Teach a Child to Fear

Last Saturday, as the people of Ferguson waited for the grand jury verdict on the shooting of Michael Brown, 500 miles away, in Cleveland, Ohio, 12-year-old Tamir Rice was shot and fatally wounded by two police officers who had been called after reports of a child playing with a gun in a playground.  The gun in question was in fact a replica ‘airsoft’ pistol.  Officers reportedly asked Tamir to put his hands up – he reached for the gun.  They fired.  He was twelve years old.

I work with 12-year-olds.  Most of them are idiots at least once a day.  Many of them are idiots for large portions of the day.  That’s ok.  They’re supposed to be idiots.  They’re kids – they’re not done yet.  I know 12-year-olds who like to break the rules and challenge authority.  I know 12-year-olds who’d think it was a bit of a laugh to wave a replica gun around and ignore a request from a police officer.  They don’t half wind me up sometimes.  But I am still happy to see them walk into the classroom every morning.  Because they sometimes ask for help with a maths problem; because sometimes they’ll reach out to help another student; because sometimes the only kind words they’ll ever hear are from teachers; and because they are so full of potential to grow out of being idiots.

Footage released today shows police officers pulling up right beside Tamir and shooting him within two seconds of arriving at the scene. It’s been reported that the officers shouted warnings as they drove into the empty park, but it appears that no attempt was made to negotiate with Tamir once they arrived.  His hand seems to go to the gun in his waistband as the police car pulls up.  I know 12-year-olds who, when in high stress situations (and one would imagine being faced by armed police officers is just a little more stressful than being asked to demonstrate something in front of the rest of the class) would not understand a simple instruction to put their hands up.  The police officers who shot Tamir Rice, we are told, however, had to make a ‘split second decision’.  What kind of world do we live in where split second decisions lead to shooting dead a child?

The unavoidable debate here is one about race.  Because Tamir Rice was black, and the officers who shot him were white.  Around 53% of Cleveland’s population is black, but blacks make up only 27% of its police force.  Over 50 years after Martin Luther King and his followers marched to Washington and with its first black President in office, the USA remains a racially divided nation, and in no area more so than the criminal justice system.  The statistics are quotable and undeniable.  Racial profiling is still rife, with blacks being twice as likely to be stopped by police in many cities in the US.  African Americans constitute nearly 1 million of the USA’s 2.3 million prison population and are incarcerated at nearly six times the rate of whites.  If current trends continue, one in three black males born today can expect to spend time in prison during his lifetime.  There are almost as many black men in prison than in college.  In 2010, African Americans comprised 13% of the population but accounted for 55% of gun homicides.  Homicide is the leading cause of death amongst African-American males aged 15-24, who are 10 times more likely to die of murder than whites of the same age group.

Although disputes over racial imbalance in the justice system remain politically explosive, fuelled further by shootings such as those of Tamir Rice, Michael Brown, Trayvon Martin, the bigger issue here is a country where officers policing the streets shoot first and ask questions later.  Guns are glorified in the US - the right to own and use them is sanctified in the constitution and politicians and a powerful gun lobby fight passionately against laws to control them.  This is a country where over 8000 people a year are killed by guns. Its gun crime rate is comparable with some of the most corrupt and dangerous regimes in the world, including the Democratic Republic of Congo and Columbia.  It’s a country where kids want to play with toy guns because they see grown-ups playing with real ones.  And it’s a country where a 12-year-old child playing in a snowy park is presumed to be a dangerous criminal, unable to be reasoned with.  How many more children have to be shot and denied the chance to ever be a wonderful idiot again before America changes the way it thinks about guns?

From Cuba with Love

When the Ebola outbreak first spiralled into an international crisis, the country that dispatched the largest contingent of medical personnel to help was not a major western power, but Cuba, a small island nation of 11 million with a GDP of $6,051 per capita[1].  There are hundreds of Cuban medical staff now in Sierra Leone, Liberia and Guinea - more than from any other nation.  In contrast, many western countries have seemed “more focused on stopping the epidemic at their borders than actually stemming it in West Africa.”

For Cuba to be playing such a major role in the medical response to the crisis is not unprecedented.  Cuba currently has around 50,000 medical workers in 66 countries around the world and has more health workers deployed abroad than any of the G8 nations.  Fidel Castro’s newly formed government first dispatched medical aid abroad in 1960, following an earthquake in Chile.  Many more missions in numerous countries followed over the subsequent decades.  The country’s current dedication to what has been termed ‘medical internationalism’ originated in the aftermath of Hurricanes George and Mitch, which devastated the Caribbean in 1998.  The Cuban government vowed to train one doctor for every life lost in the storms.  To achieve this aim they established the Latin American Medical School: ELAM.  Initially it was free for all students to attend (Raoul Castro’s reforms since taking power from his brother Fidel in 2008 have included charging North American students to attend ELAM) and has subsequently trained over 33,000 students from 76 different countries, who return home to practice, usually amongst the world’s poorest people.

After the Haiti Earthquake in 2010, it was Cuba that provided the highest number of health workers, many of whom had been there since the 1998 storms.  Cuba also sent 2,250 doctors to treat survivors of the Kashmir Earthquake in 2005.  But Cuba does not limit its offers of assistance to poorer countires.  Within 3 days of Hurricane Katrina hitting New Orleans in 2005, Cuba had assembled 1,100 doctors and nurses and 24 tonnes of medicines, ready to fly to the US, but the Bush government did not even acknowledge the offer. 

