By 1998 Fernando had already spent a year and a half working for free in the civil war in Angola where, to get to a clinic in an isolated hamlet, he had to be accompanied by a landmine deactivation expert. Twenty-five years later he is packing his bags for Venezuela.
This time there is no war. The government of General Raul Castro has turned Cuban medicine into the country’s premier export industry. It is a profitable business. Doctors are to Cuba what petroleum is to Venezuela.
According to figures from the National Office of Statistics and Information (ONEI), in 2011 the depleted state coffers took in around five billion dollars just in the exchange of Cuban doctors for Venezuelan oil.
In 2003 the government of the late Hugo Chavez reached an agreement in which PDSVA, the state oil company, would send 105,000 barrels of oil a day to Cuba for which Havana would pay by sending doctors, sports trainers and military advisers to Venezuela.
When Fernando, a medical specialist, travelled in an Ilyushin Il-62 jet to lend his services in the Angolan jungle, Fidel Castro’s official rhetoric was quite different. Money did not matter. In speeches he reiterated that he was motivated only by altruism and ideological solidarity, known as “proletarian internationalism.”
The Cuban regime did not begin charging for medical services until after 1991, the year Soviet communism said goodbye. Cut off from the wealth of rubles, petroleum and raw materials coming from Moscow, Cuba entered a period of unending economic crisis.
The Soviet Union defrayed the cost of the island’s military expenditures. A phone call to the Kremlin was all that was needed to obtain financial credits. Subversion was not Fidel Castro’s only tool for exporting his brand of revolution. On any given day he might use funds from the national budget to build a school in Kingston, Jamaica or to provide a sugar mill to Nicaragua.
It did not matter; the money was not coming out of his pocket book. But with the precipitous fall of the Berlin Wall and the disappearance of the Soviet Union, subsidized Cuba had to adapt to changing times.
Exports fell 40%. Sugar production some 70%. There was only tourism, which generated somewhat more than two billion dollars annually. And family remittances, which with hard currency, packages from overseas and cash spent by Cuban Americans on trips to the island amounted to almost five billion dollars a year.
But what contributed the most green-backs to GDP was the export of services. Not all the statistics are readily available but Carlos, an economist, believes that “just in terms of the services provided to the ALBA countries (Venezuela, Ecuador, Bolivia and Nicaragua) the figure approaches ten billion dollars annually.
It is estimated that currently some 40,000 doctors, specialists, nurses, technicians and others are working in sixty countries on five continents. Schools of medicine at Cuban universities graduate as many as 5,000 physicians annually. It is an assembly line, a highly profitable one.
Most of them are paid between two thousand and three thousand dollars a month, though some nations such as South Africa pay twice that. The regime retains 95% of their salaries.
Recently, Brazil announced it had agreed to hire about six million Cubans to work in the country’s depressed, rural areas. In a statement Brazil’s Federal Medical Council branded the agreement as “irresponsible and questioned the “technical and ethical quality” of the Cuban professionals.
After Brazil’s physicians exerted pressure, the government of Dilma Rousseff instead decided to hire Spanish and Portuguese doctors, whom it considered to be more qualified.
Cuba’s medical system does not enjoy good health but, so far, this situation is not reflected in the country’s favorable statistics. The average lifespan is 78 years. In 2012 the rate of infant mortality was 4.6 deaths for every thousand live births, the lowest in the Americas.
However, many hospitals are in ruins, their equipment in poor condition and their personnel mediocre. The mass exportation of doctors provokes unease among Cubans. Oneida, a housewife, says that specialists are rare. “At the clinic where I go, the dermatology department is open only one day a week due to a shortage of dermatologists. No hospital in Havana has a staff of dermatologists on duty. Those who treat you are foreign students and their quality leaves something to be desired. Most of the trained physicians are on ’missions’ (working overseas).”
According to the Brazilian Medical Council 94% of Cuban medical school graduates who took Brazil’s medical licensing exam in 2012 failed.
More than 5,000 Cuban doctors have deserted the international medical missions. Due to a lack of rigorous training for many of Cuba’s medical professionals, some doctors and specialists who decide to leave their homeland opt to work as medical assistants and nurses in the United States.
“Acquiring an American medical license is an arduous task. The exams are very rigorous. Once you live here, you realize there are a lot of gaps in our medical training. For me it’s not bad. While I am learning English, I work in a private clinic as a nurse. It pays well,” admits Eduardo, who has lived in Miami for two years.
Fernando, the doctor who 25 years ago was stationed in Angola, acknowledges that quality these days is not the best. “The reasons vary. From not having immediate access to specialized information, in spite of the national network Infomed, to low salaries and lack of technology. But I don’t think that the world is full doctors willing to work for two years in remote locations for subsistence wages.”
In 2012 sixty-eight Cuban doctors died in Venezuela. The Chavez government memorialized them, unveiling a plaque in their honor. “To heath care workers killed in Bolivarian lands while carrying out their duty,” reads the bronze inscription in a Caracas hospital, as though they fell in combat. Most were killed in street violence, which last year alone claimed 12,000 lives in that country.
“Then why are you going,” I ask Fernando.
“It’s the only way to acquire hard currency — performing abortions, doing small-scale business transactions and saving what little money they pay you — so that, when you go back home, you can fix-up your house and provide a better living for yourself and your family,” he says.
Some doctors with whom I spoke said it was economic necessity and not altruism that was leading them to work in out-of-the-way and dangerous locations, even at the risk of losing their lives.
19 June 2013