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Investigation: Public Health in Cuba

Havana's lies: How Cuba covered up the salaries of Cuban doctors in Brazil, and how it got the PAHO involved

The diplomatic cables obtained by DIARIO DE CUBA reveal that the Pan American Health Organization was incorporated into the negotiations on Más Medicos at the last second.


In an attempt to respond to what it describes as "libel" about the Más Médicos program and the working conditions of Cuban doctors in Brazil, the official website Cubadebate claimed that they "do not receive salaries" because they are "interns."

"Employees in Brazil do not receive salaries, because they are not employees of the health system, but rather interns who provide services, specialising in primary services in Brazil, which is allowed under the Federal Law of the Más Médicos Program," the source said.

However, cables from the Brazilian embassy in Havana that reconstruct the negotiations for the creation of the Más Médicos program –classified as confidential, kept under wraps for five years, and obtained by DIARIO DE CUBA– tell a different story.

"Contracted" doctors

On April 20, 2012, the Vice-president for Business of the Comercializadora de Servicios Médicos Cubanos (CSMC), Tomás Reinoso, met in Havana with the Embassy of Brazil's charge d'affaires Alexandre Ghisleni.

Reinoso then assured the Brazilian diplomat that Cuba's commercial services encompassed everything from sending doctors and nurses, to consulting on the construction of hospitals and the development of health systems. Reinoso clarified that Cuba offered "special prices to its partners", mentioning "Algeria, China, Jamaica, Portugal, Qatar and Suriname, as well as Venezuela".

One month later, on May 22, at a meeting in Havana of the Brazil-Cuba Working Group for Economic and Commercial Affairs, it was recorded that "at the meeting held between the head of the Brazilian delegation and Cuba's vice-minister of Public Health [Marcia Cobas], the interest in 'hiring Cuban doctors' was confirmed by the Brazilian side."

Later, on June 22, after a visit to the Department of Central America and the Caribbean in Havana, the Regional Integration Coordinator at Brazil's Ministry of Health confirmed that his ministry "is negotiating with Cuban health institutions for the sending of 6,000 Cuban doctors, who were to be 'hired to work' in remote areas of Brazil."

According to the official, the project was to have been initiated in a clandestine manner, given the concern about the Brazilian medical community’s reaction to the Cuban doctors’ arrival. The president of the Republic, he said, wanted to see the project completed by the end of that year.

In the face of this urgency, just one week later, between June 27 and 29, another Brazilian delegation, this time headed by the Secretary of Labor and Education Management of the Education Ministry, Mozart Sales, met with Cuban leaders "for the purpose of advancing in negotiations for the hiring of Cuban doctors". At these meetings, the main sticking point was "the sum to be paid for each Cuban doctor."

Havana announced at that time the designation of the Comercializadora de Servicios Médicos for the signing of the contract, based on a model that has served as a basis for the export of Cuban medical services to "countries such as Qatar, Angola, Portugal, Kuwait and others. "

In relation to the amount to be paid, the Brazilian ambassador in Havana, José Eduardo M. Felicio, gathered information at other diplomatic offices about the fees Cuba charged other countries "to which it exports such services". The result of these inquiries is revealed in the following cable: "It is perceived that the price of the service is variable, depending on the bilateral negotiation, as the Cuban Government considers the economic circumstances of the partner who wishes to import the medical services. As has been shown, the amount proposed for Brazil is similar to that charged countries like Venezuela and Qatar."

At this point, the delegations addressed the delicate issue of "the form of the agreement." They asked whether it should be "a contract for the purchase of medical services, of a commercial nature, or if it would be advisable to sign an intergovernmental agreement, with greater security and commitment." The disadvantage of this last form, they noted, is that "an intergovernmental agreement [...] may have to be submitted to the Congress [of Brazil], where, incidentally, it would generate controversy."

The Pan American Health Organization (PAHO) appears

The Cuban state media source Cubadebate claims that "the Brazilian government does not pay the PAHO salaries, but rather pays for the services that the organisation has contracted from the Ministry of Public Health."

The PAHO was not mentioned in the negotiations for the contracting of Cuban doctors by Brazil until December 2012, during a visit to Havana by Brazil's Health Minister Alexandre Padilha. That is, between February and December, the representatives of Cuba and Brazil only spoke of the "contracting" of Cuban doctors. At no time were they referred to as "interns."

The idea of ​​involving the PAHO, voiced by Minister Padilha, was for two reasons: to circumvent the Brazilian Congress, which should have been involved, in the event of a bilateral agreement; and to not tilt the trade balance between the two countries towards the Cuban side, which would have happened if Brazil had paid Havana directly for the doctors hired.

According to the diplomatic cables held by DIARIO DE CUBA, Minister Padilha offered the triangulation with the PAHO as a solution: "In view of the lack of a bilateral agreement, approved by the Brazilian Congress, which would allow the transfer of resources from the Union to Cuba in the medical area, the Brazilian side suggested using the Pan American Health Organization as an intermediary, characterising the contracting of services as an act of cooperation in the medical sphere."

In response to this proposal, the Cuban Minister of Public Health, Roberto Morales, "pointed out the difficulties that would arise due to the involvement of a third party in the particular, the fact that the resources would have to be processed by an organisation with its headquarters in Washington, which, alone, would generate the risk of the application of US embargo regulations on the project's operations."

It was at this juncture, faced with these objections by Minister Morales, that his Brazilian counterpart, Alexandre Padilha, counterproposed that the participation by the PAHO "be limited to the approval of the project, and that all the operations for the transfer of resources be made directly between the [regional] offices of the Organization in Brasilia and in Havana."

Minister Morales considered this counterproposal satisfactory, and it was not until the afternoon of December 3, six months after the negotiations began, that a technical meeting was held between the members of the two delegations and the representatives of the PAHO in Brasilia and Havana. According to the diplomatic cables, "the representatives of the PAHO were enthusiastic about the project, which, if approved according to the terms currently discussed, would be the largest in the history of the Organization in terms of the volume of resources and personnel employed."

Recently incorporated into the project, the representatives of the PAHO "stated that they were not yet clear on the technical requirements necessary to make the operation viable, but they stated that the Organization was entirely ready to make the necessary adjustments".

At that time, the highest representative of the PAHO in Brazil was Cuba's Joaquín Molina.

What the cables reveal

The Brazilian diplomatic cables on the negotiations with Havana for the sale of medical services and the emergence of the Más Médicos program reveal that the inclusion of the PAHO in the project was a subterfuge with two objectives: to evade control by the Brazilian Congress, and prevent the bilateral trade balance from tilting to the Cuban side.

Havana's role entailed Cuba's participation in a fraud orchestrated by the Government of Dilma Rousseff, and its intervention in the design of a scheme now serving as an excuse, as it claims that Cuban doctors were actually interns, and that what they were paid, an amount from which Comercializadora de Servicios Médicos Cubans retained more 70%, were not, in fact, wages.

"The Government of Brazil does not pay the PAHO for salaries, but rather pays for the services that the organization has contracted from the Ministry of Public Health," says the regime's Cubadebate, when, in fact, it was the Brazilian and Cuban governments that turned to and involved the PAHO, months after having begun their negotiations, to overcome legal hitches hampering the agreement that they would eventually sign.

The PAHO, meanwhile, adopted by Cuba and Brazil as a solution for their dealings, entered fully into them, accepting a commission based on the funds withheld from Cuban medical personnel.

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