Brain Drain Politics: The Cuban Medical Professional Parole Programme

Abstract

AbstractCuba's international medical aid programmes are more extensive than those of any other country or international organisation in the world. Washington, fearing that such aid activities will generate increased international political influence (i.e., softpower) for Havana and thereby complicate US efforts to bring about regime change there, has responded with its own countermeasures. The primary US initiative has been the Cuban Medical Professional Parole (CMPP) programme, which is designed to encourage and facilitate defections to the US by Cuban medical personnel assigned to overseas aid missions. The dynamics and impact of the CMPP programme will be the main focus of this article.Operating within a policy analysis format, the article provides a summary of Cuba's medical aid programmes. For comparative purposes, similar summary data will be provided regarding US medical aid activities. It provides detailed background information about the formation and operation of Washington's CMPP programme. It also analyses the extent to which the CMPP programme has succeeded in persuading Cuban medical internationalists to defect and how far it has undermined Havana's medical aid programmes.Keywords: defection, medical aid, softpower, CMPP (Cuban Medical Professional Parole programme), ELAM (Latin American Medical School), GHI (Global Health Initiative), public diplomacy, Pogo SyndromeIntroduction'Softpower' is an idea which lately has attracted increasing attention in foreign policy circles. Joseph Nye, who first popularised the concept, summarises it as follows:Power is the ability to alter the behavior of others to get what you want. There are basically three ways to do that: coercion (sticks), payments (carrots), and attraction (softpower).... A country's softpower can come from three resources: its culture (in places where it is attractive to others), its political values (when it lives up to them both at home and abroad), and its foreign policies (when they are seen as legitimate and having moral authority).1While softpower, which might be viewed in more traditional terms as 'influence', has always represented a dimension of Havana's international personality, it has become more prominent in recent years and has clearly overshadowed a tradition of Cuban hard power politics which emerged during the Cold War era.2 At the epicentre of this phenomenon are Havana's medical aid programmes, which began in the early 1960s and which today are the most extensive in the world.3An often unstated assumption by observers of international affairs is that participation in serious power politics, whether of the hard or softvariety, is essentially the purview of the world's larger, more economically developed states that enjoy significant resource/technological advantages over other actors on the international stage. In this instance, however, that assumption does not hold. Cuba is a small nation of 11 million people whose level of economic development falls squarely into the LDC (Less Developed Country) category. Nevertheless, Havana's medical aid programmes have been widely recognised as an ambitious and indeed highly effective foray into softpower politics, as is illustrated by President Obama's comments in a press conference at the 2009 Summit of the Americas meeting in Trinidad:One thing that I thought was interesting - and I knew this in a more abstract way but it was interesting in very specific terms - was hearing from these leaders who when they spoke about Cuba talked very specifically about the thousands of doctors from Cuba that are dispersed all throughout the region, and upon which many of these countries heavily depend. And it's a reminder for us in the United States that if our only interaction with many of these countries is drug interdiction, if our only interaction is military, then we may not be developing the connections that can, over time, increase our influence and have a beneficial effect when we need to try to move policies that are of concern to us forward in the region. …