A Call to Action: First-Hand Accounts of Abuses in Cuba’s Overseas Medical Missions

New York Foreign Press Center Briefing on “A Call to Action: First-Hand Accounts of Abuses in Cuba’s Overseas Medical Missions”

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Okay, good morning, everyone. Thank you for being here.

[Audience Member] Good morning.

I am Morgan Ortagus, the spokesperson for the U.S. State Department, and I am honored to be joined onstage by my United States government colleagues and four very brave doctors. Dr. Tatiana Carballo, Dr. Ramona Matos, where are they, where are the doctors? Over there.

I got it, behind me. Oh good, hello. So, you can wave to everyone. Okay, Dr. Rusela Sarabia. (Rusela speaking in foreign language) Right here.

Okay. And Dr. Fidel Cruz. At the end.

Great. These four doctors have risked everything to escape a life they did not choose. This morning we will hear their personal accounts of harrowing stories about how the Cuban government exploited them, by sending them abroad for work in medical missions programs. I am also joined by a distinguished group of U.S. government officials who are working to bring these abuses to the public’s attention. With me today onstage is Carrie Filipetti, deputy assistant secretary for Western Hemisphere Affairs, John Barsa, assistant administrator for USA’s Bureau for Latin-America and the Caribbean. There he is, great. Ambassador Carlos Trujillo, U.S. permanent representative to the Organization of American States. And John C. Richmond, U.S. ambassador at large to monitor and combat trafficking in persons. In the audience we have Robert Destro, assistant security for the State Department Bureau of Democracy Rights and Labor. Right here. And my longtime friend Roger Carson’s deputy assistant secretary of state for the Bureau of Democracy Rights and Labor. Unfortunately, unable to join us today but watching from U.S. Embassy Havana are Cuban independent journalists, many of whom the Castro regime forbids from traveling outside of Cuba. We welcome you. Today the officials with me on the dais will call for action to stop the abuses that exist in Cuba’s medical missions programs. DAS Filipetti has been following this story closely, and initiated today’s briefing. We’ll start with her.

Good morning, thank you so much for everyone’s attendance today. And thank you to the Foreign Press Center and USAID for helping to organize this event. I also want to thank my colleagues both onstage and in the audience from the State Department and USAID. I think the high level participation in this briefing is a reflection of how seriously the United States takes the accusations against the Cuban regime. I really don’t want to say too much upfront, because the whole purpose of this briefing is to hear from our doctors, Dr. Matos and Dr. Carballo. Their government, the Cuban regime, has really denied them a voice for years. During their abuse they had their voices, their families, their money, their freedoms, in some cases their lives, stolen from them. Here at the United Nations our purpose is to come together as an international community to draw attention to abuses, and to help make the world a more equitable place for countries and our communities, and to seek justice for those who have been wronged. We’ve all read the numerous accounts in the media about the allegations on the Cuban regime’s use of human trafficking under the cover of the doctors program. But a few months I had the opportunity to meet with these two doctors to hear their stories upfront, and their brave testimonies, and those of hundreds of others that we have spoken to, paint a picture of a program that is not intended to provide support to countries in need, but rather is a manipulative corruption scheme intended to boost revenue for the Cuban regime all under the guise of humanitarian assistance. We have heard repeatedly that the Cuban government collected revenue for each professional services and paid the worker a mere fraction of the revenue, almost all of which was deposited in a bank account in Cuba to which they only had access upon completion of their mission and returned to Cuba. We have heard how the government collected $7.2 billion in a single year from the export of professional services through programs like the foreign medical missions. And while those services were ongoing, refused to provide even a living wage to those who are participating in it. We have heard accusations that doctors are coerced into the labor program and deprived of their rights and pay while separated from their families in Cuba. They are given no rights to travel. They are forced under Cuban surveillance. And they see retaliatory measures taken against their families should they choose to speak out. The United States Trafficking Victims Protection Act defines labor trafficking as the “recruitment, harboring, transportation, “provision, or obtaining of a person “for labor or services through the use of force, “fraud, or coercion for the purpose of subjugation “to involuntarily servitude, peonage, “debt bondage, or slavery.” What you will hear from Dr. Ramona Matos and Dr. Tatiana Carballo will not only alarm you but will raise serious concerns about Cuba’s role in human trafficking. We hope it will inspire countries who have participated in the Cuban doctors program to condition any future participation on direct payments to the doctors and other fair labor practices. It is clear that anyone who hears these stories and continues to engage with the Cuban doctors program without insisting on fair labor practices is complicit in these crimes. I want to thank Dr. Ramona Matos and Dr. Tatiana Carballo for being brave enough to step forward today and share their story. There are many others who are not able to speak for fear of retribution, either against them or their families. And you’ll hear some stories of that retribution from the doctors here today. What they have endured in their time in the medical missions program should not happen to anyone. And we sincerely hope that in sharing their stories today it will help prevent others from suffering these atrocities in the future. Thank you very much.

