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Cuban medical internationalism has been a core component of the revolution: Interview with Don Fitz, author of Cuban Health Care: The Ongoing Revolution

Don Fitz has taught Environmental Psychology in multiple universities around the US, especially in the St. Louis area, Missouri, where he lives and was the candidate for Governor of the Green Party USA in 2016. He is on the Editorial Board of Green Social Thought and, in addition to publishing his research on social and community psychology in academic journals, he collaborates with magazines like Monthly Review, ZNet, CounterPunch, Common Dreams, Global Research, Climate & Capitalism, AlterNet and TruthOut. Just a few weeks ago, Monthly Review Press published his book Cuban Health Care: The Ongoing Revolution. When talking about it, he underscores:

My writings on Cuba are a subset of a larger problem. Most of my work focuses on dangers of expanding energy production and documenting that ‘green energy’ has enormous problems poisoning and destroying the environment while replaces fossil fuels leaving capitalist relationships untouched. Cuba demonstrates how a country can have better health care while using vastly less energy.

| Cuban Healthcare The Ongiong Revolution | MR Online

Don Fitz, Cuban Health Care: The Ongoing Revolution (Monthly Review Press, forthcoming in June, 2020).

But how did he get interested in Cuban health care in particular? By 2009, when thinking about all the struggles he had joined against incinerators, landfills, manufacturing plants, poisonous chemicals and deforestation, Fitz thought “that halting capitalist destruction and creating a better world would require considerably less extraction and manufacture”. At the same time, he understood that “one economic sector stood out that might need expansion in a post-capitalist society: medicine. It seemed to me that good health care for all throughout the world would require increased production and more energy”. But a couple of years before his daughter Rebecca had decided to study at the Latin American School of Medicine (ELAM) in Cuba, and when Fitz visited her, he started to research on Cuban medicine: “I discovered multiple that Cuba spends vastly less money on medical care than does the US while having similar results for life expectancy and infant mortality. That blew holes in my earlier idea that medicine would be the only economic area requiring expansion in a post-capitalist society”. This made him think on other aspects which were seminal to his political commitment:

As climate catastrophe threatens to end human existence, it becomes increasingly clear that we must tread much, much more lightly on ‘resources’ and vigorously seek to reduce production by replacing expansion of exchange values with increasing use values—but producing what is useful for people rather than increasing profits cannot be done under capitalism. If the small economy of Cuba can improve the health of millions of the world’s people, imagine what could be accomplished if America’s enormous productive capacity changed from creating useless and destructive junk to producing what people throughout the world actually need.

These concerns, along with the realization “that there were many stories of Cuban medicine that needed to be told,” are what compelled Fitz to write Cuban Health Care. In the following interview, we discuss the book and go through the history of Cuban health system and its many lessons—an especially relevant issue in face of the current health emergency and the harshness with which COVID-19 has exposed the disastrous foundations of global capitalism.

Due to the current emergency, I would like to start talking about COVID-19. Can you tell us how Cuba has reacted to it? It seems that, contrary to other countries, its approach has been quite efficient to fight the pandemic. What has it made so different and why has its model been replicated in other countries?

Discussions at the highest levels of the Cuban Ministry of Public Health drew up the national policy. There would need to be massive testing to determine who had been infected. Infected persons would need to be quarantined while ensuring that they had food and other necessities. Contact tracing would be used to determine who else might be exposed. Medical staff would need to go door to door to check on the health of every citizen. Consultorio staff would give special attention to everyone in the neighborhood who might be high risk.

By March 2, Cuba had instituted the Novel Coronavirus Plan for Prevention and Control. Within four days, it expanded the plan to include taking the temperature of and possibly isolating infected incoming travelers. These occurred before Cuba’s first confirmed COVID-19 diagnosis on March 11. Cuba had its first confirmed COVID-19 fatality by March 22, when there were 35 confirmed cases, almost one thousand patients being observed in hospitals, and over 30,000 people under surveillance at home. The next day it banned the entry of nonresident foreigners, which took a deep bite into the country’s tourism revenue.

