A rupture between Havana and Brazil's new far-right president-elect has triggered the immediate withdrawal of all the more than 8,000 doctors that were part of Cuba's international 'white-coat' medical diplomacy, reports The Daily Telegraph. The move has left Brazil's primary healthcare system in a state of panic.
Angelita Santos cried when she heard the doctors were leaving. The Daily Telegraph reports that a health director in a town in the south-eastern state of São Paulo, she was aghast to hear that Cuba was pulling out the fleet of medical staff that kept facilities in Brazil's neediest regions afloat. "We were rocked by the news. The doctors called us that morning in tears, and we were in tears too", Santos said. Only recently, her town of Embu-Guaçu had had 19 doctors for its 70,000 residents. Now, amid a diplomatic rupture between Havana and Brazil's new far-Right president-elect, it had been abruptly left with just two. "We're praying that replacements come soon. We can’t handle the demand of patients," she is quoted as saying.
The report says health centres in peripheral areas around Brazil have been left severely short-staffed after the Cuban decision, prompted by repeated verbal attacks on the More Doctors programme by Jair Bolsonaro ahead of his 1 January inauguration. The hard-right politician dubbed "the Trump of the Tropics" has upended relations between Brazil and the socialist island, which for much of the last two decades have been close allies under leftist leaders in Brasilia.
The report says Luiz Inacio Lula da Silva and his Workers' Party successor, Dilma Rousseff, were bastions of the Latin American "pink tide", which saw leftist governments in countries such as Venezuela, Ecuador, Bolivia, Argentina and Nicaragua form a strong regional alliance. Cuban aid, including in the form of doctors, played a key part in Havana's extended reach on the continent, with large medical missions in Venezuela and Bolivia in particular.
But that tide is now turning, with the election of Bolsonaro heralding the most dramatic reverse. Before even taking office, the populist politician is flexing his muscles and pushing Brazil further to the extreme right. A staunch opponent of the Havana regime, Bolsonaro promised to kick out Cuba's doctors at several campaign events, angering its government and causing the end of its white coat diplomacy in South America's largest nation.
The report says the More Doctors programme employed 8,332 Cuban personnel, many of which have already flown out, leaving Brazil's primary healthcare system in a state of panic. The rest are expected to leave by 10 December, amid what the Cuban health ministry has called a "lamentable situation". The Cubans accounted for almost half of the 18,240 doctors brought in from overseas under the programme, launched in 2013 under Rousseff with the aim of improving healthcare in the most impoverished and remote regions.
Posturing after his election, Bolsonaro pledged he would force Cuban doctors to take proficiency tests to attest to their skills. According to the report, he claimed that “there is no proof they are actually doctors,” despite the submission of a valid medical degree being a prerequisite for the programme. "It’s a worrying situation," said Mauro Junqueira, president of the National Council of Municipal Health Departments. “The Cuban doctors were welcomed here, they did a great job," he said, adding that he hoped Brazilian replacements would fill the breach as effectively.
The report says the Brazilian government has hurriedly released an emergency tender to replace the jobs vacated by the departed Cuban doctors – and health ministry officials said 84% had been filled. However, it remains to be seen whether these gaps will be properly plugged.
Last year, the health ministry posted 2,320 new vacancies within the programme, for which 6,285 Brazilian doctors applied. However, only 1,626 showed up to work, and one third resigned within their first year. The report says Brazil's doctors are unequally distributed across the country, with an average of 5.07 doctors for every thousand residents in Brazil’s state capitals, but just 0.3 in towns of less than 5,000 inhabitants, according to official data. "It’s not easy working in the most isolated parts of the country, for some health centres it can take over a day just for the doctors to get to work," Junqueira said.
The report says the perception is that the Cuban doctors filled the jobs that Brazilian professionals do not want, such as specialised indigenous health clinics. Of the 372 doctors working in 34 indigenous districts across the country, 301 are from Cuba. The local health clinics staffed by the More Doctors programme are responsible for primary healthcare and vaccination campaigns, a crucial branch of Brazil’s public health system.
In July, Unicef warned that Brazil needed to step up its disease prevention programmes, citing data that the country’s vaccination coverage had decreased for diseases such as measles, polio and diphtheria. The country was also hit with successive yellow fever outbreaks in 2017 and 2018, causing hundreds of deaths.
[link url="https://www.telegraph.co.uk/news/2018/11/24/fears-brazils-healthcare-system-cuba-pulls-thousands-doctors/?WT.mc_id=e_DM886692&WT.tsrc=email&etype=Edi_GHS_New_Weekly&utm_source=email&utm_medium=Edi_GHS_New_Weekly_2018_11_29&utm_campaign=DM886692"]The Daily Telegraph report[/link]