'Castrocare' divides doctors in Cuba, Brazil


Renee Montagne, HOST, National Public Radio


In Brazil, the government is trying to improve medical care in impoverished and rural areas by bringing in thousands of doctors from Cuba. Brazil's unions are trying to block the program to recruit Cubans, even though few Brazilian doctors want to work in these poorer areas, as NPR's South American correspondent Lourdes Garcia-Navarro reports.


LOURDES GARCIA-NAVARRO, BYLINE: A man is getting a broken tooth cared for at his local public health clinic in the town of Pedreira, around 85 miles outside of Sao Paulo. After the procedure, Luis Fernades dos Santos tells me he's heard about the Cuban doctor who is soon to be working here and says he thinks it's a good thing.


LUIS FERNADES DOS SANTOS: (Speaking foreign language)


GARCIA-NAVARRO: Here in the city you see people sleeping - sleeping - for a day, two days, waiting in line to see a doctor, he says. And when it's their turn, there is no doctor to see them, so that's why I think bringing people in to help will make things better, he says.


Over the summer, massive protests broke out in Brazil decrying, among other things, the state of the public health system here. Aging equipment, a lack of medical facilities, all problems here, are things that take time to fix. But the government here saw an opportunity to respond quickly to the lack of doctors by bringing in Cuban physicians.


The patients may be in favor, but most of the medical community here is not.




GARCIA-NAVARRO: Those are Brazilian doctors in the Brazilian city of Fortaleza shouting slaves, slaves, at the arriving Cuban physicians in late August.


TANIA AGUIAR SOSA: (Speaking foreign language)


GARCIA-NAVARRO: We are not slaves, says Tania Aguiar Sosa, from Cienfuegos, Cuba. We are health workers, she says. We are professionals that provide help to whatever country needs it. Cuba has a long history of sending its doctors to countries around the world. Aguiar was headed to Angola before rerouting to Brazil. She's been in Venezuela and Haiti already and has decades of experience.


Some of what the Cubans call missions are purely humanitarian in nature, like Haiti. Others, like the so-called Oil For Doctors program, see the Cuban government reap the benefit of sending its medical manpower abroad. Venezuela, for example, gives Cuba subsidized oil for the use of its doctors.


JOSE ROBERTO MURISSET: (Speaking foreign language)


GARCIA-NAVARRO: Jose Roberto Murisset is the human rights secretary of the National Doctors Foundation. He and other medical unions are trying to challenge in court the use of the Cuban doctors here. He says the Cuban doctors see the majority of their salary siphoned off by the Cuban government. The Brazilian government has also decreed the doctors have no right to ask for asylum if they want it.


MURISSET: (Speaking foreign language)


GARCIA-NAVARRO: Brazil has strong labor rights, he says, but these Cuban doctors don't have their rights guaranteed. But the main bone of contention is that foreign doctors arriving under the new program don't have to take the Brazilian medical exam to practice here. He claims many of the doctors coming from abroad would fail the test and are underqualified.


MURISSET: (Speaking foreign language)


GARCIA-NAVARRO: Maybe the government thinks that these regions don't need a full doctor, he says. Maybe they think they need only a half doctor. Dr. Adriano Peres Lora disagrees. He's the head of the Pedreira Municipal Hospital. He says at the moment he has 40 beds serving 44,000 people. He says if he can get more doctors doing preventative care, then the main hospital will feel less pressure.


ADRIANO PERES LORA: (Speaking foreign language)


GARCIA-NAVARRO: What we need is basic attention. We lack doctors willing to work as general practitioners in marginal communities; 80 to 85 percent of the health problems people face can be resolved by seeing a doctor at an early stage, he says. He says most Brazilian doctors don't want to work in communities like his, and the need is great.


When the government announced the program to bring in foreign doctors, over 4,000 towns and cities applied to the federal government for extra help. Back at the health clinic where the Cuban doctor will be working, her Brazilian colleague, Dr. Flavio Blois de Mattos, says he welcomes the help. He's overwhelmed at the moment. But he also thinks the Brazilian government's program is unethical.


FLAVIO BLOIS DE MATTOS: (Speaking foreign language)


GARCIA-NAVARRO: He says the Cuban doctor told me that she comes here because even though the Cuban government gets the lion's share of her salary, she makes more here than she would in Cuba. It will help her 15-year-old daughter. He says, I don't think its correct. We are a democracy. Why aren't we giving them the same rights we have?


Lourdes Garcia-Navarro, NPR News.



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