Cuba's Lucrative Medical Aid Programme

Cuba's Lucrative Medical Aid Programme

Healthcare workers on foreign assignments have to hand over much of
their pay to the Cuban government.

Cuba's medical aid programme is a useful diplomatic and public relations
tool for the government, and also brings in much-needed foreign
currency. But some of the medics sent abroad are unhappy about having to
hand over much of their wages to the Cuban government.

Those who join the "medical brigades" abroad enjoy higher wages, a more
comfortable lifestyle and access to superior goods. At the same time,
they have to surrender at least 50 per cent of their income to their
government, depending on the rules that apply to the posting they are given.

In an investigation into the way the medical brigades operate, IWPR
spoke to Cuban health professionals working in Trinidad and Tobago, who
said that although they were paid directly by the host government, they
had to deposit half their wages in an account in the name of the head of
the medical brigade.

Although this payment was not stipulated in their contracts, brigade
members said they were afraid they would be sent home or have their
contracts suspended if they did not comply.

"They say that it's for the oncology hospitals. It's economic
assistance," said one doctor who requested anonymity for fear of getting
into trouble. "If you don't deposit 50 per cent of your salary, they
send you back to Cuba."

For many, this system is just part and parcel of working in the medical
aid programme of a communist regime.

One Cuban nurse said he did not care what happened to the rest of the money.

"It doesn't matter to me. I'm here on contract," he continued. "For
example, if my contract is for four pesos and they have to give me 40
pesos [in Trinidad and Tobago], the rest doesn't matter, those 36 pesos.
I focus on my four pesos. I want those four."

According to Cuban health minister Roberto Morales, the country has
50,000 doctors working in more than 66 countries.

In 2014, the official newspaper Granma reported that the government
would receive an estimated 8.2 billion US dollars from its medical
workers abroad, making this the primary source of foreign-currency receipts.

PAYMENTS EITHER DEDUCTED OR "VOLUNTARY"

A Cuban medical professional who has worked in a number of countries
spoke to IWPR on condition of anonymity about how the system operated in
Venezuala.

She explained that before she signed up for the scheme, she was told her
pay would go directly into a bank account, from which 70 per cent of
would be deducted by the government. Her family would be able to draw on
some of the remaining 30 per cent, and the rest would be held back until
she returned to Cuba.

However, she ended up getting about 20 per cent of her wages rather than
the 30 per cent she was promised.

She said her total salary came to 1,500 dollars a month. An individual
she knew only as "the economist", who ran the administrative side of the
medical brigade, gave her 130 dollars a month as living costs.

The remaining 1,370 dollars were deposited in an account in "convertible
pesos". Known as CUC, this is an official Cuban currency operating in
parallel with the normal peso and pegged to the US dollar at one to one.

Only 150 CUC of this monthly amount reached her own account in Cuba. Her
family had access to 50 CUC a month and she was told she would receive
the remaining 100 CUC upon her return home.

That meant she earned 280 dollars a month and the government 1,220
dollars from her work.

She said she had no choice in the matter, and in any case the money was
still much more than she would have earned in Cuba.

Practices vary from country to country. In some cases, the Cuban
government makes arrangements directly with the host nation. In Brazil,
for instance, the authorities pay the Cuban government a lump sum, and
it then decides how much the doctors receive.

This was highlighted in February 2014 with the defection of Dr Ramona
Matos Rodríguez, who left the More Doctors for Brazil programme and
asked for political asylum at the US embassy in Brasilia.

She claimed that she had been misled about the salary she would receive.
She said she should have received half the 4,000 dollars a month the
Brazilian government pays for each doctor, but instead she got only a
quarter – 400 dollars in Brazil and another 600 dollars a month held in
an account for when she returned home.

This system of bilateral deals also applies in other countries. An
investigation by a Portuguese magazine Jornal i uncovered contracts
worth 12 million euro which Lisbon signed with Havana for medical
services over six years. The magazine revealed that 80 per cent of
health professionals' salaries went directly to the Cuban government.

"IT'S ALL THEIRS"

In Trinidad and Tobago, more than 200 Cuban medical professionals have
been hired under the Compensated Technical Assistance programme, a
bilateral agreement in place since 2003.

Under this scheme, the Trinidad and Tobago government pays salaries
directly to Cuban doctors, just as it does for local employees.

Rody Cervantes Silva, coordinator of the Juan Almedia Bosque Medical
Brigade, the Cuban team in Trinidad and Tobago, said that 52 doctors,
137 nurses, 17 pharmacists and one entomologist were working there, and
the total number was soon expected to rise to over 300.

Cervantes Silva acknowledged that Cuban doctors working abroad often
gave part of their wages to the government.

"Cuba is a poor country in the third world, and of course it needs our
help," he said. "Whoever leaves Cuba has a signed contract and agrees to
certain things. The money sent from other countries goes to the ministry
of health and social programmes such as the fight against childhood
cancer and leukaemia."

He insisted, however, that the health professionals in his team did not
pay anything to the government.

"It's all theirs," he said in a telephone interview with IWPR.

This claim was contradicted by other members of the medical brigade.

One doctor at a hospital in Port of Spain told IWPR that when she was
recruited for the two-year programme, she was told she had to give 50
per cent of her monthly salary to the Cuban government.

