"Nobody is in agreement…It’s that, no one says it and no one takes the risk to say it, to speak the truth. That’s what is happening. In other words, one of the foundations, of what are the regimes in the entire world, in all of history, has been fear and lies. In other words, once you are in fear that's when you don’t take a risk, where you collect yourself and don’t unite…understood? To be in fear is not to offer help to anyone because that signifies risk." -Gorki Águila Carrasco, lead singer, guitarist of the music group Porno Para Ricardo and political prisoner
"Socialist ideology, like so many others, has two main dangers. One stems from confused and incomplete readings of foreign texts, and the other from the arrogance and hidden rage of those who, in order to climb up in the world, pretend to be frantic defenders of the helpless so as to have shoulders on which to stand." --Jose Marti

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Monday, January 17, 2011

Julia Stiles on Being Stranded in Havana

Julia Stiles on Being Stranded in Havana


Julia Stiles

WILL BEG, BORROW OR STEAL: When actress Julia Stiles (pictured) found out she'd been nominated for a Golden Globe in Havana last December, she was too preoccupied trying to brainstorm her way home for the news to sink in.

With three days left to go in my trip, I was walking around Havana flat broke. I had been spending my convertibles, the secondary currency used by tourists, like Monopoly money. I figured when my cash supply got low, I'd simply slow down my spending. With funds dwindling, I realized I had miscalculated the cost of my lodging, and forgotten about the exit fee at the airport. Cuba is not a place where one can access American banks or use credit cards, so if you run out of cash you cannot get anything. You can't even get off the island. I had been staying in a casa particular, where specific families are licensed to rent out a bedroom in their homes by the night. The couple putting me up had become like my surrogate Cuban parents; Carlos knew just how I took my coffee, and would stay up waiting for me if I came home late at night. We would sit in their sun room and chat about everything from rations to folkloric dance, and I couldn't bear the thought of not being able to pay my bill. When he tried to teach me a Spanish phrase using the tricky subjunctive tense, the example he gave translated to, "I would go out with you tonight if I had the money..." I almost choked on my own tongue. What could I sell? Who did I know that I wouldn't be ashamed to ask for a loan? How would I ever reimburse Carlos and his wife if I couldn't send a check back from the States? I thought about reciting monologues in the Plaza Vieja for spare change.

Julia Stiles

With only three days left to go in, Stiles found herself walking around Havana flat broke.

I could swallow my pride and ask to borrow from someone in the humanitarian aid group that brought me, but they had already left for the other side of the island. With few cell phones, most everyone is still accustomed to leaving messages at someone's home and waiting for a return call. My younger sister, who was there with her college, had agreed to cover for me. That is, if anyone could find the person to unlock the dormitory safe, and that could take days. I knew I might not starve, but I would have to beg, borrow or steal to pay for the rest of my stay.

Julia Stiles

Cuba is not a place where one can access American banks or use credit cards, so if you run out of cash you cannot get anything.

I replayed every expense that had gotten me to this point. If only I had argued with the taxi drivers more. If only I had waited in the very long lines with the locals for a better exchange rate, instead of lazily going to the Hotel Nacional. I was under the impression I had been quite frugal, but I was so accustomed to thoughtlessly using credit cards, I had underestimated how much cash to bring even just for the basics.

There are two currencies in Cuba, one for tourists and one for Cubans, and therefore two prices for everything. The first day I arrived, I wandered into the part of town everyone warned against to hear some live rumba. The music was free, but the overall experience was not. Two women decided to take me under their wing, explaining customs and the symbolism behind their dances. In exchange, they seemed only to want me to buy them drinks, and I was happy to oblige. "From each according to his ability," I figured. It's easy to romanticize the socialist ideals graffitied on every concrete wall, because generosity seems to be contagious. Obviously the reality is more complex.

Julia Stiles

Stiles learned that Cubans have had to become resourceful in order to survive.

I needed to access my email in order to have a glimmer of hope that my group might learn of my dilemma, which was unlikely, considering virtually no one has internet access in their home. Even the controversial blogger Yoani Sanchez uses a flash drive to upload her blog posts at hotel kiosks. When I met her days before, I noticed paint on her hand and asked if she was a painter as well as a writer. Chuckling, she told me she was doing construction on her house—literally, as in she was doing it herself. She told me that every Cuban has to be resourceful in order to survive.

