Slaves in White Coats / Miriam Celaya

Cuban doctors arriving in Brazil. The joy of the escape.
Cuban doctors arriving in Brazil. The joy of the escape.

In the nineteenth century, slave crews were rented out after the harvest to other landlords, providing the slaves a few trifles. 

HAVANA, Cuba, Feb 12 — The recent “defection” of Cuban doctor Ramona Matos Rodríguez, who provided services in Brazil under an agreement signed between that country and Cuba, part of the program “More Doctors for Brazil” once again brings to the forefront the controversial topic of the exploitation of health professionals by the Cuban regime in its desperate race to obtain hard currency.

Matos’s claims are based on the deception which she stated she was victim of, since she was not aware of the two countries’ agreement providing for a monthly royalty payment equivalent to about $4000 per physician, of which Cuban doctors would only be paid $1000 each month, that is, approximately 25% of the total of the original contract.

Medical Sciences graduates. Professionals to export
Medical Sciences graduates. Professionals to export

In addition, the Cuban government would have violated the contract signed by doctors in Cuba prior to their departure to Brazil, since, in practice, they get just over $300 per month, while the Cuban bank holds back $600 to be accessed by the doctors with the use of a debit card on their return to Cuba three years after completing their “mission”.

A Longstanding Trick

The subcontracting system of Cuban doctors to other countries has become one of the most important sources of hard foreign currency for the Cuban government, plus an instrument of political manipulation for electoral purposes by some populist governments. In this sense, the olive-green caste behaves like the old slave-holding landowners in the nineteenth century Cuban sugar industry aristocracy, whose crews were rented out after the harvest to other landlords for dissimilar tasks, providing the slaves with a few coins of some other trifles.

 Cuban doctors in Bolivia, instruments of populist campaigns by Evo Morales
Cuban doctors in Bolivia, instruments of populist campaigns by Evo Morales

However, manipulation of these services by the regime is neither really new nor limited to physicians. Other Cuban slaves are equally contracted out with unconscionable benefits for the regime, although the movement of physicians has been the most conspicuous and substantial. It began in the early and distant decade of the 1960’s by sending the first doctors to Algeria, and it was kept up more or less regularly in other places of the Third World, especially in African countries as part of commitments by the regime with Moscow.

They were mainly programs that responded to the political interests of the Kremlin, which Cuba was a satellite of, though back then doctors were deployed in small numbers without detriment to the health care of the Cuban people.

Since the 1990’s, rental of doctors increased with the pressing need to find alternative sources of income that would allow the alleviation of the crisis sparked by the disappearance of the “socialist camp”. Since then, the practice has been maintained at an increasing pace, with health care in Cuba rapidly deteriorating. The revenue from these contracts is not used for technological equipment, improving the infrastructure or other essential items to offer Cubans efficient and high quality service.

After  “solidarity”,  the facts

Nicolás Maduro has used the Barrio Alto program to win followers in the hills and villages in the jungle.
Nicolás Maduro has used the Barrio Alto program to win followers in the hills and villages in the jungle.

According to an undisclosed unofficial source, it is true that few Cuban doctors know how much they will earn in the countries where they provide services.  “One thing is the ‘contract’ we signed in Cuba, usually at a mass meeting where they read us the ideological-political act and they presented us with paperwork which we had to sign in a hurry, without having read it and without receiving a copy, and another thing is what we will find at our destination, because sometimes reality is harder than what we imagined, and we find ourselves in a position of having to use our own funds in order to survive, or at least to improve conditions”.

Extreme violence is another danger faced by doctors in many destination countries, and their contracts, in which indemnification payments are not addressed, do not protect them against that.

An undetermined number of doctors have been murdered, while still others have been victims of assaults, aggression and rape. The lack of knowledge on the part of physicians, both about the exact amount of payments received by the Cuban government and what they will get is another trick of the regime to exploit, on a large scale, the qualified workforce that enrolls in these missions only to improve their living conditions.

Dr. Ramona Matos asked the Brazilian opposition party for protection.
Dr. Ramona Matos asked the Brazilian opposition party for protection.

