Where no Doctor has Gone Before: Cuba's Place in the Global Health Landscape ‐ by Huish, Robert

Abstract

Huish, Robert (2013) Where no Doctor has Gone Before: Cuba's Place in the Global Health Landscape, Wilfrid Laurier University Press (Waterloo, ON), xv + 180 pp. $32.99 pbk. Cuba has been lauded internationally for its commitment to education and healthcare. Since the 1960s, the island has developed a reputation for providing international disaster relief, medical training, services and programmes, particularly in disadvantaged areas. In addition to Cuba's substantial human capital and expertise in the medical field, these efforts have largely resulted from Cuba's commitment to overall health equity and from economic and political need. Cuba has participated fully in global health efforts, with over 135,000 Cuban medical professionals working in over 100 countries and training tens of thousands of other professionals from marginalised regions. In recent years, this has become known as ‘medical internationalism’, an invaluable contributor to the island's development. Yet research on that commitment has in many ways been limited. While scholars such as Kirk and Erisman (2009) have contributed significantly to our understanding of that medical internationalism, further research has been needed, in particular focusing on how Cuba engages with global health as a whole. This is precisely the area that Where No Doctor has Gone Before successfully illuminates. Building on the work of others who have contributed to the understanding of global health as a concept, such as Farmer (2001, 2005), Orbinski (2009) and Davies (2010), Huish significantly contributes to the discussion by offering a comprehensive account of Cuba's experience. In addition to his considerable research, Huish also draws on his own personal experiences on the island and abroad, to determine how Cuba's efforts (and in particular its medical internationalism) engage with the global health landscape. The book is divided into six chapters. Discussions of health care as a human right are the focus of the first, while the second chapter explores the Cuban understanding of the right to health and health care. The third explores and analyses international health efforts as foreign policy, while the fourth and fifth chapters discuss questions of ethics related to medical training. The chapters include research on Escuela Latinoamericana de Medicina (ELAM, Latin American School of Medicine) and the specific medical training that promotes equality in health and health care, with a focus on marginalised areas. The final chapter discusses Cuba's efforts within global health, and meaningfully contributes to the greater understanding of how global health care can be achieved. The book offers significant insights into two major areas. First, it provides a full discussion of the evolution of Cuba's unique experience and understanding of health and health care. It follows the development of Cuba's particular health care system, including the view of health as a human right, the development of the system as a whole and the ethics promoted throughout medical training. Little has been written in depth about this area of the Cuban approach; this book thus offers a comprehensive view of Cuba's healthcare model. Second, the book places the island's international efforts within, and contributions to, the global health landscape. These include ELAM and the significant level of medical training provided to international students, as well as specific projects such as Operation Miracle; indeed, it highlights how Cuba draws upon its own unique system to participate in global health. The ongoing difficulty with attempting to place Cuba within the global health landscape, however, is that the concept of global health itself is continually evolving and being redefined. Indeed, it has yet to be fully conceptualised and delineated, necessitating a specific characterisation. While the book could gain from a more complete discussion, or definition, of global health, it significantly adds to the debate through its detailed assessment of the Cuban experience. Overall, Where No Doctor has Gone Before is a welcome and important addition to any specialist or general reader on Cuban medical internationalism or global health. It employs an excellent analysis of Cuba's experiences to highlight the challenges facing global health, and how governments could engage with it.