US pressure on Cuba is rising. A country that has already been under US-led and enforced embargos for almost 70 years, Cuba is now in the crosshairs of the Trump administration, with a new policy that is isolating it further and having a devastating effect on Latin America and the Caribbean. The US has blocked the employment of Cuban doctors, medical professionals who go where others fear to tread and who have propped up healthcare across the region for decades.

I spoke to the Guardian’s South America correspondent, Tiago Rogero, about the impact of Trump’s policy and what makes Cuban doctors special.

The doctors who go where others will not

Thanks to sanctions, Cuba has two main sources of revenue, Tiago told me: “tourism and doctors”. Shortly after its 1959 revolution, Cuba established a programme to send its medical personnel overseas, with the first major mission deployed to assist Chile after its devastating 1960 earthquake. The scheme evolved from one of help during crisis into a structured series of agreements between Cuba and other countries in Latin America and the Caribbean, and around the world, to plug gaps in their healthcare systems.

But these decades-long programmes are now being cancelled as a result of US pressure, with a dozen countries complying. The US claims that as the Cuban government retains a portion of the doctors’ salaries, the schemes amount to “forced labour”. While there is corroborating testimony from some doctors that there was indeed exploitation, “this is not the majority”, said Tiago. The experts he spoke to believed the main reason for the US policy is “financial – stopping the Cuban government from receiving revenue”.

Cubans plug the gaps in Brazil

Tiago has personal experience with the deployment of Cuban doctors. In 2013, Brazil launched the More Doctors programme, in which Cuban doctors were sent to the country. “I remember it very well,”, he told me. “The programme was huge.” Eighteen thousand Cuban doctors spread out into Brazil’s favelas and remote areas in the Amazon. “They were sent to regions where Brazilian doctors don’t want to go,” he said – into the “interior” of Brazil, which is hard to access. Government salaries paid to Brazilian doctors were also higher in urban areas such as Rio de Janeiro and São Paulo, and the poorer areas where Cuban doctors were deployed did not have the sort of affluent classes that could pay the fees Brazilian doctors would need to set up private practice. The result is that few Brazilian doctors wanted to go into poor areas or the country’s hinterland.

Tiago put it this way: “Who wanted to go? Cuban doctors.”

Higher payment, poorer treatment

Those doctors would get paid about $50 a month in Cuba, but when they would go abroad, they would still make multiples of that, even with the government taking about 80% of their salaries. And so the financial incentive was strong even though, Tiago told me, Cuban doctors suffered prejudice and racism in countries such as Brazil, where medicine is a prestigious and expensive trade that is the preserve of better-off non-Black populations.

“Most are Black, they are Afro-Cubans,” he said, adding that, in a country where the Afro-descendant majority of 56% is relegated to the lowest-paid positions, it is not uncommon for racist Brazilians to refuse treatment when they discover the doctor is Black. African-Brazilian professionals make up fewer than 20% of all doctors – one of the most competitive and expensive degrees at Brazilian universities. In addition to racism, Cuban doctors are also met with suspicion about their agenda, an attitude linked to anti-communism.

How a Cuban doctor is formed

I was curious about how a small embargoed country came to be such a medical behemoth. Tiago said that according to the experts he has spoken to, “you cannot compare how a Cuban doctor is formed, and how it is in all the other capitalist countries”. Outside Cuba, professions are seen as an investment, one that has to then earn back, for personal gain, the fees and training that went into them. “The Cuban state invests in these people to give back to the community,” Tiago said, “but also to serve other countries. Obviously there is an economic side to it, but since the 60s, Cuba has also sent doctors when there is no money involved,” to help with natural disasters and healthcare crises.

Cuban doctors are not only a regional export but also a global one, sending doctors around the world and training foreign doctors in Cuba in an endeavour known as “medical diplomacy”. But there might also be another, more unquantifiable reason for the skill and range of Cuban doctors, I suggest to Tiago: the resourcefulness and perseverance forged in countries with little to start with. I saw this in Sudan, another country that suffered under decades of sanctions, but also has a large diaspora of doctors educated under embargo. In response, he quotes the Brazilian geographer and thinker Milton Santos, who spoke about the “revolutionary capacity” of “bottom up production”, one which thrives because riches and comforts are “obstacles to the production of knowledge and to the creation of the future”.

A US policy that smashes solidarity

The forced ending of Cuban doctor deployment has profound implications for the countries that are now deprived of their services. The US has huge reach through its sanctions power, and is able to threaten countries into compliance through embargos, banking sanctions and visa bans. But, Tiago told me, “the US is not proposing anything in return. Most of these countries do not have enough doctors of their own. I talked to doctors who work in NGOs in poor communities, and they already know there will be a healthcare crisis. We have a dozen countries that have already ended their partnerships in Cuba, but there is no plan B.”

Tiago makes a crucial point about the irresponsibility of the US policy. “All of this comes after the US dismantled USAID last year, which was very, very important for Latin America.” And so the US withdraws its own aid, prevents other medical assistance, all while “offering no alternative”.

The political context looms large. The US is in a war with Iran that it is failing to bring to a successful conclusion. Its focus on Cuba, which has accelerated not only in terms of the doctor ban but in the application, earlier this year, of a strict fuel blockade on the country, seems like an expression of something broader – a frustration on the part of the Trump administration regarding regimes that still will not bend despite US demands.

The people who will be hit hardest are those who are already grappling with difficult circumstances, those who don’t have access to infrastructure and good healthcare. As Tiago puts it: “How will they cope now without the few doctors they had? Those who will suffer the most are those who are already suffering.”