Cuba's first military doctors
By Don FitzDecember 1, 2018 – Links International Journal of Socialist Renewal – Cuba's deployment of military doctors to Africa in the 1960s was secret, known only at the highest level of government. Accounts of these hidden efforts were not published until the beginning of the 21stcentury.
Multiple forces during that decade pulled Cuba toward struggles in sub-Saharan Africa. First was the mushrooming of popular movements across the globe. The US civil rights movement was joined by millions opposing the war on Viet Nam. Zaire won independence from Belgium in June 1960 and the popular Patrice Lumumba became its first prime minister. After leading the National Liberation Front to victory over French domination in 1962, Ahmed Ben Bella was elected as the first president of Algeria. In August, 1966 Mao launched the Great Proletarian Cultural Revolution to thwart the growth of capitalism in China. May 1968 saw a huge left upsurge in France going beyond the Communist Party.
A second force pushing Cuba's foreign policy came from the US. Its continuous violence gave a clear message that the best defense for the island would be an international offense. Two decades earlier, the US had experimented with nuclear extermination in Hiroshima and Nagasaki. During the previous decade, the US had slaughtered roughly 20% of the population of North Korea and the CIA engineered the overthrow of the progressive Jacobo Arbenz government in Guatemala. Fresh on the mind of Cubans was the connivance of John and Bobby Kennedy in the 1961 Bay of Pigs invasion and the 1962 missile crisis. The US began its series of efforts to kill Fidel Castro about the same time the CIA contemplated how to poison Lumumba.  Asserting dominion over Latin America, Lyndon Johnson invaded the Dominican Republic in 1965.
In the meantime, the Soviet Union was not acting like a reliable ally. The USSR had not sent troops to fight in Korea and did not do so in Viet Nam, even after the massive US build-up following the 1964 Gulf of Tonkin incident. Nikita Khrushchev had settled the missile crisis without bothering to consult Fidel. His successor, Leonid Brezhnev, was clear that Cuba should accept the subordinate status of sugar producer for the Soviet bloc.
Furthermore, Latin American Communist Parties (CPs) did not take kindly to Cuba's “foco theory” of revolution. Those CPs centered on urban working class movements while the Cuban leadership looked to a dedicated vanguard in the countryside, garnering support through armed struggle. As Che Guevara wrote, “a small group of men who are determined, supported by the people, and not afraid of death...can overcome a regular army. This was the lesson of the Cuban revolution.” 
Unlike countries in Latin America, those in Africa did not have established Communist Parties hostile to guerrilla efforts.  With at least a third of Cubans being of African heritage, Cuban leaders felt beckoned from across the Atlantic.
Despite efforts by the US to isolate Cuba, by 1964 it had embassies in the African countries of Algeria, Egypt, Ghana, Guinea, Mali, Morocco and Tanzania. Lumumba had been murdered in January 1961 by allies of Moise Tshombe. The Simbas (lions), admirers of Lumumba, began a guerrilla struggle, routed government forces in 1964, and seemed to have strong revolutionary potential. 
In December 1964 Che began a three month trek to Algeria, Ghana, the Congo, Guinea, Mali, Benin, Tanzania, and Egypt. Planning to lead an African initiative himself, Che went to develop strategies and agreements with liberation movements. During his January 1965 meeting with leaders in Tanzania, Che emphasized the Simba upsurge and proposed Zaire as the location for centralized training. They disagreed with him, each wanting training camps in their own country. 
The more Che came to know the heads of several organizations, the more skeptical he became. He observed that they “live comfortably in hotels and have turned rebellion into a profession, at time lucrative...”  Once on the battlefield, his doubts were confirmed:
“Che had been told that he would find several thousand well-armed Simbas, eager to fight. There were, in fact, some 1000 to 1500 widely dispersed rebels, who had no idea of how to maintain their modern weapons ... they lacked a unified command.”
“The scouting teams … brought back grim reports from the fronts: idle rebels who ... did not know how to use their firearms and showed no inclination to attack or to prepare to defend themselves. Everywhere chaos, disorganization, and lack of discipline.” 
Cuban leaders, soldiers and doctors wrote of their frustration in Zaire. In November 1965, after a governmental coup, a Simba leader notified Che that they wanted to end the war. Che returned to Cuba with part of the unit he commanded, while others went to different African locations. 
The neighboring Congo was headed by Alphonse Massamba-Débat, whose socialist views were similar to those of the Chinese Communist Party.  In August 1965, Fidel dispatched a unit to the Congo which joined the 50 or so Cubans already there. The group was headed by Jorge Risquet, who was “the descendant of an African slave, her white master, a Chinese indentured servant, and a Spanish immigrant.” 
In the Congo the Cubans discovered that the rhetoric of the country's leaders did not match their politics, which were based on opportunism and personal feuds. Since Fidel had charged Risquet with defending the Congo, when an attempted coup broke out on June 27, 1966, the Cubans came to the defense of the government. Wanting to resolve the dispute diplomatically rather than with force, Risquet appointed a doctor to lead the maneuvers. The rebels backed down when confronted by the determination of the smaller number of Cubans. On July 6, the revolt ended with only one Congolese death. 
