Earlier this year a Cuban doctor named Jorge received a WhatsApp message from a health official offering him the chance to work in rural Mexico. If he wanted the position, the official said, he’d have just a few hours to pack his bags. Jorge agreed immediately.

It wasn’t the first time Jorge, a trim man in his 40s with intense hazel eyes, had been posted abroad. Over the past six and a half decades, Cuba has turned its abundance of well-trained doctors and nurses into a valuable export. In much of the developing world, people associate the country not with missiles or Marxism, but with the health-care workers who live and work in places their local counterparts shun: rural villages, urban slums, the Amazon rainforest. The doctors programme is a humanitarian initiative, an expression of soft power and a lifeline for Cuba’s communist government—it is the country’s biggest source of foreign currency, bringing in about $4bn a year. 

Jorge’s first medical mission was during the pandemic, when he was placed in an intensive-care unit for covid-19 patients in Mexico City. It was the first time he had left Cuba, and the culture shock left him reeling. Having grown up in a country impoverished by a command economy and a decades-long American embargo, he was used to ageing infrastructure, secondhand clothes and empty shelves. In Mexico he spent hours staring wide-eyed at shop windows. Unused to feeling full, he would eat so much he felt sick. He’d wasted so much time standing in queues, fixing ancient appliances and walking to work when there was no petrol. Now he discovered the calm that came with not having to devote all his energy to survival.