Why Cuba has decided to pull 8,000 doctors out of Brazil

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According to the Cuban government, 20,000 doctors attended 113 million Brazilians in the last five years. Image: Agência Brasil, CC BY 3.0

SAO PAOLO, Brazil — Thousands of Brazilians could be left without healthcare as Cuba begins pulling out 8,400 doctors who have been stationed in the country’s smallest and remotest towns for the past five years.

In an official statement dated November 14, Havana announced it will end its agreement with Brazil as a response to president-elect Jair Bolsonaro’s public comments about the program, which it deemed “threatening and depreciative”. On multiple occasions over the course of the presidential campaign, Bolsonaro has disputed the skills of the Cuban doctors and criticized the agreement’s terms.

Launched in 2013 by former president Dilma Rousseff, the program “Mais Médicos” (More Doctors) sought to widen healthcare access in Brazil’s most vulnerable towns, some of which never had a resident doctor before. It opened thousands of job posts in those areas, offering salaries of around 3,500 dollars per month plus a stipend for housing and meals (for comparison, Brazil’s minimum wage is currently around 300 dollars per month).

The program gave preference to Brazilian doctors, but after they’ve signed up for only six percent of the job openings, the remaining vacancies were filled by Cuban doctors who were brought in through a deal signed by Brazil’s Ministry of Health and Havana and mediated by WHO’s Pan American Health Organisation. By the agreement’s terms, Brazil doesn’t hire the Cuban doctors directly: instead, it pays the Cuban government, who recruits, manages and compensates them as civil servants — with a salary that is around 25 percent of what Brazil would pay them had they been hired individually.

The deal met plenty of criticism since the first doctors began to arrive. They were booed in airports by massive crowds and were called “slaves” in protests led by Brazilian medical associations.

Bolsonaro himself, at the time a congressman at the Chamber of Deputies, went to the Supreme Court demanding the program’s suspension. Both during his time as congressman and the presidential race, he repeatedly said that the program was “slave work”. He’s promised to send the doctors back to Cuba with the “strike of a pen” so that they could assist the “the members of the Workers’ Party who will soon be sent to Guantanamo”. In a TV interview in July 2018, he said that “no one has any proof of whether [the Cuban doctors] have any knowledge of medicine”.

In its official pull out statement, Havana said: “The Brazilian people — who made the ‘More Doctors’ program a success, who trusted the Cuban doctors from the beginning, who appreciated the respectful, sensitive and professional treatment they received — will understand who is responsible for our doctors being unable to continue providing support in the country.”

Bolsonaro responded on his social media channels that Havana simply didn’t want to accept new terms: to relay the full salary back to its doctors and that they’d validate their medical diplomas in Brazil through an exam. He called it an “irresponsible decision by the Cuban dictatorship” for disregarding the impact it would have on the lives of Brazilians.

As journalist Leonardo Sakamoto writes, this could lead to the “first social crisis in Bolsonaro’s government”, and one that’s unfolding even before he takes office.

Cubans make up 45 percent of the More Doctors professionals. Around 28 percent of Brazil’s cities served by the program only count with one resident Cuban doctor. Around 90 percent of the doctors working in indigenous areas in Brazil are Cubans.

Brazil problems, Cuban solutions

Five years ago, Brazil had a deficit of 54,000 doctors in its public health system. The country had 1,8 doctors for every 1,000 inhabitants. For comparison, that rate is currently of 2,5 in the United States and 7,5 in Cuba.

Small towns in Brazil have always struggled to attract medical professionals, who complain about the lack of infrastructure. Brazil also doesn’t train enough doctors to serve its 200-million population.

The small socialist nation, on the other hand, has doctors to spare. Currently, Cuba has 50,000 health workers stationed in 67 countries. Leasing of medical experts is Cuban’s main export: they generate US$11 billion in revenue to the state per year, more than tourism does.

Cuba has sent its first medical brigade abroad in 1963, after the independence war in Algeria. Since then, according to a story by Radio Ambulante, almost 500,000 Cuban physicians have worked in Africa, Asia, and the Americas.

Over the years, a few Cubans have told the Brazilian press that they felt “exploited”. Some have joined lawsuits against both governments as well as the WHO. Others have reported threats made by their government. However, many said in a podcast by Radio Ambulante that, even with Havana’s retention of 75 percent of the wages, they don’t think the salary is unfair.

The results

A study by the Federal University of Minas Gerais, which interviewed 14,000 patients in 700 cities one year after More Doctors began, revealed a high level of satisfaction with the program: 85 percent said that healthcare in their regions were “better” or “a lot better”. The participants highlighted poor infrastructure and the lack of medicines as unresolved problems.