Thank you, DAS Filipetti, and thank you for organizing this today. Now, we’re gonna hear from Dr. Tatiana Carballo who worked in Cuba’s medical missions program in Venezuela for seven years, and in Brazil. She left the program in Brazil, putting herself and her family at risk. Dr. Carballo, would you please step to the lectern and share your story about being recruited into the Brazil program? And, then, please describe your time in Venezuela. (doctor speaking in foreign language)

Good afternoon, everyone, thank you so much for the U.S. State Department. And for the Foundation for Human Rights in Cuba, and allowing us the opportunity to tell our stories and let you know about the Castro regime. I graduated as a doctor in 1994 in the Medicine Faculty at Matanzas. So, as the Cuban government claim education is free of charge, therefore we are their property. So, since we graduate we get a menial, minimum salary, and that’s where the story with the medical missions, that’s where that starts. First we were sent to a country, to Belize, for 11 months. And, supposedly, in their contract which was no contract at all. They claim for this to be voluntary and for humanitarian purposes. And in none of the missions, whether it was Venezuela, Brazil, or Belize, this was not voluntary at all. So, in the Venezuela mission it was under military supervision where we were restricted. We were deprived from our freedoms. We were deprived from engaging with local people from Venezuela. So, we only got about 10 to 15% of the monies that the Venezuelan government was paying for our services. The rest of the money was being sent to an account in Cuba. Many of us decided not to return to Cuba. This money didn’t go to our families. This money was seized and was frozen in accounts by the Cuban government. So, in Venezuela we were under very, very difficult circumstances. We got pressure from the coordinators “who were nothing but agents of the government.” So, these security agents had us under constant pressure and what bothered me the most is that we had to falsify statistics. And, also, we had to influence the general population to vote for the regime, either for Maduro or Chavez. So, after the mission in Venezuela, I, myself, and many of us went there. I was there for seven years. Once this mission was over the Brazil mission was offered to us, and this was for people who had already undergone or went through the Venezuelan mission, which was like the starting point for the missions. PDVSA which is the petro company, the oil company from Venezuela, they were the ones who were disbursing the money and making payments for the mission. So, Brazil was actually very different, because this was actually being sponsored by PAHO, the Pan American Health Organization. So, we had to use the PAHO as intermediaries in order to be or participate in these missions. In Brazil, 75% of our earnings were going to the Cuban government, and 5% was going to Brazil. We only obtained the remaining to make us whole, or make the 100% of our fees. The money that was going to Cuba, and Ramona will talk about this, monies that we were paying for our services in Brazil was being sent to Cuba, and was being deposited into an account that was frozen by the government. So, in my case, we got paid 1,200 reales or local currency. Regardless of the U.S. exchange rate that’s all we got. So, in Brazil, each local government would pay for things such as food, clothing, and other necessities. In Brazil they have special conditions where they actually allow husband and wife and their children, their family unit. So, in my case, my son went there for three years. He was a minor, so his visa was derived from mine. When I went back to Cuba in 2016, I was forced by the government to sign a piece of paper which they called a contract. Stating that according to the Cuban conditions, my son had to return to Cuba every three months. He was not allowed to stay outside the country for three years. And that was impossible, because the airfare from Cuba to Brazil is super expensive, and we had to pay out of pocket. So, I decided to leave him in Brazil, basically hiding at home under the pressure of the so-called coordinators. I was tired of being subjected to all the abuse, feeling like a slave. They withheld my passport. I got tired of all the pressure that they were putting on us. I was exhausted and tired of lying, so I decided to join the Cuban parole visas, and that’s why I’m here telling you my story. That’s it, thank you so much. (audience applauding)