I knew that the painfully slow connection at a hotel was too expensive for me at this point, but I was told of a student's residence hall that had a computer room. I snuck in and logged on to their ancient PC. Of course I got caught, but pleaded with the attendant to just give me five minutes. Before I was able to address my cash situation, an email from friends back in the States sidetracked me, congratulating me on a Golden Globe nomination. There I was, thrilled to have received such a professional honor, yet still unable to barter it for cab fare.

Julia Stiles

There are two currencies in Cuba, one for tourists and one for Cubans, and therefore two prices for everything.

In Havana, everything can seem poetic. At movie theaters and baseball games, a few entrepreneurial people strap cardboard boxes to their shoulders and sell "Rositas de Maiz." Instead of calling it popcorn, though, Cubans refer to the treat as "little roses of corn." As elated as I was about the recognition from my industry, it would afford me no special treatment on this remote and yet not-so-distant island.

Eventually the Keeper of the Safe was located, and I was able to borrow money to pay for my housing. My host generously offered to drive me to the airport in his 25-year-old stick shift, and I boarded the flight to Miami. With all of its crumbling beauty, Havana taught me the true value of a dollar. It also taught me that the people you know, and the ways in which you rely on one another, are more valuable than any paper currency.

—Ms. Stiles will be appearing on Broadway this spring in the Neil LaBute play "Fat Pig."

New Prize in Cold War: Cuban Doctors

New Prize in Cold War: Cuban Doctors

By JOEL MILLMAN

Felix Ramírez slipped into an Internet cafe in the West African nation of The Gambia, scoured the Web for contact information for U.S. diplomats, then phoned the U.S. embassy in Banjul, the capital.

Associated Press

Cuban doctors, shown above treating a patient in Haiti, have been dispatched across the globe

He told the receptionist he was an American tourist who had lost his passport, and asked to speak to the visa section. As he waited to be connected, he practiced his script: "I am a Cuban doctor looking to go to America. When can we meet?"

Dr. Ramírez says he was told to go to a crowded Banjul supermarket and to look for a blond woman in a green dress—an American consular official. They circled one another a few times, then began to talk.

That furtive meeting in September 2008 began a journey for the 37-year-old surgeon that ended in May 2009 in Miami, where he became a legal refugee with a shot at citizenship.

Dr. Ramírez is part of a wave of Cubans who have defected to the U.S. since 2006 under the little-known Cuban Medical Professional Parole immigration program, which allows Cuban doctors and some other health workers who are serving their government overseas to enter the U.S. immediately as refugees. Data released to The Wall Street Journal under the Freedom of Information Act shows that, through Dec. 16, 1,574 CMPP visas have been issued by U.S. consulates in 65 countries.

From Cuba to America

Jason Henry

Cuba has been sending medical 'brigades' to foreign countries since 1973.

Cuba has been sending medical "brigades" to foreign countries since 1973, helping it to win friends abroad, to back "revolutionary" regimes in places like Ethiopia, Angola and Nicaragua, and perhaps most importantly, to earn hard currency. Communist Party newspaper Granma reported in June that Cuba had 37,041 doctors and other health workers in 77 countries. Estimates of what Cuba earns from its medical teams—revenue that Cuba's central bank counts as "exports of services"—vary widely, running to as much as $8 billion a year. Many Cubans complain that the brigades have undermined Cuba's ability to maintain a high standard of health care at home.

The U.S. immigration initiative is reminiscent of the sort of gamesmanship that was common during the Cold War. It has interfered with Cuba's program by triggering defections of Cuban medical personnel all over the globe—an average of one a day since the U.S. countermeasure began in 2006. Cuba generally doesn't include doctors among the 20,000 or more Cubans it authorizes to immigrate to the U.S. each year.