It soon appeared to the Cubans that their major task in the Congo was protecting one faction from another. Risquet persuaded Havana that the best thing for them to do was to leave, which they soon did. Two years later, a successful coup overthrew Massamba-Débat’s government. 
The uprising against the Portuguese in Guinea-Bissau stood in sharp contrast. Even US intelligence reports described it as having been “Africa's most successful liberation movement.”  During his 1965 journey through Africa, Che spoke with Amílcar Cabral, head of the African Party for the Independence of Guinea and Cape Verde (PAIGC, for its acronym in Portuguese. 
Fidel recognized the importance of the Non-Aligned Movement, which coalesced Third World countries breaking from the yoke of imperialism. He persuaded those organizing the Tricontinental Congress to meet in Havana on January 3, 1966 and invited Latin American groups dedicated to armed struggle. It was there that Fidel and Amílcar Cabral first met and spoke extensively. Fidel promised Cabral doctors, military instructors, and mechanics.  Both made impressive speeches to the delegates and Fidel emerged as a champion of revolutionary movements.
For a critical year, Victor Dreke headed Cuba's military undertaking in Guinea-Bissau. Dreke was a black Commander who received extremely high praise from Che for his efforts in Zaire. Dreke was impressed by the discipline of the PAIGC. When he returned to Cuba in late 1968, Cabral's forces had strengthened their position. The Portuguese lost ground even while increasing their troops from 20,000 to 25,000. 
Cuba never had more than 60 soldiers in Guinea-Bissau. This was one way Cabral kept the PAIGC in command, the other being the restriction of foreign military aid only to Cubans. Yet, the Cubans’ roles as military advisers and teachers proved invaluable. When Castro went to Africa in 1972, the PAIGC was the only force on the continent successfully fighting against a white regime. 
Cuba also played minor roles in Angola, Cameroon, Equatorial Guinea, Tanzania and possibly other countries.  However, this article concentrates on Zaire, the Congo, and Guinea-Bissau, which were, by far, its major arenas.  Much of the information regarding experiences of Cuban physicians in Africa is from extensive interviews with military doctors deployed in the three countries, as well as Tanzania.
Cuban doctors going to Africa were almost all white while its troops were almost all black. It was very rare for black people to become doctors before the revolution. But they rose quickly to high positions in the revolutionary military. Race was critical in every aspect of the African conflicts.
The US had strong advantages over Cuba in its influence of Africa: it could offer vastly more economic aid and wield the political power of its European allies, accrued by their history of conquest and ongoing domination. But throughout the 1960s, the US was increasingly tied up in Viet Nam and its ongoing racism repulsed people around the globe.
Racism in the white regimes of Africa was blatant and horrific. The London Observer reported that mercenaries paid to put down the Simba rebellion “not only shoot and hang prisoners after torturing them, but use them for target practice and gamble over the number of shots to kill them.” One mercenary wrote in his memoirs of the “the White Giants—‘tall, vigorous Boers from South Africa; long-legged, slim and muscular Englishmen from Rhodesia’—who would restore, in Zaire, the white man to his proper place.” 
African resistance leaders realized that they could use the inability of racists to tell one group of black people from another to their advantage. The revolutionaries in Zaire requested that the Cubans sent to their aid be black so they could pass undetected by US and Europe spies. Cabral asked Cuban officials to send technicians who were “black or dark mulattoes so that they would blend in with his people.” This fell into place with the PAIGC's policy of denying that they involved any foreigners. 
When Fidel asked Dreke to select troops who would serve with Che in Zaire, he specified that he had to “choose a platoon of men who have shown their mettle, who are all volunteers and who are dark-skinned blacks.” Both Dr. Rodrigo Álvarez Cambras and Dr. Julián Álvarez Blanco did not know that Africa was their destination until they saw that almost all the combatants in training camps were black. 
This meant very different experiences for those traveling by ship to Africa. Dr. Álvarez remembers Pavlovian conditioning when traveling aboard the Soviet ship Félix Dzerzhinsky:
“Since the doctors were all white, there were no problems with anyone seeing us. But the troops were all black, and, in order to make sure that none of the passengers or US spy planes would guess the purpose of the mission, they had to stay in the lower deck of the ship, which was hot and had poor ventilation. Occasionally, they could come out for brief times at night.
“Since the Russian food was very strong with disagreeable odors, the comrades who had to stay below without fresh air would get nauseated and vomit when they smelled it. The captain had a gong that he hit in front of a microphone in order to announce that it was time to eat. Some of the comrades started vomiting when they heard the gong.
“At that point, I told Risquet that he had to tell the ship’s captain to stop banging the gong. He replied that it was me, as a doctor, who had to have the conversation with the captain. When I did so, that robust Russian failed to understand the situation and argued that it was a tradition that he could not violate.” 
