Tag: Emilio González

Senators Menendez and Rubio Call for Restoring U.S. Parole Program for Cuban Doctors

On January 9,  Cuba-American U.S. Senators Bob Menendez (Dem., NJ) and Marco Rubio (Rep., FL) offered S.Res. 14—Affirming that the Government of Cuba’s foreign medical missions constitute human trafficking.[1]

This proposed resolution, however, is based upon a false premise as will be shown in the final section of this post. First, we will examine this new resolution itself and the two Senators statements in support of the resolution and then the basics of the Cuban medical mission program and the former U.S. immigration parole program for Cuban medical professionals engaged in that program.

The Cuban Medical Mission Program[2]

According to a 2011 article in the Wall Street Journal, since Cuba since 1973 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 [2010] 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.

In more recent years, many of the Cuban medical missionaries have gone to Venezuela and Brazil, the latter of which late last year terminated the program and most of the Cubans returned to the island, while some remained in Brazil.

The U.S. State Department in its annual reports on human trafficking has alleged that Cuba’s use of Cuban medical personnel in its foreign medical mission program constitutes illegal forced labor.[3] This allegation will be rebutted in the last section of this post.

The Former U.S. Immigration Parole Program fo Cuban Medical Professionals[4]

On August 11, 2006, the U.S. Department of Homeland Security in conjunction with the Department of State, announced 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.

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.

On January 12, 2017, in the final days of his president, President Obama terminated this program. The announcement said that the U.S. “and Cuba are working together to combat diseases that endanger the health and lives of our people. By providing preferential treatment to Cuban medical personnel, the medical parole program contradicts those efforts, and risks harming the Cuban people.  Cuban medical personnel will now be eligible to apply for asylum at U.S. embassies and consulates around the world, consistent with the procedures for all foreign nationals.”

The Cuban government applauding the end of this program, said it “was part of the arsenal to deprive the country of doctors, nurses and other professionals of the sector, . . . and an attack against Cuba’s humanitarian and solidarity medical missions in Third World countries that need it so much. This policy prompted Cuban health personnel working in third countries to abandon their missions and emigrate to the [U.S.], becoming a reprehensible practice that damaged Cuba’s international medical cooperation programs.”

The termination of this program was welcomed by Senators Patrick Leahy (Dem., VT) and representative Kathy Castor (Dem., FL), but criticized by Senators Rubio and Menendez with Rubio expressly calling for the then new Trump Administration to restore the program.

The Proposed New Resolution[5]

After multiple Whereas clauses, the proposed Resolution would declare that it is the sense of the Senate that:

  • “The Government of Cuba subjected Cuban  doctors and medical professional participating in the Mais Medicos program to state-sponsored human trafficking;
  • Cuban doctors participating in the MaisMedicos program should have been permitted to work under the same conditions as all other foreign 9 doctors participating in the program;
  • the Government of Cuba should compensate  Cuban doctors that participated in the Mais Medicos programs for the full amount of wages that were garnished by the Government of Cuba;
  • Foreign governments that sign agreements with the Government of Cuba or the for-profit Cuban Medical Services Trading Corporation (CMS) or other companies affiliated with the Government of Cuba to procure the services of Cuban professionals  directly assume risks related to participation in forced labor arrangements;
  • The Pan American Health Organization must immediately provide greater transparency about its participation in the Mais Medicos program and its agreement with the Government of Cuba and the for-profit Cuban Medical Services Trading Corporation (CMS);
  • The United States Department of State must downgrade Cuba to Tier 3 in its annual Trafficking in Persons (TIP) report, given new evidence on Cuba’s foreign medical missions and the Government of Cuba’s longstanding failure to criminalize most forms of forced labor; and
  • the Department of State must re-establish the Cuban Medical Professionals Parole (CMPP) program.”

The Senators’ ‘Press Releases for the New Resolution[6]

The two Senators issued essentially identical press releases. Here is what Senator Menendez’s stated.

Senator Menendez condemned “ the Cuban regime for a program that sends tens of thousands of Cuban medical professionals to foreign countries to work under conditions that qualify as human trafficking.” In addition, he stated.“For 60 years, the Cuban regime has been finding new ways to exploit its people. Recent information from Brazil shows how the Cuban government profits from its state-sponsored foreign medical missions, which they sell as medical diplomacy but look a lot more like indentured servitude. This bipartisan resolution sheds additional light on the Cuban regime’s role in human trafficking, and is another call for greater accountability from Cuban officials, their overseas partners, and the international community.”

The press release also quoted Senator Rubio. ““It is outrageous, though not surprising, that the Cuban dictatorship continues to manipulate and traffic physicians in order to enrich itself. This form of forced labor should not go unnoticed by the international community. We must stand against the regime’s modern-day slavery scheme and support the doctors seeking justice after serving in these so-called international medical missions.”

Finally the press release stated that the “introduction comes after an investigative report by the Diario de Cuba recently revealed the indentured servitude of Cuban medical professionals described in Brazilian diplomatic cables detailing the terms of the Government of Cuba’s medical missions to Brazil. In 2016 alone, it is estimated that the Castro regime earned more than $8,000,000,000 from exporting the services of Cuban professionals, of which foreign medical missions represent the majority of the income.”

Analysis of the Merits of the Resolution[7]

The resolution is without merit and should be rejected. Why? Because the Cuban medical mission program is not illegal forced labor.

The U.S. parole program for Cuban medical personnel was and is also unjustified. Cuban students receive their medical education without any tuition. As a result, it is only reasonable to require such students, after receiving their medical degrees, to “give back” by serving on a Cuban foreign medical mission for which they are paid more than they would have earned in Cuba. Yes, the Cuban government is paid more for their services on such missions by foreign governments than the medical personnel are paid by the Cuban government, but that also is reasonable and appropriate. The contention that such service is illegal forced labor or semi-slavery is absurd.