She said that Cuban staff members went to the bank every month to
transfer half of their salaries to an account in Cervantes Silva's name.

"There was no written rule," she explained. "It was just stated that you
have to pay this and if you don't, they will pressure you, or send you
back to Cuba."

She said that Cervantes Silva controlled the money and issued a monthly
report on payments. Any doctor who did not make the contribution on time
was pressured to pay.

She acknowledged that net wages, working conditions and hours in
Trinidad and Tobago were better than in Cuba.

"I don't mind giving 50 per cent because it's still better than the 67
CUC they pay me in Cuba. This [life in Trinidad and Tobago] is very
expensive, but you can get everything."

Following a recent raise, doctors in Cuba currently earn between 67 and
80 dollars per month. The average monthly wage is around 23 dollars.

The doctor said while some specialists were on 25,000 to 30,000 Trinidad
and Tobago dollars (TTD), a month, most brigade members were paid around
9,000 TTD, worth about 1,370 dollars. Of this total, 2,500 TTD went on
accommodation and the remaining 6,500 TTD was divided in half between
the recipient and the Cuban government.

"They say it is to pay for the oncology centre, the health system," she
said.

Trinidad and Tobago health minister Fuad Khan told IWPR that his
department hired foreign staff through an intermediary and that they
were paid similar wages to locals.

David Constant, director of international cooperation at the health
ministry, added, "We don't know what agreement the Cuban health
professionals have with the Cuban government."

Austin Trinidade, head of public relations at the Trinidad and Tobago
Medical Association (TTMA), said he was surprised to learn that the
Cubans were obliged to hand some of their wages over to their government.

"I don't know the details of their contracts or the arrangement that
they have with the Cuban government. We heard about how they have to
send all of their money back to Cuba; I don't know exactly," Trinidade said.

He added that the TTMA would be willing to help the Cubans receive their
full payment, but that it could not intervene unless they asked for help.

"If a group of Cubans send us something that says that they are working
in the same conditions as the locals and they are receiving the same
salary, but they do not have access to their payments… then we could
probably do something," Trinidade said. "I don't know if the Cuban
government would listen to us… We can't act on our own account."

IWPR contacted the Cuban embassy in Trinidad and Tobago but was told
that no one was available for interview as all staff were on holiday.

There are other advantages to working in Trinidad and Tobago. Cubans are
allowed to visit without a visa and remain in the country if they have
an invitation to work. Some staff on medical missions manage to obtain
new contracts independent of the Cuban government, and can then remain
in country or return to take up their new posts.

Although the government tries to prevent this happening, Cervantes Silva
confirmed that the practice existed and around 80 Cuban nationals were
currently working on private contracts in Trinidad and Tobago's health
sector.

INTIMIDATION AND SURVEILLANCE

Cubans deployed abroad are subject to tight controls intended to deter
them from defecting. Before leaving Cuba, they attend lectures warning
them of the supposed multiple dangers of life in their destination country.

The doctor whom IWPR interviewed about her experiences in Venezuela said
that when she arrived there, her passport was taken away to stop her
defecting or requesting asylum at a United States embassy.

In Trinidad and Tobago, a Cuban doctor said everyone's behaviour was
monitored. They were told it was inappropriate for them to go out after
work as the Cuban authorities could not be responsible for their safety
after seven pm.

Anyone who broke the rules received a bad report and was threatened with
being sent back to Cuba or never again being selected for a medical brigade.

Team members are also instructed to keep watch over one another. If
individuals defected or broke a rule, the person assigned to monitor
them was also sanctioned.

There are written regulations to the effect that team members must
"inform their superiors of any violations of disciplinary standards they
are aware of, as well as inappropriate conduct that is detrimental to
the prestige of the mission". It is also considered a disciplinary
infraction to "maintain friendships or relationships of other kinds with
Cuban citizens… or foreigners who hold hostile views, or are against the
Cuban Revolution".

The regulations make it difficult to interview Cuban health
professionals working abroad. The rules say it is an infraction to
"articulate opinions or views to the press, radio or television that
compromise the Cuban collaboration [with host nations], or that concern
internal situations in the work centres where they provide their
services or in the country where they are based, without prior
instructions and authorisation on these matters".

One Cuban doctor in Trinidad and Tobago said that she could not comment
because she was "not authorised to talk to the press".

Another agreed to be interviewed, only to change his mind shortly before
the meeting. He said IWPR should contact Cervantes Silva. Asked why he
did not want to be interviewed, he answered, "I can't. I don't want them
to send me back to Cuba," and hung up immediately.

The same story happened with various doctors and nurses in the Trinidad
and Tobago cities of Port of Spain and San Fernando. Many referred all
enquiries to Cervantes Silva.

Asked about this reluctance to be interviewed, Cervantes Silva replied,
"It's always good to see what the purpose of the interview is."

He denied that he was the only person authorised to speak.

"There's no problem. They tell me, and there's no problem," he said.

Julio C.A., Pablo P. and José Luis P. are Cuban journalists. Reshma
Ragoonath is a journalist in Trinidad. Cuban journalists Luzbely E.,
Ernesto P., Osniel C. and Augusto César S.M. also contributed material
to this report.

Source: Cuba's Lucrative Medical Aid Programme | IWPR -
https://iwpr.net/global-voices/cubas-lucrative-medical-aid-programme