Thank you so much, doctor. Wonderful. Dr. Ramona Matos worked in Cuba’s medical missions programs in Bolivia and in Brazil. Dr. Matos, will you please share your story about your pay and restrictions? Then, you can tell us about your escape and what happened to your family. (doctor speaking in foreign language)

Good morning. (audience member speaking in foreign language) (doctor speaking in foreign language) I am Ramona Matos Rodriguez. I specialize in family medicine. I went to two missions, one to Bolivia in 2008. And the second one was in 2013 in Brazil. There is a lot to be told. I will briefly explain and tell you some of my own experience as to what we went through, how we were basically being trafficked, and how we were victims and exploited by the Cuban government. So, in 2008, I went to Bolivia in small town in the Amazons called San Augustine. When we went to Bolivia we were handed a red passport, which is an official passport. So, we were with this passport with us, stayed with us for the nine hours of the flight. So, as we were doing immigration to get into Bolivia at the airport, there was a state agent, a security agent from Cuba, who was taking away our passports. So, we basically were without any identification. We were undocumented. We had no documents bearing our names. We had no passport, no I.D. whatsoever. So, anything happened to us, suppose we got hurt, we die, nobody would know who that person who died or got hurt or anything, no one would know our identity. They never explained to us the geographic conditions that we had to endure in Bolivia. So, it was never explained to us the issues with the altitude. A few doctors or some of the doctors, five or six days into arrival, got very, very ill. Some of them died due to cardiac complications. What bothered me the most in that small town in the Amazons was that every day I had to write in a piece of paper fake names, fake ages, and addresses of people. That was just statistics. So, our handlers, these coordinators, we were forced and required to collect all this fake information, and otherwise we would be sent back to Cuba without any of our earnings or salaries, what they call a broken mission. If we broke the mission that meant that we would lose all our earnings. So, I was also– (doctor speaking in foreign language) Also, medication-wise, we had to see all these patients that did not exist, so we had to correlate the medication for the care of the patients, for patients that did not exist. So, we had to destroy the medications. In 2013 I went to Brazil in the Amazons area. The company called Mais Medicos. That’s where I realized that this was all a lie. We were getting $400 and $600 were being deposited into the bank account in Cuba, which monies that were actually frozen. Until you successfully finished and completed your mission. That’s why I went to the congress in Brazil. And I denounced the slaver-like work performed by Cuban doctors. They helped me a great deal. I had to request asylum in Brazil and also here in the United States, through the Parole for Medical Practitioners. When we got here aided by the Foundation for Human Rights we were able to establish and set up a legal claim, and that’s why we are here today. That’s it. (audience applauding)

Thank you so much, Dr. Matos, for sharing your story. Thank you. Now, I’d like to invite Assistant Administrator John Barsa to the lectern.

Thank you. Thank you for the opportunity to be here today. The disturbing accounts that we’ve heard from Dr. Carballo and Dr. Matos is really just the tip of the iceberg. Like DAS Filipetti, I’ve had the opportunity to sit down with both of them and engage in conversation. And what you hear about the details about the entire process, what they’ve gone through, it’s truly horrifying. They studied medicine to be doctors, to be healers, to dedicating their time and talent to others. And from what we’ve heard of today, the Cuban regime is exploiting them, making them sell their services. This business of forced labor is the functional equivalent of modern-day slavery. It constitutes the regime’s largest source of revenue. And it’s a primary means of spreading their influence and propaganda internationally as we’ve heard as well. So, you have still realize while these skilled doctors are sent to work in other countries allegedly for pennies on the dollar, Cubans on the island themselves struggle to find adequate health care and other basic services. The people of Cuba deprived of essential healthcare while the regime exports the island’s human resources, medications, and medical supplies in the name of profit, all the while the regime touting the false narratives that it treats its citizens with the best medical care in the world. Sunlight is the best disinfectant. So, we are calling on independent journalists, social media, bloggers inside Cuba and outside Cuba to try to bring light to this horrible practice that’s taking place right now in this modern-day age. Expose this gross violation of human rights. Let the world know about what these crimes. So, as Dr. Matos did, what she was able to do in Brazil, she was able to go to entities within Brazil to bring light of this. It’s certainly difficult for independent journalists and NGOs to operate within Cuba. What we have right now is with this practice of human trafficking, it’s taking place in foreign countries where NGOs, human rights activists, journalists have more access and more ability to expose this. So, we are calling on, again, journalists, activists, civil society organizations to bring light to this in these countries wherever it takes place. We also encourage civil society groups to combat the forced labor and trafficking in persons by supporting and advocating for the victims themselves. We ask you to raise awareness through networks in the international community. Let the world know about these crimes, about the human rights victims, the doctors. Thank you very much. (audience applauding)