State Department officials say it isn't the intention of the U.S. government to use the immigration program, known as CMPP, to engage in espionage or to disrupt medical missions. Cuban doctors, a State Department spokesman says, "are often denied exit permission by the Cuban government to come to the U.S. when they qualify under other established legal channels." One goal of CMPP is to get Cuba to change that.

A little-known U.S. initiative called Cuban Medical Professional Parole allows Cuban doctors working for their government overseas to get asylum from American embassies around the world. WSJ's Joel Millman reports.

CMPP was the brainchild of Cuba-born diplomat Emilio González, director of the U.S. Citizen & Immigration Services from 2006 to 2008. A former colonel in the U.S. Army, Mr. González is a staunchly anti-Castro exile. He has characterized Cuba's policy of sending doctors and other health workers abroad as "state-sponsored human trafficking." The Cuban doctors, he says, work directly for health authorities in other countries and have no say in their assignments, salaries, hours or work conditions.

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Cuban doctors themselves regard such overseas assignments differently. Their salaries in Cuba top out at about $25 a month. When serving overseas, they get their Cuban salaries, plus a $50-per-month stipend—both paid to their dependents while they're abroad, according to Cuban doctors interviewed for this story. In addition, they earn overseas salaries—from $150 to $1,000 a month, depending on the mission, the doctors say.

"In Haiti they paid us $300 a month, in gourdes, the Haitian money," says one former overseas doctor who is now back in Cuba. "I converted my salary, and lived fine on $100 per month." With her savings, she says, she bought a television and laptop computer, items she couldn't have gotten in Cuba.

Ramón González, a defector who served on medical missions to Ghana and Gambia, says Cubans' entrepreneurial instincts make for almost unlimited profit opportunities. "You go to the African flea market and buy a bathing suit from the U.S., anything with a Speedo or a Nike label. It's like 45 cents in Africa," he says. "You sell it for $5 in Cuba."

An even more lucrative sideline, he says: private medical practice, including abortions. Dr. González says performing abortions can be a gold mine for Cubans, particularly in the Middle Eastern nations that pay the best salaries.

"The vast majority of Cuban doctors fight to get onto a mission because they can accumulate thousands of dollars," says Dr. Darsi Ferrer Ramírez, director of the antigovernment group Juan Bruno Zayas Center of Health and Human Rights in Havana.

The 41-year-old dissident says the program is rife with corruption. "It's known that to get to the better countries—we're speaking of South Africa, Brazil—there are functionaries who will take money under the table. It costs between $500 and $1,000," he says.

Juan Bautista Palay, chief of physical therapy at Havana's 10 de Octubre Hospital, acknowledges that money is what draws colleagues abroad. "You'd go, too, if you could triple your pay," he says. He denies anyone from his facility has paid bribes to serve abroad.

The U.S. immigration program gives Cuban doctors yet another reason to serve abroad: a way to resettle in the U.S. Ordinary Cubans seeking asylum must reach American shores before applying. Under CMPP, Cuban doctors can do so from U.S. embassies anywhere in the world.

Of the nearly 1,600 defections through Dec. 16, more than 800 health workers have defected from Venezuela alone, and nearly 300 have come from Colombia and Curacao, which don't host Cuban medical brigades but are easily reached from Venezuela. Another 135 have come from four other countries: Bolivia, Guatemala, Namibia and Peru. Others have showed up to defect in such far-flung locales as Qatar, Fiji, Djibouti and Mauritius.

Dr. Ramírez's odyssey began when he was selected for a two-year posting to Gambia. Cuban doctors there are at the pinnacle of the public-health community, teaching in medical colleges and running hospitals. Dr. Ramírez says his aim from the start was to use CMPP to defect. He says he kept his plan secret from his wife and parents, who stayed behind when he left Cuba in 2008.

Dr. Ramírez was assigned to run the surgery unit at the Royal Victoria Teaching Hospital in Banjul. When he arrived in the country to join a 138-person Cuban delegation, he surrendered his passport to security personnel at Cuba's embassy. Cuban doctors also had to turn over other identification documents like driver licenses, Dr. Ramírez says, to hinder any attempt to satisfy U.S. diplomats of their bona fides as defectors. He kept his.

