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Cuba pulls more than 8000 doctors out of Brazil after qualifications are questioned

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4860 (Published 15 November 2018) Cite this as: BMJ 2018;363:k4860
  1. Owen Dyer
  1. Montreal

Cuba has said that it will bring more than 8000 doctors back from Brazil after that country’s president elect, Jair Bolsonaro, made comments that Cuba’s health ministry called “contemptuous and threatening to the presence of our doctors.”

Cuban nationals account for more than half of the 16 000 doctors working in Brazil’s “More Doctors” (Mais Médicos) programme, started in 2013 by the former president Dilma Rousseff to deliver healthcare to the country’s poorest and most remote regions.

On 2 November Bolsonaro, who has yet to take up office, told Brasilia’s Correio Braziliense newspaper that the Cuban doctors would all have to requalify in Brazil.

Cuba’s health ministry said in a statement announcing the end of their participation, “It is not acceptable to question the dignity, professionalism, and altruism of Cuban co-workers.” 1

The president of Brazil’s National Council of Municipal Health Secretariats (Conasems) told O Globo newspaper that 24 million Brazilians live in regions that depended on Cuban doctors. “In 90% of indigenous areas there are only Cubans,” said Mauro Junqueira.

Cuba’s health ministry said its doctors worked in more than 3600 Brazilian urban and rural municipalities, of which over 700 had never previously seen a resident doctor. Roughly 60 million Brazilians have consulted a Cuban doctor under the programme since 2013, many of them in the favelas of Rio de Janeiro and São Paulo, in the country’s deprived north east, and in its 34 special indigenous districts.

The Cuban doctors in Brazil, who generally stay for three years, are trained in Portuguese before leaving home under the terms of the agreement, which was negotiated under the auspices of the Pan American Health Organization.

In its statement Cuba said that Bolsonaro was violating that agreement, which had been officially ratified in late 2016. The agreement specifically exempts foreign doctors working in the More Doctors programme from having to take the Brazilian exam known as the revalida.

In his 2 November interview Bolsonaro couched his argument against Cuban doctors in the language of human rights. Brazil pays roughly $3000 a month for each Cuban doctor—less than it pays Brazilians in the same programme—but 75% of that goes to the government in Havana and the doctor keeps just 25%. Bolsonaro also said that the doctors had to leave any children in Cuba, which was “torture for the women.”

“Cuba suppresses the liberties of these professionals and their families,” he said. Changing these two conditions, as well as making Cubans take the revalida, were his three conditions for their participation to continue, he added.

“Unfortunately Cuba did not accept,” he later wrote in a tweet.

By refusing his conditions, “the Cuban dictatorship shows great irresponsibility in dismissing the negative impact on the lives and health of we Brazilians,” wrote Bolsonaro.

On 14 November Brazilian media were reporting that Bolsonaro had told a press conference that he doubted that people would want to be treated by Cubans and that there were reports of “barbarities” committed by them.2

Cuba currently has doctors working on what it calls “internationalist missions” in 67 countries, an effort that has only accelerated in recent years. Most missions’ costs are borne by Cuba, but some recipients, like Brazil, pay for the service. Cuba’s health ministry said that its travelling doctors keep their Cuban jobs and salaries while abroad.

The biggest Cuban missions are currently in Haiti and Venezuela. Cuba is also training thousands of South African doctors, has been expanding its missions in Oceania and Asia, and was the biggest contributor of health workers to combat the 2014 outbreak of Ebola virus disease in West Africa. Since 2006 the United States has its own programme encouraging Cuban doctors abroad to defect, called the Cuban Medical Professional Parole programme.

Cuban doctors have accounted for 51% of all doctors in the More Doctors programme since its inception Brazil’s government has had little success in persuading Brazilians to work in many poor or remote regions served by Cubans.

The governor elect of Espírito Santo state, Renato Casagrande, in Brasilia for a meeting with Bolsonaro, said that Cuba’s departure from the programme posed “a problem for state governors and even more for municipalities that are broke. Local government has no ability to pay doctors to stay in communities.”

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