Number 567 December 17, 2014

This Week: Cuba and Ebola

"Quote" of the Week: "Law Enforcement Has No Choice but to Be Racist and Unjust"
Engaging With Ebola: Systems and Individuals
Cuba: "The Only Country Well Poised to Answer That Call"


There is such a strong bias in mainstream U.S. culture toward individualism that it colors our thinking about everything. The idea that heroic individuals—or evil individuals—are the ones who make history is an insidious form of what I call Deep Propaganda. I don't argue that individuals are unimportant. What I'm always saying is that the structures and systems that govern our lives shape the possibilities that individuals face in responding to big problems.

Many activists understand this basic idea. The Occupy movement was criticized for being unfocused, for not having a specific "program" to promote. But that is actually the strength of the movement: They're talking about The System. The same with the Black Lives Matter movement—which I think we can call a movement, seeing how it's spreading and growing. Listen to the activists involved in this: Very few are saying that an indictment of a police officer will solve the problem (important though that is). Most of the activists I have been hearing and reading are talking about Systems: The "justice" system, the economic system, the housing system, and more.

And many spokespersons are talking about the ideological system that lies beneath these systems, providing both the foundation upon which they are built and the glue that holds them together. In my other life as a maker of political buttons I just made a button that says "White Supremacy Kills." This is what I was talking about. (The buttons are going like hotcakes.)

Readers in the Twin Cities can hear me on the radio airwaves this Friday, December 19th. I've been invited to be a guest on the show CATALYST: Politics and Culture, hosted by long-time activist and radio personality Lydia Howell. It's on the air from 9:00 to 10:00 am and, now that I think about it, you don't have to be in the Twin Cities, or even in Minnesota. You can listen to it online no matter where you are by going to the KFAI website and listening in real time. Or, if you can't listen then,go to the KFAI site for Catalyst, where the show will be available for downloading. We'll be talking about objectivity, propaganda, and stuff like that. Lydia's show is always engaging and provocative, and it's all about social change. Check it out.

Welcome to the new readers this week! I look forward to hearing your responses to the Notes.

In solidarity,



"Quote" of the Week: "Law Enforcement Has No Choice but to Be Racist and Unjust"

This is Mychal Denzel Smith, writer at The Nation magazine, speaking about the policing system on the December 5th edition of Democracy Now!:

"What we're talking about here is the disposability of black life. Like, we're dancing around it, but the reason that Eric Garner lay there and no one helped him is this is a large black man. The reason Michael Brown's body lay in the street for four-and-a-half hours is because this is a black man. The reason that the police show up on the scene and shoot Tamir Rice when he's holding a toy gun in Cleveland is because he's a black boy. We are talking about the fact that you have a racist and unjust system. You have racist and unjust laws. Your law enforcement then has no choice but to be racist and unjust. That's built into the fabric of what the police do.

"So, if we're not just talking about accountability after the fact, if we're talking about preventing these deaths from the very beginning, [then] it's not about training the police officers not to carry their gun while they're patrolling inside of public housing. It's about why are they in the public housing buildings in the first place. It's about this perceived threat of blackness. And it's about undoing all of that and asking ourselves why we've become so reliant on police, in the first place, to respond to things that are so minor."

Listen to the full discussion online HERE.


Engaging With Ebola: Systems and Individuals

On December 10th TIME Magazine announced its annual "Person of the Year." Every once in a while TIME's "Person of the Year" is not a person at all, but instead is an archetype, or sometimes a group of persons, such as 2011's "The Protester," or 2002's "The Whistleblowers." Until 1999 the award was known as "Man of the Year." The TIME Man of the Year in 1975 was "American Women." (I'm not making this up.) The Person of the Year for 2014 is "The Ebola Fighters: The Ones Who Answered the Call."

Back in March, when the first Ebola cases of 2014 were reported, it took a while for this public health problem to get the attention it deserved. In the eyes of TIME, this failure to respond rapidly was the fault of "feckless African governments and complacent Western powers, rival healers and turf-guarding bureaucrats." But on the bright side, TIME says, "For now, consider the stories of individuals who stood up to Ebola and, by doing so, raised hopes that victory is possible."

