There’s a story playing out right now across the Caribbean that should have every African health minister losing sleep — and almost nobody on this continent is paying attention.
But let’s start in The Gambia, because that’s where the story actually makes sense. In June 1996, the Cuban leader Fidel Castro, sent thirty-eight Cuban health workers to one of the smallest, least resourced countries on the continent. No fanfare. No CNN cameras. They just show up, and they start working. Thirty years later, the Barrow administration is welcoming 260 more, to staff 23 new clinics across the country. And somewhere in that gap between 38 and 260, between 1996 and 2026, something remarkable happened that the global development industry has never quite known how to categorise, because it doesn’t fit the story they like to tell about Africa.
It wasn’t aid. It wasn’t charity. It was two countries in the Global South deciding that they needed each other, and making it work for three decades.
I’ve been thinking about why this partnership doesn’t get more attention, and I think it’s because it’s inconvenient. It complicates the narrative that poor countries need Western institutions to function. The Gambia became one of the first African nation to implement the Integrated Health Programme in 1999, a full decentralisation of primary care that made the Cuban Medical Brigade the actual backbone of the country’s physician workforce. That happened not because of the IMF or USAID or a G7 summit. It happened because of a bilateral agreement between Banjul and Havana.
And then there’s Operation Miracle, the specialised surgical initiative that restored sight to thousands of Gambians. Or the School of Medicine and Allied Health Sciences, where Gambian students are now training to become the next generation of doctors in their own country. These are structural achievements. The kind of thing that takes decades to build.
The United States, specifically the Rubio State Department has spent the last year systematically pressuring governments to sever their agreements with Cuban medical brigades. They’ve revoked visas of Brazilian, African, and Caribbean officials whose only offence was maintaining health partnerships with Cuba. They’ve sent “sensitive” internal memos mapping out strategies to dismantle Cuba’s international medical programme country by country. Guatemala folded. Honduras folded. Jamaica, which received 50 years of Cuban medical solidarity, where Cuban doctors delivered babies and restored sight and performed tens of thousands of surgeries — is winding it all down.
The official justification is “forced labour.” And look, the internal economics of how Cuba compensates its doctors abroad is an internal issue but one doctor that I have spoken with tells me that “it’s a way to give back to my country after studying medicine for free.” They also said that the doctors feel a sense of pride in representing their nation overseas in a positive way.
But let’s be honest about what this campaign actually is. Cuba’s medical export programme is one of the last significant sources of revenue keeping the island’s economy from complete collapse, particularly after Washington imposed a total oil blockade in January of this year. Cutting off that income isn’t a labour rights initiative. It’s economic warfare — and the patients in rural Guatemala and Kingston, Jamaica are the collateral damage.
Some countries have refused. Trinidad and Tobago told Washington, essentially, to kick rocks and that it would rather lose American visa privileges than abandon the healthcare its people depend on. That took courage. The kind of institutional courage that comes from actually believing in your own sovereignty, not just performing it.
There are three lessons from 30 years on the ground that we can see. The first is that primary care is not glamorous, and that’s the point.The Cuban model, community clinics, preventive medicine, doctors embedded in the places where people actually live. Africa has too many glass-tower hospitals that serve the urban middle class and too few functioning rural health posts. The Cuban model inverts that.
The second is that the goal of any external partnership should be to make itself unnecessary.The most important thing happening in this Cuba-Gambia relationship isn’t the 260 doctors arriving this year. It’s the Gambian students at SMAHS who won’t need them in twenty years. Dependency isn’t solved by getting better partners, it’s solved by building your own capacity until partners become colleagues.
The third is that solidarity needs defending the way any strategic asset does.What happened in Jamaica didn’t happen overnight. It happened through sustained diplomatic pressure, visa threats, and a carefully constructed narrative that reframed doctors as exploiters. African governments and the African Union need solid frameworks, protecting South-South cooperation agreements from exactly this kind of third-party interference.
Thirty years ago, 38 people got off a plane in Banjul and went to work. They weren’t making a statement. They were just doing the job.
But it turned out to be a statement anyway, about what’s possible when two small nations in the Global South decide to take each other seriously. About what healthcare looks like when it’s built on need rather than profit. About the kind of solidarity that outlasts election cycles and geopolitical fashions and pressure from powerful countries that would rather you were dependent on them.
The Caribbean is being picked apart right now. Partnership by partnership, clinic by clinic. And the argument being made — implicitly, through visa revocations and diplomatic pressure — is that developing nations don’t get to choose their own health partners without consequences.
Africa’s answer to that argument is being written in Banjul. In 23 new clinics. In 260 doctors who showed up.
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