Thus, the motivation of physicians is not just humanitarian but practical: to get material and financial benefits or to cover essential needs – such as purchasing what is needed to repair their homes, for example — that their income in Cuba cannot meet.  “Otherwise, there would not be thousands of us willing to sacrifice, being away from the family and running many risks” said the source. There are also those who view the missions as a way to emigrate.

Our source philosophizes: “No teacher in medical school in the 1980’s explained to us that the Hippocratic Oath included abandoning the priorities of Cuban patients, but it is still difficult to talk about ethics in the current conditions.

As for the money, not all missions pay the same. For example, in Haiti, it’s the equivalent to $200 per month, of which it is necessary to disburse $50 per month for a low-quality meal, plus $30 a year for connection to the internet. At the end of one full year of work, we would have accumulated $2000 in a Cuban bank, paid out in CUC. Living conditions depend on where the doctor is providing these services: in Port au Prince it’s usually in a group home, while elsewhere it is in a tent. There is a great risk of contracting contagious diseases, such as dengue fever and respiratory ailments, etc.  At the same time, extreme personal hygienic and sanitary measures must be strictly adhered to in order to avoid cholera.

Five more doctors have abandoned the Brazilian program.
Five more Cuban doctors have abandoned the Brazilian program.

Payment varies in Angola, but it averages about $600 a month, while in South Africa it’s $900 to $1000. Venezuela has been the most permanent destination, and though years ago it was attractive to Cubans because it allowed importing home appliances for some time; restrictions on imports have increased because the regime in Havana finds it more profitable to optimize extraction of hard currency of these “slaves-missionaries” through its own sales networks, at exorbitant prices.

Not all slaves qualify to be rented out. When asked about the requirements a doctor must complete to be selected for a mission, the source consulted ensures us that there is a selection process, but nobody knows the exact criteria and procedures to be followed. “There is a preceding decanting”.

For example, one does not necessarily have to be a member of the party and stand out as ‘fire-eater’, but any suspicion that they might be a possible emigrant because they have close relatives living abroad can result in cancellation of the mission. I know of many cases like this, but you are never told the reasons for the cancellation clearly. These are things that leak out. They aren’t always thorough in their research, and every once in a while, one slips by them. I don’t know who is responsible for conducting the “investigations” exactly, because they are not carried out by medical authorities, but they are done, and the methodology appears to be that of (State) Security. ”

Indignation without the indignant

Brazilian Public Health Minister, Alexander Padilha
Brazilian Public Health Minister, Alexander Padilha

Another specialist, in this case an instructor, details other aspects that the press has barely addressed and that constitute a serious problem: the impact the missions have had on shortages of doctors in clinics for the care of the Cuban population. Thus, at this time a very complicated process is underway consisting in taking out the “non-essential” physicians to occupy permanent positions in hospitals and offering them one of two options: go on a foreign mission or work in an office as a family doctor.

This has sparked the widespread discontent on the part of many doctors who, while they trained as required in general practice, at present they practice in diverse specialties, including surgery, from training in courses for preparation of the fulfillment of massive collaboration programs, such as Operation Miracle and others, which allowed them to rise in rank through their qualifications.

To leave the specialties they have achieved in order to handle consults in primary care means a significant setback as professionals. Some doctors comment informally they would prefer to stay at home and devote their time to private care rather than to accept such conditions. On the other hand, a significant group of physicians who finished their services abroad don’t feel ready now to repeat the experience, arguing that the risks and the sacrifices are greater than the obtained benefits.

“It’s a process of outrage, but with no outraged” a female doctor friend of mine tells me, referring to all the doctors who complain among each other about the treatment they receive from the Cuban authorities, which treats them as slaves or as basic resources, but who are not motivated enough to get organized and demand their rights.

Meanwhile, many “democratic ” governments complicity lend themselves to violations of the most basic labor rights of these and other Cuban specialists, and some institutions and international officials are pleased with the cooperation programs of the Castros and with the health rates coldly reflected in the official statistics of the dictatorship.  Certainly, if there is something as vast and deep as the foundling of the people of Cuba, it’s the impunity of her government.

Translated by Norma Whiting

Cubanet, 12 February 2014 | Miriam Celaya