COVID-19 threatens not only lives and livelihoods, but also governments and democratic institutions. The International Republican Institute (IRI) is profiling our partners and other leaders who have been the “first responders” in our global fight to protect and strengthen democracy.

In this new series, #DemocracyFirstResponders, we spoke with an anti-corruption activist in Nepal, a journalist in Zimbabwe, a former government official in Georgia and others to discuss their efforts to prevent democratic backsliding in the time of COVID-19.

For the fifth episode of this series, our host Natalie Longwell spoke with Dr. Daily Coro, former head of Cuba’s Medical Commission of Hygiene and Epidemiology in Venezuela, who today lives in Spain and is a vocal critic of Cuba’s internationalist medical missions.

You can listen to this conversation and others by subscribing to the Global Podcast on Soundcloud, Apple Podcasts, Google Play or wherever you get your podcasts. A transcript, edited for length and clarity, follows.

 

Natalie: Dr. Coro, thank you so much for joining us. First, can you describe your experience working in Cuba’s healthcare system and the access that the average Cuban has to quality healthcare?

Daily: The Cuban system is broken up into three levels: the primary, the secondary and the tertiary. The primary being the family doctors, the polyclinics; the secondary: the hospitals; and the third: the research centers.

Cuba actually has a large number of doctors, approximately nine doctors for every 100 thousand inhabitants, but a health system that has no economy, that has no diagnostical capacity, that does not have access to new medication or state-of-the-art equipment … . Medicine is a science that if you do not have the technology, or your doctors are not able to stay up-to-date with the latest research, that will [interfere] with the quality of care.

That is to say: Doctors on their own in a health system cannot solve much. That is the situation in Cuba — that we have a lot of doctors per inhabitant, but we do not have the capacity to diagnose, nor to treat or solve problems that arise.

The Cuban population does not die because of the doctors, but because the means to treat them do not exist. Cuba’s health characteristics are appalling. Given the social and governance system in Cuba, the flow of information is reduced. The doctors do not have access to [reliable] information from the outside, nor is information able to flow effectively within the island.

Internet access is very limited. International medical websites are restricted. For example, right now, with this COVID situation, protocols are going to be drafted, obviously, according to the Cuban regulations. But Cuba does not comply with international standards. Today, for example, they are using fabric masks. However, the World Health Organization’s protocols say that doctors should not be using [fabric masks] to treat patients with COVID-19. However, the protocol that the Cubans are following indicates that the doctors on duty are using fabric masks that will protect them.

By restricting access to international information, the only information doctors can receive is from the Cuban Health Ministry inside the island. Doctors will not be able to debate this information because they do not have the knowledge, nor do they have another way to find information.

Internet for the average Cuban is extremely expensive. A doctor with an average salary will not be able to afford internet and do research. They would have to go to the library and will generally only have access to Cuban authors from the ’90s — no updated information. 

In addition, doctors cannot talk freely about what is happening with the health situation. There is no feedback between Cubans, the Ministry of Health and the Cuban government. The government’s priority is to project this image that everything is excellent in Cuba. So, they cannot have a professional saying: “It is not excellent in Cuba because citizens don’t have access to clean water, and if they don’t have clean water, they can have parasitic diseases.”

As long as there is not a change in the system, there is not going to be an improvement to the health system in Cuba. 

Natalie: What was your experience like as a participant of Cuba’s medical missions?

Daily: I served in Venezuela for two years and seven months. The medical missions, if the humanitarian objective was met, were excellent, because it is certain that a lot of Latin American countries have real medical necessities, especially in difficult-to-access areas in remote communities.

Cuba deployed international aid to Venezuela in the early 2000s and tried to establish the same three-level system in Venezuela that can be found in Cuba. But Venezuela’s health problems were not being solved at all. They were promoting the statistic that they had a certain number of ophthalmologists [eye doctors], when in reality, 100 percent of those ophthalmologists are not necessarily specialists — they have only been certified after six months or a year of studying ophthalmology.

Cuba’s medical missions in such countries, in my opinion, are only used to exert political influence in the region, because actually solving the region’s health problems is not the priority.

To give an example, in Venezuela, where I was sent, there was a large percent of patients with HIV … . There were also a lot of problems with infections patients developed as a result of what the virus did to their immune systems. There was a high need for cardiologists, for nephrologists [doctors specializing in diseases of the kidney] and yet, Cuba did not provide either. So, patients were not being properly diagnosed and their health issues were not being resolved.