Though the white doctors could lean over the side of the ship to vomit, it must have been profoundly unpleasant for black troops confined to the lower deck. In response, and to the outrage of the Russian captain, the Cubans stole the gong and heaved it into the Atlantic. 
How successful was the strategy of recruiting black troops? It significantly slowed the ability of Western powers to detect Cuban involvement. A British adviser in Zaire observed US agents looked “for whites and their eyes … passed over Cuban blacks or mulattoes.” The same was true for the Congo, where bewildered officials from the US, France, West Germany and England “...were unable to ascertain how many Cubans were in the Congo.” A Belgian ambassador could not tell if there were 100 or 800 Cubans since “they are difficult to pick out because they are all colored.”  It was likely a serious affront to the dignity of white supremacists to see black Cubans so successfully bamboozling them.
Western observers could only be successfully confused about Cuban involvement if Cuba’s own recruits were in the dark concerning their destination. Rodolfo Puente was the only one of nine physicians interviewed by Hedelberto López who was openly told where he was going (the Congo).  Others were led to believe that they were going to Algeria, Vietnam, or “other lands,” or that they should tell their families that they would be studying in the Soviet Union. 
The physicians were accustomed to disruption in their careers. Of the nine interviewed by López Blanch, two had to delay when they began medical school because Batista had closed it at the end of 1956. The other seven started school before the 1956 closing but had to halt their studies and resume them after the 1959 revolution.
Waiting to discover exactly where they would be serving was only one indication of the vital importance of their mission. Every one of the nine physicians interviewed in Historias Secretas met some combination of Fidel Castro, Raúl Castro, Che Guevara, MINSAP (the Cuban Health Department) head José Ramón Machado, Commander Jorge Risquet, Commander Victor Dreke, and Amílcar Cabral either before, during, and/or after their trip to Africa.
Preparing to leave for Zaire, Rafaél Zerquera recalled that “April 10, 1965 was the happiest day of my life when I was interviewed by Fidel Castro.”  Shortly after arriving in Zaire, Diego Lagomasino “gave Che a suitcase with asthma medicine and bullets for a M-1 gun. Meeting someone like Che had a big impact on [him].”  Héctor Vera spoke with Fidel upon returning from Zaire: “Fidel asked about sicknesses, malaria, how we were able to diagnose, and what treatments we used. After chatting, he told us that we could not divulge anything about the mission.” 
Before departing for the Congo, Rodrigo Álvarez described having breakfast with Fidel.
“[He] spoke to us of Africa in general without specifying the country. He asked if we had pistols, and I said, yes, a P-38. He told his assistant to find a better weapon and he brought a Stich of 20 shots. Fidel saw that I wasn’t wearing a watch and told me that it was important for a doctor going to war to have one. He took off one of the two watches he was wearing, a Longines, and gave it to me.” 
When Diego Lagomasino did his post graduate Rural Medical Service (RMS) in Santo Tomás, he worked alone and “had to be the doctor, nurse, distribute medications, and look for supplies.”  This multi-tasking helped prepare him for Africa. Rafaél Zerquera's RMS was used as a screening to see if he was suitable for Zaire. He explained that …
“When I graduated, a document circulated asking where we would like to do our RMS and I wrote 'wherever the revolution needs me.' José Ramón Machado of MINSAP, called me to his office and said that there was a conflict zone in the Sierra Maestra, where a group had burned the medical post and killed the doctor. He asked me if I was still disposed to going.” 
Zerquera replied that he would go where Machado assigned him. After a short stint in the Sierra Maestra, Machado called him back to let him know that an important but highly risky international mission awaited him and Zerquera was soon on his way to Zaire.
Once they learned of their destinations, the doctors still had little idea of what was in store for them. Luís Peraza recalled that all he “knew about Africa was the Tarzan movies.” Impressions of their experiences differed sharply according to country, with Zaire being the gloomiest. As the curtain was drawing to a close in Zaire, Che called a meeting of Communist Party members and asked who still thought that they could win. Only two military leaders and two doctors raised their hands and Che concluded that they might have been showing him personal support. Che then asked who would be willing to fight until death and all the hands went up. 
Rafaél Zerquera recollected that the Simbas did not seem interested in preparing for a guerrilla struggle. “It was an experience but it wasn’t pleasant. If it had been a sacrifice with a reward, I would have felt satisfied. But it was not rewarding.” 
Justo Piñero had different feelings about the Congo. “The population identified with us. We bought things from them. We went to the same places and knew the local people from seeing them on the street.” 
By far, the most positive memories were of Guinea-Bissau. Domingo Díaz knew “many brave Guinean officers and soldiers who would have given their lives to prevent a Cuban from falling into the hands of the enemy.”  Dr. Milton Hechevarría emphasized that when he got back to Cuba, he “couldn’t forget Guinea-Bissau.” 
Whatever country they went to, Cuban doctors faced a combination of stressful conditions that they were unlikely to have experienced at home: incredibly rough terrain, enemy fire, and unpleasant and dangerous animals. Diego Lagomasino described arriving in Zaire: “We had to go to the base camp that was on the top of a high ridge. We left at 6 in the morning and at 7 in the evening we were still climbing. Never in my life had I seen a ridge that tall. I thought I was going to die.” 
