Exporting Medical Expertise during the Cold War: Medical Humanitarianism, Ideological Expansion or Pragmatism? A conversation with Bogdan Iacob

The medical aid programs established by socialist states nuance the Cold War dichotomy regarding the transfer of knowledge. The latest RevDem Democracy and Culture podcast with Bogdan Cristian Iacob explores the legacy of socialist regimes in the transnational circulation of expertknowledge during the Cold War, with a particular focus on medical aid.

Bogdan Cristian Iacobis a researcher at the Nicolae Iorga Institute of History at the Romanian Academy and at the Institute for Habsburg and Balkan Studies at the Austrian Academy of Sciences. His work focused on the relationship between state socialist countries and the Global South, the transnational circulation of expert knowledge, and the legacy of state socialism’s global entanglements in shaping the transformation of Eastern Europe. He is a co-author of the collective monographSocialism Goes Global.

During its initial phase, the historiography of the socialist states labeled Eastern Europe as a disconnected region from the international transfer of knowledge. In this logic, the only possible knowledge exchange was from Western to Eastern Europe, due to the Iron Curtain. However, this initial paradigm has since been revisited and by now, historians provide amuch more nuanced perspective on this issue. Revisionist and post-revisionist historiography emphasize that Eastern and Central Europe were never completely isolated. Instead, exchanges, influences and mobilities occurred across threecore geographical axes – firstly, within the socialist bloc, another one with the West and finally, with the Global South. The decision-making process regarding international collaborations was far more complex than the Cold War dichotomy, as it involved domestic political pressures, as well as economic, social, and public health challenges. Bogdan Cristian Iacob favors this approach. Throughout his research, he sheds light on the public health programs created by the socialist states, situating them in the context of decolonization. This approach is highly relevant as it reframes Eastern Europe as an active participant in global public health strategies.

Infectious disease eradication - a battlefield?

The eradication of infectious diseases was a central debate in the post-war socialist states, as Bogdan Cristian Iacob argues in this podcast. He highlights the example of malaria. This disease was officially eradicated in Romania in 1963 and presented by the leadership as a unique and modern healthcare program, with the program later implemented in other countries. This case is relevant within the broader framework. The scope of malaria, typhus, and smallpox eradication was beyond individual countries, particular regions or one political regime. Based on such initial achievements, countries that engaged in the public healthcare competition exported medical knowledge to the postcolonial world.  Initially, in the 1950s the reason for this‘export’ was anticolonial solidarity for the newly independent countries. Yet, in the 1960s, the medical assistance programs from Eastern Europe were no longer driven by mere solidarity. Instead, competition emerged, as BogdanCristian Iacob argues. The reasons included access to naturalresources and new markets, as well as the emphasis on the supplying country's modernity. Within this competition, postcolonial governments leveraged rivalries between donor countries sending medical aid and healthcare experts toappeal to the 'modernity ego' of state socialist officials, as Iacob points out.

Healthcare support - paternalism or solidarity?

While postcolonial solidarity was one of the main driversof healthcare support from Eastern European countries, it did not prevent the emergence of hierarchies. As this podcast demonstrates, Eastern European healthcare experts often perceived postcolonial countries as economically underdeveloped and culturally backward. The paradox is that socialist medicine demonstrated its own form of paternalism that replicated colonial practices.Often, doctors failed to distance themselves racializing their patients.

Balancing domestic public health and expertise export

Iacob argues that three elements dominated thepublic healthcare competition: anti-colonial solidarity, regional economic interests, and ideological rivalry. This, in turn, created a problem in the mid-1970s, as medical workers were deployed to certain postcolonial countrieswhile domestic healthcare systems faced staff shortages. As a result, ‘healthcare export’ became both a political tool for legitimation and a source of revenue. One of the best examples of this is Cuba, as this podcast shows.

Relevance

According to Iacob, this approach is relevant for both the historiography of socialist states and the history of medicine, as it highlights the multiple vectors of knowledgetransfer during the Cold War. However, within this debate, some questions remain unanswered. Iacob suggests three key questions for further examination. First, how do we further assess the relationship between Eastern European medicine and practices of racialization at home and those in global context? Second, how did global circulations of socialist medicine affect or influence specific medical fieldsback in the region? Lastly, how might the archival openings in the Global South might emphasize the agency of the postcolonial countries and change our current understanding about socialism and disease and in more broad terms, aboutemancipation?