Without its flying doctors, Cuba’s economy will be in intensive care


A falling-out with Brazil’s new president threatens one of Havana’s biggest exports.


Mac Margolis, Bloomberg


When the Cuban government gave the word earlier this month to recall the more than 8,000 physicians it deployed in Brazil, the media, physicians and public health wonks were alarmed. What would become of the patients the expatriate doctors had been tending in parts of the country where public services were already precarious at best and the only folks in white were Pentecostal pastors?


That the exodus was triggered by yet another outburst by intemperate right-wing President-elect Jair Bolsonaro only aggravated the worries. Bolsonaro not only offended Cuba by accusing it of promoting slave labor — keeping some 70 percent of the contracted doctor’s fees while barring their families from joining them in Brazil — he also had no fallback plan for the services they rendered. Millions of poor patients would be left unassisted, it was said, so inviting a public health disaster. “This is a sad day for Brazilian health and foreign policy,” former health minister Alexandre Padilha lamented.


Two weeks on, the Cassandras appear to have botched the prognosis. While Brazil will indeed have to scramble to replace their imported help, filling those white coats is proving less daunting. Shortly after the government posted help wanted ads, applications for replacements poured in; by Nov. 26, the Brazilian health ministry announced it had filled 97 percent of the vacancies in some 2,800 municipalities.


The real loser, it now seems, is Cuba. To appreciate the blow to Havana, consider the island’s vital signs. Forget sugar, cigars and luxury resorts on the Malecon: flying physicians have become Havana’s most recognizable global brand.


For the last half century, professionally trained medical workers have been the Castro regime’s most formidable calling card, spreading primary care and tending to emergencies in needy societies throughout the developing world. By a recent count, 37,000 Cuban doctors were still administering primary care, conducting surgeries, delivering babies, delivering vaccines and training local medical personnel in 77 countries.


That mission has brought Havana good will and soft power cachet. Not least because most of Cuba’s global clients paid next to nothing, its visiting doctors were treated like heroes. International health care specialists and international media showered Havana with praise, touting “medical diplomacy” as the island’s greatest export.


As it happened, Cuba was taking bows with a tip of someone else’s beret. For decades, the governments of Fidel and Raul Castro could deliver medical services pro bono thanks largely to life-support from Havana’s erstwhile foreign sponsor, the Soviet Union.


With the Cold War largess long gone, however, the struggling island economy turned increasingly to paying customers to raise precious foreign exchange. From 2013 to 2017, professional services accounted for 55 percent of total exports of Cuban goods and services, the Cuban economist Pavel Vidal, who teaches at the Pontifical Xavierian University in Cali, Colombia, reckoned. Medical doctors led the way.


Cuba’s medical internationalism raked in some $9.6 billion on average annually from 2011 to 2016, the Economist Intelligence Unit (EIU) estimated last year. According to Vidal, better than three-quarters of that bounty came from just two markets: Brazil and Venezuela.


The end of the “More Doctors” deal with Brazil will deprive Cuba of some $400 million to $500 million a year, according to Mark Keller of the EIU. That’s more than Cuba earns every year from its signature cash crop, sugar .


Sure, more than 21,000 Cuban physicians are still deployed in Venezuela, in exchange for cheap oil and loans. Another 500 physicians were dispatched to Caracas just this month, an ostensible display of resilience. Yet with the Bolivarian economy in shambles and oil production plummeting, how long that revenue stream will last is unclear. “Under Nicolas Maduro Venezuela is no longer a stable country,” said Keller. “If the government changes, it would be catastrophic for the Cuban economy.”


The island’s fortunes are already looking wan. In the last four years, Cuba’s haul from exporting medical-led professional services fell from $10.2 billion to $7.7 billion, Vidal said. That shortfall, he said, has worsened Cuba’s already under-performing foreign trade, sapping the island economy of some $2.5 billion a year to pay for imports and meet foreign debt obligations.


Throw in the lack of export diversity and declining educational standards, and Cuba’s house-call economy looks even more precarious. Physicians returning from Brazil will be reassigned to Cuba’s public health system, where salaries in pesos make even the garnished foreign wages seem grand, and left to hope perhaps for the next foreign posting. “Cuba still boasts well-trained medical professionals, but in a normal country you wouldn’t send your doctors abroad for cash,” said Keller.


Some ailments not even the best doctors can heal.


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