That was the day that Cuba’s Civil Defense went on alert to respond rapidly to COVID-19 and the Havana Defense Council decided that there was a serious problem in the city’s Vedado district, famous for being the largest home to nontourist foreign visitors who were more likely to have been exposed to the virus. By April 3, the district was closed. As Merriam Ansara witnessed, “anyone with a need to enter or leave must prove that they have been tested and are free of COVID-19.” The Civil Defense made sure stores were supplied and all vulnerable people received regular medical checks.

Cuban health officials wanted the virus to remain at the “local spread” stage, when it can be traced while going from one person to another. They sought to prevent it from entering the “community spread” stage, when tracing is not possible because it is moving out of control. As U.S. health professionals begged for personal protective equipment and testing was so sparse that people had to ask to be tested, Cuba had enough rapid test kits to trace contacts of persons who had contracted the virus.

During late March and early April, Cuban hospitals were also changing work patterns to minimize contagion. Havana doctors went into Salvador Allende Hospital for 15 days, staying overnight within an area designated for medical staff. Then they moved to an area separate from patients where they lived for another 15 days and were tested before returning home. They stayed at home without leaving for another 15 days and were tested before resuming practice. This 45-day period of isolation prevented medical staff from bringing disease to the community via their daily trips to and from work.

The medical system extends from the consultorio to every family in Cuba. Third-, fourth-, and fifth-year medical students are assigned by consultorio doctors to go to specific homes each day. Their tasks include obtaining survey data from residents or making extra visits to the elderly, infants, and those with respiratory problems. These visits gather preventive medicine data that is then taken into account by those in the highest decision-making positions of the country. When students bring their data, doctors use a red pen to mark hot spots where extra care is necessary. Neighborhood doctors meet regularly at clinics to talk about what each doctor is doing, what they are discovering, what new procedures the Cuban Ministry of Public Health is adopting, and how the intense work is affecting medical staff.

In this way, every Cuban citizen and every health care worker, from those at neighborhood doctor offices through those at the most esteemed research institutes, has a part in determining health policy.

We have also seen that countries that kicked the Cuban doctors out are suffering greatly due to the lack of an efficient health system, especially for the poor. What can you tell us about this?

This is an extremely important question because the US and international financial institutions are seeking to prevent national health care systems from coming into existence and to destroy those that do exist. Let me compare two countries with a national plan (Cuba and Venezuela) to two where national health care has been eliminated (Brazil and Ecuador).

Venezuela has attempted to replicate fundamental aspects of the Cuban health model on a national level, which has served the country well in combating COVID-19. An example: In 2018, residents of the Socialist Commune Altos de Lidice organized seven communal councils, including one for community health. A resident made space in his home available to the Communal Healthcare System initiative so that the doctor could have an office. He coordinates data collections to identify at-risk residents and visits all residents in their homes to explain how to avoid infection by COVID-19. The nurse, who helped implement the Mission Barrio Adentro (Mission Into the Neighborhood) when the first Cuban doctors arrived, in 2003. She remembers that residents had never seen a doctor inside their community, but when the Cubans arrived “we opened our doors to the doctors, they lived with us, they ate with us, and they worked among us.”

As a result of building a Cuban-type system, by April 11, 2020, the Venezuelan government had conducted 181,335 early Polymerase Chain Reaction (PCR) tests in time to have the lowest infection rate in Latin America. Venezuela had only six infections per million citizens while neighboring Brazil, which had thrown out Cuban doctors, had 104 infections per million.

When Rafael Correa was president of Ecuador, over one thousand Cuban doctors formed the backbone of its health care system. Lenin Moreno was elected in 2017 and Cuban doctors were soon expelled, leaving public medicine in chaos. Moreno followed recommendations of the International Monetary Fund to slash Ecuador’s health budget by 36%, leaving it without health care professionals, without personal protective equipment, and, above all, without a coherent health care system. At the time Venezuela and Cuba had a total 27 COVID-19 deaths, Ecuador’s largest city, Guayaquil, had an estimated death toll of 7,600.