Looking back on the same walk, Héctor Vera felt like he could not bear the weight of his pistol, ammunition, medical supplies and personal belongings in his knapsack. He was saved by a Zairean boy who motioned that he would carry it for him. 
In Guinea-Bissau, Domingo Díaz went on strenuous walks for 7 or 8 days, walks with deep holes that could not be seen after it rained. “In this region, we didn’t measure time with a watch,” Díaz recounted. Instead, time was measured “with distance, which is to say one day’s walk, half a day walk.” He concluded that the terrain was so rough that “in Cuba there was no possibility of training for this type of event.” 
The land intensified military dangers. To avoid detection by the enemy, Héctor Vera's group crossed Lake Tanganika with several Simbas who began lighting matches to see where they were going. The Cubans in the boat told them not to because there was a gasoline motor that could catch on fire. However, they replied that there was no other way to see and continued with the matches. Upon arriving in Zaire, they had not gone 50 meters before they had to fall to the ground as enemy planes flew overhead. 
In Guinea-Bissau, the Portuguese attacked Amado Alfonso Delgado's group with napalm while 15 helicopters landed to hunt them. They survived by running from 7 in the morning until 5 in the afternoon. 
The doctors encountered insects, reptiles and other creatures they had never seen before. In an emergency military undertaking in the Congo, Rodrigo Álvarez saw anthills so tall that they prevented their plane from landing.  Fleeing from the Portuguese in Guinea-Bissau, Amado Alfonso Delgado
“… bumped into an enormous beehive. I had over 300 stings. Only 10 are dangerous and can send a person into shock. But I was under so much tension that my body was producing steroids, which is exactly the treatment used. None of the stings became inflamed and the other six with me had the same luck.” 
While none of Cuba's snakes are poisonous, many are in the Congo, where Julián Álvarez thought he ran across them everywhere. 
Waters in Guinea-Bissau were often inhospitable. Domingo Díaz described walking through a lake for hours with water up to their chests. “It was full of leeches and they advised me to tie my pants tight and walk with my arms up so they could not get in. When we got out we were attacked by mosquitoes that bit through my coat.” Another day, they found that
“The Corubal and Gaba Rivers met where they emptied into the sea. It was like an arm of the sea where there were sharks, hippopotamuses, and crocodiles. As we crossed in canoes made from tree trunks they told me to be careful because a man had recently fallen in and never reappeared.” 
Physicians found working conditions to be quite different from Cuban polyclinics. It was very clear to Virgilio Camacho that “although I was a doctor, I was armed because at any moment I might have to participate in combat.”  The Cuban doctors practiced in small groups. In the Congo, the group of Rodrigo Álvarez included a surgeon, an orthopedic, and two pediatricians. Later, they were joined by an anesthesiologist nurse and dentists.  In 1966, Domingo Díaz traveled toward Guinea-Bissau as 1 of 9 physicians. Once there, he was assigned to Saará in the northern region where they were “the only three doctors and there were no Cuban nurses.” They worked closely with several young Guineans and trained them as nurses. 
Since the Cuban staff rotated and PAIGC policy was to understate the extent of their involvement, some writers are not aware of the more than 40 Cuban doctors who served in Guinea-Bissau between 1966 and 1974 as historian Piero Gleijeses carefully documents. 
The physicians were forced to minimize their use of modest resources. When Amado Alfonso Delgado reached his assigned eastern front in Guinea-Bissau he found the hospital grounds consisted of “four huts: one for the wounded; one was a kitchen; one for supplies; and one, a little further away, for the doctor.” 
Juan Antonio Sánchez “was in Tanzania for a military mission from 1969 to 1970. I was a medical internist at Pemba Island. Cuba had permission from Tanzanian government as long as their presence was secret. There were no Cuban troops, only three doctors.” Their “operating room had been a garage.” 
The priority for Cuban doctors was always the health of combatants. They were treated for bullet wounds, fractures and health issues such as hernias and tropical diseases. There were many surgeries including the one in which Héctor Vera participated: “Four men who had been injured by a grenade arrived. The one who was seriously injured was operated on at night and survived. We put him on a table; Che held a lantern; Oliva gave him anesthesia; Tabito operated; Lagomasino worked as an assistant; and I observed.” 
Virgilio Camacho was in the southern front of Guinea-Bissau where the Portuguese frequently ambushed civilians who helped supply the military. Several Cubans died or were injured in these attacks.  Amado Alfonso Delgado illustrates the difficulties of surgery during combat:
“We operated whenever there were battles. Small reconnaissance planes passed overhead frequently, and when they returned multiple times we moved the camp because an attack was almost certain to follow. The hospital was burned four times. Every time a plane flew overhead two times they attacked us ... We were between two rivers. Planes and boats kept coming by and destroyed almost all the canoes we could use to flee … Most of the time we operated in places where we could set up a tiny hospital. They brought us people who had stepped on a mine or were wounded in an ambush. Almost always the wounded arrived at night and we had to operate by the light of bundles of grass. I did about 50 operations like this including several amputations. We cut dry grass, folded it over, and tied it with straw, and used it as a candle. Sometimes we couldn’t see what we were operating on, even with 8 or 10 wicks like this.” 
