The Business of Exporting Cuban Doctors

The Business of Exporting Cuban Doctors / Ivan Garcia

Posted on June 25, 2013



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.



Iván García



19 June 2013



Source: "The Business of Exporting Cuban Doctors / Ivan Garcia |

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