When Nelson Rodriguez’s flight touched down at the Guararapes airport in Recife last weekend, he became one of the first of 4,000 Cuban doctors scheduled to arrive in Brazil this year.
The decision to hire Cuban physicians here was brokered through the US-based Pan-American Health Organization (PAHO) with Brazil’s More Doctors program earlier this month. It means thousands of professionals will now be sent to some of the poorest and most remote regions in Brazil, tackling a chronic shortage of medical care in the country.
The idea of recruiting Cuban doctors was first proposed in May, but was suspended in July as the government reacted to criticism and demonstrations by doctors who claimed there were enough homegrown professionals to meet the country’s needs. Brazil is the largest country in Latin America with more than 193.3 million people, according to the 2010 census, covering a landmass of more than 3.28 million square miles.
Last week, Health Minister Alexandre Padilha announced that the government had changed its mind and Cuban doctors would be hired as originally planned.
“After the first stage of our recruitment in the More Doctors program it became evident that the supply of Brazilian doctors would be insufficient to meet the demands of the program,” Mr. Padilha said.
Brazil's new model for public services?
The first stage of the program enlisted 1,096 Brazilian doctors along with 493 foreign physicians from 35 countries including Portugal, Spain, Russia, and Argentina. However, this represents just over 10 percent of the 15,460 professionals needed to work in highest need medical positions. Around 84 percent of cities in need of medical support are in remote rural areas in the north and northeast of the country.
During the next three years the Brazilian government plans to continue hiring physicians from all over the world, so long as they meet the country’s medical criteria. It has instructed the PAHO to actively seek further international partnerships.
This type of collaborative arrangement may be the way forward in Brazil’s quest to improve other public services beyond health care. Within hours of Padilha announcing the reinstatement of the Cuban partnership, Minister of Education Aloizio Mercadante said he planned to use the initiative as a template to bring teachers from abroad to work in areas where there are high vacancy rates.
“Brazil has a low basic education and human development index. Our greatest need, especially today, is to have teachers in mathematics, physics, chemistry, and English," Mr. Mercadante said.
The Cuban doctors are in fact a stopgap measure to give strategic planners enough time to develop and improve Brazil’s medical curriculum. The foreign doctors are on three-year contracts, and by 2017 the government hopes to see the fruits of its investment with 12,000 more Brazilians graduating from medical school. The goal is 20,500 practicing medical graduates by 2021.
World Bank data shows Brazil currently lags behind other developed economies in terms of access medical care with 1.8 doctors for every 1,000 Brazilians. This doctor to patient ratio is below that of countries such as the United Kingdom (2.7), the United States (2.4), Portugal (4), and other Latin American nations like Argentina (3.2), and Mexico (2).
Working 'for love'
As Mr. Rodriguez stepped off the plane on Saturday, he and his colleagues waved both Cuban and Brazilian flags. “We are very happy to be in Brazil,” Rodriguez said at a press conference at the Recife airport. He and his colleagues will likely be placed in far-flung regions and in the impoverished outskirts of Brazilian cities, according to Padilha.
None of the Cuban physicians have been given a choice in where they will be sent. All will have three weeks of cultural and medical training, as well as Portuguese language training.
“Brazil is large and beautiful. We came here in solidarity to collaborate in primary health care,” Rodriguez said. Cuba is known for its medical care, and this is not the first overseas arrangement. Doctors have been sent to Pakistan, Haiti, Guatemala, Venezuela, and Honduras. In Venezuela, for example, the program Barrio Adentro brought Cuban doctors into underserved urban areas to provide care where local doctors were less likely to work. Under an agreement reached with the late Venezuelan leader Hugo Chávez, Cuba sent doctors in exchange for cheap oil.
In Brazil, there has been some controversy over the arrangement that allows the Cuban government to take a percentage of the physician’s salaries. The amount, which remains undisclosed, is rumored to be between 25 percent and 40 percent of the $4,238 monthly paycheck.
“As for our wages, they are sufficient,” he added.
“We are doctors by vocation, not for money. We work in any country for love,” Rodriguez said.
'Where doctors are needed'
But the government continues to face pockets of resistance in bringing in foreign doctors. On Friday, before the Cuban physicians arrived, the Brazilian Medical Association (AMB) filed a legal challenge with the Supreme Court requesting the suspension of the More Doctors program. The body says the move by the government is "electioneering" as there is no urgency for extra physicians.
But the decision to bring more doctors into the country was in part a response to the tens of thousands of protestors who took to the streets across the country last June demanding better public services, particularly in health and education, observers say.
“We are confident in the legal certainty of what we are doing,” said Padilha. “Whoever wants to criticize and make suggestions is welcome, but their actions will not threaten the health of our population where doctors are needed,” he said.