Cubans felt obligated to treat civilians injured in attacks which meant that there was an overlap between military and non-military medicine. Amado Alfonso Delgado became acutely aware that a lack of specialists had its costs. He describes an event in Guinea-Bissau,
“…a bomb fell very close to a woman and injured her in the abdomen. Since I didn’t have my assistant with me, I had to read from a booklet to find out how to apply anesthesia. I had to open her abdomen to see if she had peritonitis. I gave her a local anesthetic, and just as I was about to give the general, a plane dropped a bomb very close to us. The woman jumped up with her wound half open and ran away. I never saw her again. Later I learned that she had been found dead four kilometers from the tiny hospital.” 
Domingo Díaz had a more positive experience in the northern front:
“One day in Saará they brought us a boy about four years old named Kumba who had a large wound in his left leg. His good spirit impressed us; he didn’t have a tear or expression of pain. A few hours before the Portuguese attacked a nearby village that had no combatants and no protection. Luckily, they were able to bring this little boy to our small rural hospital. We cleaned the very dirty wound and partially sutured it because we didn’t want future complications such as gangrene. During all the treatment without anesthesia, Kumba continued as before, without a tear or expression of pain.” 
Cuban officials knew that the behavior of doctors toward civilians was as important for diplomatic relationships as troop discipline was for military advances. When Cuban physicians first went to Algeria in 1963, Raúl Castro issued a strict code of conduct that included a prohibition of alcohol and intimate relations with women, and demanded absolute respect for Algerian traditions. Che spoke to physicians in Zaire of the moral aspect of their mission: “I don’t want any scandal. Anyone who is undisciplined will have to be counseled or sent back to Cuba.” A couple of years later, the Cuban command in Guinea-Bissau replaced a doctor accused of not showing respect for local customs. 
The importance of this respect grew as contact between Cubans and Africans became closer. Unlike Catholic and Protestant missionary doctors who stayed at fixed locations and required Africans to come to them, Cubans went on long walks to isolated villages to provide care. As Zaireans learned of the arrival of Cuban doctors, “peasants from the surrounding area flocked in.” Before the Cubans arrived, only nine doctors had provided care for 850,000 Congolese. Hugo Spadafora, a Panamanian who was the only foreign doctor with the PAIGC, wrote that when the Cuban physicians arrived with medicine and equipment, “the quality of the hospital’s care increase exponentially.” 
The guidelines laid out by Raúl and Che served Cuban efforts well. While their military allies in Zaire were often accused of mistreating local people, there were “no reports of the Cubans perpetrating any crimes or acts of violence against the population.” 
Instead, the Cubans won people's trust by doing countless simple procedures. These included tooth extractions, operations for hernias and cataracts, and treatments for high fever, diarrhea, confusion and stomach and shoulder pain. In Tanzania, Justo Piñero recalled that “most patients were civilian and a few were military. The most frequent problems were malnutrition, malaria, pneumonia and parasites.” 
Amado Alfonso Delgado learned to treat parasitic diseases he had never seen in Cuba:
“I saw whole villages with trachoma, an infection of the eyes and eyelids that leaves people blind. I visited villages where almost everyone was blind. I saw people with advanced leprosy without fingers. There was a sickness, miasis, produced by a fly bite that causes an abscess from which worms grow. Another produces boils on the body, called oncocerciasis, that is a type of filaria. This disease has a special treatment. There is a worm that gets under the skin and the Guineans use a little stick to which they fasten a palm thread and put it in the boil and roll it around until they pull out an enormous worm called ‘the worm of Guinea.' There are many parasites and harmful insects such as the jigger flea (nigua), that gets under people’s skin in dry weather and causes a boil. You have to extract the parasite, which looks like a tick.” 
Perhaps the most unexpected tragedy was a Cuban soldier dying from eating a strawberry. They had no idea of how acidic the fruit could be and he had a perforated ulcer. “By the time he reached me” Domingo Díaz remembers, “he was in agony. We did all we could to stop the bleeding, and since we didn’t have surgical instruments, we tried to move him to the small hospital in Boké. But he died on the road.” 
Though the Cubans tried to attend to civilian medical needs, operations had to be authorized by the PAIGC zone director due to shortage of materials. This required creative searches for alternative materials, such as using coconut water (which is sterile) in intravenous fluids. On multiple occasions, Dr. Camacho “had to suture patients with domestic sewing thread,” which led to deal-making with local thread vendors. 
The riches of Africa were being drained out as its people lay crippled or dying from totally curable diseases which did not peak the interest of wealthy Western investors. This was the case with polio. When Rodrigo Álvarez arrived in the Congo, he saw that
“Many suffered from polio. I visited an asylum attended by a single nun which was full of children with this disease. The children were crawling across the floor in very bare surroundings. The nun didn’t have supplies or staff to deal with them. I operated on dozens of these children ... The French had left nothing of the infrastructure; there were no lawyers or engineers; and only two native doctors.” 
