An alternative imaginary of community engagement: state, cancer biotechnology and the ethos of primary healthcare in Cuba

This paper analyzes a form of community engagement that differs from the way it is usually conceived and practiced in the domain of global health. This story takes place in the Cuban context and more specifically in a recent programme of oncology clinical trials implemented in primary healthcare (PHC) centres. By considering both the genealogy of this program and local interactions between PHC professionals and patients and their close relatives, I show that, in the context of Cuban socialist biomedicine, community engagement emerges as an implicit practice that forms part of the PHC professional ethos. I explore the ways cancer biomedicine is adapted in order to address specific needs and demands related to public acceptance of cancer in the Cuban society, diagnostic communication and palliative care. I argue that the way community engagement is enacted within Cuban socialist biomedicine is alternative to the global health dominant paradigm since it does strengthen existing relations between citizenry, health professions and public health infrastructures. Finally, by questioning the specificity of such socialist approach to community engagement, I suggest it greatly contributes to global health literature, because it creates continuity within existing state infrastructures rather than bypasses them, and, furthermore, offers a unique vantage on the treatment of chronic disease.