Although the Cuban Henry Reeve Brigade (named after a US volunteer in Cuba’s war of independence against Spain of 1868-1878) is trained in disaster relief medicine, Cuba also commits to long-term projects.  They dislike the paternalistic term ‘medical aid’ and instead prefer ‘medical cooperation’ or ‘collaboration’.  When Cubans are sent to disaster areas, they are there for the long haul, usually working in the affected area for two years, and will be replaced by more Cubans should the need persist.

The importance of a robust healthcare system has been a key Cuban policy since Castro’s rebels overthrew Batista in the Revolution of 1959.  Ernesto ‘Che’ Guevara, Fidel Castro’s right hand man and himself an outsider who came to the aid of a country in need, had qualified as a doctor back home in Argentina before turning to life as a revolutionary.  Both he and Castro believed that unrestricted access to medical care was a basic human right and it was therefore enshrined in the Cuban constitution.  Despite the fact that almost half of Cuba’s doctors had fled from the communist regime by 1961, Che’s ‘revolutionary medicine’ encouraged a new generation of poor Cubans to train as doctors and return to those poor areas to practice.

The emphasis placed on good quality medical care still persists.  In Cuba, doctors visit all their patients at least once a year, regardless of whether they are ill or not.  This model has been in place since the revolution – the cornerstone of Cuba’s medical system is that prevention is better than cure.  This, alongside a comprehensive programme of vaccinations, has led to a significant reduction in the infectious diseases that blight Cuba’s Caribbean neighbours.  The net result is a mortality rate similar to that enjoyed by developed nations: “as Cubans joke, they live like the poor but die like the rich.”  In addition, “Cuba produces some 80 per cent of its own medical products, which are sold at a fraction of the price they would cost elsewhere.”

However, alongside these admirable principles lie some uncomfortable truths.  The average Cuban doctor’s salary is only $25 a month and many doctors trained for free in Cuba defect once they are sent abroad.  The Bush Administration was particularly keen on promoting this and set up a special programme in 2006, specifically targeting Cuban doctors and encouraging them to defect to the US.  Until January this year, when the high price of exit visas for Cubans was dropped, the cost of leaving the country prevented the ‘brain drain’ suffered by other poorer nations.  Since January, there has been a marked increase in the number of Cubans exiting the country legally and it remains to be seen what impact this will have on Cuban medical care.  What is certain, however, is that medical internationalism has had an effect on Cuba’s national healthcare system, with waiting times for GPs increasing.  Yet although approximately 20% of Cuban doctors are working abroad, “the ratio of doctor to patients in Cuba is still probably the best in the world.”[2]

Prior to this year’s Ebola outbreak, Cuba had been a longstanding friend of many African nations.  In 1963, Cuban doctors and nurses accompanied Algerian soldiers fighting on the border with Morocco and the injured were brought back to Cuba for free treatment.  In 1965, Che himself went to fight alongside local insurgents in Zaire (now the Democratic Republic of Congo) and whilst there “helped launch one of Africa’s first mass immunisation campaigns." Many more operations took place over the following decade, but it was the medical support, rather than the military, which was more effective and ended up forging the stronger links.  In the 1970s, when many emerging nations were experimenting with socialism and aligning themselves with communist states who opposed their former colonial masters, ties deepened between Cuba and Africa.  When Sierra Leone president Ernest Bai Koroma welcomed the first Cuban delegation in the capital Freetown last month, he announced “this is a friendship that we have experienced since the 1970s and today you have demonstrated that you are a great friend of the country.”

Why is Cuba so committed to medical collaboration?  First and foremost, it is Cuba’s main export.  The largest cohort of Cuban medical personnel working abroad are in Hugo Chavez’s Venezuela, in exchange for around 100,000 barrels of oil a day at preferential prices.  The Cuban government is now specifically looking to expand their collaboration into wealthier countries.  Secondly, medical internationalism is unquestionably a form of soft power for Cuba, winning the country influence with potentially hostile governments and consolidating support from other smaller nations.  Just last month, 188 members of the United Nations voted for the 23^rd time to condemn the US embargo against Cuba, first imposed by President Kennedy in the 1960s.  There are signs that the US may be ready to take a more open approach to Cuba’s medical internationalism, and, much to the consternation of the Republicans, the Obama administration has sent officials to meet with the Cubans to discuss a joint approach to the Ebola crisis. It is hoped that this combined response to Ebola may pave the way for an ending of the embargo.

There are those who argue that Cuba’s medical internationalism does little to negate the serious human rights abuses taking place within its own borders.  There is widespread repression of civil liberties in Cuba, especially with regards to political dissidents and journalists, with all media being heavily censored.  Though capital punishment was officially ended in 2003, there remain complaints of unfair trials, unjust sentences and torture in Cuban prisons.  Even within the revered healthcare system there is no right to privacy, patients do not have the right to refuse treatment and doctors are expected to report on the political leanings of their patients.  The favourable international view of Cuban healthcare is doubtless coloured by suppression of dissenting views.  The fact that such a small nation has made such a disproportionate contribution to the wellbeing of some of the world’s poorest nations is commendable and there is no doubt that Cuban medical personnel working abroad have significantly improved the health of millions around the world; it is only a shame that it should come at such a high cost to the freedoms of the Cuban people.

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[1] To put that in context, the GDP of the USA is $53,143 per capita.

[2] There are 6.7 GPs per 1,000 people in Cuba – there are 2.4 per 1,000 people in the US and in Canada - http://www.counterpunch.org/2012/12/14/medical-internationalism-in-cuba/