  • First, the State Department reports admit that there is conflicting information and allegations on the foreign medical mission work. Coercion is alleged by “some participants” and unnamed “other sources.” On the other hand, the reports admit that the Cuban government denies these allegations, and instead the Government and “some participants” assert the postings are “voluntary and well paid compared to jobs within Cuba.” The reports also concede there is conflicting information on whether other means, including withholding Cuban passports, are used to coerce or force participants to remain in the program.
  • Second, there apparently has not been any fair adjudicative process to determine which of these conflicting sets of information is valid.
  • Third, the accusation of forced labor for such participants has been rejected in a study by Indiana State University’s Emeritus Professor of International Politics and Latin America, Dr. H. Michael Erisman. He says, although there may be “some cases where . . . [Cuban medical professionals] are pressured into accepting overseas assignments, . . . most evidence indicates that the overwhelming majority are motivated by philosophical and/or pragmatic considerations. In the first instance, one needs to understand that the Cuban medical profession . . . is permeated by norms which stress self-sacrifice and service to the community, both at home and abroad. At the core of this ethos is the principle, which is firmly entrenched in the curriculum of the island’s medical schools and reinforced throughout one’s career, that health care should not be seen as a business driven by a profit motive, but rather as a human right that medical personnel have an unconditional duty to protect. Such convictions often underlie participation in the medical aid brigades. There are, however, also some pragmatic factors that can come into play. Overseas service could . . . help to further one’s professional aspirations and for some assignments the total remuneration involved is more generous than what is available back in Cuba. . . . [T]hese are the considerations which apply to the vast majority of people” in such programs, not involuntary servitude.
  • Fourth, According to Granma, Cuba’s Communist Party’s newspaper, “Internationalist medical aid has been a longstanding part of the Cuban people’s tradition of solidarity, since the beginning of the Revolution. As early as 1960 a brigade was sent to Chile following an earthquake there, and to Algeria in 1963, to support the new country recently liberated from colonialism.” The Granma article included the reflection of four Cuban doctors who have participated in such missions and who treasure the positive impact of those experiences on their professional and personal lives.
  • Fifth, this reports do not cite to the relevant legal definition of “forced labor” to assess this claim. Most pertinent is Article 2(2) of the Forced Labour Convention, 1930, which states, in part, ”the term forced or compulsory labour shall not include . . .  any work or service which forms part of the normal civic obligations of the citizens of a fully self-governing country.” (Emphasis added.)

Moreover, as a previous post noted, a respected international journalist, Alma Guillermoprieto, recently reported that Cuban medical doctors serving on the island now earn $67 per month, but $500 per month when serving on a foreign medical mission.

The $67 monthly salary for Cuban physicians in Cuba compared with the $24 or $27 monthly income of other Cubans is a result of Cuba’s adoption of a “pyramid” compensation system whereby highly trained workers like physicians earn more than lower-skilled workers like busboys. This system, however, is being undermined by lower-skilled workers like gas-station attendants and waiters earning additional income from stealing and illegally selling gasoline and from earning tips in hard currency at restaurants and hotels serving foreign tourists. Indeed, Raúl Castro in his speech at the April 2016 Congress of the Communist Party of Cuba called this the “inverted pyramid” problem that had to be solved.

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[1] Resolution by Bob Menéndez and Marco Rubio asks to restore the US refugee program for Cuban doctors, DiariodeCuba Cuba (Jan. 10, 2019); Menéndez: the Cuban regime and its foreign partners ‘must be held accountable’ for the exploitation of doctors, DiariodeCuba (Jan. 10, 2019). 

[2]  See New York Times Calls for End of Special Immigration Relief for Cuban Medical Personnel, dwkcommentaries.com (Nov. 22, 2014). 

[3] See these posts to dwkcommentaries: U.S. Upgrades Cuba in State Department’s Annual Report on Human Trafficking (Aug. 7, 2015); U.S. Reasserts Upgrade of Cuba in Annual Report on Human Trafficking (July 2, 2016); Cuba’s Unchanged Status in U.S. State Department’s Annual Report on Human Trafficking (Aug. 15, 2017).

[4] Ibid;  U.S. Ends Special Immigration Benefits for Cubans, dwkcommentaries.com (Jan. 13, 2017). 

[5] S. Res. 14- a resolution  affirming that the Government of Cuba’s foreign medical missions constitute human trafficking. (Jan. 9, 2019); Sen. Menendez, Press Release: Senators Menendez, Rubio Introduce Senate Resolution Condemning Castro Regime’s Forced Labor of Cuban Doctors (Jan. 10, 2019);CubanSen. Rubio, Press Release: Rubio, Menendez Introduces [sic] Resolution Condemning Castro Regime’s forced Labor of Cuban Doctors (Jan. 10, 2019).

[6] Ibid.

[7] See posts listed in the “Cuban Medical Personnel & U.S.” section of List of Posts to dwkcommentaries.com—Topical (CUBA).

New York Times Calls for End of U.S. Program for Special Immigration Relief for Cuban Medical Personnel

On November 17th the New York Times published another editorial in its series urging changes in U.S. policies regarding Cuba.[1] 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 [2010] 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 [2010] 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.”[2]

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.”[3]

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:

Fiscal Year Number
2006      11
2007    781
2008    293
2009    519
2010    548
2011    384
2012    681
2013    995
2014 1,278
TOTAL 5,490

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.[4] 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.”

Conclusion

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,[5] 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.

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[1] 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.

[2] 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.

[3] 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.

[4] This calculation is based upon a November 9, 2014, article in Venezuela’s El Universal newspaper.

[5] 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”.