B1 · Intermediate
13 min
healthpoliticsinternational relationshistory
La Isla que Cura: Cuba, la Salud y el Bloqueo
The Island That Heals: Cuba, Health, and the Blockade
Fletcher breaks down this story in English. Octavio reacts and expands in Spanish. Follow along with the live transcript, tap any word for its translation. Intermediate level — perfect for intermediate learners expanding their range.
So here's a story that landed on my radar this week and I couldn't stop thinking about it.
Iberia, the Spanish airline, just announced it's suspending all flights to Cuba.
From June through October.
No planes.
Bueno, y la razón es importante.
Right, and the reason matters.
No es un problema técnico ni económico normal.
It's not a normal technical or economic problem.
Es el bloqueo de petróleo que Estados Unidos impuso a Cuba.
It's the oil blockade the United States imposed on Cuba.
Sin combustible, el país simplemente no puede funcionar.
Without fuel, the country simply cannot function.
And the health angle here is what really gets me.
Because Cuba, of all places, has this extraordinary reputation for medicine.
For healthcare.
It's one of the things the island is genuinely famous for around the world.
Mira, es una contradicción enorme.
Look, it's an enormous contradiction.
Cuba tiene uno de los mejores sistemas de salud del mundo, con muchos médicos y hospitales.
Cuba has one of the best health systems in the world, with many doctors and hospitals.
Pero ahora no tiene gasolina para las ambulancias.
But now it doesn't have fuel for its ambulances.
Es casi absurdo.
It's almost absurd.
I want to sit with that for a moment, because I think people outside of Cuba don't fully appreciate just how central medicine is to Cuba's whole identity.
This isn't incidental.
It's foundational.
A ver, cuando Fidel Castro llegó al poder en 1959, Cuba tenía muchos problemas de salud.
Well, when Fidel Castro came to power in 1959, Cuba had many health problems.
Muchas personas en el campo no tenían acceso a médicos.
Many people in rural areas had no access to doctors.
La situación era muy difícil.
The situation was very difficult.
Right, and this is the part that's historically complicated.
Because the revolution, whatever you think of it politically, did produce something remarkable in public health.
Life expectancy went up.
Infant mortality dropped to levels that rivaled the United States.
Exacto.
Exactly.
La verdad es que los números son impresionantes.
The truth is that the numbers are impressive.
Cuba tiene más de 90.000 médicos para una población de once millones de personas.
Cuba has more than 90,000 doctors for a population of eleven million people.
Eso es más médicos por persona que casi cualquier país del mundo.
That's more doctors per person than almost any country in the world.
More than 90,000 doctors for eleven million people.
I mean, the United States has a higher ratio of something, I'm sure, but doctors per capita?
Cuba genuinely punches above its weight.
Here's what gets me though, Octavio, how did a small, poor island do this?
Es que el gobierno cubano decidió desde el principio que la educación médica era gratuita y obligatoria.
The thing is, the Cuban government decided from the very beginning that medical education would be free and mandatory.
Cualquier estudiante con talento podía estudiar medicina.
Any talented student could study medicine.
No necesitabas dinero, solo buenas notas.
You didn't need money, just good grades.
And they built the Latin American School of Medicine in Havana, which trained doctors from all over the developing world for free.
I interviewed a doctor from Haiti once who got his entire degree there.
Said it was the best training he ever had.
Bueno, y eso nos lleva a la diplomacia médica.
Right, and that brings us to medical diplomacy.
Cuba envió médicos a más de sesenta países del mundo.
Cuba sent doctors to more than sixty countries in the world.
A África, a América Latina, a Asia.
To Africa, Latin America, Asia.
Durante el Ébola en África Occidental, los médicos cubanos fueron de los primeros en llegar.
During the Ebola outbreak in West Africa, Cuban doctors were among the first to arrive.
And this is genuinely extraordinary.
Cuba, a country under economic embargo for decades, sent more doctors to Ebola-affected zones than most wealthy nations.
There's something almost defiant about it.
Mira, es defiance, sí, pero también es política.
Look, it is defiance, yes, but it's also politics.
Cuba exportó médicos a Venezuela y recibió petróleo a cambio.
Cuba exported doctors to Venezuela and received oil in return.
Durante muchos años, ese era el acuerdo.
For many years, that was the deal.
Médicos cubanos por petróleo venezolano.
Cuban doctors in exchange for Venezuelan oil.
Which is a fascinating kind of geopolitical barter system.
And it worked, for a while.
But then Venezuela's economy collapsed, the oil shipments became unreliable, and Cuba started running out of fuel.
