Sep. 8, 2013 -- Last week, Brazilian medical associations and human-rights groups greeted Cuban doctors who've been hired to bolster that country's ailing health system with accusations of entering the country to steal Brazilians' jobs.
The Brazilian government has condemned the demonstrations, and officials have repeatedly tried to convince medical associations of the necessity of importing doctors as part of an initiative called Mais Médicos (More Doctors). The public program aims to send health professionals to some of the country's poorest and most remote areas.
Brazil has one of the worst patient-to-physician ratios of all the major economies, according to World Bank data. While Spain has four doctors for every 1,000 citizens, Brazil has 1.8. Cuba, meanwhile, has a large amount of doctors, despite its numerous economic problems, with 6.7 physicians for every 1,000 people.
"We created this program because society is calling for it," President Dilma Roussef said last week. "We hear you have a problem with the [health] service. So we created a program to search for doctors for those places where there aren't enough. Here in Brazil, there are 700 municipalities where there is no doctor living there."
Under Brazil's constitution, everyone is guaranteed access to free public healthcare, so the lack of doctors presents a problem for the government. It also represents a fundamental setback for millions of Brazilians who live in the remote municipalities where doctors are rare.
To solve this problem, Dilma Roussef's government came up with the Mais Médicos program. Initially, the government offered 15,460 posts in remote parts of the country to Brazilian doctors. The posts paid considerable salaries ($4,250 a month) and offered free housing and board. Despite those benefits, only 938 Brazilians physicians applied for the jobs.
Most doctors in Brazil live in large cities, and come from middle class families. So they have few connections with the remote, poverty stricken places where the government was offering jobs.
The government then decided to offer the positions to foreign doctors. Physicians from Argentina, Portugal and Spain applied for three-year contracts to live and serve as general practitioners in Brazil. The incentive for these doctors was clear: They all come from places with high unemployment rates, whose economies aren't doing too well.
The Cuban doctors, who are paid $30 a month or less on the communist island, have an even greater incentive to head abroad. In Brazil they will earn around $4,250 per month, and even though the Cuban government will retain as much as two thirds of their salary, Cuban doctors will still be left with an amount of cash that is astronomically greater than what they make at home.
Brazil is set to hire around 4,000 Cuban doctors to fill some of the vacant positions for the Mais Médicos program. But this has not pleased doctors' unions in the South American country.
Brazilian medical groups have two complaints against plans to bring in Cuban physicians. The first source of anger is connected to politics. Cuban doctors working outside the island must pay between a fourth to two-thirds of their salary – the figure is not clear -- to the Cuban régime, which will earn around $150 million a year if Brazil's government hires 4,000 physicians. For doctors in Brazil, this arrangement constitutes a severe form of exploitation, and is also seen as a way to give foreign aid to a regime with a questionable human rights record.
The second problem has to do with the Cubans' professional capabilities. According to some Brazilian doctors, the Cubans are not up to the task, and the government is only bringing them in order to mask its health policies' deficiencies.
"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," Jose Bonamigo, a doctor who belongs to the Brazilian Medical Association, told The Washington Post. "It is not medicine."
There does not seem to be very solid evidence for this second argument. Since the 1960s, Cuba's healthcare system has been recognized by the UN as one of the best in the world, and the island has already exported thousands of physicians to many other countries as part of economic, diplomatic, and cultural exchange initiatives.
Although Cuba's health system is far from perfect, the island does seem to perform well in preventing basic illnesses, which is what Brazil is looking for. Cuba has some of the lowest child and maternal mortality rates in the western hemisphere.
The government and some local doctors have also responded to those who are against doing business with Cuba's communist regime.
The money taken by the Cuban government from the doctors that will be sent to Brazil, can be seen as a form of tax, Maria Geisiane, a 32-year-old Brazilian doctor who is a part of the Mais Médicos program, told the O Globo newspaper.
"Each country has its problems. Some sell weapons, Cuba is sending doctors. Here in Brazil we pay taxes and we don't know where the money goes," Geisane said.
"We can't have an arrogant attitude," Brazilian Health Minister Alexandre Pradilla said. "We have to separate a critical ideological stance on Cuba, which is legitimate, from a program that provides an alternative for millions of Brazilians who currently have no access to any doctor."