Part one of this article addresses the need for Cuba’s participation in conflicts in Zaire, the Congo and Guinea-Bissau during the 1960s to remain concealed for over three decades. It covers the background to the struggles, what Cubans found in Africa, the role of race relations in Cuba’s campaigns, and the recruitment of doctors. The second part will explore the working conditions of revolutionary military doctors, physical and emotional consequences for participating physicians, interactions with African civilians, Cuba’s first large medical scholarship program, the first mass vaccination effort in Africa, and how Cuba’s military and medical efforts affected Africa.
Cuba’s deployment of military doctors to Africa in the 1960s was secret, known only at the highest level of government. Accounts of these hidden efforts were not published until the beginning of the 21st century.
Multiple forces during that decade pulled Cuba toward struggles in sub-Saharan Africa. First was the mushrooming of popular movements across the globe. The US civil rights movement was joined by millions opposing the war on Viet Nam. Zaire won independence from Belgium in June 1960 and the popular Patrice Lumumba became its first prime minister. After leading the National Liberation Front to victory over French domination in 1962, Ahmed Ben Bella was elected as the first president of Algeria. In August, 1966 Mao launched the Great Proletarian Cultural Revolution to thwart the growth of capitalism in China. May 1968 saw a huge left upsurge in France going beyond the Communist Party.
A second force pushing Cuba’s foreign policy came from the US. Its continuous violence gave a clear message that the best defense for the island would be an international offense. Two decades earlier, the US had experimented with nuclear extermination in Hiroshima and Nagasaki. During the previous decade, the US had slaughtered roughly 20% of the population of North Korea and the CIA engineered the overthrow of the progressive Jacobo Arbenz government in Guatemala. Fresh on the mind of Cubans was the connivance of John and Bobby Kennedy in the 1961 Bay of Pigs invasion and the 1962 missile crisis. The US began its series of efforts to kill Fidel Castro about the same time the CIA contemplated how to poison Lumumba. Asserting dominion over Latin America, Lyndon Johnson invaded the Dominican Republic in 1965.
In the meantime, the Soviet Union was not acting like a reliable ally. The USSR had not sent troops to fight in Korea and did not do so in Viet Nam, even after the massive US build-up following the 1964 Gulf of Tonkin incident. Nikita Khrushchev had settled the missile crisis without bothering to consult Fidel. His successor, Leonid Brezhnev, was clear that Cuba should accept the subordinate status of sugar producer for the Soviet bloc.
Furthermore, Latin American Communist Parties (CPs) did not take kindly to Cuba’s “foco theory” of revolution. Those CPs centered on urban working-class movements while the Cuban leadership looked to a dedicated vanguard in the countryside, garnering support through armed struggle. As Che Guevara wrote, “a small group of men who are determined, supported by the people, and not afraid of death…can overcome a regular army. This was the lesson of the Cuban revolution.”
Unlike countries in Latin America, those in Africa did not have established Communist Parties hostile to guerrilla efforts. With at least a third of Cubans being of African heritage, Cuban leaders felt beckoned from across the Atlantic.
Hope Meets Reality in Africa
Despite efforts by the US to isolate Cuba, by 1964 it had embassies in the African countries of Algeria, Egypt, Ghana, Guinea, Mali, Morocco and Tanzania. Lumumba had been murdered in January 1961 by allies of Moise Tshombe. The Simbas (lions), admirers of Lumumba, began a guerrilla struggle, routed government forces in 1964, and seemed to have strong revolutionary potential.
In December 1964 Che began a three-month trek to Algeria, Ghana, the Congo, Guinea, Mali, Benin, Tanzania, and Egypt. Planning to lead an African initiative himself, Che went to develop strategies and agreements with liberation movements. During his January 1965 meeting with leaders in Tanzania, Che emphasized the Simba upsurge and proposed Zaire as the location for centralized training. They disagreed with him, each wanting training camps in their own country.
The more Che came to know the heads of several organizations, the more skeptical he became. He observed that they “live comfortably in hotels and have turned rebellion into a profession, at time lucrative…” Once on the battlefield, his doubts were confirmed:
“Che had been told that he would find several thousand well-armed Simbas, eager to fight. There were, in fact, some 1000 to 1500 widely dispersed rebels, who had no idea of how to maintain their modern weapons … they lacked a unified command.”
“The scouting teams … brought back grim reports from the fronts: idle rebels who … did not know how to use their firearms and showed no inclination to attack or to prepare to defend themselves. Everywhere chaos, disorganization, and lack of discipline.”
Cuban leaders, soldiers and doctors wrote of their frustration in Zaire. In November 1965, after a governmental coup, a Simba leader notified Che that they wanted to end the war. Che returned to Cuba with part of the unit he commanded, while others went to different African locations.
