Cuba’s Health Ministry Desperate over Doctor Exodus

Francisco Aburto

HAVANA TIMES — Any entity making good profits and sensing dangers that threaten its very existence would have good cause for concern.

Currently, the incomes generated by medical services offered abroad constitute the most important source of hard currency revenue for Cuba’s State budget – and this sector is facing a serious threat, in the form of a mass exodus of the medical professionals responsible for offering such services.

The interests of Cuban physicians are well known. Salaries in Cuba are a bad joke. Health professionals earn a little over 50 dollars a month – an inadequate sum from any conceivable point of view, despite compensation through some subsidized services in other areas.

When these professionals sign a contract for work abroad, they receive one fourth (or less) what the foreign counterpart pays. When one deducts what they spend on living expenses in this foreign country, far from their homes and families, one gets a sense of the meager takings they end up with. One of the most demanding jobs in society, the one involving the highest degree of responsibility, does not allow these people to live in decorous material conditions.

After decades of a life based on political rallying calls and principles of sacrifice, we are now witnessing the exhaustion of the ideological tools wielded by the authorities. People have begun to look for concrete solutions to their vital problems whichever way they can, and this leads them away from the medical profession or towards private employers within the field in other countries, away from Cuban authorities.

Cuba’s Ministry of Public Health (MINSAP), true to the totalitarian tradition, is very much upset because those who work for the ministry don’t like living like slaves. News of frantic meetings and measures aimed at tightening the screws on “its” personnel are leaked regularly. People have even reported an attempt to take reprisals against health workers who have “dared” invite their spouses to stay with them, at their own expense.

I recently got my hands on a document which appears to contain a list of reprisals conceived to punish this unruly bunch. The apparent document details the measures considered, the personnel responsible for implementing them and other things. Fake or real, it is perfectly in step with what we know these authorities to be capable of, and one or two comments in this connection are worth making.

The document opens with a number of internal restructuring policies. These reflect the new logic of rationalization being adopted following the failure of the so-called “Battle of Ideas.” There’s nothing irrational about them, from a mathematical and objective point of view. The terrible stuff comes after, with the measures conceived to revert the exodus of professionals.

The list includes furious lobbying by the Cuban health officials with their foreign counterparts, so that they will take measures against the individual, private contracting of Cuban medical doctors. Here, they are to apply all imaginable pressures, to the point of halting or hampering current hiring processes if foreign institutions do not abide by the will of the Cuban agency. These pressures are to be taken to the level of foreign ministers in the countries with the largest numbers of Cuban health professionals.

Other measures are aimed at Cuban personnel that step out of line, demanding more restrictive commitments, tighter discipline and fuller submission from potential candidates.

In the event of disobedience, they plan on stepping up repressive measures, such as demoting workers to lower positions or invalidating their degrees. The ministry hopes to improve coordination with immigration authorities to control the lives of these people more efficiently.

In short, the document is congruous with the policies we face in our jobs on a daily basis as medical professionals. As I see it, these measures do not really stand a chance to revert the phenomenon, as it is a repressive policy that attacks the surface of the problem and does not aim at the well-known roots of the issue.

It also goes against the current of the political, social and economic policies being implemented elsewhere in the country, which promote greater openness. What they are likely to do, rather, is make doctors more upset, give the young more reservations about pursuing a medical career and make those who are already studying medicine think twice about continuing.