Cuba Cuts Benefits for Doctors in Brazil and Add Restrictions

By Jose Alberto Gutierrez  (Cafe Fuerte)

Cuban doctors on a military plane being sent to the outlying regions of Brazil where they will work for three years. Photo: Ministry of Health

HAVANA TIMES — The Cuban government has doubled down on its legal precautions and control over doctors it sends on the Mais Medicos (More doctors) mission in Brazil, drawing up a stricter work contract for those who will now join this health program in the South American country.

As well as introducing more restrictions or “obligations for Cuban health professionals”, the new work contract (which Cafe Fuerte had access to) also cuts down on the financial advantages this program offers doctors who take part.

One of the steps that stands out in the contract drawn up by the Cuban Medical Services Marketing company Ltd. (CSMC Ltd.) is the explicit ban on Cuban participants to take revalidation tests of their medical title in Brazil, an exam which opens up the door for them to practice this profession outside of the mission’s framework. According to the new laws, taking this kind of exam is reason enough to be immediately kicked off the program, as well as being absent from your work for more than 48 hours, as stipulated in clause 3.4 in the section “Other Agreements”.

Pregnant doctors will have to return to Cuba

In spite of Brazil’s commitment to cover medical attention, hospital and dentist costs for Cuban doctors in this country, the contract stipulates that if Cuban doctors are pregnant during their time on the mission, they must return to the island once they are 22 weeks along in the gestation period, using the argument that they must “receive medical care established in the country.”

Under Brazilian law, children of foreigners born in this territory, regardless of their migration status, are born Brazilian citizens and this automatically paves the path for parents to apply for residency and later citizenship.

With regard to family visits, as well as the obligation of having to communicate “the reason for receiving children, parents or spouses” to the mission’s board, the new contract also limits these visits to a “a maximum period of three months”, after which the relative must return to Cuba. Nevertheless, all of the costs of the visit (tickets, accommodation, health insurance, etc) need to be covered by Cuban doctors, according to the document.

Similarly, “in the case a relative passes away while in Brazil, the Cuban health professional is required to cover the costs of repatriating the corpse,” the legal agreement points out.

Missions won’t be renewed

The document also states that the period of the mission is three years maximum, thereby prohibiting Cubans from renewing their contracts for another three year period, something which the Mais Medicos statute allows. It is a rule imposed with the implicit intention of reducing the likelihood of Cuban doctors creating family relationships with Brazilians.

A copy of the new contract that the Cuban doctors must sign before being sent to Brazil.

Renewing the mission was a request of many Cuban doctors’ who had established family in Brazil, as well as local health authorities in this country, who preferred to keep a professional already adapted to local idiosincrasies and customs, who knows the community where they work and has already mastered speaking Portuguese.

Another point which Cuban and Brazilian parties differ on was the increasing number of Cuban doctors who, after receiving the order to return to the island, filed claims with the court so as to stay on the Mais Medicos program but as independent workers. There are currently 190 claims of this kind being processed by the courts.

Some of these claims have managed to be successful, such as the case of Doctor Yolexis Jaramillo, who received a positive ruling from the judge at the Brasilia’s 20th Federal Court so that the Health Ministry could reintegrate her to her position within the Program, and to pay her the full 11,520 BRL (3600 USD) paid by Brazil to every doctor directly into her account, instead of the 2976 BRL (930 USD) which the Cuban government pays, after witholding 72% of their income.

All of this has sparked an impasse in the negotiations for replacing doctors who had finished their mission. As a result, Cuba suspended its sending of doctors to Brazil for some months, creating a deficit in doctors on the program. In June 2017, after all Cuban demands were met, the medical contingent in Brazil began to receive new physicians, who traveled with the new contract in force.

The Cuban government increases its cut

According to an announcement made by Brazil’s Health Ministry, Ricardo Barroso, wages for participants of the Mais Medicos health program (foreigners and Brazilians) increased by 9% since January 2017, going from 3,300 to 3,600 USD. However, the Cuban government didn’t give a single cent of this to its doctors, taking all of the increase for themselves.

The appropriation of this benefit, given by Brazil in order to compensate for inflation during the first three years of the program and the devaluation of the Real against the Dollar, was confirmed by the report which compared a contract from 2014 (before the increase) and the current contract, where the “fee” remains the same.

On the other hand, even though the CSMC Ltd. keeps the clause that stipulates “paying the due financial assistance for installation, the day before (the professional) arrives at their destination” among its contractual obligations, in the most recent version of this contract, it doesn’t specify the quantity that needs to be paid for this, leaving it up to the Cuban State to determine how much it allocates to doctors for the things they need when they arrive. Since 2013, Brazil has been paying between 6000 and 9300 USD for the installation of each professional (depending on where they are carrying out their mission) and Cuba has been pocketing over 60% of this.

Less money for accommodation

The previous version of the contract stipulated that doctors were to be paid 2500 USD for furniture and appliances, a sum which is paid in instalments months after doctors arrive in the municipality where they will work, according to a doctor who went on the mission in 2014. According to this same source, other colleagues who arrived a year ago in the same town were only given half of this sum.

In Brazil, houses are normally rented completely unfurnished, without electrical appliances, fridge, stove and furniture. Town halls contribute to the whole or partial payment of the rent of doctors who work in their municipalities, but it’s common for Cuban doctors to share homes.

In keeping with cuts, the current contract has eliminated deposits included previously as “a fixed sum for getting an internet service which corresponds to the professional’s work,” as well as “covering the costs for getting a debit card” and a deposit for “the payment of the annual registration in the Medical Regional Council.”

Vacation complaints

Paid holidays are another benefit affected since the second semester of 2016, according to what several interviewed doctors claimed. In accordance with the Mais Medicos Program regulations, every participant has a right to 30 days of paid holidays, after 11 months of work. The Cuban Medical Services Marketing company Ltd. contract includes this rule, although in practice it only pays for holidays during the first two years of the mission.

According to accounts from Cuban doctors, once the 11th month in the third year of the mission has ended, only what corresponded to the last month of work has been paid, while pay corresponding to the 12th month was never paid, deeming them holidays, in spite of countless complaints. It’s worth highlighting that Cuban health professionals have to obligatorily “enjoy Cuba” during the 30 days of their holidays.

As well as all of the cuts in medical resources, the contract is emphatic about prohibiting economic activities outside the mission.

Finally, the contract incorporates attempts to ironclad it from any legal protection doctors can find in Brazil’s more advantageous labor laws.

“Cuban health professionals keep their working relationship with the CSMC Ltd. without being subject to any working relationship with the institution where they work,” the legal agreement clarifies, dissociating them from any Brazilian body, whether that’s the Health Ministry in this country, local town halls or health centers and hospitals, in an attempt to isolate them in legal terms from where they work.

Mais Medicos is a program that was launched in 2013 by Dilma Rousseff’s government to make up for the shortage of doctors in interior municipalities, indigenous areas and in the outskirts of Brazil’s large cities. Out of the 18,240 doctors that currently take part, 8,600 are Cuban (47.1%). The rest are Brazilian doctors and doctors from other countries, whose governments aren’t the guardians of their professional work.