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.