Thank you, Assistant Administrator Barsa. Ambassador Trujillo, we welcome your remarks.

Thank you and good morning. It’s an honor to be here. And I would like to congratulate the courage doctors who have taken the time to be here. Listening to their story definitely inspires all of us. I think it’s important today to draw attention, for not only here in the United States but also for the, and the organizations in country in which you represent. And I think our call today is very, very clear. I had prepared remarks to go into the depths of this program. But what we’re really asking here is for a lot of the countries, the majority of whom are democracies and share the same values, respect human rights, who are continuing to traffic and conduct these type of activities with Cuban doctors in their countries, to please stop. Our message is very powerful. Across the Americas there are multiple countries that continue to have these programs. Brazil has renounced that program. President Bolsonaro mentioned in his speech. Other countries have that same obligation. The stories that you’ve heard today should not continue to take place. This should’ve never happened. And it’s a tragedy that right now as we stand here with these four doctors, there are thousands of others who are in the same position across the world. So, to our friends and to the countries who celebrate democracy, to the countries who honor human rights, to those civil society groups that defend them, you have a duty to stop this awful behavior. Thank you. (audience applauding)

That was very moving. Thank you, ambassador. I would now like to invite Ambassador John Richmond to the lectern.

The crime of human trafficking destroys human dignity. It is a crime that attacks the basic idea that everyone has inherent value. I am so grateful that the United States Congress created an office within the State Department to focus on human trafficking. And it’s a great honor to get to serve as the United States ambassador for this issue of human trafficking, which at its heart is all about freedom. It’s this idea that everyone should be free to make the most basic decisions about their lives. That they get to decide when they wake up in the morning, where they work, and who touches their bodies. I am deeply concerned. And you’ll see reflected in this years Trafficking in Persons Report from the United States State Department that Cuba has been downgraded to tier three, which is the lowest level of our ranking system regarding trafficking in persons. It was downgraded for its failure to meet minimum standards for the elimination of trafficking, and for making no significant efforts to do so. Despite persistent allegations, the Cuban officials have threatened and coerced some participants to remain in the medical program. The government took no actions to address forced labor in its medical foreign missions. In fact, the United States State Department has documented indicators of human trafficking in Cuba’s overseas medical missions each year since 2010, including in this year’s Trafficking in Persons Report. Forced labor, which is also referred as labor trafficking encompasses a whole range of activities from recruiting, harboring, transporting, and providing individuals, whether it’s through force, threats of force, psychological coercion, abusive legal process, deception, holding people’s identity documents, threats to their family members or third parties, traffickers. Whether they are traffickers as individuals, traffickers as organized gangs, or traffickers as state-sanctioned forced labor, that traffickers are using non-violent coercion to compel people to engage in work, or to compel people to engage in commercial sex acts. And this must stop. To date, the Cuban government has not made serious and sustained efforts. And we call on them to do so. We also look to governments around the world that they can, in host countries, investigate these crimes, gather information about indicators of trafficking and where cases of trafficking occur, that they can focus on those. The bottom line is that we want to keep freedom and human dignity at the center of our foreign policy. And we wanna on governments around the world to join us in that effort. I’m grateful for the courage of the physicians that spoke here today, grateful for their voice, their willingness to share their stories. It’s an honor to be here with them today. Thank you. (audience applauding)

So, we’re now gonna go into our Q and A portion. We’re gonna be able to take a few questions. But I’m gonna take the liberty of actually asking the first question. So, to Dr. Matos, when you were in Bolivia, how did you manage the medicines and the patient lists, and what instructions were you given about recordkeeping? (interpreter speaking in foreign language) (doctor speaking in foreign language)

