Latin America
4:52 am
Wed October 2, 2013

'Castrocare' Divides Doctors In Cuba, Brazil

Originally published on Tue October 8, 2013 9:48 am

Call it "Castrocare." Cuba's former leader Fidel Castro sent doctors abroad for decades to work throughout Latin America and as far away as Africa.

In some cases, like Haiti, the medical missions were seen as purely humanitarian. In other places, like Venezuela, it was a form of barter that provided Cuba with subsidized oil imports.

Cuba has long boasted of its program, which has generally been well-received. So now Cuba is sending thousands of doctors to Brazil, which badly needs the physicians in poor, rural areas and has the money to pay for them. However, the program is meeting resistance in Brazil — not from patients but from the medical establishment.

In the town of Pedreira, about 85 miles outside Sao Paulo, Luis Fernades dos Santos is getting a broken tooth cared for at his local public health clinic.

After the procedure, he says he's heard about the Cuban doctor who is to be working here soon and thinks it's a good thing.

"Here in the city, you see people sleeping — sleeping — for a day, two days waiting in line to see a doctor. And when it's their turn, there is no doctor to see them," he says. "So that's why I think bringing people in to help will make things better."

Over the summer, massive protests broke out in Brazil, decrying, among other things, the state of the public health system. The problems include aging equipment and a lack of medical facilities, things that take time to fix. But the government moved quickly to address the lack of doctors by bringing in Cuban physicians.

Opposition From The Medical Establishment

The patients may be in favor, but most of the Brazilian medical community is not.

When Cuban physicians arrived in the city of Fortaleza in August, Brazilian doctors shouted at them, "Slaves, slaves!"

"We are not slaves," says Tania Aguiar Sosa, one of the Cuban medical workers with decades of experience. "We are health workers. We are professionals that provide help to whatever country needs it."

She's worked in Venezuela and Haiti previously and was headed to Angola before being rerouted to Brazil.

Brazilian medical unions are trying to mount a court challenge to the use of Cuban doctors here.

Jose Roberto Murisset, the human rights secretary of the National Doctors Federation, says that the Cuban government takes most of the money that is paid for the doctors. The Brazilian government has also decreed that the Cuban doctors have no right to ask for asylum in Brazil.

"Brazil has strong labor rights, but these Cuban doctors don't have their rights guaranteed," he says.

The main bone of contention is that foreign doctors arriving under the new program don't have to take the Brazilian medical exam to practice. Murisset says that many of the doctors coming from abroad would fail the test and are underqualified.

"Maybe the government thinks that these regions don't need a full doctor. Maybe they think they need only a half doctor," he says.

Hospitals In Need

But Dr. Adriano Peres Lora, head of the Pedreira Municipal Hospital, disagrees.

He says he has 50 beds at his facility serving 44,000 people in the community. If he can get more doctors handling preventive care, then the main hospital will feel less pressure, he says.

"What we need is basic attention. We lack doctors willing to work as general practitioners in marginal communities," he says, adding that 80 percent or more of the health problems people face can be resolved by seeing a doctor at an early stage.

He says most Brazilian doctors don't want to work in poor, rural communities like his, though the need is great.

When the Brazilian government announced the program to bring in foreign doctors, more than 4,000 towns and cities applied to the federal government for extra help.

Back at the health clinic where a Cuban doctor will be working, Brazilian doctor Flavio Blois de Mattos says he welcomes the help. He's overwhelmed at the moment. But he also thinks the Brazilian program is unethical.

He says the Cuban doctor agreed to come even though the Cuban government gets the lion's share of her salary, paid by the Brazilian government. Still, the Cuban physician will make more in Brazil than she would in Cuba. And that will help her 15-year-old daughter.

"I don't think it's correct. We are a democracy. Why aren't we giving them the same rights we have?" he says.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

RENEE MONTAGNE, HOST:

In Brazil, the government is trying to improve medical care in impoverished and rural areas by bringing in thousands of doctors from Cuba. Brazil's unions are trying to block the program to recruit Cubans, even though few Brazilian doctors want to work in these poorer areas, as NPR's South American correspondent Lourdes Garcia-Navarro reports.

