Brazil, facing health-care crisis, imports Cuban doctors

Originally published Saturday, October 12, 2013 at 8:04 PM

Brazil, facing health-care crisis, imports Cuban doctors

4,000 Cubans will arrive in Brazil by the end of the year to serve for
three years in forlorn outposts where health officials say Brazilian
doctors will not work. Under the contract, Brazil will pay the island's
cash-starved government $4,200 a month per doctor, or $200 million annually.
By Paula Moura and Juan Forero
The Washington Post

EMBU GUACU, Brazil — Since the 1960s, Cuba has deployed an army of
doctors to the world's most inhospitable corners by the tens of
thousands, from Haiti to Africa's killing fields to the ultraviolent
barrios of Venezuela.

Now, hundreds of Cubans are arriving in relatively affluent Brazil to
shore up a decrepit health-care system that has become a national
embarrassment.

Two months after mass protests against the condition of public health
and other substandard services, President Dilma Rousseff's government
has inked a deal to bring 4,000 Cubans by the end of the year to serve
for three years in forlorn outposts where health officials say Brazilian
doctors will not work. Under the contract, Brazil will pay the island's
cash-starved government $4,200 a month per doctor, or $200 million annually.

But the government's plan has its doubters. Among them is Aline Lais
Ribeiro, 17, who this week waited three hours to see the lone doctor
working a 24-hour shift in a shabby clinic in this gritty São Paulo
suburb, one of the 700 towns where Cuban doctors will be assigned.

She asked why the government has not put the resources into building a
quality health-care system to match Brazil's developed-world pretensions.

"The service is terrible," said Ribeiro, who said it would take two
months to see a specialist for what she believed to be a urinary
infection. "I think it's wrong. They should bring doctors from this area."

The arrival of the first 400 Cubans is raising hackles in Brazil's
health-care establishment and prompting uncomfortable questions about
the inability of Rousseff's center-left government to provide quality
care in slums and remote Amazonian districts, where hospitals are in
shambles and medical personnel are in short supply.

Critics see bringing in the Cubans as a half-baked measure designed more
to buttress Rousseff ahead of next year's presidential election on an
issue in which she is vulnerable.

During the demonstrations in June, when Rousseff's approval ratings fell
sharply, Brazilians told Datafolha pollsters that their greatest
concern, more so than corruption, crime or failing schools, was the
country's ramshackle public-health system.

"The government doesn't organize the health system, doesn't fund the
system and now they think that bringing the Cubans in to provide aspirin
and hold a patient's hand is medicine. It is not medicine," said Jose
Bonamigo, a doctor and treasurer of the Brazilian Medical Association,
which opposes the plan.

What bad health care looks like

Here in Embu Guacu at the one-story Basic Health Unit, the harried
doctor, Francisco de Brito Pedrao, 31, said Brazilian doctors are
reluctant to work in remote areas or poor urban districts because of
inadequate equipment and facilities.

As he spoke, a black street dog roamed a corridor. The facility has
cracked wooden doors, walls where brick is exposed behind peeling paint
and rooms outfitted with decades-old metal beds.

To make matters worse, Pedrao is the only doctor in the facility. "I
spend 24 hours alone — it's hard," he said, listing off the basic but
much-needed equipment the clinic lacks. "I usually see 200 people. I'd
like to have more time, but I can't give people the attention they deserve."

Indeed, 40 people were waiting to see Pedrao, including Joao Antonio de
Sousa, who wondered when his 6-year-old son, suffering from a fever for
two days, would get service.

"The health system is terrible not only here, but terrible all over
Brazil," Sousa said.

Riordan Roett, director of Latin American studies at Johns Hopkins
University and author of the book "The New Brazil," said importing the
Cubans underscores the "extraordinarily bad health-care system." But he
said it also reflects the huge gaps between rich and poor that are a
part of life in Brazil, despite the bigger middle class that has
sprouted up in recent years.

"What the elite do in Brazil is the same as in Argentina and elsewhere
in Latin America: They support private health clinics and private
schools and are reluctant to help the poor," Roett said. Rousseff's plan
might be a good short- or medium-term solution, he said.

Brazil short of doctors

In an interview, Brazil's health minister, Alexandre Padilha, extolled
the Cubans for their know-how — 84 percent of the first 400 doctors have
at least 16 years of experience — and their ability to work in difficult
conditions with people on the margins of society.

Padilha said the Cubans are being assigned to "small communities, in the
poorest barrios, where 13 million Brazilians live who do not have the
care of any doctor."

Brazil has only 1.8 doctors per 1,000 people — fewer than not only
developed countries, but also a smaller ratio than neighbors such as
Argentina and Uruguay. That led Brazil to appeal to doctors from Spain,
Portugal, Argentina and other countries to come work here. Although
hundreds have in recent weeks, Padilha said it is far from enough.

The minister said the arrival of the Cubans is part of a broader
strategy under way to improve medical infrastructure and train more
Brazilian doctors.

Critics, though, have questioned the quality of the service the Cubans
will provide and the legality of the contract that permits them to work
in Brazil. Some also say Cuba keeps the vast majority of the money paid
for its medical services, providing only a small percentage to the
doctors, nurses and medical technicians who serve in 58 countries.

Brazil's government will channel payment to the Pan American Health
Organization, or PAHO, a Washington, D. C-based branch of the World
Health Organization, which then pays Cuban President Raul Castro's
government.

Brazil's government and the PAHO say they do not know how much Cuba will
pay its doctors. But Cuban's vice minister for health, Marcia Cobas,
said the Cubans in Brazil would receive 40 to 50 percent of the $4,200
that Brazil is paying monthly for each doctor.

That's a fortune to Alain Garcia Caballero, a Cuban nurse who last year
defected from Venezuela, where Cuba has its largest medical presence. He
said he was paid less than $100 a month for working in a violent barrio.

He said many of the Cubans arriving in Brazil will think of defecting,
but most will not because of fear that their families in Cuba will face
reprisals. "I think all the Cuban doctors, everyone on these missions,
think about it," Garcia said from Miami, where he now lives.

He said medical personnel sent overseas go through a rigorous
"ideological" preparation course in Cuba, during which they are taught
to avoid talking to the media or people in their host countries about
politics. To keep defections to a minimum, Garcia said, Cuban agents are
deployed along with doctors.

In an interview with Brazilian radio, Rousseff said the Cubans would be
treated well, receiving "housing, food, everything that we can do under
the law to take doctors to areas where there are no doctors."

She stressed that the Cubans are being welcomed along with doctors from
other countries who have agreed to work in remote regions.

In the clinic at Embu Guacu, Marilene Braz, 33, said the arrival of the
Cubans could improve services. She accompanied her husband, who had been
hurt in a motorcycle accident and had been waiting three hours to see
the doctor.

"If they can do some good, they can come here," she said. "I'm worried
about the language. But I think they might be able to learn Portuguese."

Source: "Brazil, facing health-care crisis, imports Cuban doctors |
Business & Technology | The Seattle Times" -
http://seattletimes.com/html/businesstechnology/2022013188_brazilcubandoctorsxml.html