Rodolfo Puente was the manager and one of the principle advocates for a polio vaccination campaign. He ran into two Soviet medical staff who were vaccinating as one of their duties. He asked for 5000 doses, which they happily gave him, and made arrangements with the mayor to vaccinate students. Realizing the seriousness of the situation and knowing that Cuba had recently conducted its own polio vaccination campaign, Dr. Puente called MINSAP in Havana for permission to take on a similar endeavor. MINSAP director Machado approved and assigned Dr. Helenio Ferrer, Cuba's Director of Epidemiology, to fly to Moscow for the vaccines. The Soviets agreed to provide 200,000 doses to the Congo for about $4000. Following appeals by the Cubans, they agreed to donate the vaccines, which arrived in June 1966. 
There were too few doctors and nurses to administer the vaccines; but, since they were in a caramel, it was possible to train others to distribute them. In cooperation with the Congolese government, its militia, the Federation of Women, and Cuban troops, Dr. Ferrer coordinated the vaccination of over 61,000 children in the first such campaign in Africa. 
However, the attempted coup of June 27 blocked administration of the second dose. Since accounts tend to be vague regarding whether this would prevent the first dose from being effective, I asked that question directly to Dr. Justo Piñero, who was in the Congo from September 1966 to November 1967. He explained that, “as a result of not getting the second dose, there would be the same rate of polio.” He returned to the Congo in May 1969 and witnessed the Congolese Ministry of Public Health administering both doses, which were provided by the Soviets. He strongly believed that the earlier joint experience with the Cubans was critical in making the 1969 effort successful. 
In Guinea-Bissau, Domingo Díaz' group found themselves with no Cuban nurses, so they trained several local youth. They were so impressed with the work of the Guineans that they obtained permission from Cabral to bring four back to attend Cuban nursing school, from which they graduated. 
A much larger venture happened earlier in the Congo when Cuban doctors noticed dedicated young people studying at night under street lights. They asked the Congolese government about sending some of them to Cuba to study. It agreed, and, on January 24, 1966, 254 youth boarded a ship for Havana. This was the first time a significant number of foreign scholarship students went to Cuba. Nevertheless, there were problems. Rather than choosing students strictly on the basis of academic performance, many were selected according to personal connections or bribes. By late 1967 more than 100 had returned home, at the request of themselves or Cuba. Despite this, by 1978, 25 had Cuban medical degrees and others graduated as lab technicians or engineers. 
Cuban authorities soon decided that its military forces would leave Africa. Yet medical personnel would continue with replacement teams of “pediatricians, orthopedics, surgeons, and ear-nose-throat specialists who would be civilians rather than military doctors.” 
Cuban doctors provided preventive care and treatment not only to troops and civilians but also to themselves. The most famous example was Che. With him in Zaire, Rafaél Zerquera remembered the day Che's malaria was complicated by an asthma attack. Zerquera worried “How can I tell Fidel that I let Che die here?” Che was not an exception. Amado Alfonso Delgado, for example, treated himself three times for malaria. 
Virgilio Camacho spoke about how, soon after his arrival, acute jaundice caused another doctor, Jesús Pérez, to return to Cuba, leaving him with only one other doctor at their medical post. A year later he was transferred to head the military hospital in Guinea-Bissau's southern front because a doctor there was ill. 
The long walks and physical exhaustion of battlefield medicine took their toll. When Domingo Díaz arrived in Guinea-Bissau he weighed 180 pounds. He left 20 months later weighing 100 pounds. He had experienced the unusual danger of disappearing shoes.
“I returned to the base after it was completely destroyed, and I could not find any of my belongings, not even my tennis shoes. This type of footwear was the best in the circumstances, since we had to cross many rivers, and they dried out much more rapidly than boots and were a lot lighter … during the first long walks, I lost all of my toenails...my feet were constantly wet and the hiking was forever...and in Cuba I had the habit of walking five kilometers every day.” 
Some of their most unpleasant surprises awaited doctors upon completion of their African assignment. Amado Alfonso Delgado recounted
“The year that we returned almost all of us tested positive for filaria in the blood. In the subtype Loa loa, it goes from vital organs to the eyes, leaving the person blind. This was precisely the type we had. Reading about it scared me a bit because it was said at that time, that there was not a guaranteed cure. We were treated in a hospital for two months.” 
Virgilio Camacho was also more than a little nervous:
“I had filaria, which doesn’t exist in Cuba, and I had no idea until passing through the check point. It required a double treatment: both for the adult and larva of the parasite. They didn’t have the medicine in Conakry and had to look elsewhere. Finally, I had both the intravenous injections and pills...We arrived in Cuba in January 1968.” 
