Latin America’s Doc Deficit: Brazil, a Continental Giant, Still Needs to Import Cuban Medics

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Eraldo Peres / AP

Cuban doctors attend a training session at a health clinic in Brasília on Aug. 30, 2013

A Brazilian prosecutor is investigating whether President Dilma Rousseff’s government violated federal labor laws by recruiting 4,000 Cuban physicians this month to work in remote areas like the Amazon. That’s just the latest wrinkle in Brazil’s acrimonious Cuban-doctors controversy, which has everyone from Brazilian physicians in Brasília to Cuban-American politicians in Washington, D.C., up in arms.

But there is a much larger problem involved here than Marxist medics — and it’s one that plagues not just Brazil but most of Latin America. Whether or not Brazilian judges eventually let the Cuban physicians stay or order them to leave, it won’t solve Brazil’s doctor shortage, especially in the medically deprived rural and favela (slum) zones the Cubans are headed to.

If you’re wondering why Brazil was the site of sometimes violent street protests this summer, this latest dustup offers one useful clue. Brazil is now the world’s sixth largest economy and considers itself on the doorstep of the developed world. Yet, as Brazilian demonstrators are all too aware, its education system is widely regarded as abysmal, especially science preparation. Brazilian physicians aren’t bad practitioners, though Rousseff has a point when she says many are too elitist to practice in the boonies. But while the medical community may share much of the blame, critics say Brazil’s notoriously corrupt and indifferent officialdom has done little to provide the infrastructure needed to create and support enough doctors to serve the nation’s 200 million people.

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According to the World Health Organization (WHO), Brazil — despite its recent economic boom and constitutional guarantee of universal health care — has only 1.8 doctors per 1,000 people. (Cuba, despite its endless economic bust, has 6.7.) Almost two-thirds of all health care spending in Brazil is private, even though three-fourths of the population depends on public medical services.

Spending on Brazil’s well regarded but underfunded national health system accounts for little more than 3% of GDP, but the WHO urges at least 5%. “Brazil is creating more spaces in its medical schools,” says Katherine Bliss, senior associate at the Center for Strategic and International Studies’ Global Health Policy Center in Washington, D.C. “But increasing the number of medical professionals may take a generation, since Brazil will need to ensure students are prepared, and that means reaching back to strengthen or reform education at the elementary and secondary levels.”

Rousseff launched Mais Médicos (More Doctors), the program that’s trying to augment Brazil’s physician ranks, in response to protesters’ demands for better public services. But the country’s National Federation of Physicians is fuming that Cuban doctors aren’t trained well enough to practice in Brazil — and by many accounts, Cuban medical training today isn’t as high caliber as it once was — and the Cuban-American congressional caucus calls the Cubans’ recruitment part of Rousseff’s “complicit blindness” toward the island’s communist dictatorship.

But Cuba’s medical-diplomacy mission — which currently has 40,000 doctors serving abroad and, along with other medical services and sales, brings the Cuban government some $6 billion a year (of which the doctors themselves get only a tiny fraction)— is a fixture in the third world, and was generally praised for its work in Haiti after the 2010 earthquake. And it points up the fact that Brazil’s problems are hardly unique. In fact, six of Latin America’s seven largest economies have two or fewer doctors per 1,000 people. (The exception is Argentina, which has 3.2.)

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As in Brazil, the region’s complacency toward science education is a big culprit. That’s reflected in the fact that while Asia accounts for 30% of the world’s technology research and development today, Latin America’s share is 3%. “Latin America has a strong history of research and collaboration in health sciences that dates back to the 19th century,” says Bliss. “But it’s been a challenge for governments to make sure there are sufficient opportunities for people from all social sectors to engage in that kind of work.” Rousseff hopes her Science Without Borders program, which is sending tens of thousands of students to countries like the U.S., will improve things. But as experts like Bliss point out, it could take at least a generation to get the South American giant on track.

Still, Americans like the Cuban caucus members shouldn’t get too self-righteous. The U.S., with 2.4 doctors per 1,000 people, has its own doctor shortage; and like Brazil’s, it’s most acute in poor rural regions. The Association of American Medical Colleges warns that the U.S. may in fact face a deficit of as many as 100,000 doctors by 2020. In Florida, 16 counties have fewer than one doctor per 1,000 residents. Miami, one of the U.S.’s largest metropolitan areas (and where most of the Cuban-American caucus is from), didn’t have a public medical school until 2009.

That doesn’t excuse Brazil’s situation. But the U.S. does offer Brazil a helpful warning — namely, that being a rich country is no guarantee of adequate access to physicians. And that has nothing to do with Cuba.

6 comments
reis2101
reis2101

The truth about the Cuban doctors coming to Brazil is that many of these are supporters of President Rousseff`s party . The health system of Brazil is chaos, and after 12 years of government, became an emergency, an excuse to hire doctors from anywhere in the world, the Cubans doctors. What the government doesn’t say is that medical organizations have never been against the entry of foreigners, but to allow entry without revalidation of diplomas coming from their countries of origin, something that both the Brazilian media and the irresponsible government didn’t say!

