Just three months ago, the public clinic near Maria Selma Dos Santos’s home didn’t have a single doctor on staff. Prior to that, she could schedule an appointment weeks in advance, only to show up and discover the doctor hadn’t come in that day.
“They didn’t seem to want to work,” Ms. Dos Santos says, sitting in an examination room at the Gilberto Freire clinic, located in a poor, cliff-side neighborhood about 45 minutes southwest of downtown Recife.
Today the clinic is staffed by two doctors – one Spanish and one Italian – who arrived two months ago through Brazil’s Mais Medicos, or More Doctors, program. The doctors treat the patients with respect, show up for work, and prescribe medicine, Dos Santos says.
The Mais Medicos program since September has brought nearly 14,000 foreign doctors to underserved regions and neighborhoods of Brazil to temporarily assuage a shortage of medical professionals here. Although the program was at first met by protests and even lawsuits, it now enjoys broad support among Brazilians. And for those experiencing access to regular primary care for the first time, the program has been life-changing.
"Everything’s improved now that we have doctors," says Paulete Alves do Nascimento, another patient at Gilberto Freire. “In the beginning I couldn’t understand a thing [because of the doctors’ accents],” she notes. “But that’s gotten better, too."
Brazil in recent years has been suffering from a shortage of doctors. It currently has only about 1.8 doctors for every 1,000 people, compared to 2.4 and 4 doctors per 1,000 in the US and Spain respectively.
Moreover, the doctors Brazil has aren’t evenly distributed across the country. The ratio of doctors to residents in northeastern Maranhão, one of Brazil’s poorest states, is only about 0.58 per 1,000, compared to the more well-off state of Rio de Janeiro with a ratio of 3.44.
To change this, the Brazilian government last fall launched the Mais Medicos program, which brings doctors from countries including Spain, Portugal, Russia, Argentina, and Cuba to deliver primary care to more than 46 million Brazilians, or about a quarter of the population.
The foreign doctors sign three-year contracts to fill the gap. At the same time, the government has opened up more seats at medical schools to train scores of doctors to catch up with demand. The goal is to have at least 12,000 newly trained local medical professionals by 2017.
Once their contracts are up, the foreign doctors will have the opportunity to sit for Brazil’s medical certification exam and keep working, says Ed Ruas, a ministry of health spokesperson.
'Not very able'
But some, particularly those in the medical field, were – and still are – critical of the program.
When the program was announced, the Brazilian Medical Association argued that the country didn't need more doctors and unsuccessfully sued to stop the program, which it called "electioneering." And some warned that the foreign doctors – particularly the thousands arriving from Cuba – were unqualified and coming to take Brazilian jobs.
“I think we need more physicians because there are a lot of poor people in Brazil who need assistance,” says Dr. Claudia Maga Lhães, a dermatologist in Recife. “But these foreign doctors … aren’t very able. The program just won’t work.”
Criticism is harshest around the arrival of Cuban doctors. Though Cuba has a record of exporting top-notch medical care to places like Venezuela, Honduras, and Haiti, some say the quality doesn't live up to its reputation. They are also seen as victims of the program: "slave laborers" in thrall to the Cuban government.
The program pays foreign governments 10,000 reais (about $4,500) per month per doctor. In most cases that money is then transferred directly to the professionals. However, Cuban doctors working in Brazil have reportedly received a small fraction of this salary, and ended up living on an income below minimum wage. Some Cuban doctors in Brazil have even defected from the program and sought asylum.
But while some criticism still simmers, a March survey by a local polling firm Datafolha showed that national approval for Mais Medicos has jumped to 67 percent from 54 percent in August. Approval is even higher in communities where the doctors are working, reaching 72 percent in the northeast, the country's poorest but fastest growing region.
And not everyone in the medical community is against Mais Medicos. “My impression is that these are good doctors working in places that aren’t so good,” says Dr. Rodrigo D’Aurea, who works at a public clinic in a low-income neighborhood of São Paulo.
Maria Cristina Neves arrived at the Gilberto Freire clinic two months ago, after three weeks of training on the Brazilian medical system and intensive Portuguese lessons. The Madrid native with a doctorate in public health and a masters in international affairs has years of experience abroad, working everywhere from Mali to Peru, and Senegal to Cambodia. She helped set up a maternal health center in Caracas, Venezuela, and provided medical care in Afghanistan at the height of the war.
Dr. Neves says she hasn’t experienced any discrimination since her arrival, although she acknowledges that it’s been tougher for her Cuban counterparts. Protests against the program stem from social inequality, Neves says, and from Brazilians who don’t realize how poorer citizens live.
She had misconceptions herself. She thought she’d be treating extreme cases of malnourishment or illnesses from water-born diseases at her posting. Instead, many of the patients she sees – she says their number hovers around 20 a day from a community of 2,000 families – are suffering from high blood pressure, diabetes, and obesity. All of these changes are associated with Brazil's recent economic growth; an estimated 36 million people have moved out of extreme poverty into the middle class over the past decade.
And with the rise of Brazil’s poor came a transformation of what that population expects, particularly when it comes to public services such as health care. “People in Brazil have evolved,” Neves says. “They’re now citizens, not just inhabitants. And they’re aware that they can demand [respect for] their rights from the government.”
Whitney Eulich reported from Brazil as a fellow with the International Reporting Project (IRP).