And the figures — the regime did not collect actual statistics, so they were not able to form strategies to fix the real issues. Doctors were only given light cases they could actually solve. Problems that couldn’t be fixed were treated as if they didn’t exist.

Natalie: What were some of the ways that doctors were intimidated or controlled into doing things that may not have been in the best interest of patients?  

Daily: I only had one such experience in Venezuela, but I can talk about my colleagues who informed me that on every overseas mission, there is a secret agent from the Cuban state.

These agents would torment you psychologically, exert verbal abuse. They threaten you. They can lower your salary, and doctors who wish to leave the mission are punished and cannot enter Cuba for eight years.

They threaten your family as well. There is a common saying with them that, “As long as you do the right things and the things we tell you, you and your people will be all right.”

The secret police know the power that the state police has over every Cuban, so they use that to threaten the doctors.

Natalie: How were you able to escape?

Daily: When I arrived in Venezuela, I requested my withdrawal from the mission after three months. I requested to come back to Cuba, but it was impossible because I had signed a two-year contract. In total, I spend two years and seven months in Venezuela, because they kept telling me that they did not have a replacement. I worked as an intensivist doctor [a physician providing care for critically ill patients, often in the intensive care unit], and I ran a therapy office, in which I had no replacement because the doctors willing to go to Venezuela were decreasing because they knew the reality of the situation within the country. 

When I came back to Cuba, they included me in the health system, but they prohibited me from continuing my education. According to the ministry’s regulation, I had to continue my specialty in intensive therapy, but this was prohibited. In my job, I was not accepted well by the leaders, and they excluded me from all of the trainings. 

I didn’t have a permanent job, just a contract. Every time I demanded things be done properly —  because you need to be extremely professional when you have a human life on your hands — they changed my job location. Every time there was a controversial situation, they put me aside.

In the end, I did not get my professional training. I requested a new job but instead, they sanctioned me. They withdrew me from the Ministry of Health for two years. They told me, if I wanted to come back to the Ministry, it would be under their rules. I would have to go to an arbitrary place, and do whatever they asked of me and I did not have any choice of continuing my specialty.

Natalie: You said that after three months that you wanted to leave Venezuela, why?

Daily: I left Cuba at the age of 24. I had recently graduated from medical school with an intensive therapy diploma. When they informed me I was going to spend two years in Venezuela acting as an intensivist, they promised I was going to have a teacher, that decisions were not going to be made solely by me, because intensive therapy is a specialty with a lot of responsibility.

You are taking care of patients and your decisions can determine who lives and dies and you have to be well prepared. You have to make quick decisions, and I was a recent graduate.

After my arrival in Venezuela, I realized that I had no teacher, that only I was going to conduct intensive therapy at that time and on the top of that, I was dealing with 24-hour shifts. Afterwards, you can only rest for 24 hours —  and sometimes not even 24 hours — because I had to teach medical classes, which they had not previously told me.

I had to direct hygiene and epidemiology in the state and also, the medical commission. It was an overload, an exploitation. And besides that, I was going to play a role for which I did not have a professional certification at the time. Within three months, I requested they take me out of there, that they return me to Cuba, or that they allow me to have a professor.

They also told us in Cuba that in Venezuela we were going to receive training courses, that we could even start doing the specialty in Venezuela.

But this never happened. 

When we arrived in Venezuela, none of these promises were real. 

Natalie: Cuba, of course, is not immune to the coronavirus pandemic. Even as many are getting sick within the island, the regime is still sending hundreds of these doctors abroad on international mission[s]. Meanwhile, many Cubans cannot get the medical care that they need. And many do not even have access to running water, face masks, to soap and many of the basic supplies for prevention that Cuba stresses so much … . Why has the regime made the decision to send so many of its medical professionals abroad precisely when Cubans need them the most, and what do you think is the biggest challenge that Cubans are going to face as a result of this pandemic? 

Daily: This is a moment for the Cuban health system to vindicate itself after all of the negative information about the missions that have come out. So the regime is taking advantage of the vulnerability of the situation when countries like Spain are facing more than 15,000 casualties due to COVID-19. 

Another factor is the economy. Medical missions have always been a great source of income for the Cuban state. They are going to take advantage of the fact that the world is vulnerable, and that they need medical personnel because all over the world, doctors are getting sick from the coronavirus.

The only thing the Cuban regime can sell right now is the professionals, the doctors. They don’t care if the doctors are prepared for this or not.