Cuba has led some relevant scenes of international solidarity during this crisis. There were already many medical missions all over the world, but health care professionals have been sent to other parts too, including Western countries like Italy. Also, a medicine such as Interferon Alpha 2B has been used and requested worldwide to control the virus. And Cuba was the only country in the region to allow the British cruise ship MS Braemar to dock, treating the crew members and passengers in Cuban hospitals. All this seems quite impressive, considering the many difficulties the country goes through in its daily basis. But some critics have pointed at all these actions as simply gestures of propaganda by the Cuban government. What do you think about it? 

As a psychologist, I coin the term “neglect projection” to encompass several of the attacks on Cuban humanitarianism. The term “projection” describes individuals who attribute their own unacceptable thoughts or impulses to another. “Political projection” would be a country attributing its own reprehensible action to another government.

Medical “neglect projection” against Cuba shows up in two forms. First, medical associations in several Latin American countries have displayed intense hostility toward Cuban doctors, accusing them of taking jobs from the country’s own doctors, being in a guest country just to spread political propaganda, not being qualified, and not providing follow-up care.

The claim that jobs are being taken away from doctors in Brazil and Venezuela is belied by the fact that Cuban medical staff go to poor and rural areas where doctors in these host countries will not work. The Chávez government began the first Barrio Adentro program in 2003 to provide community medicine to poor and working class Venezuelan districts.

The call went out for Venezuelan doctors to participate. Only 50 volunteered. It was this pathetic response that led Cuba to deploy over 9,000 by the end of that year.

After Barrio Adentro began, the Venezuelan Federation of Medicine (FMV), which sympathizes with the Venezuelan opposition, demanded that Cuban doctors be expelled, partially because they were accused of spreading leftist propaganda. Yet, unlike the FMV, Cuban doctors have been trained to not participate in the politics of any country where they are serving. This is critical for medical agreements with countries that, unlike Venezuela, have a right wing government.

Some Latin American medical associations have charged that students trained to be doctors in Cuba scored lower on qualifying exams, overlooking the unique Cuban focus on community health in distressed and rural areas, family medicine, and disaster management. Cuban doctors aim to diagnose over 80% of medical problems by examinations and detailed histories. Given that the Cuban system does far better at improving the main health indicators, it would be more useful to ask how graduates from other Latin American medical schools would perform on examinations in Cuba.

Additionally, Cuban doctors have more staying power in distressed communities than do those making the charge, because when Cuban doctors rotate home, others from the island replace them.

The other major form of “neglect projection” has been ignoring or minimizing the significance of Cuba’s emergency response teams for floods, earthquakes, hurricanes, tsunamis, volcanoes, epidemics and the Chernobyl meltdown. Medical internationalism has been a core component of the Cuban revolution since 1959. A revolutionary promise was to bring health care to poor, black, and rural areas, and from there, it was a short jump to bring care to other countries in need, as it was done in Chile in 1960 and Algeria in 1963.

Cuba’s medical internationalism has been expressed in four ways.

First, Cuba has sent medical personal abroad. As mentioned, during the past six decades more than 400,000 Cuban medical professionals have worked in 164 countries and improved the lives of hundreds of millions of people. What Cuba did in Italy was a continuation this pattern. On March 26, Cuba sent 52 doctors and nurses to Crema, in the Lombardy region, when the emergency room at its hospital was filled to capacity, and they set up a field hospital with three intensive care unit beds and 32 other beds with oxygen. A smaller and poorer Caribbean nation was one of the few aiding a major European power.

