The gift of health : Cuban medical cooperation in Kiribati : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Development Studies at Massey University, Turitea, Palmerston North, New Zealand

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Since its 1959 Revolution, Cuba has assisted more than 160 countries to deliver health care to the poorest and most remote communities in the world. Cuba draws on its experience of expanding primary care and building health workforce capacity with limited resources to help partner countries to develop their own comprehensive health systems. This example of South-South Cooperation reached Kiribati, a Pacific nation at the forefront of climate change where a combination of scattered geography, public health issues and insufficient health workforce continue to be barriers to the achievement of universal health coverage and the fulfilment of the right to health. Cuba has offered scholarships for I-Kiribati students to undertake medical education at the Escuela Latinoamericana de Medicina (Latin American School of Medicine, or ELAM) and nearly doubled Kiribati’s health workforce. While much of the literature on the Cuban medical cooperation analyses the programme itself, less has been said about the way it functions in particular contexts, particularly in small nations such as Kiribati. This thesis analyses how the Cuban health care model aligns with understandings of health in Kiribati, focusing on the similarities and differences between the countries’ health care systems, on the experiences of I-Kiribati doctors in translating the training received in Cuba to the Pacific context, and on the successes and limitations of the Cuban outreach. I argue that the Kiribati health system, and most of health assistance offered through traditional aid channels to Kiribati, focuses on a curative model of care that is not sufficiently responsive to the reality of the country. Drawing on Maussian gift theory to explore the value of reciprocal exchanges in international development, this study concludes that the Cuban approach to foreign assistance is primarily oriented by an ethos of solidarity that differs from conventional aid and which has the potential to provide an alternative way forward to deliver the gift of health to the global community. However, this approach does not always translate easily into Pacific health contexts and more work is needed to integrate the skills and knowledge of the Cuban-trained graduates and best use the gift of health they represent.