There’s no way Cuba can say that they are prepared to treat the coronavirus when the images we see coming out of Cuban hospitals are doctors who wear cloth face masks and no gloves. They do not use face shields. They touch the patients. And they do not maintain a distance of two meters [6.6 feet].

You have medical students making home health visits, looking at people who have an infection, without thinking that they themselves can spread the infection because they see 80 houses in a day and can infect people in those 80 houses. It’s very dangerous what they are doing at the moment, and, unfortunately, it’s the Cuban people who are going to suffer.

Of course, they are not ready. But the regime wants to project the image that everything is perfect, everything is fine — even if you have citizens dying on the street. I don’t like to give negative forecasts, but it is very likely that this will happen in Cuba.

As long as the ruling party continues to be in power, they are going to say that the number of infected people is very small, same with the number of deaths, but they are not even counting patients with respiratory infections that arrive at the hospitals.

It is very difficult to say, but even as organizations like the Cuban Observatory for Human Rights denounce the working conditions of Cuban doctors in medical missions to the European Union, countries like Italy, Andorra, and Spain are going to use these missions to solve their health crisis, even when this is violating the human rights of Cubans.  

In the end, the Cuban government treats its own people as second-class citizens, disposable people. It’s very hard to say it like that. But analyzing the situation as it is being presented, the government is not interested in the health of the Cuban people. 

They keep saying that everything is perfect. But there is no water or disinfectant. People have to stand in long lines to acquire food. They suspended public transportation, despite there being people who have to keep going to work. 

In my opinion, we will see chaos in Cuba in two or three weeks. It is very worrying, in my opinion.

Natalie: Cuba has released official statistics on the number of coronavirus cases and confirmed patients who recovered and patients who died, do you think these numbers are accurate?

Daily: No. The statistics they are giving are not real. 

Natalie: In the past, when you spoke out, I understand members of your family were targeted by the regime, are they ok?

Daily: In the past, of course, my family was harassed and mistreated. They were threatened with being fired from work. They even told my family that I could spend up to 20 years in jail. I didn’t do anything illegal, but they wanted to portray it that way. Not only my family, but people close to me, my friends. There were days when I woke up with a member of the state police at the door of my house. I went to the market and he was behind me, watching and filming me.

When people left my house, the state police were a few meters behind them. They inspected them, threatened them and told them to stay away from me. 

They treated me like they treat any other dissident of the regime. At this time, I know my family is under surveillance and the regime’s security system has been telling some of my friends not to be in touch with me. 

The regime has tried to bribe some of my friends in order to get information about me. I do not know what kind of information, because I do not understand how they operate. I know that my family is the object of surveillance. However, I maintain communication with them just to make sure everything is fine and they do the same. 

I tell them I’m getting used to my new location, but overall, very few things, because even back in Venezuela we knew that communications with our families were surveilled by state police. They threatened us and told us about conversations that we had had by telephone so that we would know that we were under surveillance. They wanted us to know that they were always watching.

Natalie: What do you think will happen next? Are you worried or hopeful for democracy in Cuba?

Daily: Very worried. I really don’t see any democratic advancement in Cuba, despite there being a large number of activists inside the island. Those activists continue to be harassed and repressed.

And really, if there’s no drastic change, democracy will not exist. In addition, I always think that information is power and in Cuba, many do not even know the concept of democracy and cannot demand something they do not know.

The regime prefers to keep us ignorant of these issues to keep us oppressed.

Natalie: You currently live in Spain, which as we’re speaking has recorded over 19,000 coronavirus deaths. How is it to be there as a medical professional and are you able to help? 

Daily: At the moment, I am not working as a doctor because I am not yet certified here.

I have spoken with other doctors, and I know that the work they are doing has exhausted them. There are those who are psychologically exhausted by the working conditions. The conditions in which this pandemic has occurred, have also affected them because they have to keep their distance from their families to keep them safe.  

Natalie: What do you think is important for everyone outside of Cuba to know about the island?

Daily: Well, specifically there is something that all Cubans, those inside the island, are bothered by. Even depressed. It’s when foreigners who do not know the real situation in Cuba, try to pass judgment on the Cuban system. Many who speak well of systems like Cuba, should think about why there are thousands of Cubans who prefer to die at sea, rather than to stay in a country with such “good health indicators,” with such a “good society” … . A country that does not have human rights.

Living in Cuba is not what the regime would have you believe. 

Especially in these moments of health crises, [people overseas] shouldn’t listen to anything that comes from the Cuban regime, because they always lie. And they will continue to lie and always try to maintain the image they have achieved so far. 

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