Second, Cuba has brought people to the island, both as students and as patients. When Cuban doctors were in the Republic of the Congo in 1966, they saw young people studying independently under streetlights at night and arranged for them to come to Havana. They brought in even more African students during the Angolan wars of 1975–88 and then brought large numbers of Latin American students to study medicine following Hurricanes Mitch and Georges. Establishing ELAM was the culmination of bringing students to study medicine. Cuba also has a history of bringing foreign patients for treatment. After the 1986 nuclear meltdown at Chernobyl, 25,000 patients, mostly children, came to the island for treatment, with some staying for months or years. Cuba opened its doors, hospital beds, and a youth summer camp. Cuba’s action with the MS Braemar was part of this tradition. On March 18, Cuba became the only country to allow the Braemar’s over a thousand crew members and passengers to dock. Treatment at Cuban hospitals was offered to those who felt too sick to fly. Before leaving, Braemar crew members displayed a banner reading “I love you Cuba!”

Third, Cuba seeks to offer drugs at low cost to poor nations rather than price-gouge the sick as is the habit in corporate medicine. Cuba has sought to work cooperatively toward drug development with countries such as China, Venezuela, and Brazil. Collaboration with Brazil resulted in meningitis vaccines at a cost of 95¢ rather than $15 to $20 per dose. Cuba seeks to help countries adapt medical systems to better serve the poor and teaches them to produce medications themselves so they do not have to rely on purchasing drugs from rich countries.

Fourth, Cuba aid is genuine rather than propagandistic. This brings us back to “neglect projection,” which happens when those responsible for the under-treatment of the world’s poor seek to blame others who are actively trying to help. Haiti was not at all reluctant to accept Cuba’s help following the devastating earthquake of 2010. Cuba was the key provider of help since it had had so many medical personnel in Haiti since 1998. Over the years, 6,000 Cuban medical staff have treated over three million Haitians. Cuba had previous emergency experience in Haiti, having sent a medical brigade during the massive flooding of 2004. Within a month of the 2010 earthquake, many foreign emergency teams were gone. But 600 Cubans and 380 Haitians trained in Cuban medical schools remained. In October, 2010 Haiti was hit by the first cholera outbreak it had seen in over a hundred years. Had Cuba not had the habit of staying in a country after the initial excitement of disaster relief and if it had not been teaching Haitians preventive medicine, the cholera death toll would have been much, much worse.

Though Cuba was in Haiti before the earthquake, provided the quickest and most professional emergency assistance, and remained long after the earthquake was history. Spain’s leading paper, El País, omitted Cuba from its list of countries that provided help. Fox News in the US actually criticized Cuba with the astounding claim that it failed to provide assistance.

The 22,000 Americans in Haiti were almost entirely military. Not only did US doctors reach Haiti later and depart sooner than those from Cuba—they did not stay where Haitian victims huddled. After working hours, they tended to return to luxury hotels. Cuban doctors lived in the communities of Haitians they treated.

John Kirk uses the term “disaster tourism” to describe the way that many rich countries respond to medical crises in poor countries. Many go to disaster areas “to have an ‘experience’ rather than provide meaningful assistance to those affected.” Many of them get in the way of serious rescue work.

The approach of Cuban doctors is in stark contrast to “disaster tourism.” Cubans have extensive training in intercultural disaster response. They build on experiences of thousands of medical staff who have already worked in poor countries. Cuban response teams (or replacement staff) stay in afflicted countries for months or years, helping to develop programs of community medicine and preventive health.

The current pandemic is being dramatic worldwide, but nonetheless, there have been plenty of other health crises before. How did Cuba respond to these?

Every preventable disease is a health crisis. Vaccination began shortly after the revolution; but the policlínico integral structure vastly increased its effectiveness. In 1962, 80% of all children under 15 were vaccinated against polio in 11 days. In 1970, it took one day for the same national effort. Malaria was eradicated in 1967, as was diphtheria by 1971.

The mosquito-borne dengue fever hits Cuba every few years. What is unique about Cuba is that its medical students leave school and go door-to-door making home evaluations. Students from ELAM come from over one hundred countries and speak with a huge number of accents. They have no trouble walking through homes, looking for mosquito-attracting plants, and peering onto roofs to see if there is standing water.