Another study from Fundação Getúlio Vargas (FGV) shows that the program helped the government to reduce a third of its expenses with hospitalizations.

Débora Mazetto, one of the economists who led the study, told BBC Brazil: “There has been an improvement on the quality of the services offered to the population. Can you imagine a community that never had a doctor? With the rising numbers of appointments in areas that were complete unassisted before, it’s now possible to identify and treat diseases faster, avoiding unnecessary hospitalizations.”

What next?

Since November 14, over 200 doctors have already returned to Cuba. The Pan American Health Organization expects that all of them will have returned by December 12.

In many public clinics, people have found themselves without medical care this past week or were told that they’d only have a doctor available once a week from now on. Although the Brazilian government claims that 92 percent of the spots left vacant by the Cubans have already been filled, newspaper Folha de S. Paulo said this number might not mean much at the end of the day: “In 2017, the health ministry opened a call to select Brazilians to More Doctors. In total, 6,285 applied to 2,320 openings, but only 1,626 showed up to work. Around 30 percent left their jobs before completing one year on them.”

As with many social programs in Brazil, More Doctors did have its gray areas, but it also dramatically changed public health in regions that were completely forgotten by the Brazilian state. Perhaps the greatest challenge so far for the next government-elect is to learn from its mistakes and where it got it right. How, and if, Bolsonaro’s government will ensure healthcare is available in those regions is still to be seen.

This article written by GV Brasil originally appeared on Global Voices on November 28, 2018

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7 COMMENTS

      • Not sure I understand. They would rather go back to Cuba and starve than stay in Brazil where they can be recipients of the high salary now being confiscated by Cuba. 3500 per month vs starvation wages if any in Cuba. I think I would opt for Brazilian citizenship.

  1. Richard when communist countries with the closed type of emigration policy that Cuba has, you cannot leave without State permission. You cannot leave if you or a member of your direct family is a military or police personnel. Even if you are a politician of learned professor you cannot get a permit to go and live abroad unless you are a well-paid spy and there are plenty of those. The whole family and extended family at home in Cuba will be punished if a doctor simply runs away.

    The Doctors who work abroad like all Cubans who work abroad are paid by the Cuban government silly low wages not international wages. Foreign governments pay the Castro owned bank in London, Havin Bank LTD.

    Havin gets the money and launders it in such a way that some is sent back to Cuba which pays the workers low wages and a profit for the State. The balance is sent to a corresponding bank in the United Arab Emirates where it disappears from the US and European scrutiny.

    Some of the other ALBA leaders, prime ministers, presidents and a collection of others are using the Emirates as well. Panama, Lichtenstine and Switzerland are out of favor since they have all had staff exposing who owns what accounts, that can never happen in the Emirates.

    There are also dodgy private banks in most of the ALBA countries who do the dirty business. They try not to use prime or international banks for obvious reasons.

    When Maduro of Venezuela was paying money to Señor Puigdemont leader of the JxCat Pro-independence Party of Catalonia, he paid that through a private bank in Saint Vincent and the Grenadines. That could only be done with the direct permission and most certainly help of someone in the leadership of the SVG government.

    Why was the money paid at all? Because the Castro’s and Maduro wanted to help establish a new breakaway [from Spain] state that was communist controlled, which is the object of all ALBA members. Therefore a valuable future affiliated or a guest member of ALBA. There is little that Venezuela does without permission from Cuba.

  2. Jolly Green
    Are the aforementioned banks allied to the ones the CIA uses (in Panama and the English Islands) to launder its enormous Narco-Dealing profits, from Colombia, Afghanistan, etc.?
    You should know these things since you have stated all the (US-Government-supplied conjecture?) info on Venezuelan and Cuban officials’, financial dealings.
    Only a US Government-Paid-Troll, would be fed such a bag of lies’, to use against the rising stars of the Socialist world, Venezuela, Cuba and Nicaragua.
    My guess is that you are paid ‘by the word’, to write the drivel in your above post, as a functioning Military/Industrial/Complex, CIA-Sponsored, US Troll or Dissident (depending on where your home country really IS located).

  3. Don even when the truth is presented you are sent to try and make wrong right. Beware the Karma that must surely come for you eventually.

    What I wrote has nothing whatsoever to do with anything that the US may or may not have done. That is just thrown in by you to muddy the water and try and dilute the truth.

    Don is a Canadian ‘make wrong right’ paid and rewarded Cuban operator that has been appointed to fight through reverse propaganda But besides that, he propagizes on all exposes of wrong by all the communist rabble countries who are friends of Cuba. But his specialty is Cuba because his wife is Cuban and he would sooner be a Cuban communist than a Canadian self-employed printer.

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