Despite the progress the UIC-Cuban Ministry of Health collaboration has made for patients and diplomacy, the path ahead for US-Cuban healthcare partnerships is far from sure. Political and policy changes have already begun, and they have the potential to completely reshape US-Cuban relations.

Firstly, political power has changed hands in the United States. The Chicago programs’ main political supporters at the federal level were Democrats, who do not currently hold the majority in Congress.  The Chicago program was built off the foreign policy of the previous Democratic president, and has already been walked back by the current Republican one, who seems inclined to further distance the United States from its island neighbor. In fact, the Cubans’ first Chicago visit was expedited, according to Dr. Jose Armando Arronte Villamarin, so it could be completed prior to January 20th, 2017 – Donald Trump’s inauguration day.

Since the election, President Trump’s June National Security memorandum, and subsequent Office of Foreign Assets Control (OFAC) November regulation changes, have “reaffirmed” the embargo. Some Congress members, such as Senator Marco Rubio, have been strong activists for a rollback of President Obama’s policies. In September, the State Department ordered the withdrawal of non-essential personnel from the US embassy in Havana and Cuban diplomats in the US were expelled due to a series of mysterious “sonic attacks.”

The overall impact on the bilateral relationship has been immediate and chilling. Visa operations at the US embassy have been suspended, so Cubans have to go to a third country for visas. For American scientists, the attacks, policy transition, and political aftermath discourage their participation in Cuban programs and have put some collaborations on hold.

These changes have not, however, definitively invalidated the 2016 memorandum of understanding (MOU) between the American Department of Health and Human Services and the Cuban Ministry of Health, which “establish[ed] a strategy for cooperation in the field of health and its development, through … scientific, academic, technical, and research based projects and exchanges”- in short, projects like the one in Chicago.

The contrast between the living MOU and the new administration’s positioning have left both Cuban and American academics hesitant but determined to continue working together. Looking forward with cautious optimism, the doctors all expressed their doubts and deep belief in their humanitarian mission.

Based on American public opinion, they have reason to be hopeful. Polls show that, in 2015, 59% of Americans supported ending the trade embargo and re-establishing diplomatic relations. In 2016, the Pew Research Center found that 3 in 4 Americans supported those policies, including 57% of conservative Republicans. When applied under Obama, those policies generated notable business interest as well.

However, cooperation also depends on Cuban political support, and Cuba is about to undergo an even bigger political shift than the recent American election. Cuba will be leaving behind the Castros for a new name and generation.

Raul Castro is set to step down in April 2018, and first vice president of the Council of State, Miguel Díaz-Canel, is predicted to take his place. Raul’s departure has already been delayed once, and there is some doubt as to how much power he would immediately hand over to a successor. Given the choice, Díaz-Canel, may push to open trade and global relationships. The fact he is not a Castro may make a closer relationship with the United States that much more possible. However, Díaz-Canel’s personal position on American rapprochement and the amount of power he will yield are not yet clear.

Regardless, biotechnology has long been a Cuban priority, and a relationship with the United States means a market for Cuban products and opportunities for further research. Problems with existing programs could make new agreements even more attractive.

Sending low-wage, high-skill workers abroad has always been a risk for Cuban medical diplomacy missions. Not only can workers defect, but doctors and other health professionals in receiving nations may object to displacement by Cubans. In Brazil, Cuban doctors sued due to low wages and poor work conditions, while Brazilian organizations questioned the constitutionality of the exchange program.  In Venezuela, Cuban doctors have objected to the appalling local conditions. In Cuba, the problem of desertions among non-physicians on missions has become pronounced enough for authorities to consider measures to minimize non-medical workers abroad.

Medical cooperation with the United States may present an opportunity for Cuban medical diplomacy to establish alternative, lucrative partnerships, and for Cuban medical science to overcome some of their in-country restraints – even without a rollback of the embargo.

The collaboration in Chicago seems to have been proof of this successful diplomacy. With the embargo securely in place, Cuban medical diplomacy has made its way into US labs and communities. Setting new precedents, the Chicago project yielded promising results and lasting relationships. Despite a political shift, the academic, economic, and popular desire to work across the straits is strong.

Mutually beneficial partnerships are a stepping stone, and ideas spring eternal. Even now, Drs. Winn, Armando, and Tossas-Milligan are planning new projects to improve healthcare in both Cuba and the United States together, and they are not alone.

The content of this piece and series is based on interviews with medical doctors involved with the UIC-Cuban Ministry of Health program.

Originally published in Open Americas