In 1981, Cuba’s research institutes created Interferon Alpha 2B to successfully treat dengue. The same drug became vitally important decades later as a potential cure for COVID-19. Since 2003, Interferon Alpha 2B has been produced in China by the enterprise ChangHeber, a Cuban-Chinese joint venture, and has shown its efficacy and safety in the therapy of viral diseases including Hepatitis B and C, shingles, AIDS, and dengue. Cuba has researched multiple drugs, despite the U.S. blockade obstructing access to technologies, equipment, materials, finance, and even knowledge exchange.

Cuba’s first patient of a new disease called AIDS died in 1986. As it isolated soldiers returning from war in Angola who tested positive for HIV, a hate campaign against Cuba claimed that the quarantine reflected prejudice against homosexuals. That this was part of attempts to discredit Cuba was demonstrated by the facts that (1) those soldiers returning from Africa were overwhelmingly heterosexual (as were most African AIDS victims), (2) Cuba had quarantined dengue patients with no outcry, and (3) the US itself had a history of quarantining patients with tuberculosis, polio and even AIDS.

In December 1991, the Soviet Union collapsed, ending its $5 billion subsidy, disrupting international commerce, and sending the Cuban economy into a free fall that exacerbated the AIDS crisis. The HIV infection rate for the Caribbean region was second only to southern Africa. The embargo simultaneously reduced the availability of drugs, as it made existing pharmaceuticals outrageously expensive and disrupted the financial infrastructures used for drug purchases. If these concurrent factors were not enough, Cuba opened the floodgate of tourism to cope with lack of funds. As predicted, tourism brought an increase in prostitution. There was a definite possibility that the island would succumb to a massive epidemic.

The government response was immediate and strong. It drastically reduced services in all areas except two which had been enshrined as human rights: education and health care. Its medical research institutes developed Cuba’s own diagnostic test by 1987. Testing for HIV went into high gear, with completion of over 12 million tests by 1993. Education about AIDS was massive for both the sick and the healthy, for children as well as adults. By 1990, when homosexuals had become the island’s primary HIV victims, anti-gay prejudice was officially challenge as schools taught that homosexuality was a fact of life. Condoms were provided free at doctor’s offices. Despite their high cost Cuba provided antiretroviral (ART) drugs free to patients.

Cuba’s united and well-planed effort to cope with HIV paid off. At the same time Cuba had 200 AIDS cases New York City, with about the same population, had 43,000 cases. NYC residents were far less likely to have recently visited sub-Saharan Africa, where a third of a million Cubans had just returned from fighting in war for Angolan independence.

In 1997, Chandler Burr wrote in The Lancet that Cuba had “the most successful national AIDS programme in the world”, despite having only a small fraction of wealth and resources of the US.

Ebola Virus Disease (EVD) was quite different. Viruses that cause EVD are mainly in Sub-Saharan Africa, an area that Cubans had not frequented for several decades. When the Ebola virus increased dramatically in fall 2014, much of the world panicked. Soon, over 20,000 people were infected, more than 8,000 had died, and worries mounted that the death toll could reach into hundreds of thousands. The US provided military support; other countries promised money. Cuba responded with what was most needed: it sent 103 nurse and 62 doctor volunteers to Sierra Leone. With 4,000 medical staff (including 2,400 doctors) already in Africa, Cuba was prepared for the crisis before it began. Since many governments did not know how to respond to Ebola, Cuba trained volunteers from other nations at Havana’s Pedro Kourí Institute of Tropical Medicine. In total, Cuba taught 13,000 Africans, 66,000 Latin Americans, and 620 Caribbeans how to treat Ebola without themselves becoming infected.

