HAVANA, Cuba (AP) — Every few years Dr Leonardo Fernandez flies to a nation shaken by natural disaster, political turmoil or disease, leaving his hospital in eastern Cuba for countries that have included Pakistan, Nicaragua and East Timor.

On Tuesday, the intensive care specialist was headed to the epicentre of the Ebola epidemic along with 90 other Cuban medical workers as part of a half-century-old strategy that puts doctors on the front lines of the country’s foreign policy.

The 91 nurses and doctors going to Guinea and Liberia join 165 already in Sierra Leone — making this island of 11 million people one of the largest global contributors of medical workers to the fight against Ebola.

The commitment has drawn rare praise from the US and focused worldwide attention on Cuba’s unique programme of medical diplomacy, which deploys armies of doctors to win friends abroad and

earn more than $6 billion a year in desperately needed foreign exchange.

Cuba has more than 50,000 medical workers in more than 60 countries, many in nations like Brazil that pay hundreds of millions a year for their services. Others are on humanitarian missions that generate goodwill abroad and bolster Cuba’s efforts to portray its medical system as one of the most important successes of a socialist economy wracked by slow growth, shortages and chronic underinvestment.

“Cuba is a lightweight boxer which boxes in the superheavyweight classes precisely because of its foreign policy and its international cooperation,” said John Kirk, chair of Latin American studies at Canada’s Dalhouse University and an expert on Cuban medical missions. “This is part of the Cuban political DNA… this is altruism as well as burnishing its international credentials.”

Despite a recent set of pay raises, most Cuban doctors’ salaries don’t top $75 a month, less than many workers who work in tourism or other sectors that bring in money from abroad. The foreign missions almost uniformly offer the chance to earn extra pay, in many cases enough to buy a bigger home or new car.

Critics of Cuba’s communist government have accused it in the past of exploiting the doctors by giving them only a meagre portion of the money paid for their services and keeping the lion’s share for the national treasury.

But those who believe strongly in Cuba’s communist revolutionary ideology say a mission abroad is fundamental to the health workers’ self-identity.

“This is part of our training as Cuban doctors. When they ask for volunteers, whatever the situation, most of us raise our hands,” Fernandez said. “This is a commitment to Africa, and it’s a commitment to this nation that has shaped us with the ideals of altruism, self-sacrifice and humility.”

Doctors in the small group who gave interviews to the foreign press in Cuba on Tuesday declined to discuss the details of their compensation. The head of the tropical medicine institute that trained them said Friday that they would be receiving their normal salaries from the Cuban government and an unspecified “per diem” from the World Health Organisation.

All men, most of the volunteers have at least 20 years of experience, have completed several missions overseas and are married with children, who are often adults who themselves work in the Cuban medical system.

“I spoke with my three children and we know the

risk we’re running,” said registered nurse Luis Alberto Perez Lopez. “We have a commitment to the revolution and to our commander-in- chief and we’ll be back here in six months with our mission accomplished.”

Cuba’s first medical mission was dispatched in 1960 in response to an earthquake in Chile. Cuba offered to send thousands of doctors to the US to help after Hurricane Katrina but Washington rejected the offer. In Washington on Friday, Secretary of State John Kerry cited the Cuban doctors as

a global example of contribution to the Ebola battle.

Fernandez said he had volunteered for the Ebola mission a day after his daughter, a medical technician, put herself forward but wasn’t accepted. At the moment, Cuba isn’t sending women to fight Ebola.

“Saying that we’re going without any fear would be a lie. We all have some fear,” Fernandez said. “But how could a father say ‘no’ after that? What greater motivation is there?”

Cuban officials initially announced they would send 461 doctors to Africa. Iliana Gonzalez, head of training at Cuba’s Central Medical Cooperation Unit that helped prepare the anti-Ebola contingent, said Tuesday the number actually sent to Africa will remain at 256 until there is sufficient infrastructure to accommodate the rest.

She said many of the doctors received weeks of instruction in protective measures and equipment. Once in Africa, the Cubans will get two to three weeks’ additional training before heading into the field. They will be quarantined in Africa for weeks at the end of

their mission before returning to Cuba.