That was happening even before this new blockade.
La verdad es que Cuba ya tenía problemas de energía muy serios antes del bloqueo americano nuevo.
The truth is Cuba already had very serious energy problems before the new American blockade.
Había cortes de electricidad de ocho, diez, doce horas cada día.
There were electricity cuts of eight, ten, twelve hours every day.
Los hospitales usaban generadores, pero los generadores necesitan combustible.
Hospitals used generators, but generators need fuel.
And that is where the health story gets really dark, really fast.
Because it's not abstract.
Vaccines need refrigeration.
Operating rooms need electricity.
ICUs need electricity.
You lose power in a hospital and people die.
Exactamente.
Exactly.
Hay informes de médicos cubanos que operaron a pacientes con linternas porque no había electricidad.
There are reports of Cuban doctors who operated on patients using flashlights because there was no electricity.
Esto pasó en hospitales en La Habana, no en zonas rurales.
This happened in hospitals in Havana, not in rural areas.
En la capital.
In the capital.
Operating by flashlight.
In Havana.
In 2025, 2026.
I've covered war zones where conditions were like that.
The idea that this is happening in a peacetime capital city is...
look, it's genuinely shocking.
A ver, y ahora el bloqueo americano de petróleo empeora todo.
Well, and now the American oil blockade makes everything worse.
Iberia suspende los vuelos, sí, pero el problema más grande es que Cuba no puede importar petróleo de casi ningún país porque tiene miedo de las sanciones americanas.
Iberia suspends flights, yes, but the bigger problem is that Cuba cannot import oil from almost any country because they fear American sanctions.
Right, so the blockade has this extraterritorial reach.
It's not just American ships.
Any company, anywhere in the world, that does business with Cuba in a way Washington doesn't like, risks being cut off from the American financial system.
That's the real leverage.
Bueno, y Iberia lo explica exactamente así.
Right, and Iberia explains it exactly like that.
No es que no quieren volar a Cuba.
It's not that they don't want to fly to Cuba.
Es que sin combustible en el país, los aviones no pueden repostar.
It's that without fuel in the country, the planes cannot refuel.
Y también hay menos turistas porque el país tiene tantos problemas.
And also there are fewer tourists because the country has so many problems.
And the tourism angle connects back to health, because Cuba actually built a parallel, high-quality healthcare system for foreign tourists, called health tourism.
People flew to Cuba specifically for medical procedures.
Cheaper than the US, quality on par with Europe.
Sí, es un negocio muy importante para Cuba.
Yes, it's a very important business for Cuba.
Personas de muchos países fueron a La Habana para operaciones de los ojos, tratamientos para el cáncer, cirugías ortopédicas.
People from many countries went to Havana for eye operations, cancer treatments, orthopedic surgeries.
Pagaron en dólares y eso era dinero muy necesario para el gobierno.
They paid in dollars and that was money the government very much needed.
So now that's collapsing too.
No flights, no medical tourists, no hard currency.
And here's the deeper historical irony that I keep coming back to: the US embargo was supposed to weaken the Castro government.
But for sixty years, the Cuban government used the embargo as the explanation for every problem.
Es que tienes razón.
The thing is, you're right.
Durante décadas, el gobierno cubano dijo: nuestros problemas son culpa del bloqueo americano.
For decades, the Cuban government said: our problems are the fault of the American blockade.
Y muchas veces eso era una excusa.
And many times that was an excuse.
Pero ahora, con este nuevo bloqueo de petróleo, la excusa es completamente real.
But now, with this new oil blockade, the excuse is completely real.
No, you're absolutely right about that.
And this is the uncomfortable position for critics of Cuba, myself included sometimes.
When you starve a system of fuel and then point to the system failing, it's not a clean argument.
Mira, yo no defiendo al gobierno cubano.
Look, I'm not defending the Cuban government.
Tiene problemas serios: la falta de libertad política, la corrupción, la emigración masiva.
It has serious problems: the lack of political freedom, corruption, mass emigration.
Pero el sistema de salud, el acceso a médicos, eso fue real y fue importante para millones de personas.
But the health system, access to doctors, that was real and it mattered for millions of people.
And the emigration point is crucial too, because Cuba has been losing doctors.
Tens of thousands of medical professionals have left in the last few years, going to the United States, Spain, other countries.
The brain drain is real and it's accelerating.
A ver, es una ironía dolorosa.
Well, it's a painful irony.
Cuba formó durante décadas a médicos excelentes, y ahora esos médicos se van a Miami o a Madrid porque en Cuba no tienen electricidad en los hospitales y sus salarios son muy bajos.
