The Price of Alignment
Guatemala announced this month it will phase out its Cuban medical program, 412 workers, including 333 doctors, who've staffed rural clinics since Hurricane Mitch devastated the country in 1998. The decision came months after Guatemala agreed to accept more US deportation flights, part of a broader shift toward Washington under President Bernardo Arevalo, elected in January 2024.
The timing isn't coincidental. Guatemala joins a pattern visible across Latin America where Trump administration pressure is systematically dismantling Cuba's medical diplomacy network. Brazil expelled Cuban doctors in 2018 after Jair Bolsonaro's election. Jamaica is renegotiating its program now. The mechanism is straightforward: countries that want US economic access and cooperation must sever healthcare partnerships that have, in some cases, lasted more than 25 years.
What makes this effective is that it targets both ends of the arrangement simultaneously. Cuba faces severe power, food, and medical shortages since the Trump administration imposed an oil blockade in January. Partner nations face a choice between maintaining healthcare infrastructure and preserving their relationship with Washington. The doctors themselves become pawns, recalled to an island in crisis or left in limbo as host countries terminate contracts.
How Cuba Built Influence Through Stethoscopes
Cuba began sending medical missions shortly after the 1959 revolution brought Fidel Castro to power. The logic was simple: a small, resource-poor nation couldn't compete militarily or economically with regional powers, but it could train doctors. Lots of them.
The model evolved into a sophisticated revenue system. Cuba leases medical personnel to countries worldwide, collecting the majority of doctors' salaries while paying the workers a fraction. The exact figures remain opaque, Cuban government finances aren't transparent, but the arrangement has generated substantial foreign currency for decades. Host countries get healthcare workers at below-market rates. Cuba gets cash and geopolitical influence. The doctors get international experience and modest income, though critics call it exploitation.
Guatemala's program illustrates how these missions embed themselves in host countries' infrastructure. The Ministry of Public Health stated the partnership was originally meant to support recovery from Hurricane Mitch, which killed over 11,000 people across Central America in 1998. Nearly three decades later, those 333 Cuban doctors aren't emergency responders, they're the primary care system in rural areas where Guatemalan doctors rarely practice.
That's the vulnerability Trump's team is exploiting. These aren't symbolic partnerships that can be quietly shelved. They're load-bearing structures in healthcare systems that lack alternatives.
The Architecture of Pressure
The Trump administration's approach differs from previous US efforts to isolate Cuba. Rather than simply maintaining the embargo and waiting for the Cuban government to collapse, this strategy actively dismantles Havana's alliance network by pressuring third parties.
The oil blockade imposed in January creates domestic crisis in Cuba, power outages, food shortages, hospitals running low on supplies. That makes it harder for Cuba to support its overseas missions logistically and politically. Simultaneously, the US leverages its economic and diplomatic weight with partner nations. Guatemala's cooperation on deportation flights signals broader alignment with US priorities. Terminating the Cuban medical program becomes part of that package.
Brazil's 2018 experience set the template. Bolsonaro campaigned against the Cuban program, calling it "slave labour" and demanding doctors be allowed to bring their families and validate their credentials through Brazilian medical boards. Cuba withdrew its 8,000 doctors rather than accept those conditions. The program ended, and Brazil's rural healthcare system lost a significant portion of its workforce overnight.
Guatemala's situation mirrors this but with a crucial difference: Arevalo didn't campaign against the Cuban program. His government moved closer to the US after his election, and the medical mission became collateral damage in that realignment. The Ministry of Public Health framed the decision as "phasing out" rather than termination, bureaucratic language that suggests discomfort with the optics.
The Calculus for Developing Nations
What does Guatemala gain by ending the program? Access. The US remains Central America's dominant economic partner and security guarantor. Cooperation on deportations and Cuban doctors signals reliability to an administration that views hemispheric politics through a transactional lens. That cooperation could translate to trade preferences, development aid, or simply avoiding punitive measures.
What does Guatemala lose? Healthcare capacity it cannot immediately replace. Training a doctor takes years. Recruiting Guatemalan physicians to rural posts has failed for decades, that's why the Cuban program existed. The 333 doctors leaving represent a gap that won't be filled by market forces or goodwill.
The patients in those rural clinics don't factor into the diplomatic calculation. Neither do the Cuban doctors themselves, who face recall to an island where hospitals lack basic supplies and power outages last for days. The transaction happens above their heads.
Jamaica's Renegotiation and the Ripple Effect
Jamaica's decision to renegotiate its Cuban medical program signals that other countries are watching Guatemala's move and calculating their own positions. The details of Jamaica's renegotiation haven't been made public, but the fact that it's happening at all indicates the pressure is hemispheric, not isolated.
Several countries have maintained Cuban medical partnerships for more than 25 years. Those relationships predate the current political moment and have survived previous shifts in US policy. That they're now vulnerable suggests the Trump administration's approach is more aggressive than past efforts.
The question facing these nations is whether they can maintain Cuban partnerships while preserving US relationships. The answer appears to be no, at least not without significant political cost.
Who Pays When Healthcare Becomes Leverage
The Trump administration wants to stop Cuban doctors from serving abroad, viewing the missions as a revenue stream that props up a government Washington opposes. That goal may succeed. Cuba's economic crisis makes sustaining overseas missions harder, and diplomatic pressure is forcing partner nations to choose sides.
But ending the missions doesn't solve the underlying problem that created them: developing nations lack sufficient healthcare workers, particularly in rural areas. Guatemala won't suddenly produce 333 doctors willing to work in remote clinics because the Cuban program ends. Jamaica won't either. The market failure that made Cuban doctors attractive persists.
The irony is that both governments, Havana and Washington, claim to be acting in doctors' and patients' interests. Cuba frames medical missions as internationalist solidarity. The US frames pressure to end them as liberating exploited workers. Neither framework accounts for the Guatemalan patient who loses access to primary care, or the Cuban doctor recalled to an island where hospitals lack electricity.
The doctors caught between two governments, and the patients who depend on them, aren't abstractions in a geopolitical chess match. They're the people who pay when healthcare becomes a weapon.