Regional leaders are set to meet in St. Kitts from Feb. 24 in what is shaping up to be one of their most consequential conferences in recent years, as governments complain about a steady and protracted increase in superpower pressure from the U.S. to comply with a string of demands from the Trump administration.

First, the U.S. picked on nations that have for decades employed the lifeline services of Cuban medical professionals, shuttered USAID and all of its funded programs, and then demanded that member states accept people the U.S. is deporting for various reasons.

As if that is not enough, requests for countries to allow the U.S. military to set up high-tech radar stations on local soil remain on the agenda. As a signal to other nations about the importance of total compliance, the State Department in December singled out citizens of Dominica and St. Vincent, for example, banning them from applying for tourist visas. Shortly thereafter, Washington added most of the 15-nation regional members to a list of 75 countries worldwide that have been banned from processing immigrant or permanent visas. Threats of visa revocations for anyone associated with hiring Cuban professionals have also been explicitly communicated to the region.

And while authorities struggle to keep pace with the relentless string of political edicts, Prime Minister Philip Pierre of St. Lucia this week reported on the latest attack from the U. S. He says the island nation has received direct orders to ban local students from studying medicine and other subjects in Cuba, leaving him with a massive political dilemma on his hands.

All this is happening to a region that has never done anything of significance to harm the US, as far as most leaders say they know.

So far, only St. Lucia has publicly admitted to receiving such an edict. PM Pierre says the Cuba ban will pose enormous problems for his island nation and its health sector in the coming months.

“Many of our doctors got trained in Cuba, and now the great US has said we cannot do that any longer so that is a major problem I have to face. Some of my colleagues (prime ministers) have already taken a position on this and banned them. So, the American government has said that we cannot even train them in Cuba, so I have a major issue on my hands,” he told the conference.

The regional three-day summit will be chaired by Prime Minister Terrance Drew, himself a Cuban-trained medical doctor and a staunch supporter of professionals working in the region and of students studying in Cuba. He says no one is exploiting the Cubans.

“Since 2003, St. Kitts and Nevis has welcomed Cuban professionals who have come, not as outsiders, but as family, helping us to build a stronger, healthier, and more resilient nation. Our Cuban health care professionals have saved lives. Our Cuban-trained professionals have become pillars of society, let there be no doubt. Let me be unequivocal. The federation values its relations with both Cuba and the U.S. We are a friend to all and an enemy of none. Any accusations of labor practices in our federation are inconsistent with our laws and values,” the Prime Minister said in a recent address to the nation. “I, like so many of my fellow citizens, had the privilege of receiving a first class education in Cuba. Cuba has been an indispensable partner of the Caribbean,” he said, defending the program.

His reference to labor practices has much to do with the current payment system for the Cubans in some jurisdictions, as the monthly take-home pay for some professionals is usually less than 20 % of the sum negotiated with the Cuban government. Secretary of State Marco Rubio, Trump’s frontman on this issue, calls the practice of the Cuban government taking away the majority of their salaries a form of slavery and human trafficking.

So far, several countries, including The Bahamas, Guyana, and Antigua, have scrambled to comply, in part, to allow the medical brigades to continue their lifesaving work and to avoid sanctions such as visa revocations.

Most of the bloc’s 15 members have retained the services of the Cubans. Several governments had made it clear to Secretary Rubio on a visit to the region last year that some health sectors would collapse without the Cubans.