The neighboring Congo was headed by Alphonse Massamba-Débat, whose socialist views were similar to those of the Chinese Communist Party. In August 1965, Fidel dispatched a unit to the Congo which joined the 50 or so Cubans already there. The group was headed by Jorge Risquet, who was “the descendant of an African slave, her white master, a Chinese indentured servant, and a Spanish immigrant.”
In the Congo the Cubans discovered that the rhetoric of the country’s leaders did not match their politics, which were based on opportunism and personal feuds. Since Fidel had charged Risquet with defending the Congo, when an attempted coup broke out on June 27, 1966, the Cubans came to the defense of the government. Wanting to resolve the dispute diplomatically rather than with force, Risquet appointed a doctor to lead the maneuvers. The rebels backed down when confronted by the determination of the smaller number of Cubans. On July 6, the revolt ended with only one Congolese death.
It soon appeared to the Cubans that their major task in the Congo was protecting one faction from another. Risquet persuaded Havana that the best thing for them to do was to leave, which they soon did. Two years later, a successful coup overthrew Massamba-Débat’s government.
The uprising against the Portuguese in Guinea-Bissau stood in sharp contrast. Even US intelligence reports described it as having “Africa’s most successful liberation movement.” During his 1965 journey through Africa, Che spoke with Amílcar Cabral, who head of the African Party for the Independence of Guinea and Cape Verde (PAIGC, for its acronym in Portuguese).
Fidel recognized the importance of the Non-Aligned Movement, which coalesced third world countries breaking from the yoke of imperialism. He persuaded those organizing the Tricontinental Congress to meet in Havana on January 3, 1966 and invited Latin American groups dedicated to armed struggle. It was there that Fidel and Amílcar Cabral first met and spoke extensively. Fidel promised Cabral doctors, military instructors, and mechanics. Both made impressive speeches to the delegates and Fidel emerged as a champion of revolutionary movements.
For a critical year, Victor Dreke headed Cuba’s military undertaking in Guinea-Bissau. Dreke was a black Commander who received extremely high praise from Che for his efforts in Zaire. Dreke was impressed by the discipline of the PAIGC. When he returned to Cuba in late 1968, Cabral’s forces had strengthened their position. The Portuguese lost ground even while increasing their troops from 20,000 to 25,000.
Cuba never had more than 60 soldiers in Guinea-Bissau. This was one way Cabral kept the PAIGC in command, the other being the restriction of foreign military aid only to Cubans. Yet, the Cubans’ roles as military advisers and teachers proved invaluable. When Castro went to Africa in 1972, the PAIGC was the only force on the continent successfully fighting against a white regime.
Cuba also played minor roles in Angola, Cameroon, Equatorial Guinea, Tanzania and possibly other countries. However, this article concentrates on Zaire, the Congo, and Guinea-Bissau, which were, by far, its major arenas. 
Much of the information regarding experiences of Cuban physicians in Africa is from interviews with 13 military doctors which both parts of this article refer to.
White Doctors, Black Soldiers
Cuban doctors going to Africa were almost all white while its troops were almost all black. It was very rare for black people to become doctors before the revolution. But they rose quickly to high positions in the revolutionary military. Race was critical in every aspect of the African conflicts.
The US had strong advantages over Cuba in its influence of Africa: it could offer vastly more economic aid and wield the political power of its European allies, accrued by their history of conquest and ongoing domination. But throughout the 1960s, the US was increasingly tied up in Viet Nam and its ongoing racism repulsed people around the globe.
Racism in the white regimes of Africa was blatant and horrific. The London Observer reported that mercenaries paid to put down the Simba rebellion “not only shoot and hang prisoners after torturing them, but use them for target practice and gamble over the number of shots to kill them.” One mercenary wrote in his memoirs of the “the White Giants—‘tall, vigorous Boers from South Africa; long-legged, slim and muscular Englishmen from Rhodesia’—who would restore, in Zaire, the white man to his proper place.”
African resistance leaders realized that they could use the inability of racists to tell one group of black people from another to their advantage. The revolutionaries in Zaire requested that the Cubans sent to their aid be black so they could pass undetected by US and Europe spies. Cabral asked Cuban officials to send technicians who were “black or dark mulattoes so that they would blend in with his people.” This fell into place with the PAIGC’s policy of denying that they involved any foreigners.
When Fidel asked Dreke to select troops who would serve with Che in Zaire, he specified that he had to “choose a platoon of men who have shown their mettle, who are all volunteers and who are dark-skinned blacks.” Both Dr. Rodrigo Álvarez Cambras and Dr. Julián Álvarez Blanco did not know that Africa was their destination until they saw that almost all the combatants in training camps were black.
