Johana has a small cafeteria in La Víbora, the capital municipality of Diez de Octubre. With it she supports her family, consisting of two teenage children, her husband, and her parents, already retired. She opened the business with the money she received from a medical mission in Venezuela, in 2006.
"After two years of mission work I had an account in the bank with 10,000 CUC. I could only access that money when I arrived in Cuba. There were doctors who got their houses that way. As ours is well located and in good condition, we decided to invest in this cafeteria, which doesn't make us rich, but we get by," said the doctor, who works in a local polyclinic for the salary of 800 Cuban pesos per month.
For most health workers in Cuba, going out on a mission is a great opportunity, as the maximum salary they receive on the island is around 1,500 Cuban pesos, about 60 CUC (currency that the Government pegs to the dollar).
The salary on the mission depends on several factors: the country where it is carried out, one's educational level, and the position one occupies.
A source from the health sector who asked to remain anonymous said that the Cuban government is currently placing 180 CUC a month on a "frozen" card (not usable until after the mission) for Stomatology professionals who are working in Venezuela.
Due to the strong depreciation of the bolivar, the same professional in Venezuela receives the equivalent of less than ten dollars, this being the black market rate.
The physicians’ salaries are completed by a sum in Cuban pesos, depending on their salary prior to the mission, which their relatives in Cuba receive.
The sum that these collaborators can accumulate today in their frozen accounts in Cuba is about 4,320 dollars – a little more than 40% of what Johana amassed a decade before, which suggests that the payment has been dropping in recent years.
Given the rise in prices on the island, it is no longer possible for doctors to buy a home with their savings. A small apartment in La Víbora costs about 15,000 CUC, and one in Alamar, one of the cheapest neighborhoods, does not go for less than 10,000.
In addition, the personal and emotional cost of the mission is often high. Johana went two years without seeing her children, who were then three and five years old.
"All kinds of things have happened on the missions," said Belkis, an assistant stomatologist for the Bahia division. "Husbands and wives who were cheating in Cuba, and doctors who got involved there, being married here. Doctors who never saw their children grow up, because they renewed their contract, and spent up to eight years traveling."
The harsh working conditions in countries like Venezuela, with high rates of violence and growing poverty, in addition to the abusive practice of the Cuban government, which keeps most of the professionals' salaries, have led to thousands of desertions, which is more and more worrisome for authorities on the Island.
Alberto occupied a physiotherapy position at the 13 de Marzo polyclinic, in Alamar, between 2008 and 2010, when he was assigned a mission. At the end of the first of his two mandatory years he decided to escape.
"It was difficult to make the decision because, although it was what I wanted, and I had even thought about it from the moment I decided to study Physiotherapy, the fear paralyzes you. One is constantly watched, even by the people who travel with you, your supposed friends," he explained.
"One night I escaped, helped by Cubans already settled in Venezuela, and I don't regret it. I don't think that my economic conditions would have improved much when I returned to Cuba," he reasoned.
"The salary they paid us in Ecuador was 800 dollars, but that country paid the Cuban Government 3,000 for our services. The math is simple; they took more than 70% of what we made," said Marcos, a psychologist from the town of Playa.
"Stomatologists are highly prized, due to the aesthetic and non-clinical nature assigned to this specialty in other countries. Even so, I know from the payroll that we have to sign that the Stomatology technicians have been recording us as doctors, but paying us as assistants, and keeping the difference," said Belkis.
Despite being aware of these abuses, the paltry salaries in Cuba mean that for many doctors and health professionals it is still worth it work abroad under the conditions imposed by the Cuban authorities. For the Government it is an extremely lucrative business, from which it derives most of its revenue.