Screwing Global Health for the Sake of Spying

Two weeks ago, my husband and I visited a couple that we knew from university that I hadn’t seen since before we left for Korea in 2012. The wife actually got her Master’s in international development and worked in DC for a few years after graduating, but returned to Texas with a general distaste for the development industry. “I always wanted to work for USAID,” she told me, “until I figured out that they were just a tool of US foreign policy. I felt kind of betrayed – I thought they just helped people!”

usaid branded aid
Photo credit: USAID.

My friend’s complaint is common among development professionals. Many in the industry believe that US foreign assistance should come without political strings attached to it, and they object to practices such as obvious branding of foreign aid supplies and using aid as a tool to strong-arm other countries into going along with American foreign policy moves. Personally, I get that foreign aid is one of many tools in a country’s foreign policy toolkit – it may not be ideal, but it’s at least logical.

What’s not logical to me, however, is the use of aid – specifically, of global health interventions – as a cover for intelligence operations.

Development types will remember the uproar over the CIA’s use of a vaccination drive as a cover for collecting DNA in a (failed) effort to locate Osama bin Laden in Pakistan. (Widely reported as a polio vaccination drive, the CIA scheme actually used hepatitis B vaccine.) Pundits predicted – correctly – that it would set polio eradication efforts back and put aid workers in danger. Luckily for us, the CIA has now promised not to do it again – which is lovely, but a shame that it took three years for them to get around to doing.

Now it would seem that USAID is trying its hand at endangering global health efforts through half-baked intelligence schemes. Last week, the AP released its major investigative journalism report on a USAID operation that used young and inexperienced Latin American activists to try to stir up dissent in Cuban civil society. Aside from major issues such as the fact that the Latin American youths were poorly trained (and paid!) and not prepared for the risks they faced (particularly when USAID’s management of the scheme was utterly amateur), or the fact that this really is not USAID’s job, development professionals have been irate that yet another government covert operation has jeopardized global health – in this case, HIV/AIDS prevention efforts, in response to the revelation that one of the operatives used an HIV workshop to “recruit promising individuals”:

The choice of a U.S.-sponsored HIV workshop in Cuba is an interesting one, since Cuba’s HIV infection rate is one of the lowest in the world, and one-sixth that of the U.S. But it appears the disease was not necessarily the focus of the workshop, which was attended by 60 people. Fernando Murillo, after returning from Cuba, put together a report detailing his activities for Creative Associates, the USAID contractor hired to work against Cuba’s government. His only mention of HIV says it was “the perfect excuse for the treatment of the underlying theme,” meaning anti-government organizing.

In a press release, Congresswoman Barbara Lee (D-CA) blasted the program. “As co-chair of the Congressional HIV/AIDS Caucus, I am particularly concerned by the revelation that HIV-prevention programs were used as a cover,” she said. “This blatant deception undermines U.S. credibility abroad and endangers U.S. government supported public health programs which have saved millions of lives in recent years around the world.”

Frankly, I am scratching my head at why USAID thought that this kind of operation, or the “Cuban Twitter” called Zunzuneo that was uncovered earlier this year, was a good idea. Perhaps they are fighting to stay relevant in an era of US global health policy when the State Department and the White House are also jockying for position, but it’s no excuse. Jeopardizing global health programs, particularly programs that target HIV/AIDS – which is universally acknowledged as at the top of the global health agenda – is just a way to shoot yourself in the foot. In the end, they only lose credibility – and USAID, as a development agency, should understand what that can cost. They should know better.

Cuban Disaster Preparedness: Lessons Learned

Guest blogger: Joe Vargas

The California Disaster Medical Services Association, in conjunction with the Medical Education Cooperation with Cuba (MEDICC), provided an opportunity for 17 health care professionals to be part of an exciting research team to examine Cuba’s acclaimed public health system, including its renowned disaster preparedness and medical response systems. The research group traveled to Havana, Cuba in December 2010 for nine full days of lectures, educational presentations and interchange with Cuban medical professionals and public health response teams. Although the United States has not had diplomatic relations with Cuba and travel is restricted, the group was allowed permission under the US treasury’s general license for professional research that includes full-time health and emergency response professionals doing research in Cuba.

During the visit, the group examined Cuba’s elaborate yet unsophisticated system for population protection during disasters. Given their limited physical, technical and transportation resources, the Cuban people, including school children, are taught at an early age about their role and responsibility in a disaster. Education is compulsory up to the 12th grade. Cuba’s hurricane-prone geographical location has necessitated an efficient and coordinated approach with an emphasis on accurate, early and frequent communication information. These internationally recognized measures include prioritized evacuation procedures for vulnerable populations that include high-risk seniors, pregnant women, disabled and individuals living in remote areas where flooding occurs. Transportation is prearranged using city buses to evacuate large communities to safer ground until the storm diminishes. Other preparatory efforts include frequent meteorological reports, monitoring and the shutdown of power and utilities days before the storm arrives. Cuba is one of the few countries that offer early advisories and information phases as preludes to the hurricane watch. Historically, very few deaths and injuries have occurred as a result of the many powerful hurricanes (Charlie, Wilma, Ivan) that have struck Cuba using this preparation approach.

The group also toured several medical facilities including Havana’s polyclinics (neighborhood clinics). At these facilities, the research team was able to view Cuba’s robust primary prevention-focused medical system and understand its critical ties to civil defense teams and meteorological and information sharing systems. Highlights included meeting with grassroots organizations in disaster preparation, response and recovery, including neighborhood organizations and the neighborhood-based physician medical team. The Ministry of Public Health directs all health sectors to support a comprehensive system of healthcare specifically oriented to prevention activities and primary care. Family physicians work in residential neighborhoods where they are provided a home and a functional clinic. Working alongside a nurse, they are responsible for approximately 80-130 families in their community. This closeness allows healthcare professionals to provide immediate emergency and personal care to their neighbors. Physicians develop an overall understanding of all their community needs, which contributes to their overall wellness and whose population health indicators are comparable to developed countries like the US and Canada.

Team members will be sharing their experiences throughout the country at conferences and workshops. To schedule a presentation or for further information you may contact Joe Vargas at jvargas [at] ochca [dot] com.