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Mas Médicos: The Withdrawal Fiasco

What happened in Brazil will curtail the contracting out of doctors to other countries, and has put Cuba's system of modern slavery in an impossible position.

La Habana

47 days before taking office, Jair Bolsonaro, president-elect of Brazil, outlined three conditions for the permanence of Cubans in the Más Médicos program: they would have to 1- be able to go with their families, 2- be paid a full salary, directly and 3 - be recertified.

The Cuban government's response was to withdraw them.

Information from the Brazilian embassy in Havana about the secret negotiations between Havana and Brasilia, as revealed by DIARIO DE CUBA, shows contradictions in the Cuban response and the real factors behind that decision.

The return demonstrated that the Cuban doctors did not voluntarily go abroad, but rather were "rented"; that, with some exceptions, they could not travel accompanied by their relatives; that they received only a small portion of the money paid for them; and that if they left the program they were punished by being barred from entering country for a period of eight years, conditions that qualify the Cuba system as one of modern slavery. 

If Bolsonaro issued his demands before assuming the presidency of Brazil, the Cuban government should have negotiated before unilaterally deciding on their withdrawal.

On two previous occasions the Más Médicos program was on the verge of closure. The first came in 2016 –after Dilma Rousseff's fall from power– when Cuba withdrew 1,200 doctors to pressure a renegotiation of the contract. The second was in 2017, under the Government of Michel Temer, when dozens of Cubans, at the end of their mission, decided to stay in Brazil. In both cases the Brazilian authorities yielded to Cuba's demands. 

The experience of the pressure exerted in those two cases seems to have shaped the regime's calculations regarding the current withdrawal. For Havana, based on the political importance of medical care, especially in the most remote and worst-case areas of Brazil, the withdrawal before Bolsonaro assumed the presidency posed a potential crisis, with more than 29 million Brazilians left without medical care, but one that could have been avoided if Bolsonaro had retracted his demands, which would have meant a "triumph for the Government of Cuba" against the newly elected president. But it didn't turn out that way.

To counteract the negative impact of the withdrawal, Brazil took action to hire 8,517 doctors; first, Brazilian and foreign doctors with recertified degrees; and then other doctors, including Cubans who would benefit by not having to first have their degrees revalidated. A few days later, on November 27, Brazil's Health Ministry announced that most of the places left vacant by the Cuban doctors had been occupied, such that the potential crisis had been averted. The latest information was that only 106 slots were unfilled in the most remote and poorest municipalities in the country indigenous districts, and municipalities of the Amazon region.

On the Cuban side, despite the surprising and rapid evacuation, “defections” could not be avoided. On December 9, 5,853 doctors had been evacuated, which represented a bit over 70% of the 8,332 who were serving in that country. Until that point the information provided by DIARIO DE CUBA indicated that 22% of the doctors had decided not to obey the withdrawal order.

According to the official press, Flight No. 32 marked the end of their withdrawal. Several calculations yield the following possible figures. An aviation specialist, published in DIARIO DE CUBA, estimated that "on average, each plane must have carried some 200 passengers," such that on 32 flights some 6,400 doctors would have returned. If one takes into account the 22% calculated by this newspaper, some 6,500 would have returned. At the same time, the Pan American Health Organization had stated in November that some 1,400 Cuban doctors could remain legally in Brazil: that is, close to 6,932 would return. In these and other calculations, the number of desertersranges between 1,400 and 1,900. This is a major blow if one takes into account that, for each one that did not return, others certainly thought about it, although, for various reasons, they decided to return.

The magnitude of the defection is confirmed by the silence of the Cuban authorities, who did not say a word about those who remained, as if they were not Cuban, or had never existed, although they will continue saving lives in Brazil.

Their reason for staying is simple: regardless of any humanitarian dedication, the decision to stay in any country hinges, fundamentally, on the miserable salaries that doctors receive in Cuba: about $34 per month on average. Therefore, even if the government keeps 75%, every monthly salary in Brazil represents about 18 months of salary in Cuba, which allows the doctors to improve their situations and that of their families. 

For these services –fundamentally medical– the Cuban regime received almost 11.38 billion dollars in 2017, which made it a more lucrative activity than exports of sugar, nickel or other products.

The Cuban State's renting out of doctors provided it with two big benefits: 1 - it partially offset the inefficiency of the nationalised model and 2 – it sold to the world the image of doctors willing to save lives anywhere in the world.

The negative consequences of the withdrawal are many. In addition to the loss in revenue, going forward it will be difficult for other countries –except ones like Venezuela­– to accept a deal like the one that was established with Brazil. It would also be strange, after the civic-legal suits filed in Brazil against the terms of the Más Médicos program, for the PAHO to become involved in something similar.

What happened –along with phenomena like associations of jurists in Brazil offering free assistance to Cuban doctors who did not return, and the fact that the Foundation for Human Rights in Cuba, based in Miami, is supporting several Cubans in a "massive lawsuit" seeking compensation– will influence the behavior of doctors working in other countries, or those who are sent in the future. 

Due to all the above, the disaster has averted the future rental of doctors, and placed Cuba's system of modern slavery in an impossible position.

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