LOURDES GARCIA-NAVARRO, BYLINE: A man is getting a broken tooth cared for at his local public health clinic in the town of Pedreira, around 85 miles outside of Sao Paulo. After the procedure, Luis Fernades dos Santos tells me he's heard about the Cuban doctor who is soon to be working here and says he thinks it's a good thing.

LUIS FERNADES DOS SANTOS: (Speaking foreign language)

GARCIA-NAVARRO: Here in the city you see people sleeping - sleeping - for a day, two days, waiting in line to see a doctor, he says. And when it's their turn, there is no doctor to see them, so that's why I think bringing people in to help will make things better, he says.

Over the summer, massive protests broke out in Brazil decrying, among other things, the state of the public health system here. Aging equipment, a lack of medical facilities, all problems here, are things that take time to fix. But the government here saw an opportunity to respond quickly to the lack of doctors by bringing in Cuban physicians.

The patients may be in favor, but most of the medical community here is not.

(SOUNDBITE OF PROTEST)

GARCIA-NAVARRO: Those are Brazilian doctors in the Brazilian city of Fortaleza shouting slaves, slaves, at the arriving Cuban physicians in late August.

TANIA AQUIAR SOSA: (Speaking foreign language)

GARCIA-NAVARRO: We are not slaves, says Tania Aguiar Sosa, from Cienfuegos, Cuba. We are health workers, she says. We are professionals that provide help to whatever country needs it. Cuba has a long history of sending its doctors to countries around the world. Aguiar was headed to Angola before rerouting to Brazil. She's been in Venezuela and Haiti already and has decades of experience.

Some of what the Cubans call missions are purely humanitarian in nature, like Haiti. Others, like the so-called Oil For Doctors program, see the Cuban government reap the benefit of sending its medical manpower abroad. Venezuela, for example, gives Cuba subsidized oil for the use of its doctors.

JOSE ROBERTO MURISSET: (Speaking foreign language)

GARCIA-NAVARRO: Jose Roberto Murisset is the human rights secretary of the National Doctors Foundation. He and other medical unions are trying to challenge in court the use of the Cuban doctors here. He says the Cuban doctors see the majority of their salary siphoned off by the Cuban government. The Brazilian government has also decreed the doctors have no right to ask for asylum if they want it.

MURISSET: (Speaking foreign language)

GARCIA-NAVARRO: Brazil has strong labor rights, he says, but these Cuban doctors don't have their rights guaranteed. But the main bone of contention is that foreign doctors arriving under the new program don't have to take the Brazilian medical exam to practice here. He claims many of the doctors coming from abroad would fail the test and are underqualified.

MURISSET: (Speaking foreign language)

GARCIA-NAVARRO: Maybe the government thinks that these regions don't need a full doctor, he says. Maybe they think they need only a half doctor. Dr. Adriano Peres Lora disagrees. He's the head of the Pedreira Municipal Hospital. He says at the moment he has 40 beds serving 44,000 people. He says if he can get more doctors doing preventative care, then the main hospital will feel less pressure.

ADRIANO PERES LORA: (Speaking foreign language)

GARCIA-NAVARRO: What we need is basic attention. We lack doctors willing to work as general practitioners in marginal communities; 80 to 85 percent of the health problems people face can be resolved by seeing a doctor at an early stage, he says. He says most Brazilian doctors don't want to work in communities like his, and the need is great.

When the government announced the program to bring in foreign doctors, over 4,000 towns and cities applied to the federal government for extra help. Back at the health clinic where the Cuban doctor will be working, her Brazilian colleague, Dr. Flavio Blois de Mattos, says he welcomes the help. He's overwhelmed at the moment. But he also thinks the Brazilian government's program is unethical.

FLAVIO BLOIS DE MATTOS: (Speaking foreign language)

GARCIA-NAVARRO: He says the Cuban doctor told me that she comes here because even though the Cuban government gets the lion's share of her salary, she makes more here than she would in Cuba. It will help her 15-year-old daughter. He says, I don't think its correct. We are a democracy. Why aren't we giving them the same rights we have? Lourdes Garcia-Navarro, NPR News. Transcript provided by NPR, Copyright NPR.