Cuba trained excellent doctors for decades, and now those doctors are leaving for Miami or Madrid because in Cuba there's no electricity in hospitals and their salaries are very low.
I spoke to a Cuban cardiologist in Miami a few years ago.
She'd trained at a hospital in Santiago de Cuba, said the training was world-class, genuinely rigorous.
But she left because she was earning fifteen dollars a month.
Fifteen.
Bueno, eso es el problema fundamental.
Right, that's the fundamental problem.
El sistema cubano produce médicos muy buenos, pero el Estado no puede pagarles porque la economía es desastrosa.
The Cuban system produces very good doctors, but the State cannot pay them because the economy is a disaster.
Entonces los médicos se van y el sistema pierde lo mejor que tiene.
So the doctors leave and the system loses its best people.
So you have this almost tragic situation.
A country that made medicine its primary export, its global calling card, is now watching that system hollow out from the inside, and the blockade is accelerating the process from the outside.
La verdad es que la situación es muy grave.
The truth is the situation is very serious.
Y lo que más me preocupa no son los aviones de Iberia.
And what worries me most is not Iberia's planes.
Lo que me preocupa son los cubanos normales, los ancianos con enfermedades crónicas, los bebés que necesitan vacunas, las personas que necesitan operaciones urgentes.
What worries me is ordinary Cubans, elderly people with chronic illnesses, babies who need vaccines, people who need urgent operations.
The thing is, sanctions and blockades always claim to target governments.
But they land on people.
On the elderly diabetic who can't get insulin.
On the kid with leukemia who needs medication that isn't there.
The government officials are fine.
Es que eso es verdad en Cuba y en Irán y en cualquier país con sanciones.
That's true in Cuba and in Iran and in any country with sanctions.
Los líderes tienen acceso a todo.
The leaders have access to everything.
La gente normal sufre.
Ordinary people suffer.
Es un patrón que se repite siempre en la historia.
It's a pattern that always repeats itself in history.
And yet the counterargument is also real.
You don't lift the pressure, you potentially keep a repressive government in power indefinitely.
I've argued this in print, I've argued it with colleagues who were in Havana, and I've never felt fully settled on either side.
Mira, sesenta y cinco años de embargo americano no cambiaron el sistema político en Cuba.
Look, sixty-five years of American embargo didn't change the political system in Cuba.
No funcionó como estrategia política.
It didn't work as a political strategy.
Pero sí causó mucho sufrimiento.
But it did cause a lot of suffering.
Ese es el problema con los bloqueos: son un instrumento muy blunt, muy torpe.
That's the problem with blockades: they are a very blunt, very crude instrument.
Sixty-five years.
Nine American presidents.
And Cuba is still run by the same party.
So whatever the embargo achieved, it wasn't regime change.
And now you've added a fuel blockade on top of decades of sanctions, with a healthcare system already on its knees.
A ver, lo que queda es una isla con médicos extraordinarios, con una tradición médica muy importante, pero sin los recursos para usar esa tradición.
Well, what remains is an island with extraordinary doctors, with a very important medical tradition, but without the resources to use that tradition.
Es como tener un libro muy valioso y no tener luz para leerlo.
It's like having a very valuable book but no light to read it by.
That's a good image.
I might steal that.
So where does this end?
Because Iberia says they plan to resume flights in November if conditions improve.
But conditions improving means the blockade lifting, or at minimum easing.
And right now there's no sign of that.
Bueno, el futuro es muy incierto.
Right, the future is very uncertain.
Pero creo que lo importante es recordar que Cuba no es solo política.
But I think what matters is to remember that Cuba is not just politics.
Es once millones de personas con enfermedades, con familias, con necesidades médicas reales.
It's eleven million people with illnesses, with families, with real medical needs.
Eso es lo que está en riesgo ahora.
That's what is at risk now.
Eleven million people.
And the extraordinary thing is that this island built something the whole world studied, sent its doctors everywhere from Angola to Venezuela to Pakistan, and is now struggling to keep the lights on in its own hospitals.
That's the story of Cuba's health system in 2026.
Es una historia de contradicciones.
It's a story of contradictions.
Un país pequeño con grandes médicos, una revolución que mejoró la salud pero destruyó la economía, y ahora un bloqueo que amenaza lo único que todavía funciona bien.
A small country with great doctors, a revolution that improved health but destroyed the economy, and now a blockade that threatens the one thing that still works well.
No es una historia simple, Fletcher.
It's not a simple story, Fletcher.
Nunca lo fue.
It never was.