The reports show that these medical documents are unreadable, do not prove their proficiency in Portuguese, let alone prove that they are doctors. That is, a mess!

The chaos of the Brazilian public health is based on the allocation of a measly 3.9% of GDP for the sector, while the World Health Organization directs at least 5%. The number of physicians in Brazil is around 1.8, while in neighbouring countries is around 2.5 to 3.5 , with the exception of Chile , which has one doctor for every thousand inhabitants and has the best health indicators in Latin America.

The number of hospital beds has been declining year after year and the government is not applying the budget for health as it should, in 2012, lacked U.S. $ 17 billion and in 2013, of the sum to be invested, only 26.5% of the budget was spent. While the country does not invest in sanitation and illiteracy increases, there is spare cash for World Cup, Olympics and bullet train project, which is estimated at U.S. $ 50 billion.

Given the above, it is easy to see why the health of Brazil is in chaos, and because the government has no way to justify their incompetence, transfers to the doctors of the public health sector in Brazil the responsibility. There are bad doctor, yes, of course, as there are bad engineers, bad lawyers, bad politician…

But, most important, is the government deceive an entire population and absolve themselves of their responsibilities. Time will show that this program is electioneering and that nothing will change in the Brazilian healthcare system, unfortunately. We just hope it is not too late for the country's recovery, which now begins to looks of suspicion not only in their social bases, but in its economy, employment and income as well.

Cubaverdad
Cubaverdad

As the example of Zimbabwe has shown: replacing local trained doctors or filling deficits with indentured Cuban doctors is no solution. Brazil should set up a special program for local bright kids to get an education for free in return of a couple of years service. That would be fair. To abuse Cuban doctors that are condemned to a life of servitude to support the regime that oppresses them is criminal.

Brazil should demand that 90% of the salaries go to the Cuban doctors and that they are allowed to bring their families with an option to stay in Brazil.

ArthurMombach
ArthurMombach

@ShastaCNN PT reestatizou estradas no RGS. Resultado? Buracos, acidentes e nenhuma manutenção. É o delírio comunista no século XXI

mariawerlau
mariawerlau

The deal to send 4,000 Cuban doctors to underserved areas of Brazil violates a number of international agreements and has the Cuban doctors serving under conditions of bonded servitude. 

Cuba will reportedly withhold around 75% of the US$4,200 a month that Brazil will pay per doctor through PAHO (Pan American Health Organization). This will leave the Cuban dictatorship net annual revenues of around US$151.2 million a year to continue repressing and avoiding needed structural reform. Plus, it will rob Cubans of needed health services and medical supplies, exacerbating the public health crisis in Cuba.

PAHO should foster a dialogue on innovative international healthcare arrangements to develop guidelines and best practices to address the need for doctors in the region, but guaranteeing the protection of all patients and the rights of all health workers.

JoaoEduardoMadureira
JoaoEduardoMadureira

The Brazilians doctors are a real shame to Brazil.

Last week, a television station showed a report denounced fraud in the public health system, committed by Brazilian doctors. The exclusive story of Fabio Diamond show professionals who subscribe to the point and leave without paying any attention. They are paid for a hundred hours a week, but do not remain more than ten minutes in the hospital. See the video HERE.

The Brazilian medical associations are the most biased institutions in Brazil.

The Regional and Federal Medicine Council. which are supposed to regulate the Brazilian medical profession, have a double standard when they evaluate the public healthcare situation in Brazil. When the Brazilian press shows the public hospitals crowded to its capacities, they said the patients are not receiving properly medical attention, because there are no doctors enough. However, when the Federal government launched the “More Doctors” program, they said there are plenty of Brazilian doctors enough for all areas.

Since 1808, when the first medical school was established in Brazil, the public healthcare sector is a completely fiasco.

The National Health System (SUS) is managed and provided by all levels of government. The public health services should be universal and available to all citizens of the country for free, however it is not what happen. Those in need of medical attention and cannot afford to pay for a private health care coverage, remain without any medical assistance at all, due to the lack of physicians.

The physician shortage is a reality not only on Brazil´s rural and remote areas, but also in areas like Rio, and Sao Paulo -- public hospitals in these metropolitan areas are always crowded. People must wait in very long queues just for a possibility to be attended -- many of them must come back in the following day, in order to see a doctor. If the treatment depends on a medical specialty, then it can take several months until a patient see a specialist.

The Brazilian public health services is a completely chaos!

The massive street demonstrations in June was focused basically on the Brazilian public health services -- the Brazilians pay heavy taxes, but the service is not properly delivered. False claims, kickbacks, and self-referrals are common frauds committed by doctors in Brazil, but the Brazilian Federal Medical Council do nothing about it.

Besides the  Brazilian Federal Medical Council works on to keep the number of doctors as low as possible.