By the end of the 1960s, when the Cuban revolutionary government had been in power for only 10 years, doctors had been through four different scenarios in Africa:
1. In Algeria, they treated only civilians.
2. In Zaire, the rebels showed little enthusiasm for victory.
3. In the Congo, the militancy of the government proved to be empty rhetoric.
4. In Guinea-Bissau, there was a successful military uprising with a strong commander and dedicated troops.
Cuba knew that US could invade at any time. As a result of African expeditions and experience gained by military doctors, a new generation of physicians would be trained by those who had been through war and could teach others how to treat combat victims.
Perhaps the most lamentable irony of Cuba's forays into Africa was that its most capable leader, Che Guevara, led guerrillas into the least promising front, Zaire. Since no Cuban leader had been to sub-Saharan Africa for more than one day, the strategy of going to Zaire was based on misinformation, solidarity with Cuba's own black population, and the defense of its revolution. When Che ventured into his last battleground of Bolivia the following year, it was because he and Fidel agreed that Latin America must again occupy the foreground of Cuba's participation in armed struggles. 
There had been very little connection between upheavals in the approach to medicine practiced on the island and what its doctors did overseas.  Experiences of the polio campaign in Cuba was adopted in the campaign in the Congo. The exposure to medical problems in Africa was invaluable for developing Cuban understanding of tropical and infectious diseases. Nevertheless, nothing like Cuban polyclinics appeared in the battle conditions of Africa, where the necessity to provide emergency care was all-encompassing.
Cuban engagements in Africa left profound impacts, both on the host countries and on the Cubans who went. Cuba learned that if students were to travel to the island for education, they must be screened for academic potential. The Congo became prepared to complete its own vaccination campaign. Guinea-Bissau recognized its debt to Cubans for its successful struggle for independence. “Many of our comrades are alive today only because of the Cuban medical assistance,” noted PAIGC official Francisco Pereira. “The Cuban doctors really performed a miracle. I am eternally grateful to them: not only did they save lives, but they put their own lives at risk. They were truly selfless.” 
White doctors who experienced the stressful conditions and parasitic diseases of Africa witnessed even greater sacrifice by black troops. One reason that so many volunteered to serve in Africa was a feeling of urgency to spread the revolution. Later, Olvaldo Cárdenas told Piero Gleijeses that
“… we believed that at any moment they [the US] were going to strike us … and for us it was better to wage war abroad than in our own country. This was the strategy of 'Two or Three Vietnams;' that is, distracting and dividing the enemy’s forces. I never imagined then that I would be sitting here [in a living room in Havana] talking about it now—we all assumed that we were going to die young.” 
When the volunteers returned to Cuba, they did not march in parades or receive any type of public praise. There were no medals, decorations or material rewards. Bound to secrecy, decades passed before they could share their stories.  Yet the insights obtained by what they endured were essential for designing Cuban strategy, which is why Fidel grilled so many upon their quiet homecomings.
Before 1959, dedication to revolutionary medicine was expressed by students and doctors demanding full treatment for Cubans in poor urban and rural areas. This became the foundation for doctors volunteering for international missions during the 1960s. With the dawning of the 1970s, the question remained: Would sacrifices by the first doctors going to Africa come to fruition by medical staff playing a key role in toppling a major racist government on that continent?
Don Fitz is on the Editorial Board of Green Social Thought and is editor for the newsletter of the Green Party of St. Louis. He had been the candidate of the Missouri Green Party for Governor (2016) and for State Auditor (2018).
A version of this article first appeared in Monthly Review. The author thanks Rebecca Fitz for interview translation and John Kirk, Linda M. Whiteford and Steve Brouwer for their helpful comments on an earlier draft of the article.
1. Piero Gleijeses, Conflicting Missions: Havana, Washington, and Africa, 1959-1976(Chapel Hill: The University of North Carolina Press, 2002), 61.
2. Ibid, 22.
3. Peter G. Bourne, Fidel: A Biography of Fidel Castro(New York: Dodd, Mead & Company, 1986), 255.
4. Gleijeses, 30, 60, 61.
5. Bourne, 260;Gleijeses, 80, 85.
6. Gleijeses, 87.
7. Ibid, 111,114.
8. Bourne, 261.
9. Ibid, 260.
10. Piero Gleijeses, (2006), Risquet, Jorge. Encyclopedia of African-American Culture and History. Cited in Helen Yaffe, http://www.counterpunch.org/2015/10/02/ches-economist-remembering-jorge-risquet/.
11. Gleijeses, (2002), 161, 163, 170,171.
12. Ibid, 183.
13. Ibid, 185.
14. Hedelberto López Blanch, Historias Secretas de Médicos Cubanos(Centro Cultural de la Torriente Brau: La Habana, Cuba, 2005), 113,114.