In a culture that reveres the heroic individual, it's not surprising that the editors of this ultra-mainstream publication would denigrate governments and elevate individuals. For example, after celebrating the individual "Ebola Fighters" who are featured, TIME goes out of its way to find fault with the U.N.'s World Health Organization (WHO), whose budget is eighty percent paid by governments. While it's true that WHO's response was too little and too late, TIME fails to mention that part of the problem is a lack of funds from member governments, the largest of which is the United States. In a September article, Mother Jones Magazine reported, "In 2010, US support for the WHO's general fund totaled $280 million, according to WHO documents; two years later, Washington had reduced its contribution 23 percent, to $215 million." It's a classic tactic from "small-government" conservatives and libertarians to de-fund public institutions, then criticize them for not doing their jobs. Is a magazine that enhances this argument really a member of the "liberal media," as has been alleged by some?

Liberal or conservative, TIME's feature has a narrow focus on the heroes—and they are heroes—who have answered the call for help during this crisis. But an epidemic cannot be effectively confronted by individuals, no matter how heroic. Individuals can only be effective if and when they act as a part of a larger, systematic response. That's why it's particularly unfortunate that TIME failed to inform its readers of a very important, and inspiring, story of just such a coordinated response. It's the story of one nation's longstanding commitment to public health around the world. That nation is the one to which we now turn: Cuba.


Cuba: "The Only Country Well Poised to Answer That Call"

Explaining "why the Ebola fighters are TIME's choice for Person of the Year 2014," TIME writes: "There was little to stop the disease from spreading further. Governments weren't equipped to respond..." This is not true. There is one government that was not only equipped to respond to a global health crisis, but that is responding, and in a big way: Cuba.

TIME's failure to mention Cuba is an odd omission, since it was just over one month ago (November 5th) that TIME ran an article by health reporter Alexandra Sifferlin entitled "Why Cuba Is So Good at Fighting Ebola." It started out by saying that "It's the only country besides the U.S. to send substantial human resources to West Africa."

That's an understatement, really. In late October the London Guardian reported, "Havana has pledged more health professionals to combat the disease than any other government, with 461 Cuban doctors and nurses receiving specialist training for a six-month mission to the affected countries. Cuba has already deployed 165 medical workers to Sierra Leone, bringing its total presence in the three countries to 256."

If the U.S. sent the same number in relation to its population, we would be sending 14,000 health professionals to West Africa. So far we have sent sixty-five. If we add in the 2,900 military troops providing non-medical support, such as logistics, engineering, and training, we still come up far short, proportionally, of the Cuban response. And it tells us something about the systems and structures of the United States, does it not, that in the face of an international health crisis the U.S. is able to provide 45 times as many military personnel as medical personnel.

The disparity can be seen within the two countries, not just in the international response. For example, there are 6.7 doctors for every 1,000 people in Cuba, while the U.S. has 2.4 doctors per 1,000 people.

TIME chose to highlight the contribution of the U.S. Government's Centers for Disease Control and Prevention, or CDC, noting that "The CDC, a large and very well-regarded public-health agency, is unsurpassed in its capacity for action, maintaining some 2,000 field workers in 60 countries around the world."

Unsurpassed? TIME's Sifferlin reported last month that "More than 50,000 health care workers from Cuba are working in 66 countries around the world". Cuba, a nation of 11 million, has an economy of $68 billion. The U.S. has a population of 316 million and an economy of $16.8 trillion, or roughly 247 times the size of Cuba's.

In TIME's Person of the Year article, they spelled out what brings people to help the Ebola-stricken population of West Africa, saying "In the killing heat of August, with Ebola uncontrolled, with no sign of help on the way from local or national or international cavalry, the time came for choosing. Who would run away? Who would stand and fight? The choice was deeply personal, one heart at a time."