So, when I was in Bolivia the advisors, the bosses, the handlers, who were not physically in that town. They demanded report at 6:00 p.m. In that report you had to write down that you had seen as a minimum 30 patients a day. I was shocked by that when I got there. The first day that I went to work I realized that no one was going there for health care. And I asked my fellow doctor who was there, too, I asked her how do see 30 patients a day? She said, “Well, you’ll figure it out.” That day I called my boss at 6:00 p.m. I told him, I haven’t seen any patients. You have to send me 30 names, with 30 patients. You have to make them up. You have to make up diagnosis. And that’s what I did that one month that I was there. If I didn’t do that, I would be sent back to Cuba with a revoked mission, and I’d be punished. And no access to the money that was being deposited into the account in Cuba. I witnessed at the pharmacy since we had no patients, all the excess medication had to disappear. We burned it or we got rid of it any way possible. Because the Cuban government, they had to justify the medication being used for those 30 fake patients. That medication was to be used for them, but there were no patients.

So, these stories are just so incredibly brave. I’ve been really honored to be here today. I’m now gonna turn it over to journalists Q and A. I have my very capable brand-new deputy Cale Brown, who just joined the State Department who’s gonna take over for me from here. Thanks, Cale.

Thanks, Morgan. So, we have time for a few questions. This first hand up.

Hi, I’m Maria Navarro from Agence France-Presse. Thank you very much for this opportunity. So, I have one question for the doctors, and another one for U.S. officials. My first question is what happened when you defect the program, when you abandon? What are the consequences, and what happened to the money that was frozen? Or if you could explain us that? (speaking in foreign language) And for the U.S. official, I would like to know if there is a program to help this professional to keep being doctors here in the U.S., and keep their healing vocation. Thank you. (doctor speaking in foreign language)

So, the first question was what happened with the money.

[Journalist] That was the first. (doctor speaking in foreign language) (journalist speaking in foreign language)

Okay. (doctor speaking in foreign language)

The monies were not given to our families. They stayed in Cuba, frozen, our earnings. Part of the money, a small amount, was given to us in the host country. The other money was going to Cuba. And for defecting or leaving the mission we were penalized eight years, even though we were so-called volunteers. (journalist speaking in foreign language) And your second question if there’s a program to help us out. (doctor speaking in foreign language) To be able to practice medicine in this country. The answer is no. (speaking in foreign language)

Okay. (journalist speaking in foreign language)

Yeah, I can. Sorry, I’m just gonna add one point to that. Yes, so, I mean, the issue is a lot of the when the doctors flee these programs. As was described, a lot of them have had their papers stolen from them and so on. So, we’ve had throughout U.S. history, we’ve had a number of different programs to try to ensure that Cubans do have a place here in the United States. So, we continue to have programs like the Cuban Adjustment Act, and others to facilitate their travel here. And, so, it is important to us that we are assisting them when they come to the United States. We don’t have any specific programs in terms of facilitating their continuation of being doctors here. But, obviously, they have come to this country. We’re trying to make sure that we’re drawing attention to the issue, so that we can stop this practice, so that they can actually serve as doctors in the countries where they’d like to serve as doctors as opposed to being trafficked, wherever the Cuban government tells them to go.

[Moderator] Thank you, a second question over here.

Carla Angola from EVTV Miami. I want to know who of them were in Venezuela. (speaking in foreign language) If you can tell us what exactly you have to live there, experience there, and if some ideology thing were part of the program inside those locations. (speaking in foreign language) (doctor speaking in foreign language)

Good morning. (doctor speaking in foreign language) I am Fidel Cruz. I am also a Cuban doctor who is part of this lawsuit. I was in Venezuela from 2011 to 2014. While I was there we went through the Chavez election and also Mauro’s election. So, while I was there we were influenced and forced by the so-called representatives our Cuban government or the agents to talk to each patient what we saw about the benefits and all the positive things of the Maduro regime and government, and to influence their vote. Especially and specifically for the Maduro elections, I was on the streets knocking door-to-door, encouraging people to go to vote, to go to the electoral polls and vote for Maduro. We had to write a report for our bosses, our handlers, where we had to show statistics as to how many of those patients that we saw we were actually able to take to the polls, and how many of them actually voted for Maduro’s regime. I think that answered your question. (journalist speaking in foreign language) (doctor speaking in foreign language)

So, the question was did you get any incentives for your patients? Did you have to bribe them as to treatment for them or medications in exchange of their vote? Answer, yes. We had to incentivize them and remind them that it’s thanks to the government and the Maduro regime that you are getting healthcare services, healthcare, medicine and so on. (doctor speaking in foreign language)

[Moderator] Thank you, next question.