Do you think this pandemic is exposing, even clearer than ever before, the limitations of capitalist approaches to health care? And what is the significance of the Cuban health care model in relation to the different existing models, considering the warnings from the scientific community of new pandemics in the near future due to the destructive effects of the capitalist productive system on the planet?

The most critical parts of the Cuban health care system are (1) all parts are fully integrated into a single whole which can respond to medical problems, (2) everyone in the country has input into the system so that it enjoys the collective experiences of the country, (3) it is founded on the belief that everyone should receive complete health care as a human right.The US medical system is founded on the principle that every corporation should be able to make as much profit as possible. Despite a vicious embargo that prevents Cuba from receiving needed medical supplies, it has a longer life expectancy and lower infant mortality rate than the US while spending about 5% per person each year of what the US does on health care. The US system is not able to move away from profit-seeking, which is why it will handle future pandemics worse.

One factor which many ignore, even many who understand the advantages of the Cuban system, is the key role of animal agriculture in fostering pandemics. Domestic animals are cruelly crowded into tiny spaces and the habitats of wild animals are encroached upon continually. These maximize the potential for viral mutations such as COVID-19 to emerge. Corporate food production cannot admit the danger this poses to human health because it would challenge their business and their profits. We must all encourage health systems such as Cuba and Venezuela to analyze the danger of industrial animal agriculture and have open discussions of how to lower meat production.

I would like to talk a bit about the history of this health care model. When the Cuban Revolution triumphed, the whole health system was transformed. What were the main characteristics of this model implemented in Cuba then and how did it develop?

There are so many aspects to revolutionary medicine in Cuba that it is almost impossible to list them all without leaving something out. The first fact that stands out is the medicine was not a thing-by-itself but was an essential component of a social transformation that continues to develop. Transformations included the literacy campaign, sanitation, land reform, agricultural salaries, agricultural methods, improved diet, pensions, new roads, new classrooms, new homes, piped water, anti-racism and gender equality.

The first medical challenge to the revolution was to bring free health care as a human right to those who had never seen a doctor, especially for black and rural Cubans. This grew beyond the borders of Cuba as it sought to bring health care to other countries. In Cuba, it included many vaccination campaigns and an ongoing successful set of programs to eradicate diseases.

By 1964, it was clear that too many unconnected service health systems did not know what other systems were doing and this was resolved by creating policlínicos integrales which brought all services together. The most revolutionary aspect of this change was that every citizen had a single point of entry into the health care system via their defined geographic area. This allowed Cuban medicine to seriously sees to include 100% of the population and the single point of entry concept survived each successive change.

But many contradictions within the policlínicos integrales emerged by 1974. The system was putting too many requirements on the clinics and they were not sufficiently connected to communities. Cuban medical planners borrowed staff and ideas from Eastern European counties but realized that a problem with those systems was that clinics were under control of hospitals. Having clinics on an equal level as hospitals was preserved in all phases of transformation of the medical system.

The new system changed clinics to policlínicos communitarios. In the old system, patients went to the clinics. Beginning in 1974, clinics would go to the community. These clinics developed doctor-nurse teams based on specialties (such as internal medicine or pediatrics) and these specialty teams would be responsible for the clinic area.

Multiple contradictions emerged within this clinic system, with one of the most important being that doctor-nurse teams based on specialties were assigned areas too large for them to know patients well. By 1984, Cuban medicine began to change to doctor-nurse teams in a neighborhood consultorio or doctor’s office. The teams lived in the neighborhood they were assigned to, had a specialty of general medicine for the most frequent problems, and had an area small enough so that every patient could walk to the consultorio and the doctors and nurses could walk to all homes (in urban areas). This system has survived through today and includes almost 100% of Cubans. The doctor/nurse teams know every one of their patients by name. The neighborhood teams are thoroughly integrated with clinics, hospitals, medical schools, specialty hospitals and research institutes.

As you have already mentioned, there is an internationalist spirit behind this model of health care. But this was something present from the beginning, in harmony with many other aspects of Cuban revolutionary policy in foreign affairs. Can you tell us some significant examples of how this internationalist vision manifested throughout time?

