Cuban cooperation with the Caribbean was extended by a joint health programme between Cuba and Venezuela named Operación Milagro, set up in 2004. The initiative is part of the Sandino commitment, which sees both countries coming together with the aim of offering free ophthalmology operations to an estimated 4.5 million people in Latin America and the Caribbean over a ten-year period. According to Denzil Douglas, the prime minister of St. Kitts and Nevis and the current Caricom chairman, more than 1,300 students from member nations are studying in Cuba while more than 1,000 Cuban doctors, nurses and other technicians are working throughout the region. In 1998 Trinidad Prime Minister Patrick Manning had a heart valve replacement surgery in Cuba and returned in 2004 to have a pacemaker implanted.