Politics, Business & Culture in the Americas

Program Designed to Address Medical Needs in Brazil Arouses Controversy



The Brazilian government intends to hire 4,000 Cuban doctors by the end of 2014 through its newly established Programa Mais Médicos (More Doctors Program).  An initial group of 400 doctors arrived in late August from Cuba, through a cooperation agreement brokered by the Pan-American Health Organization between the governments of Cuba and Brazil. The doctors will be sent to rural municipalities in the North and Northeast regions of Brazil, where systemic poverty and low rates of human development persist.  These municipalities have been unsuccessful in attracting Brazilian and other foreign medical professionals who enrolled in the Mais Médicos Program but who are unwilling to work in the impoverished communities.

Criticisms of the Programa Mais Médicos are prevalent in Brazil. The Ministério da Saúde (Ministry of Health) has been criticized for indirectly hiring Cuban doctors through a brokered agreement with foreign government agencies, rather than hiring them individually. Contrary to foreign doctors who are in private practice in Brazil, Cuban doctors enrolled in the public health program will only receive 25 to 40 percent of their monthly salary), the rest of which will be sent directly to the Cuban government.

On August 23, the Associação Médica Brasileira (Brazilian Medical Association—AMB) and the Conselho Federal de Medicina (Federal Council of Medicine—CFM) filed a joint lawsuit in the Supremo Tribunal Federal (Federal Supreme Court—STF) to suspend the program, claiming that the Cuban doctors’ medical practice in the country was illegal. The AMB and CFM require foreign doctors to be certified by the Exame Nacional de Revalidação de Diplomas (National Diploma Revalidation Exam) in order to practice medicine in Brazil, a condition that was not u the Cuban doctors participating in Mais Médicos. Critics argue that disregard for the legal framework governing  medical practice will have negative implications for the quality of health care in Brazil, and say that the entry of foreign professionals to the domestic market will not compensate for existing deficiencies in the Brazilian health care system.

Padilha responded to criticism of the program by saying that it generates controversy because it is “bold and courageous.” In an interview on August 24 at a health center in the Estrutural favela of Brasília, he said the decision to hire foreign doctors is legally sound: “The government has won every legal action. We have a great deal of legal security in what we are doing. [Medical professionals] can criticize and now make suggestions on how to make improvements, but they will not threaten the health of our population, which lacks doctors.”Supporters of the program gathered to welcome doctors who arrived in the northeast city of Salvador, chanting celebratory cheers of solidarity. The warm welcome provided in Salvador, the epicenter of Brazil’s Afro-descendant movement, was strongly contrasted by the response in other cities, where racial tensions flared. Upon arriving in Fortaleza, Ceará, a group of Cuban doctors—many of them Afro-descendants—were confronted by approximately 50 Brazilian members of the Sindicato dos Médicos do Ceará (Ceará Doctor’s Union—SIMEC), who booed at them and called them “slaves.” In a later incident, journalist Micheline Borges of Rio Grande do Norte posted a Facebook status where she said that the Cuban doctors, “look like house cleaners,” and asked if they were “real doctors.”

Cuban physicians spoke out against the criticism.  Upon her arrival to Salvador, Cuban doctor Ivette Lopez told reporters, “There isn’t any concern about [the salary]. We simply came in solidarity with the Brazilian people, to help. We are not prisoners.  It is not right to say this.” Juan Delgado, an Afro-Cuban doctor who was among the group that was confronted upon their arrival in Fortaleza, also rejected the criticism. “This is not right, we are not slaves. We are slaves to [public] health, to sick patients, who we will stand with as long as we are needed…Brazilian doctors should do the same thing we are doing: go to the poorest areas and provide assistance.”

By August, surveys indicated that the number of Brazilians supporting the Mais Médicos program had jumped from 49.7 percent to 73.9 percent. Padilha also continued to voice his support for the recruits: “The Brazilian people are very moved and very happy with the fact that you have accepted our invitation to serve the population that needs it most.” Despite the controversy surrounding the program, the Brazilian government is ultimately taking strides to serve the medical needs of the Brazilian people.

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