15. Gleijeses, (2002), 187.
16. Ibid, 190-191.
17. Ibid, 191,208.
18. Ibid, 183-184, Author's interview with Dr. Juan Antonio Sánchez, Havana, Cuba, February 9, 2016.
19. Two Congos had revolutionary movements. The “Belgian Congo” was sometimes referred to as Congo Leopoldville from the name of its capital city. Upon independence in 1960, it took the name Kinshasa, became Zaire in 1971 and the Democratic Republic of the Congo in 1997. The current article refers to it as Zaire. The “French Congo” was sometimes referred to as Congo Brazzaville from the name of its capital, or the Congo. After independence in 1960 it became the Republic of the Congo, the People's Republic of the Congo in 1969 and, after 1991 the Republic of the Congo again. The current article refers to it as the Congo.
20. Gleijeses, (2002), 71, 73.
21. Ibid, 89, 188, 208.
22. López, Historias Secretas, 67, 89.
23. Ibid, 76-77.
25. Gleijeses, (2002), 136, 166.
26. Hedelberto López' interview with Dr. Rodolfo Puente Ferro, Historias Secretas, 101.
27. Gleijeses, (2002); 199, Hedelberto López' interview with Dr. Domingo Díaz Delgado, Historias Secretas, 115.
28. Hedelberto López' interview with Dr. Rafaél Zerquera Palacios, Historias Secretas,25.
29. Hedelberto López' interview with Dr. Diego Lagomasino Comesaña, Historias Secretas,60.
30. Hedelberto López' interview with Dr. Héctor Vera Acosta, Historias Secretas, 53.
31. Hedelberto López' interview with Dr. Rodrigo Álvarez Cambras, Historias Secretas, 75.
32. López' interview with Dr. Diego Lagomasino Comesaña, 56-57.
33. López' interview with Dr. Rafaél Zerquera Palacios, 22-23.
34. Gleijeses, (2002), 154, 200.
35. López' interview with Dr. Rafaél Zerquera Palacios, 36-37.
36. Author's interview with Dr. Justo Piñero Fernández, Havana, Cuba, February 9, 2016.
37. López' interview with Dr. Domingo Díaz Delgado, 132.
38. Gleijeses, (2002), 213.
39. López' interview with Dr. Diego Lagomasino Comesaña, 59-60.
40. López' interview with Dr. Héctor Vera Acosta, 43.
41. López' interview with Dr. Domingo Díaz Delgado, 120.
42. López' interview with Dr. Héctor Vera Acosta, 42.
43. Hedelberto López' interview with Dr. Amado Alfonso Delgado, Historias Secretas, 144-6.
44. López' interview with Dr. Rodrigo Álvarez Cambras, 80.
45. Hedelberto López' interview with Dr. Amado Alfonso Delgado, Historias Secretas,144.
46. Hedelberto López' interview with Dr. Julián Álvarez Blanco, Historias Secretas, 90.
47. López' interview with Dr. Domingo Díaz Delgado, 140.
48. Hedelberto López' interview with Dr. Virgilio Camacho Duverger, Historias Secretas,158.
49. López' interview with Dr. Rodrigo Álvarez Cambras, 78.
50. López' interview with Dr. Domingo Díaz Delgado, 123.
51. Gleijeses, (2002), 202.
52. Hedelberto López' interview with Dr. Amado Alfonso Delgado, Historias Secretas, 142.
53. Author's interview with Dr. Juan Antonio Sánchez, Havana, Cuba, February 9, 2016.
54. López' interview with Dr. Héctor Vera Acosta, 52.
55. López' interview with Dr. Virgilio Camacho Duverger, 161.
56. Hedelberto López' interview with Dr. Amado Alfonso Delgado, Historias Secretas, 142-148.
57. Ibid, 148.
58. López' interview with Dr. Domingo Díaz Delgado, 127.
59. Gleijeses, (2002), 44, 201; López' interview with Dr. Rafaél Zerquera Palacios, 29.
61. Gleijeses, (2002), 151.
63. Hedelberto López' interview with Dr. Amado Alfonso Delgado, Historias Secretas, 149-150.
64. López' interview with Dr. Domingo Díaz Delgado, 131-132.
65. López' interview with Dr. Virgilio Camacho Duverger, 160.
66. López' interview with Dr. Rodrigo Álvarez Cambras, 78.
67. López' interview with Dr. Rodolfo Puente Ferro, 99. 102-103. 105; Gleijeses, (2002), 168.
68. Gleijeses, (2002), 169; López' interview with Dr. Rodrigo Álvarez Cambras, 84.
70. López' interview with Dr. Domingo Díaz Delgado, 123.
71. Gleijeses, (2002), 168, López' interview with Dr. Rodolfo Puente Ferro, 104-105.
72. Hedelberto López' interview with Dr. Julián Álvarez Blanco, Historias Secretas, 93.
74. López' interview with Dr. Virgilio Camacho Duverger, 158.
75. López' interview with Dr. Domingo Díaz Delgado, 130-133.
76. López' interview with Dr. Amado Alfonso Delgado, 150.
77. López' interview with Dr. Virgilio Camacho Duverger, 162.
78. Gleijeses, (2002), 216.
79. Don Fitz, “The Birth of Cuban Polyclinics,” Monthly Review, in press.
80. Gleijeses, (2002), 203.
81. Ibid, 204.