Only 15 months after the revolution Cuba sent doctors to Chile following a 1960 earthquake. In 1963, Cuba sent a medical brigade to Algeria, which was fighting for independence from France. After learning of revolutionary movements in Zaire, the Congo and Guinea Bissau, Cuba sent doctors there to accompany military advisors. During the Angolan wars of 1975-88 Cuba sent 700-800 medical professionals to support its troops. Cuban international aide expanded globally, so that by the end of the Angolan wars it had also sent medical brigades to the African countries of Benin, Burkina Faso, Cameroon, Cape Verde, Equatorial Guinea, Ghana, Guinea, Madagascar, Mali, Mozambique, Nigeria, São Tomé Y Príncipe, Seychelles, Sierra Leone, Somalia, Tanzania, Uganda, Zambia and Zimbabwe. Cuba established a medical faculty in Jimma, Ethiopia.

The largest Cuban medical brigades sent to Latin America and the Caribbean went to Peru, Jamaica, Grenada and Nicaragua. Small Cuban brigades had also arrived in Bolivia, Columbia, Guyana, Mexico, Panama, Suriname, and St. Lucia.

Others receiving Cuban aid were Iran, Iraq, Libya, Mauritania, Morocco, South Yemen, Syria, West Sahara, Afghanistan, Sri Lanka, Viet Nam, Laos and the Ukraine. Between 1975 and 1991 over 70,000 aid workers went overseas. During the same time, Cuba brought over 50,000 students from throughout the world to study in its schools, covering the complete cost of their education. By 1984 Cuba had brought in and funded students from 75 nations, virtually all from poor countries where students typically had to pay for education. The number of students coming to Cuba to study expanded even more in 1999 when it opened classes at the Latin American School of Medicine (ELAM). By 2020, ELAM had trained 30,000 doctors from over one hundred countries.

Over the past six decades more than 400,000 Cuban medical professionals have worked in 164 countries and improved the lives of hundreds of millions of people.

In your book, when referring to the Cuban health system, you insist in the notion of “revolutionary medicine” and the importance of the ideas of Che Guevara for it. Just to end, I would like to go back to this historical episode, because Che Guevara first envisioned a model of “revolutionary medicine” in Guatemala, and even started to write a manual type of book about it, which he never finished due to the coup Jacobo Árbenz suffered in 1954. But how did it all start? How did Che Guevara form these ideas?

Che Guevara took a nine-month break from medical school in December 1951 so he could travel by motorcycle through Argentina, Chile, Peru, Colombia, and Venezuela. One of his goals was gaining practical experience with leprosy. On the night of his 24th birthday, Che was at La Colonia de San Pablo in Peru swimming across the river to join the lepers. He walked among six hundred lepers in jungle huts looking after themselves in their own way. Che would not have been satisfied to just study and sympathize with them – he wanted to be with them and understand their existence. Being in contact with people who were poor and hungry while they were sick transformed Che. He envisioned a new medicine, with doctors who would serve the greatest number people with preventive care and public awareness of hygiene. A few years later, Che joined Fidel Castro’s 26th of July Movement as a doctor and was among the 81 men aboard the Granma as it landed in Cuba on December 2, 1956. After the January 1, 1959, victory that overthrew Fulgencio Batista, the new Cuban constitution included Che’s dream of free medical care for all as a human right.

Decades before COVID-19 jumped from person to person, Che’s imagination went from doctor to doctor. Or perhaps many shared their own visions so widely that, after 1959, Cuba brought revolutionary medicine anywhere it could. Obviously, Che did not design the intricate innerworkings of Cuba’s current medical system. But he was followed by healers who wove additional designs into a fabric that now unfolds across the continents. At certain times in history, thousands or millions of people see similar images of a different future. If their ideas spread broadly enough during the hour that social structures are disintegrating, then a revolutionary idea can become a material force in building a new world.