"We had to get cellphones, too, so they always could find us," he says. Dr. Ramírez bought two cheap phones—one to talk with his bosses, the other to plot his escape.

His meeting with the U.S. consular officer at the Banjul supermarket set his plan in motion. Mr. Ramírez says he was able to persuade the officer—he says her name was Wendy Kennedy—that he was a Cuban doctor working in the country. Their next meeting was at the hospital, he says, where Ms. Kennedy conducted a formal interview to prepare his asylum request.

The State Department declined to make Ms. Kennedy available for comment, but confirmed some details of Dr. Ramírez's account, including that Ms. Kennedy worked in Gambia at the time of his asylum application.

Dr. Ramírez had to wait months before learning whether he would be granted asylum. He got the news in May 2009 via cellphone. Ironically, he says, he was at an emergency meeting called by his brigade coordinator to discuss two Cubans who had just abandoned their mission and fled to neighboring Senegal.

"They called us in to warn us not to try to flee, or else our families in Cuba would be punished," he recalls.

Ramirez Family

Dr. Felix Ramírez in The Gambia in 2008.

Getting a U.S. visa was one thing, but getting out of Gambia was another thing altogether. His Cuban superiors had his passport, and trying to get out by air would likely attract the attention of Gambian authorities, who would alert the Cubans. He figured he had to get to Senegal.

There was no one to trust among his fellow expatriates, he says. He felt like a prisoner in the home he shared with four other Cubans. "There's always one who is the informer," he says. He needed permission from a brigade coordinator even to visit an African colleague's home for dinner.

He had befriended a Lebanese merchant who was a patient. The merchant connected him with a smuggler, who agreed to take him to Senegal for $500.

Dr. Ramírez left the night after his asylum request was approved, carrying documents from U.S. consular officials in Banjul. In Senegal, he discovered five comrades from the Gambian mission who, unbeknownst to him, also had been plotting their escape. At the airport, he showed airline officials his U.S. entry documents and was allowed to board a flight to Spain. When he arrived, a U.S. diplomat vouched for him so he could board a flight to the U.S.

It is unclear how disruptive defections like Dr. Ramírez's are to Cuba's medical-mission program. Only a small percentage of Cuban doctors sent overseas have actually defected, making it unlikely the program has put much of a dent in revenues collected by Cuba.

Information about exactly how much Cuba makes from medical brigades is hard to come by. In many cases, Cuba extracts a direct payment either from a host government or an international aid group. Individual Cuban doctors are paid only a portion of what Cuba collects.

Since Hugo Chávez came to power in Venezuela in 1998, Cuba has been bartering doctors for Venezuelan oil. The U.S. Energy Department estimates that Venezuela ships Cuba 90,000 barrels of oil a day—worth more than $2 billion a year at current prices. In addition, Venezuela pays Cuba for medical teams sent to countries that Mr. Chávez considers part of Venezuela's "Bolivarian" sphere. Bolivia, Honduras, Ecuador and Paraguay all use Cuban doctors paid for by Venezuela.

Germany, France and Japan, working through the Pan-American Health Organization, paid $400 per month for each doctor sent to work in Honduras after a hurricane in 2005, according to the Honduran government.

Cuba's Public Health Ministry said in November: "As a principle, we have prioritized donating medical brigades to countries with grave health problems and few resources and hard-to-reach settlements, where local doctors refuse to work." It said that Cuba intends to send more doctors abroad, to nations better prepared to pay for services. "In countries whose economy permits, we will increase the presence of our professionals, with compensation," it said.

Julie Feinsilver, who tracks Cuba's medical diplomacy as a senior fellow of the Council on Hemispheric Affairs in Washington, a think tank, says such arrangements benefit both Cuba and the host countries. "Do you think that it is possible to hire doctors for less than $1,000 a month? The Cuban government does earn money, albeit considerably less than others would for similar services."

By summer's end, Dr. Ramírez and the five other Cubans who defected with him from Gambia were all in Miami. Four of them work as instructors at Dade Medical College. Dr. Ramírez is a surgical assistant at Baptist Health South Florida's hospital in Homestead, Fla.

