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Cuba shows way with health aid in East Timor

Canberra Times - April 29, 2011

George Quinn Since 2004 about 300 Cuban doctors, nurses and medical technicians have been working quietly but effectively in East Timor.

They provide basic health care, dealing mostly with diarrhoea, malaria and respiratory infections. They also give ante- and post-natal advice, and teach communities about basic hygiene. Most are working in rural areas where the majority of East Timor's impoverished population lives. Some are permanently stationed in very remote corners of the country. Most are on contracts of at least two years' duration.

Being speakers of Spanish they have found it relatively easy to learn the closely related Portuguese language. A good number have mastered the indigenous national language Tetum, and a few can even get by in local languages. And the Cubans are economical. Most work on a shoestring stipend, their modest salaries being paid directly to their families back in Cuba. The East Timor Government makes a small contribution to their expenses, providing accommodation, some equipment and basic transport services.

The Cuban aid program also pays for East Timorese students to study medicine. Currently about 600 are in Cuba and about 200 more are studying in East Timor under Cuban instructors. Graduates from Cuba are now trickling back into East Timor's health-care system supported by a substantial allocation of funds in the country's most recent budget.

The Cuban program is not without its problems, but, overwhelmingly, its no-nonsense approach is popular with local people. Infant mortality has dropped dramatically, household hygiene is improving and the Cubans have clamped a medical head-lock on the intractable problem of malaria.

Australia is also committed to improving the health of East Timorese. In the current five-year period beginning in 2006 AusAID is spending well over $30 million, mainly on the development of a strategic plan for the health sector and on the development of specialist medical services. In 2008, when East Timor's President Jose Ramos-Horta was critically wounded in an assassination attempt, his staff did not turn to Cuban medical workers but to Australian medics who undoubtedly saved his life by rendering expert initial care and evacuating him swiftly to Darwin. So, needless to say, Australia's medical aid is much appreciated in East Timor.

Nevertheless, there are big and fundamental differences between the two programs. The Australian program is expensive, rather narrowly focused on high-tech specialist services, and centred in cities and the major hospitals. It involves small numbers of Australian personnel on relatively short-term placements. Hardly any of them know local languages.

Cuba's program, on the other hand, is vastly cheaper and more cost-effective than Australia's. It concentrates on the fundamentals of health care in rural and remote areas. It involves hundreds of medical personnel on relatively long-term placements, and many of these medics (though far from all) are able to work without intensive reliance on interpreters.

Australia has accepted no more than a tiny handful of East Timorese into medical training programs in Australia whereas Cuba is providing invaluable, very practical medical expertise to many hundreds of them both in Cuba and on the ground in East Timor. In many ways the Cuban program and Australia's complement each other.

Yet a question hangs in the air. Despite the very real need for grassroots medical services in East Timor, Australia is incapable of matching the Cubans in supplying these services, certainly on nothing like the scale of Cuba's program. Why?

The answers to this question are complex. Australians are renowned for their practical outlook and can- do expertise, but they are increasingly shackled by deep-seated cultural and organisational problems that suggest a troubling picture of developments in our society. It is almost laughable to imagine that hundreds of Australian doctors might be willing to spend years in remote parts of East Timor, as hundreds of Cuban doctors do. It is equally laughable to imagine our medical training institutions bending their rules enough to allow access to East Timorese students, as Cuba's do. In a slightly desperate gesture of frustration with our country's medical closed shop, the Federal Government announced recently it would fund five scholarships for East Timorese to study medicine in Indonesia.

Security and insurance concerns driven largely by paranoia and ignorance play a role too. Australia's travel warnings urge visitors to "exercise a high degree of caution in East Timor because of the uncertain security situation and the possibility of civil unrest. The situation could deteriorate without warning." As our nation's daring, do-it- yourself pioneer spirit fades into myth, Australians are less and less likely to accept the rigours of work over long periods in tough surrounds that are perceived (through our Government's eyes) as unsafe. The legendary reluctance of Australians to learn foreign languages too is leading to a gradual turning away from the realities of an increasingly bilingual world, and, in my view, is closing young minds to the diversity of our neighbourhood.

In some of the darker nooks and crannies of the Australian Government there is concern at the growing influence of communist Cuba and communist China in a nation that is no more than a quick hop across the water from Darwin. And what is happening in East Timor is rippling out into the island nations of the Pacific too. In the Solomon Islands, Vanuatu, Kiribati and Nauru, Cuba and China have established secure and rapidly expanding footholds in local development aid. Aid is a powerful tool in the dynamics of international relations and regional security. But in East Timor, despite a reservoir of gratitude and goodwill towards Australia, our country is rapidly losing out to more flexible and culturally well-tuned programs from countries that are ideologically very different from us. Unless vested interests and in-grained attitudes can be faced down in Australia, I don't think there is much we can do about it.

[George Quinn is an adjunct professor and visiting fellow in the College of Asia and the Pacific, Australian National University.]

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