AFRICA, SOUTH AFRICA Strike of medical students in Cuba sparks controversy

The detention of South African medical students in Cuba, following their decision to embark on an ‘illegal’ hunger strike over food, low stipends and calls for a health attaché, has opened a debate over privilege versus expectations.

The students were released, but last week the South African government warned that they could be deported if agreement on disputed matters could not be resolved.

On 7 February, 187 of 1,200 South African students studying medicine in Cuba launched a strike, demanding a more than 300% stipend increase, the appointment of a South African health attaché in Cuba and that they not be served pork meals.



University food typically includes beef, chicken or pork, but the Cuban government has struggled to acquire beef and chicken, and so consequently has only been serving pork.

The students, completing their final year at a Cuban medical school, boycotted classes and threatened to abandon their studies and return home should their demands not be met. The Cuban authorities later intervened when the students gathered outside the South African embassy in Havana.

Some students complained to South African media that payments of food bills had been held up, leaving them without meals for days.

South Africa has a long-standing agreement with Cuba for the training of local doctors. Universities in this country are able to graduate only around 1,200 medical doctors a year – a number insufficient to fill vacant posts and alleviate a critical shortage of doctors.

The two governments jointly sponsor the students' accommodation, food, transport and tuition, with students receiving a US$200 monthly stipend. The students are demanding $700 to bring them “in line with diplomats' children”.

In all, South Africa invests about R500,000 (US$60,000) per student over the six-year training for a Spanish language course, medical education and living costs.

Department of Health spokesperson Joe Maila claimed that the students wanted more money to buy food rather than eat what was on offer. They wanted to buy “goodies and party” and were “spoilt”.

The move prompted Health Minister Aaron Motsoaledi to write the students letters, suspecting that their issues arose from cultural differences, adaptability and “perhaps psychosocial changes”.

The health department therefore dispatched a team including a social worker, psychologist, human resources manager and doctor to “assist the students”. The team joined the South African ambassador in Cuba, university staff and the Cuban government in negotiations with the students.

Government outraged

But the strike outraged Higher Education Minister Blade Nzimande – who is also leader of the South African Communist Party and has close links with Cuba – prompting him to challenge the students into carrying through with their threats.

"If they are demanding something that is a privilege, as if it is a right, and threatening to come home, then maybe they should do just that and open up that opportunity for other equally deserving young people who are thirsty for such opportunities," he said.

He added that the "sense of entitlement and lack of gratitude" was "totally unacceptable", and that their action threatened opportunities for other deserving, particularly poor, South Africans to receive medical training in Cuba.

"I condemn it in the strongest terms," Nzimande said.

Ian Davidson, the opposition Democratic Alliance shadow minister of international relations and cooperation, entered the fray with calls for the South African embassy to "urgently" come to the students’ aid and for the government to provide clarity on their safety and well-being.

"Any South African citizen visiting or studying in foreign countries should be able to depend on the Department of International Relations and Cooperation’s assistance when the need arises," he said.

Not the first time

This is not the first time that South African medical students in Cuba have had problems during their years abroad.

After two years, the students are flown home annually for a holiday, but last July a group of students sponsored by the Limpopo provincial health department were stranded when, having run out of money, the department failed to pay for their air tickets.

This left the graduates, who had completed their sixth year level and had to return to South Africa to finish their seventh year, without food and shelter for a week until the national government stepped in.

One student who spoke anonymously to The Sowetan newspaper at the time said they had been "disappointed" to find their tickets unpaid, forcing them to "scratch around to survive" until they were brought home about three weeks after their initial departure date.

The students had allegedly used up their money in preparing to come home and had packed their bags, forcing them to seek shelter and food from the embassy.

Medical training in Cuba

South Africa and Cuba entered into agreements in 1995 – the year after first democratic elections ushered the African National Congress into power – aimed at bolstering South Africa's health skills resources, especially in rural communities, by recruiting Cuban doctors.

Later, other initiatives allowed local students to train in Cuba, and statistics released by the Department of Health reflect that by last year 304 medical doctors had been produced from the 808 recruited into the programme.

There were another 406 undergoing Cuban medical training: including 98 doing final clinical training in local medical schools and 34 medical students who graduated last year. Cuba has capacity to train around 1,000 South African students annually.

Admission requirements are stringent, with students needing to show academic excellence, to come from poor backgrounds and to be prepared to work in the public sector – especially in rural areas where the need is greatest.

Last year Nzimande signed a bilateral agreement with his Cuban counterpart Miguel Diaz-Canel Bermudez to strengthen relations in education and encourage mutual understanding. Nzimande said the partnership would be ramped up to include lecturer and student exchanges and research collaboration, and that "a lot more deserving students" were ready for these opportunities.

Health Minister Motsoaledi also signed an agreement with his Cuban counterpart to enable South Africa to boost medical student numbers and ultimately strengthen this country’s ability to implement the National Health Insurance scheme.

Last September the Health Department sent another 1,000 students to Cuba to study medicine, while in November KwaZulu-Natal Minister of Health Sibongiseni Dhlomo signalled that the province would boost its primary health service delivery by establishing Cuban medical schools in KwaZulu-Natal.

He said the country was not producing enough doctors and had only eight medical schools serving 52 million people. Cuba had 22 medical schools for its 11.2 million population, prompting Dhlomo to comment that it "made sense" to bring home the Cuban model.

The department said the initiative would be a joint venture between the KwaZulu-Natal and Cuban governments "so that it is cost-effective for both parties". It would also be cheaper than sponsoring medical training abroad.

But given these discrepancies and the unhappiness of students, perhaps the exchange project is not working to the levels hoped.