in Persons.” The Report, according to the New York Times, concluded that “one in three human trafficking victims is a child, most victims are female, and traffickers operate with wide impunity” and that “the proportion of children among victims appeared to be rising.”
For Cuba, the Report stated, “The current legislation on trafficking in persons in Cuba covers sexual exploitation.The authorities in Cuba report nine cases of trafficking in persons concluded with a conviction in the year 2012. 14 persons have been convicted, 12 males and 2 females, all local nationals. These persons have been prosecuted and convicted for pandering and sexual exploitation of minors. In the year 2012, 13 victims have been identified as victims of trafficking, four women and nine girls, all . . . [Cubans] and sexually exploited.” The Report had no mention of the Cuban program of sending medical personnel to other countries.
“This Report employs the definition [of human trafficking] contained in the United Nations Trafficking in Persons Protocol. According to this definition, which has been adopted by the 160 UN Member States that have ratified the Protocol, there are three distinct ‘constituent elements’of trafficking in persons: the act, the means and the purpose. All three elements must be present in order for a case to be defined as a trafficking in persons offence. Each element has a range of manifestations, however.”
“The Trafficking in Persons Protocol specifies that ‘the act’ means the recruitment, transport, transfer, harbouring or receipt of persons. ‘The means’ refers to the method used to lure the victim. Possible means are the threat or use of force, deception, coercion, abduction, fraud, abuse of power or a position of vulnerability, or giving payments or benefits. These terms are not necessarily precise from a legal point of view and may be defined differently by different jurisdictions. ‘The purpose’ is always exploitation of the victim, though this can take on various forms, including sexual exploitation, forced labour, removal of organs or a range of other forms.”
Gladstone, U.N. Report Shows an Increase in Trafficking of Children, N.Y. Times (Nov. 25, 2014), http://www.nytimes.com/2014/11/25/world/africa/un-report-shows-an-increase-in-child-trafficking.html?ref=world; UNODC, Global Report on Trafficking in Persons 2014, http://www.unodc.org/unodc/en/data-and-analysis/glotip.html.