Dr. Ramírez's parents and wife—and a son born shortly after he left for Africa, whom he has never seen—remain in Cuba, in Camagüey. All of them are eligible for U.S. visas under the CMPP program, but there is virtually no chance they'll get out soon. Dr. Ramírez says his wife lost her job at a hospital because of his defection.

"They're blacklisted for five years, minimum," Dr. Ramírez says. "I'm a traitor to the homeland now."

Write to Joel Millman at joel.millman@wsj.com

So Much For Cuban Economic Reform

So Much For Cuban Economic Reform


The Communist Party affirms that 'central planning and not the market will be supreme.'


With his characteristic intellectual wit, Cuban writer Carlos Alberto Montaner defines communism as "the time countries waste between capitalism and capitalism." By this account, the Cuban government is now in its 52nd year of wasted time waiting for prosperity.

Much has been made of economic reforms promised by Raúl Castro, including by the Cuban president himself. "We can either rectify the situation," Gen. Castro recently stated, "or we will run out of time walking on the edge of the abyss, and we will sink." But one look at the economic platform for the VI Congress of the Communist Party of Cuba, now scheduled for April 2011, and it's clear nothing much will change.

The "Draft Guidelines for Economic and Social Policy"—a 32-page document that proposes to chart Cuba's economic future—affirms that "the new economic policy will correspond with the principle that only socialism [i.e., Cuban communism] is capable of conquering the difficulties."

The document persistently emphasizes Gen. Castro's militaristic themes of increased efficiency, discipline and control. It insists, for example, on setting prices according to the dictates of central planning. It also insists that any new "nonstate" (private sector) economic activities not be allowed to lead to the "concentration of property" (that is, the accumulation of wealth). There is no interest in introducing the market socialism of a Deng Xiaoping, who famously told China's people in 1984 that "to get rich is glorious."

It is not surprising that Raúl and his fellow generals are more comfortable with the chain of command of a centrally planned economy than with the vicissitudes of a market economy. More baffling is their failure to understand core principles of economic development.

Associated Press

Raul Castro, president of Cuba, and commander of its armed forces, will affirm that "central planning and not the market will be supreme."


After much debate and with trepidation, the Cuban economic "reformers" have decided to permit the 500,000 to 1,300,000 Cubans being fired from state jobs to solicit permits to become self-employed in certain activities. It is instructive to examine a handful of the 178 trades and professions that are supposed to help rescue the economy.

Trade No. 23 will be the purchase and sale of used books. Trade 29 is an attendant of public bathrooms (presumably for tips); 34 is a palm-tree pruner (apparently other trees will still be pruned by the state). Trade 49 is covering buttons with fabric; 61 is shining shoes; 62 is cleaning spark plugs; 69 is a typist; 110 is the repair of box springs (not to be confused with 116, the repair of mattresses). Trade 124 is umbrella repairs; 125 is refilling of disposable cigarette lighters; 150 is fortune-telling with tarot cards; 156 is being a dandy (technical definition unknown, maybe a male escort?); 158 is peeling natural fruit (separate from 142, selling fruit in kiosks).

This bizarre list of permitted private-sector activities will not drive economic development. But it does reveal the regime's totalitarian mindset. Here Cuban technocrats foreshadow the degree of control they intend to impose by listing the legal activities with specificity. These are not reforms to unleash the market's "invisible hand" but to reaffirm the Castros' clenched fist. One does not have to be an economist to appreciate that the refilling of disposable cigarette lighters, for example, will not contribute in any measure to economic development.

In his economic dream land of surrealist juxtapositions, Raúl believes that improved state management is the way to save the communist system. The desire for control by the military and the Communist Party of every aspect of Cuban life is antithetical to the individual liberty and empowerment necessary to bring about an economic renaissance.

Mr. Azel, a senior scholar at the Institute for Cuban and Cuban-American Studies, University of Miami, is author of "Mañana in Cuba" (Authorhouse, 2010).

Tuesday, January 4, 2011

Cuba HealthCare WSJ

A Cuban Fairy Tale From PBS

What public television didn't tell you about health care in Castro's socialist state.


