First aid, Cuba's and ours

President Bush spoke last week at a conference on U.S. aid to Latin America and the Caribbean where he discussed both government and private efforts and highlighted examples of “how best can the United States help people in our neighborhood.”

He drew a response this week from Fidel Castro, who highlighted Cuba’s international health and education programs. “We can do things that Bush cannot even dream of,” he said.

Cuba’s foreign minister says that 31,000 health professionals, including 20,000 doctors, are providing services in 69 countries around the world. Cuba’s medical aid also includes free medical education provided at Havana’s Latin America Medical school (enrollment in 2005 was more than 10,000 students from 27 countries), and programs such as “Operacion Milagro,” which brings Latin American patients to Havana for eye surgery.

Cuba’s aid, like that of other donors, is not a matter of pure altruism. Cuba earns money from them; they are part of agreements with Venezuela that provide Cuba 90,000 barrels of oil per day. And like other providers of foreign aid, Cuba also earns political good will. In Cuba’s case the political impact is multiplied because Cuba promotes its assistance tirelessly, and its extensive programs are not what one would expect given Cuba’s economic condition.

And Cuba’s programs come in for some international criticism, too, from local medical societies that claim Cuban doctors practicing in their countries are not qualified, and from others who say Cuban doctors are underpaid.

But even after taking all that into account, the fact remains that these programs help people in need. Scan the international media, and one finds reports of Cuban doctors in neighborhoods that have never had doctors, Cubans aiding earthquake victims in Pakistan, Cuban doctors providing emergency services in Haiti in 2004 when a civil war nearly broke out and the national medical system stopped functioning.

President Bush was right to highlight American efforts in a hemisphere where American aid is often unnoticed. He wasn’t responding to Cuba’s propaganda, but some of his examples provided a counterpoint, such as when he mentioned a literacy program, a nurse training program, and the visits of American hospital ships.

He did not mention one of his direct responses to Cuba’s medical aid programs – a special immigration policy designed to make it easy for Cuban doctors serving abroad to come to the United States.

Normally, a person of any nationality who seeks and gains asylum in another country has no special claim to a U.S. visa. But last year the Administration announced a policy whereby Cuban doctors who leave their medical missions abroad can come to America. A Congressional office reports that hundreds have taken advantage of this policy.

The policy was announced as part of a package of measures that responded to Congressional complaints about treatment of Cubans in U.S. migration policy. Unwilling to abandon the “wet foot-dry foot” policy, the Administration presented a series of minor new measures, including this one for Cuban doctors. It provided no real policy explanation, leaving the implication that its purpose is to disrupt Cuba’s medical aid missions.

I won’t deny the benefit to the Cuban doctors who make it to America, and certainly the policy earned the Administration some political credit in Miami. But this policy hurts the image of the United States before foreign publics – the same ones the President seeks to influence in his conference – and it enhances Cuba’s victim status.

The United States is not about to match Cuba by sending 20,000 American doctors abroad. But rather than tangle with Cuba with his visas-for-doctors program, President Bush would do better to promote trade and market liberalization, to fight protectionism (starting with our own), to expand U.S. education and exchange programs, and to promote public and private aid as he did last week.

Using American visas to lure Cuban doctors from their missions seems mean-spirited, especially in contrast to the high moral tone the President struck when he said it “renews our soul” and “lifts our collective spirit” when we “help a neighbor in need.”