Cuba begins pulling 8300 doctors out of Brazil following Bolsonaro’s commentsBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k5027 (Published 27 November 2018) Cite this as: BMJ 2018;363:k5027
Millions of Brazilian patients in deprived and underserved areas are facing cancelled appointments and deep uncertainty as charter aircraft hired by Cuba’s government began repatriating 8332 doctors who had worked in Brazil under an international agreement, following comments from its new far right president-elect Jair Bolsonaro which Cuba called “contemptuous and threatening” towards its doctors.1
Questioning the abilities of Cuban doctors, and suggesting that they had committed “barbarities,” Bolsonaro declared that they would have to submit to the Brazilian examination for foreign doctors known as the Revalida.
The agreement that brought the Cubans to Brazil to support former president Dilma Rousseff’s More Doctors (Mais Médicos) programme, negotiated through the Pan-American Health Organisation, specifically exempted them from that requirement, an exemption confirmed last year by Brazil’s Federal Supreme Court.
Bolsonaro tweeted that he had set conditions for the Cubans to remain, and was disappointed by their government’s refusal, which “shows great irresponsibility in dismissing the negative impact on the lives and health of we Brazilians.”
This claim was at odds, however, with statements he made during the campaign, such as at Presidente Prudente airport on 22 August, where he told a crowd that “we will expel the Cubans from Brazil with the Revalida.”2
The first planeload of Cuban doctors left Brazil on 24 November and was met on the airport tarmac in Havana by former president Raúl Castro. Cuba expects to complete the transfers by 12 December.
Not all of the Cuban doctors want to leave, however. About 150 have joined lawsuits seeking to stay in Brazil and be paid the same as Brazilian doctors. Cuba is not compelling their return but Cubans’ contracts in the More Doctors programme were not renewed this month and their jobs are already being offered to Brazilians.
Cubans in the programme currently receive lower pay, a sore point with many Brazilian doctors, some of whom greeted the Cubans at the airport with jeers of “slave” when they first arrived in 2013.
The Brazilian Medical Association sued unsuccessfully to have the programme cancelled, arguing that hiring underpaid doctors who spoke Portuguese as a second language put patients at risk. But Rousseff’s government countered that “pampered” Brazilian doctors cluster around high paying institutes in the big cities and serve only the moneyed population. More than 700 of the 3600 municipalities that received a Cuban physician had never previously had a resident doctor.
With the world’s highest doctor to patient ratio, 7.5 per 1000 population, the export of medical professionals is Cuba’s biggest source of foreign income, ahead even of tourism. But Cuba also provides many of its 67 foreign medical missions free of charge, in the poorest countries and in disaster zones.
Brazil’s ministry of health said on 26 November that it had already filled 97.2% of the 8517 vacancies offered by the More Doctors programme to replace the departing Cubans. But several state governors expressed scepticism, noting that Brazilian doctors have often failed to show up at less desirable posts in the favelas and indigenous districts, when not allocated their preferred selections. The programme has never managed to fill more than half its ranks with Brazilians, and in previous years posts were only offered to Cubans after all Brazilian applicants had been placed.
To date, according to the health ministry, 40 doctors from the new draft have presented themselves at their new jobs.