This month Brazilian President-elect Jair Bolsonaro took a hard line against communist Cuba. The right-wing congressman said when he becomes President in January, he’ll take aim at a program that pays thousands of Cuban doctors to work in Brazil.
Those doctors help fill Brazil’s acute doctor shortage – but Bolsonaro says Cuba violates their human rights. “The Cuban dictatorship,” he said, will no longer be allowed to keep three-quarters of what Brazil pays the doctors. And the doctors must be allowed to bring their families to Brazil with them.
Cuba treats these doctors like “slave labor,” said Bolsonaro, adding he also wants the physicians to get Brazilian certification.
That prompted a swift and angry response from official state television in Cuba. It blasted Bolsonaro’s conditions as “unacceptable,” and announced Havana will pull the more than 8,300 Cuban doctors out of Brazil.
Not surprisingly, that won Bolsonaro big cheers in Miami.
“We are very glad, it’s great news, because Bolsonaro has the right position against Cuba,” says Dr. Carlos Martinez, a Cuban doctor who came to Miami four years ago as a political refugee and is now on the board of Solidarity Without Borders. The non-profit group, based in Hialeah, helps Cubans like the doctors in Brazil defect to the U.S.
"Cuba exploits the doctors as merchandise, y’know?” says Martinez. “They send doctors to other countries to work 24/7 in very difficult environments.”
Whether or not Cuba treats its doctors like “merchandise,” those professionals are indeed Cuba’s most valuable export. An estimated 50,000 of them work in more than 60 developing countries. And, as in Brazil, they usually work in poor rural towns and urban slums.
What those countries pay in return brings Cuba almost $13 billion a year – more than tourism, mining and remittances from Cubans abroad combined. Brazil’s “Mais Médicos” or “More Doctors” program is an especially large revenue source for Cuba – about $300 million.
But the Cuban doctors themselves see very little of it, since about 80 percent of what Brazil pays for each of them goes straight to the Cuban regime's coffers. What the doctors get to pocket is admittedly more than they’re paid in Cuba – but so, significantly, are Brazil’s living expenses. The story’s much the same in other countries.
“I was paid only $50,” says Dr. Carlos Hernandez, who was a radiologist in the Cuban medical mission in Venezuela a decade ago. He defected to South Florida when he figured out his monthly net was a fraction of what Venezuelan was paying Cuba for his services.
“It’s a violation of my dignity as a human being,” says Hernandez.
Hernandez, who now lives in Delray Beach, didn’t have a wife and children back in Cuba at the time, and that made it easier for him to bolt the mission. Cuban doctors abroad may not bring families with them – and if they leave the missions they can’t return to Cuba for eight years.
“They use the family as a guarantee for [us not] walking away from the missions,” he says. “Like tools for punishing us.”
And yet, despite those repressive rules, there is another bottom line about the Cuban medical missions that their critics can’t ignore: The Cuban doctors perform a crucial job – especially in Brazil.
“Most of the people that live in Miami who are saying, ‘Oh, Cuban doctors just go back home,’ y’know, they don’t think about Brazil’s medical problems,” says Alexandra Maranhão-Guzik, a Brazilian interpreter who recently moved from Recife, Brazil, to Pinecrest.
Maranhão-Guzik’s parents were co-founders of the liberal Workers Party that started Brazil’s More Doctors program five years ago under then President Dilma Rousseff. She points out that since Brazil has little if any aid or loan programs for medical school, almost all Brazilian doctors come from affluent families. And most refuse to work outside large cities. The result:
“Our own doctors aren’t enough to take care of the population.”
For example, in Pernambuco, Maranhão-Guzik’s state, almost three-quarters of the doctors are in the capital, Recife. Yet Recife has less than a fifth of Pernambuco’s population.
The Cubans – who make up more than half the doctors in Brazil’s More Doctors program – are essential to filling that alarming gap. At the same time, Maranhão-Guzik says losing those Cuban doctors might at least force Brazil to find a Brazilian solution instead of relying so heavily on foreign doctors.
“The state of Pernambuco could say, ‘I will pay for your medical school,’” she says. “But in exchange, you’d have to work for x number of years in the rural area of our state. They will have to be creative.”
But that could take a long time. Meanwhile, Cuba’s feeble economy can’t afford to lose the Brazilian revenue – nor does Cuba want other countries confronting it about the doctors the way Bolsonaro is. So the two sides may need to negotiate a compromise to keep the Cuban doctors in Brazil.
Either way, they will have to be creative.