This Controversial Brazilian Program Has Doctors Enraged

“Slaves!” jeered 50 Brazilian doctors at a group of Cuban medical professionals, many Afro-Cuban, as they left reception welcoming them to Fortaleza, a city in northeastern Brazil. "Incompetent!" they added, for good measure.

Videos and photos of the incident quickly went viral. The Cubans had come to Brazil through a federal program called Mais Médicos (More Doctors), which contracts foreign professionals to work in underserved areas of the country. The first 650 of these doctors, 400 of them Cuban, arrived in cities across Brazil late last month. As the incident in Fortaleza demonstrated, the problem has generated considerable controversy.

Brazil’s troubled health care system was a mobilizing force during the enormous protests that erupted across the country in July. The country guarantees free medical treatment in its constitution, but public clinics are notoriously underfunded and understaffed. Wealthy Brazilians opt out of the state system when possible. Scrambling to respond to the demonstrations, the administration of President Dilma Rousseff launched Mais Médicos to remedy the country’s acute shortage of doctors in poor and rural areas. But the program has met resistance, if not outright hostility, in the medical community. Media coverage, especially in the United States, has largely focused on criticism related to the fact that the bulk of the program’s foreigners are Cuban. But more importantly, skepticism among Brazilian doctors is demonstrative of a deep mistrust, especially among young people, of the country’s institutional capacity to solve Brazil’s problems more generally.

Predictably, considerable hype surrounds the arrangement between Havana, Brasília, and the Pan-American Health Organization, which negotiated the deal. Some 4000 Cuban doctors are slated to serve in Brazil, but will not receive direct payments from the Brazilian government. Instead, their salaries (around 5000 USD per month) will pass through Cuba first, where roughly half of the money will stay with the Castro regime.

This is hardly unique to Mais Médicos. Cuba has some 40,000 doctors serving abroad, constituting an important element of its foreign policy and exchange earnings. Those opposed to the Cuban government have raised their hackles over what they see as a direct subsidy to the island. Others have spoken out against the supposed exploitation of Cuban doctors. Defending the language used during the demonstration in Fortaleza, one protest leader asserted that the Cuban doctors “will be used as slave labor,” so the “slave” comments should not be interpreted pejoratively. An investigation into whether the lower wages the Cubans receive violate Brazil’s labor laws is underway at the federal level.

Nevertheless, three-quarters of Brazilians — including many doctors — are fully supportive of Cubans working in the country. The rub stems from the fact that Mais Médicos seems to have been implemented without consultation with the medical community. “We do not oppose foreign doctors in Brazil,” says Felipe G., a recent graduate and ophthalmological resident in São Paulo. He characterizes the federal program as “imposed” by the government despite legitimate concerns held by state and federal medical associations. Imported doctors, for instance, are exempted from taking the Revalida, the test foreigners typically must pass in order to practice medicine in Brazil. If newcomers were required to prove their medical knowledge and command of Portuguese, Felipe says, the government could have avoided the impasse.

Professionals are also incensed by the government’s insinuation that Brazil’s problems are rooted in a deficit of doctors when the system’s larger problems stems from too little funding and too much bureaucracy. “The government is using doctors as a scapegoat for a failing health care system,” says Alex B., a young neonatologist in Porto Alegre. “The government decided not to take the blame, and instead advertised that all people need is more doctors. The more complex issue is building new and more modern hospitals while equipping old ones to end the wait for surgeries and intensive care beds.”

Some 75 percent of Brazilians rely on public health care, yet the private system accounts for two-thirds of total spending. YouTube has become a popular platform for citizens to denounce the oftentimes deplorable conditions of public facilities, such as overcrowding and a dearth of basic supplies.

One video, which gained notoriety during the fervor generated by the summer’s protests, shows a female doctor distraught over the lack of beds for sick patients. “I can’t do anything!” she shouts, “The government does nothing! We are overwhelmed!”  

To the government’s credit, experts agree that Brazil needs more doctors. Brazilian nationals are encouraged to participate in Mais Médicos, and receive priority status over foreigners, but only 1000 signed up during the program’s first registration period. Participating municipalities, however, filed petitions for over 15,000 doctors. Sending more Brazilians through medical school will obviously take years, and until then, the shortage needs to be remedied somehow. But new doctors can only do so much when faced with the same old problems. Without the state stepping up to provide basic infrastructure, it is understandable why relatively few choose to work in underserved sites.

Brazil suffers from a litany of problems stemming from the country’s inefficient and corrupt public sector, such as poor public transportation, high taxes, and education disparities. The protests in July were an energizing moment for change, and were followed by a series of government promises. But as the resistance to foreign doctors has demonstrated, the public is wary of “quick fixes” for the country’s problems.

Indeed, despite its image as an emergent global power, Brazil suffers from some of Latin America’s lowest levels of confidence in the political system and public services, barely exceeding those in Haiti. For Brazil’s doctors, this is not just a Cuba issue. This is something bigger.

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Cameron Combs

Cam Combs works at the Inter-American Dialogue in Washington, and has been published in TheAtlantic.com, Los Angeles Times, Miami Herald, World Politics Review & Huffington Post. Portfolio at cameroncombs.com

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