This meant very different experiences for those traveling by ship to Africa. Dr. Álvarez remembers Pavlovian conditioning when traveling aboard the Soviet ship Félix Dzerzhinsky:
“Since the doctors were all white, there were no problems with anyone seeing us. But the troops were all black, and, in order to make sure that none of the passengers or US spy planes would guess the purpose of the mission, they had to stay in the lower deck of the ship, which was hot and had poor ventilation. Occasionally, they could come out for brief times at night.
Since the Russian food was very strong with disagreeable odors, the comrades who had to stay below without fresh air would get nauseated and vomit when they smelled it. The captain had a gong that he hit in front of a microphone in order to announce that it was time to eat. Some of the comrades started vomiting when they heard the gong.
At that point, I told Risquet that he had to tell the ship’s captain to stop banging the gong. He replied that it was me, as a doctor, who had to have the conversation with the captain. When I did so, that robust Russian failed to understand the situation and argued that it was a tradition that he could not violate.”
Though the white doctors could lean over the side of the ship to vomit, it must have been profoundly unpleasant for black troops confined to the lower deck. In response, and to the outrage of the Russian captain, the Cubans stole the gong and heaved it into the Atlantic.
How successful was the strategy of recruiting black troops? It significantly slowed the ability of Western powers to detect Cuban involvement. A British adviser in Zaire observed US agents looked “for whites and their eyes … passed over Cuban blacks or mulattoes.” The same was true for the Congo, where bewildered officials from the US, France, West Germany and England “…were unable to ascertain how many Cubans were in the Congo.” A Belgian ambassador could not tell if there were 100 or 800 Cubans since “they are difficult to pick out because they are all colored.” It was likely a serious affront to the dignity of white supremacists to see black Cubans so successfully bamboozling them.
Western observers could only be successfully confused about Cuban involvement if Cuba’s own recruits were in the dark concerning their destination. Rodolfo Puente was the only one of nine physicians interviewed by Hedelberto López who was openly told where he was going (the Congo). Others were led to believe that they were going to Algeria, Vietnam, or “other lands,” or that they should tell their families that they would be studying in the Soviet Union.
The physicians were accustomed to disruption in their careers. Of the 9 interviewed by López Blanch, 2 had to delay when they began medical school because Batista had closed it at the end of 1956. The other seven started school before the 1956 closing but had to halt their studies and resume them after the 1959 revolution.
Waiting to discover exactly where they would be serving was only one indication of the vital importance of their mission. Every one of the nine physicians interviewed in Historias Secretas met some combination of Fidel Castro, Raúl Castro, Che Guevara, MINSAP (the Cuban Health Department) head José Ramón Machado, Commander Jorge Risquet, Commander Victor Dreke, and Amílcar Cabral either before, during, and/or after their trip to Africa.
Preparing to leave for Zaire, Rafaél Zerquera recalled that “April 10, 1965 was the happiest day of my life when I was interviewed by Fidel Castro.” Shortly after arriving in Zaire, Diego Lagomasino “gave Che a suitcase with asthma medicine and bullets for a M-1 gun. Meeting someone like Che had a big impact on [him].” Héctor Vera spoke with Fidel upon returning from Zaire: “Fidel asked about sicknesses, malaria, how we were able to diagnose, and what treatments we used. After chatting, he told us that we could not divulge anything about the mission.”
Before departing for the Congo, Rodrigo Álvarez described having breakfast with Fidel.
“[He] spoke to us of Africa in general without specifying the country. He asked if we had pistols, and I said, yes, a P-38. He told his assistant to find a better weapon and he brought a Stich of 20 shots. Fidel saw that I wasn’t wearing a watch and told me that it was important for a doctor going to war to have one. He took off one of the two watches he was wearing, a Longines, and gave it to me.”
When Diego Lagomasino did his post graduate Rural Medical Service (RMS) in Santo Tomás, he worked alone and “had to be the doctor, nurse, distribute medications, and look for supplies.” This multi-tasking helped prepare him for Africa. Rafaél Zerquera’s RMS was used as a screening to see if he was suitable for Zaire. He explained that
“When I graduated, a document circulated asking where we would like to do our RMS and I wrote ‘wherever the revolution needs me.’ José Ramón Machado of MINSAP, called me to his office and said that there was a conflict zone in the Sierra Maestra, where a group had burned the medical post and killed the doctor. He asked me if I was still disposed to going.”
Zerquera replied that he would go where Machado assigned him. After a short stint in the Sierra Maestra, Machado called him back to let him know that an important but highly risky international mission awaited him and Zerquera was soon on his way to Zaire.