Ellen Wellforce with the Thompson Lawyers Foundation. Two-part question. One, could you elaborate a little bit, I guess the doctors, on what legal claims you’re seeking from whom that the lawsuit that, I think, Dr. Matos mentioned. And, then, for U.S. officials, I’m just kind of curious, what countries are still sponsoring the Cuban medical missions, and what steps have been taken to ask them to stop?

We could start with the second part of that. The second question?


Yeah, that’s a great question, and obviously with the amount of money that we’re seeing come in to the Cuban regime it’s clear that this program is continuing across the world. So, we’re doing an in-depth analysis right now of exactly where it’s taking place. But we asses that there’s at least 66 countries around the world that are utilizing this program. I do think it’s for some of those countries, like Brazil for example, they have come forward to insist on fair labor practices. And after insisting on that, the Cuban regime decided to end the program. So, rather than engage in providing support for the people of Brazil who needed it, they decided, well, since we can’t traffic these doctors and benefit off of their labor, then we’re not going to engage. So, we’re doing a sort of outreach campaign to all of our posts to try to identify where these doctors are operating exactly, to understand the nature of those agreements. And, then, we’re putting on events like this as well as private engagements to make it clear to them exactly what is going on in these programs, so that they can’t say that they weren’t aware that it was human trafficking. And we know that lot of these countries do need medical support. But, again, that cannot be done through forced labor, and so we’re trying to find other ways that we can help them in identifying other opportunities to get medical care to their countries without using the program that uses slave labor.

I’m Sam Dub and I’m the attorney for the four doctors in the federal lawsuit. They asked a question about the lawsuit.

No, we should just do it.

[Journalist] And that question?

Yeah, we could answer that question shortly afterwards, all right. Next question.

[Lawyer] I’ll be here, I’ll be available. (journalist speaking in foreign language)

The question is just like for journalists when we are in Cuba in Cuba there’s our families. They suffer the consequences, threats and so on. So, is this the same case for the doctors who abandon the mission? And what happens to your families? (doctor speaking in foreign language) So, my name is Rusela Rivero. I also form part of this lawsuit. And I, myself, I am a victim of this prosecution or persecution. I have two children, they’re both doctors. My oldest son, he graduated. He became a doctor five years ago. And he basically lost his job. He’s working now as an exterminator. He goes with extermination technicians from all over the place, doing exterminating work. He’s not allowed to have consults or see patients. And he asked me what happened, and I, myself, am in shock and I asked. And the only answer that he gets is that, you know why this is happening and you have to comply with the plan. And he can withdraw himself from working, which he cannot because he needs to support himself. So, it’s really there and difficult situation that he’s going through, just because he’s my son. So, my second son, he graduated as a doctor in August of this year. When it came time for job placement, he was sent to a rural, faraway area on the outskirts, a city called Guama, far, far away. We are from the city of Santiago of Cuba. He does work as a doctor. He works in a doctor’s office. His fellow students, people who graduated with him, they actually got placed in the city, in Cuba. When he asked why he couldn’t get placement in the city, they told him, well, that’s what you get. That’s what you have to do. And that’s the end of it, just take it. That’s the way they were. There’s no explanations, you just have to do it.

[Moderator] Okay, I think we have time for one more question. (journalist speaking in foreign language) (doctor speaking in foreign language)

Question, do you think your children are bargaining chips? It’s the way of the regime to silence you. Answer, absolutely, they are using me, my children, they’re trying to silence me. It really breaks my heart. And it’s hard for me to admit it, but there is no way that I am going to be silenced. Gracias.


Thank you so much for your participation. Again, I wanna thank Doctors Carballo, Matos, Sarabia, and Cruz for their unwavering courage and personal sacrifice in raising global awareness about the exploitation perpetrated by Castro’s regime. Your stories are truly remarkable. And thank you guests for your participation. This concludes the event.

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