In his memoir covering four years in Cuba as a correspondent for Spanish Television, Vicente Botín tells about a Havana woman who was frustrated by the doctor shortage in the country. She hung a sheet on her balcony with the words "trade me to Venezuela." When the police arrived she told them: "Look, compañeros, I'm as revolutionary as the next guy, but if you want to see a Cuban doctor, you have to go to Venezuela."

That story was not in the three-part report by Ray Suarez on Cuban health care that aired on PBS's "NewsHour" last week. Nor was the one about the Cuban whose notice of his glaucoma operation arrived in 2005, three years after he died and five years after he had requested it. Nor was there any coverage of the town Mr. Botín writes about close to the city of Holguín, that in 2006 had one doctor serving five clinics treating 600 families. In fact, it was hard to recognize the country that Mr. Suarez claimed to be describing.

The series was taped in Cuba with government "cooperation" so there is no surprise that it went heavy on the party line. Still, there was something disturbing about how Mr. Suarez allowed himself to be used by the police state, dutifully reciting its dubious claims as if he were reporting great advances in medical science.

Castro's military dictatorship marks 52 years in power next week. But the "revolution" is dead. A new generation of angry, young Cubans now vents on Internet blogs and through music, mocking the old man and his ruthless little brother. On Nov. 29, in the city of Santa Clara, hundreds of students launched a spontaneous protest when they were denied access to a televised soccer match they had paid to watch. What began as a demand for refunds soon turned to shouts of "freedom," "down with Fidel" and "down with socialism," according to press reports.

Associated Press

Cuban public health workers fumigate a street in Havana during a campaign against dengue fever.

Dissent is spreading in Cuba like dengue fever because daily life is so onerous. One of the best documented sources on this subject is the Botín narrative ("Los Funerales de Castro," 2009, available in Spanish only), which pulls back the curtain on "the Potemkin village" that foreigners see on official visits to Cuba. Behind the façade is desperate want. Food, water, transportation, access to health care, electricity, soap and toilet paper are all hard to come by. Even housing is in short supply, with multiple families wedged into single-family homes. The government tries to keep the lid on through repression. But in private there are no limits to the derision of the brothers Castro.

Americas Columnist Mary Anastasia O'Grady debunks a health-care fable.

Mr. Suarez's report, by contrast, is like a state propaganda film. In one segment, an American woman named Gail Reed who lives in Cuba tells him that the government's claim of its people's longevity is due to a first-rate system of disease prevention. He then parrots the official line that Cuba's wealth of doctors is the key ingredient. What is more, he says, these unselfish revolutionary "foot soldiers" go on house calls. "It's aggressive preventive medicine," Mr. Suarez explains. "Homes are investigated, water quality checked, electrical plugs checked."

An abundance of doctors? Not in the Cuba Mr. Botín lived in. In 2006 the government claimed there were 65,000 doctors. That number, he says, was "a figure that many professionals considered inflated." When Cubans complained they couldn't get care, he notes that the state upped the number "magically" to 71,000 five months later. Given Fidel's habit of making things up, it's hard to know how many competent doctors the government has trained. But there is no disputing the fact that medics have been sent overseas in large numbers to earn hard currency for the regime. There is also no question that Cubans are paying the price at home.

As to doctors checking on water quality and electricity outlets, the PBS reporter might be surprised to learn that most Cuban homes have no running water or power on a regular basis. This is true even in the capital. In 2006, Mr. Botín says, a government minister admitted that 75.5% of the water pipes in Havana were "unusable" and "recognized that 60% of pumped water was lost before it made it to consumers." To "fix" the problem, the city began providing water in each neighborhood only on certain days. Havana water is also notoriously contaminated. Foreigners drink only the bottled stuff, which Cubans can't afford. In the rest of the country the quality and quantity of the water supply is even less reliable.

Mr. Suarez also reported that, according to Ms. Reed, Cuba is suffering an "embargo of medicine." But there is no embargo on food or medicine. The problem is that the government lacks the money to pay for new medicines that are protected under patent.

Reporters who want access to Cuba know that they have to toe the Castro line. I get that. Mr. Suarez must figure that his American audience does not.

Write to O'Grady@wsj.com