Once they learned of their destinations, the doctors still had little idea of what was in store for them. Luís Peraza recalled that all he “knew about Africa was the Tarzan movies.” Impressions of their experiences differed sharply according to country, with Zaire being the gloomiest. As the curtain was drawing to a close in Zaire, Che called a meeting of Communist Party members and asked who still thought that they could win. Only 2 military leaders and 2 doctors raised their hands and Che concluded that they might have been showing him personal support. Che then asked who would be willing to fight until death and all the hands went up.
Rafaél Zerquera recollected that the Simbas did not seem interested in preparing for a guerrilla struggle. “It was an experience but it wasn’t pleasant. If it had been a sacrifice with a reward, I would have felt satisfied. But it was not rewarding.”
Justo Piñero had different feelings about the Congo. “The population identified with us. We bought things from them. We went to the same places and knew the local people from seeing them on the street.”
By far, the most positive memories were of Guinea-Bissau. Domingo Díaz knew “many brave Guinean officers and soldiers who would have given their lives to prevent a Cuban from falling into the hands of the enemy.” Dr. Milton Hechevarría emphasized that when he got back to Cuba, he “couldn’t forget Guinea-Bissau.”
Whatever country they went to, Cuban doctors faced a combination of stressful conditions that they were unlikely to have experienced at home: incredibly rough terrain, enemy fire, and unpleasant and dangerous animals. Diego Lagomasino described arriving in Zaire: “We had to go to the base camp that was on the top of a high ridge. We left at 6 in the morning and at 7 in the evening we were still climbing. Never in my life had I seen a ridge that tall. I thought I was going to die.”
Looking back on the same walk, Héctor Vera felt like he could not bear the weight of his pistol, ammunition, medical supplies and personal belongings in his knapsack. He was saved by a Zairean boy who motioned that he would carry it for him.
In Guinea-Bissau, Domingo Díaz went on strenuous walks for 7 or 8 days, walks with deep holes that could not be seen after it rained. “In this region, we didn’t measure time with a watch,” Díaz recounted. Instead, time was measured “with distance, which is to say one day’s walk, half a day walk.” He concluded that the terrain was so rough that “in Cuba there was no possibility of training for this type of event.”
The land intensified military dangers. To avoid detection by the enemy, Héctor Vera’s group crossed Lake Tanganika with several Simbas who began lighting matches to see where they were going. The Cubans in the boat told them not to because there was a gasoline motor that could catch on fire. However, they replied that there was no other way to see and continued with the matches. Upon arriving in Zaire, they had not gone 50 meters before they had to fall to the ground as enemy planes flew overhead.
In Guinea-Bissau, the Portuguese attacked Amado Alfonso Delgado’s group with napalm while 15 helicopters landed to hunt them. They survived by running from 7 in the morning until 5 in the afternoon.
The doctors encountered insects, reptiles and other creatures they had never seen before. In an emergency military undertaking in the Congo, Rodrigo Álvarez saw anthills so tall that they prevented their plane from landing. Fleeing from the Portuguese in Guinea-Bissau, Amado Alfonso Delgado
“… bumped into an enormous beehive. I had over 300 stings. Only 10 are dangerous and can send a person into shock. But I was under so much tension that my body was producing steroids, which is exactly the treatment used. None of the stings became inflamed and the other six with me had the same luck.”
While none of Cuba’s snakes are poisonous, many are in the Congo, where Julián Álvarez thought he ran across them everywhere.
Waters in Guinea-Bissau were often inhospitable. Domingo Díaz described walking through a lake for hours with water up to their chests. “It was full of leeches and they advised me to tie my pants tight and walk with my arms up so they could not get in. When we got out we were attacked by mosquitoes that bit through my coat.” Another day, they found that
“The Corubal and Gaba Rivers met where they emptied into the sea. It was like an arm of the sea where there were sharks, hippopotamuses, and crocodiles. As we crossed in canoes made from tree trunks they told me to be careful because a man had recently fallen in and never reappeared.”
Don Fitz is on the editorial board of Green Social Thought and is editor for the newsletter of the Green Party of St. Louis. He has been the candidate of the Missouri Green Party for Governor (2016) and for State Auditor (2018).
A version of this article with full citations appeared the November 2018 print and online issue of Monthly Review. The author thanks Rebecca Fitz for interview translation and John Kirk, Linda M. Whiteford and Steve Brouwer for their helpful comments on an earlier draft of the article.
- Two Congos had revolutionary movements. The “Belgian Congo” was sometimes referred to as Congo Leopoldville from the name of its capital city. Upon independence in 1960, it took the name Kinshasa, became Zaire in 1971 and the Democratic Republic of the Congo in 1997. The current article refers to it as Zaire. The “French Congo” was sometimes referred to as Congo Brazzaville from the name of its capital, or the Congo. After independence in 1960 it became the Republic of the Congo, the People’s Republic of the Congo in 1969 and, after 1991 the Republic of the Congo again. The current article refers to it as the Congo.