True, the choices made in people's hearts have a lot to do with shaping our response to crises. But the actual capacity for effective action comes from work that is done, on the system level, at non-crisis times. Note this comment in the Washington Post of October 4th: "As of early September, with more than 1,800 confirmed Ebola deaths in Guinea, Liberia and Sierra Leone, there was still no coordinated global response. Alarmed U.S. officials realized they would need to call in the military." The military? That's because the U.S. has not developed sufficient non-military systems—the CDC is tiny in comparison—to respond to such a crisis. So the call to "do something" necessarily brings forward good-hearted people with guns and tools instead of good-hearted people with health-care skills.

What this shows us is that it is systems and infrastructure already in place that make it possible for the goodness in people's hearts to be translated into action at a time of crisis. And what kind of action depends on the nature of the systems. And here is where Cuba's capacity to express its solidarity with suffering people around the world—what they call "medical internationalism"—expresses itself most effectively.

This internationalism starts at home, and in the very hearts celebrated by TIME Magazine. The BBC notes that "Cuba's government has a long history of providing universal healthcare as a human right, a belief that was enshrined in the 1976 constitution." The result is that Cuba educates a huge number of doctors, from all over the world (including the U.S.). And Cuba's medical education goes beyond training in procedures and prescriptions. Here's how King's College scholar Eduardo J. Gomez put it in the BBC article cited above:

"Cuba's medical students have always been taught that it is their duty to serve others. An inscription by Fidel Castro emblazoned on a wall of Cuba's most prestigious medical school, the Escuela Latinoamericana de Medicina, sums up this ethos: 'This will be a battle of solidarity against selfishness,' it reads. Thus even prior to their arrival in West Africa, Cuba's healthcare workers believed that it was their duty to sacrifice themselves in the service of others, viewing themselves as true public servants, gladly volunteering and risking their lives to fight a virus that they had no experience of working with."

And it's not just a few heroic Cuban individuals fighting Ebola. When Cuba's government put out the call for medical workers to volunteer for Ebola duty in West Africa, more than 15,000 responded.

TIME's Sifferlin reports, "To prepare for something like Ebola, [Cuban] health care workers not only undergo aggressive training for the specific disease they are treating, but they also take courses on the region's culture and history as well."

Such courses enable Cuban medical workers to be exceptionally effective in the emotionally-charged atmosphere within which all Ebola workers must function. The Cubans are skilled providers of medical care, but, as the BBC's Gomez notes, "Apart from providing treatment, Cuba's medical workers also help to locate Ebola victims and guide them towards clinics. By providing constant reassurance of good treatment and care, Cuba's volunteers play a key part in helping Ebola victims overcome their fears of seeking medical treatment. This passion for locating, encouraging, and treating patients reflects Cuban health workers' unwavering belief in behaving in a selfless manner, treating patients with warmth, dignity, and respect. In this respect, little Cuba provides big lessons for other nations."

The concluding paragraph from TIME's Sifferlin sums up "Why Cuba Is So Good at Fighting Ebola":

"At the very least, the Cuban model has a message for the international community: that local people can work for the greater health of their homelands, and that constant preparation is more sustainable than being caught off-guard. 'Cuba's lesson for us is that health, and global health in particular, needs to be addressed with pro-active, forward-looking commitment to strengthening health systems, not just by reacting to [disaster],' says [Robert Huish, an assistant professor of international development studies at Dalhousie University in Canada]. Aid groups like the Red Cross and Doctors Without Borders have been calling for more physical boots on the ground, and so far Cuba has been the only country well poised to answer that call."

What is it, exactly, that allows a country to be poised to answer certain calls and not others? It's a set of shared values and priorities, expressed in thousands of ways over many years.

The vision that Cuba offers with its medical internationalism is a vision of a country built more on hope than on fear, more on solidarity than on selfishness. Nygaard Notes is produced in a country that produces far more soldiers than doctors. But it doesn't have to be that way. What if, when a USAmerican said, "I was in The Service," they meant the National Health Service and not the military?

I'm highlighting Cuba's inspiring response to the Ebola crisis not because I'm a member of the Cuba Fan Club. I'm sharing this as a way of saying that "We could do this, too." We have plenty of good hearts in this country; the problem is we have too many systems that are built around force and coercion. Maybe the story of the Cuban "Ebola Fighters" will help us to imagine a different United States, one that has systems built to channel the good in people's hearts into health care instead of war.