Reaching out to
are 700 municipalities in Brazil without a doctor
• Of Brazil’s 272,000 registered health
professionals (as of 2011), approximately 209,000
are concentrated in the most urbanized states of Rio
de Janeiro and Sao Paulo
Orlando Ruiz Ruiz
HERNAN Hoffman, an intern in the
final year of Medicine at the Havana University of
Medical Sciences, which has made possible the
presence of Cuban doctors, and those from other
nations, in the Federative Republic of Brazil. He is
critical of the rejection of this project by his
country’s Federal Medical Council (CFM), and ready
to dedicate himself to primary health care there.
As general secretary of the
Brazilian Workers Party (PT) branch in Cuba, he has
recently led one of the fronts defending the Mais
Médicos (More Doctors) program launched by
President Dilma Rousseff. His clarifying statements
are collected in this interview.
What are the reasons for the
rejection on the part of the Brazilian CFM of the
government decision to contract foreign doctors to
work in regions where there is an absence of public
One has to start from the fact that the health
situation in Brazil possesses a logic based on the
predominant capitalist economic model. For the well-being
of those who benefit from this system within the
health sector, any foreign interference must be
Our country covers a territory of continental
proportions, with a population in excess of 190
million inhabitants, and despite it being an
ascending economy, directed by a progressive
government seeking to find solutions to inequalities,
it is confronting the serious problem of the public
health services competing with private medicine.
This reality prevents the materialization of quality,
universal free care, without affecting the interests
of the many doctors who act in a dehumanized manner
with their sights solely set on profit.
The CFM is an autonomous and powerful body which
boasts pro-corporate positions and has political
power in Congress. With the entry of doctors from
abroad it perceives a threat to private hospitals
and clinics; for them, it is like saying, "if
foreign doctors are going to work where those in
Brazil don’t go, in the future, those previously
unattended patients will not try to find medical
care in the big cities where we are."
This issue has prompted a debate of monumental
proportions throughout the country in recent months.
While the CFM tries to impose its rules and prevent
professional services being provided from outside
the country, or nationals who have trained abroad –
as is the case of those graduating from the Latin
American School of Medicine – health personnel are
lacking in many regions.
The CFM argues that Brazil doesn’t
need more doctors, but that the care structure is
insufficient to motivate doctors to work in the
country’s rural areas. What is your response in this
As soon as the PT government announced the Mais
Médicos program the conflict began. Initially,
Brazilian graduates in Brazil were called upon to
work in the interior of the country, where there are
doctors’ offices and equipment not being used. Of a
total of 400,000, only 1,000 initially accepted, but
in the end, this figure was reduced to 400.
In the last few years, during the governments of
Lula and Dilma, more money has been directed into
health infrastructure and equipment than any prior
government investments carried out in the last
decade for public health development are in excess
of $3.7 billion, and those planned for new
facilities and equipment amount to $4 billion.
Currently, there are 300 new emergency centers, open
24 hours a day; close to 4,000 basic health units;
family clinics; recently opened hospitals from the
north to the south of Brazil, and now what is needed
so that everything works well is the presence of
doctors, doing their work every day.
A health service is not provided by just structure,
technology is needed, but the essential element is
professionals capable of using it. Cuba, blockaded
and prevented from renewing its equipment as it
would like, has excellent indicators, way above
Brazil and many other countries.
How do you assess the presence of
Cuban doctors on Brazilian soil?
The step taken by President Dilma in signing the
agreement with Cuba was the greatest test of the
fact that our government is determined to guarantee
the people’s health and well-being. For me, an
agreement like this, which permits the presence of
Cuban doctors – whom we see as our brothers and
sisters – in Brazil, is a manifestation of greatness
and has my full support. I am convinced that Cubans
are going to go where a large part of Brazilian
doctors are not prepared to go. This process has
demonstrated the importance of the training they
have received. For many in Brazil, poor people do
not merit attention because they don’t pay; here,
during the course, we learn that there are no limits
when it comes to saving the life of a rich or poor
person, a compatriot or not.
As a part of the resolute defense of these humanist
ideas, I can tell you that I have received serious
threats from countless Brazilian doctors after
affirming in radio and television interviews that I
defend Cuban cooperation in Brazil. The strange
thing is that in many encounters and debates I have
had with the CFM, they already had, as an instrument
of intimidation, my entire file, with my name, where
I was living, and other personal details.
What steps has the government taken
in order to solve the contradictions derived from
the CFM position?
The Mais Médicos program is
the principal step taken in the search for solutions
and opens the door to the entry of foreign
professionals in Brazil. It was passed by the
Chamber of Deputies and the Senate, and upon being
approved by the President, it will soon become law.
We already have hundreds of Cuban
doctors actively working in Brazil, together with
professionals from other countries and Brazilians
but, unfortunately, a number of graduates in Cuba
and in other countries have still not been
authorized because the CFM has delayed freeing up
Faced with this obstacle, the
Ministry of Health has also obtained legal
approbation to have the right to issue these records
and seek a definitive solution.
In your particular case, what are
your plans as a doctor when you return to Brazil?
I will be looking to be a doctor of
the masses who have no health care and thus get to
know my society. I think the best place for me is in
the primary healthcare sector, in a doctor’s office
for family medicine. There, what for many is a
limitation or beneath them, for me it is the highest
point of the profession.
I have the idea of a collective
project and I would like people to talk of me in the
future as a family doctor graduated in Cuba. I hope
to do something there with Cuban doctors, something
to really provide health care, by reaching out to
people, listening to their problems with the
intention of not just curing, but preventing