By Osmel Ramirez Alvarez
HAVANA TIMES – On Tuesday November 13th, the Cuban government announced that it would withdraw its doctors from Brazil’s “Mais Medicos” program with a statement from the Public Health Ministry. It was their response to the announcement of newly-elected Jair Bolsonaro’s future demands (Bolsonaro being a very controversial politician due to his extremist and exclusive attitudes, who will take on the presidency of the South American giant on January 1st).
The conditions in the announcement have primarily to do with the controversial wages that Cuban doctors receive, who only get 25% of the income that Brazil pays them (the rest going to the Cuban government). The new president is demanding that they receive these wages in full like the rest of the foreign doctors who work as part of the “Mais Medicos” program. He has publicly said that he is a critic of what he labels the “Cuban dictatorship” and he refuses to be a part of its slave-like funding scheme.
Secondly, there’s the much-disputed issue of Cuban doctors’ families. The future leader will demand that Cuba allows doctors to take their children with them. Faced with the risk of doctors deserting (which is what the Cuban government considers any doctor working abroad who then leaves their contract does), making it difficult for families to be together on the mission is a very effective mechanism they have to regulate and control human resources, thereby ensuring that this lucrative business continues to bring in cash money. They don’t care about the fact that human rights are being violated in this way, the end justifies the means in their eyes.
And in third place, there’s the issue of Cuban doctors’ having their diplomas recognized and validated. Cuba takes this personally, as if Brazil were questioning the quality and professionalism of its doctors, but it’s a well-known fact that even Brazilian doctors who have studied abroad need to also do this. And presumably every foreign doctor who isn’t Cuban (who make up 20% of the “Mais Medicos” program) have also had to experience a similar technical/bureaucratic test that Brazil deems to be necessary. So it really isn’t a demand for the Cuban government as much as it is the suspension of a privilege.
Cuba could negotiate these three points in 2013 without too many problems because Brazil had a leftist government (Dilma Rousseff’s administration) that was their ally, there’s no doubt about that. It was also the only source that had enough doctors to quickly meet the great demand for doctors that the ambitious social program needed and still needs. Just like the “Mais Medicos” program wouldn’t have existed if it weren’t for the Workers’ Party (PT).
Although it is true that Bolsonaro is a controversial figure and his main intention is to attack the Cuban government because he believes it to be a threat to his country because of its influence and dealings with a party that was as powerful as the PT (Brazil’s second strongest political force now). And this fear isn’t baseless because even though the PT didn’t become seriously infected with Cuban ideology, we only have to take a look at the crisis in Venezuela to become afraid of this Caribbean Communist dogma, when a larger dose is applied.
It would be fair for us to recognize that the PT remained firm in its democratic socialist ideology and never gave signs of becoming tyrannical. The PT’s problem was that it suffered an endemic infection, which wasn’t imported, of corruption which is one of the most firmly rooted evils in Brazil. The Right being its founder and a great deal more involved, but it isn’t a scandal when it comes to them, it’s normal because everyone knows that they represent Capital.
But, the Left becoming corrupt is striking and unforgiveable because their bastion is curbing Capital’s insatiable appetite to instead benefit society’s most vulnerable groups. And the Right is taking advantage of any mistake, making full use of their propaganda power. Recognizing its mistakes is the PT’s challenge, not becoming extremist in the face of this test and continuing to defend socialism within democracy. Without any trace of totalitarianism, so that when they do come back into power they can continue to do their good work and overcome the crisis that has been created by learning from their mistakes, not making them worse.
I believe that the new president isn’t out of his mind for wanting to renegotiate Brazil’s deal with Cuba, it’s his right and he is responding to demands made by most Brazilian and Cuban groups. The problem might perhaps lie in the way he announced this. It is also a fact that the Cuban government doesn’t accept any questioning of its ways. Even more so if these medical missions satisfy two out of its three main objectives: the first and most important is it’s committed and kind foreign policy; secondly and also important is business, the huge profits. And third of all, altruist solidarity, which does exist but it isn’t the main driving force like the Government argues, not for the Government or the doctors. That’s just being realistic, it isn’t a baseless critique.
I believe that it would be a good idea if our country had a health services company for matters abroad. It’s a good business for health professionals and for the country, making the most of a strength, which is very pricey in many aspects, achieved by the Revolution. The military and slave-like treatment of doctors is wrong, not only in regard to their wages.
If there was a democratic change in Cuba tomorrow, I believe that this business should continue as a way to bring in revenue for our economy, as well as fulfilling its humanitarian role. However, it should be the opposite of what it is today, doctors should earn 70% and the company that manages their work should receive 30% or something like that, maybe less, as long as it’s fair. And that they have the freedom to not use intermediaries, which is something they still can’t do today.
If we are to be objective and not hot-headed right now (because we don’t have this crucial democratic change yet), and we thought about the best interests of Cuban doctors, Brazilian patients and both of these antagonistic governments, the best thing to do would be to negotitate, not hastily withdraw.
I believe that a viable option would be for the PAHO to receive 5% because their mediation is extremely important; the Cuban intermediary company that hires the doctor earns 25%; and doctors earn 70% of what is fairly theirs because of their hard work. Now, this would amount to US $2,250, 37 times what they would earn in Cuba. It would be fair of them to donate 20% to Cuba’s universal and free healthcare system, to improve hospitals, GP offices and services. 50% would be a great deal of money in today’s economic landscape and 20% would make all the difference for Cuban health services, which are currently in a dreadful state.
Something that could be monitored, without things being hidden or manipulated. Not like what has been done up until now, where only a little over 400 million USD have been invested in Cuba’s public health system out of the 11 billion that it earns every year for its health personnel exports. If the objective were truly altruistic, first and foremost, then they would seek out a solution like this one.
However, things have been different. The Cuban government and media that work for them aren’t speaking about all three of Bolsonaro’s demands to the same extent, only about the validation of doctors’ diplomas. It is repeated to reinforce the idea that this is degrading for our professionals, as if this were the main reason for their discord.
And knowing that at least a third won’t return, they are offering doctors the opportunity to bring everything they want from Brazil back, their belongings there and the promise of the job they left behind, although they only earn up to 60 USD in our country a month on average, 15 times less that the unfair 25% they receive when they go on a mission. News has also been spread in Cuba that every doctor on the program who wants to keep their job will receive asylum, if they accept to have their diploma validated and will be able to earn their wages directly.
Many believe that Cuba’s radical reaction was due to business prospects that are just as lucrative (70% of their wages) with Lopez Obrador’s imminent administration in Mexico. He could take advantage of Cuban doctors leaving Brazil to have enough professionals for a similar program to that of “Mais Medicos” in Mexico, thereby meeting the expectations that he has created in the most vulnerable groups. Let’s see how things play out.