More doctors for Brazil’s poor

Lisanka González Suárez
Photos: Anabel

It is 2:00pm and doesn’t appear to be a Sunday, a day of rest and recreation. Groups of men and women wearing white coats come and go, at the speed of someone about to miss a train. The usually tranquil Medical Collaboration Center (UCCM) is abuzz with activity.

Dr. Yvonne Rodríguez García, with eight years as the Unit’s deputy director for analysis, management and medical services, is aware of every move, many involving her directly. She remains unflappable, a characteristic undoubtedly acquired over the years during which she has worked at every level of health services in Cuba and during her missions to Pakistan and Honduras. With aplomb and common sense, she is dealing with a major priority, explaining, "This week, all the doctors still lacking must leave for Brazil." This group will complete the contingent of 11,430 Cuban doctors participating in Brazil’s Más Médicos program, who began arriving in early 2013.

The departure of such a large number of professionals will not affect the quality of services provided by the public health system in Cuba, undergoing a re-organization to better and more efficiently meet the needs of the population, a healthy one as a variety of indicators show.

PARTICIPANTS

Doctors participating in the collaboration program in Brazil come from all regions of Cuba, as is the case with all international brigades from the country, for which participants are chosen on the basis of proposals made by hospitals and clinics. Candidates’ willingness to serve and availability is essential, since, as indicated above, no doctor is released to serve abroad if services in Cuba might be affected.

More than 80% of those selected for the Brazilian program have a minimum of 15 years experience and all have previously participated in at least one other international mission, while some 30% have participated in more than one other collaborative effort.

The Cuban doctors in this program will be working exclusively in primary care, in 4,070 municipalities, in 26 states, plus the Brasilia Federal District and 32 special indigenous districts.

In July, 2013, President Dilma Rousseff launched the program "More hospitals and health centers, more doctors and more training" in response to popular demands across the country. To expand public healthcare system’s services, contracting of foreign doctors was prioritized.

The international appeal to cover vacant positions in rural areas was an understandable solution, since the country faced a deficit of some 54,000 doctors, with many locations lacking a single health professional.

The Brazilian President affirmed, on March 21, that results of the program thus far indicate that the government decision to contract doctors abroad, to guarantee health care to citizens throughout the country, was the correct one. She said, according to Prensa Latina, "I knew I was going to receive a lot of criticism, but I was sure that the Brazilian people would understand that we were on the right track," sending Brazilian doctors and others from abroad to municipalities in the interior of the country and to peripheral areas surrounding large cities. She announced that, by April, some 13,225 doctors will be in place serving 46 million Brazilians.

SERVICES AVAILABLE THROUGHOUT THE COUNTRY

Cuban doctors enjoy prestige internationally, recognized not only for the quality of their professional training, but for their humanity as well.

Any community served by a Cuban doctor can rest assured that inhabitants will be treated regardless of the circumstances, in any location where assistance is needed, be it in an inhospitable or remote area, even under life-threatening conditions.

"There are hostile people who attempt to take advantage of insignificant situations, distorting or exaggerating them," Dr. Rodríguez said, "What are two or three cases compared to more than 11,000 doctors who are there? … The population has recognized us. This has always been the case, because Cuban collaborators are even changing the style of medical attention in Brazil."

Cuba’s medical personnel is distributed throughout the country, not in large cities, but in the periphery of these metropolitan areas. This has been a basic principle of collaboration – providing services in remote and neglected regions.

"Brazil is not only what we see in the soap operas we like so much, it is much more, a country as big as a continent and full of contrasts," Dr. Rodríguez continued, "and our doctors go where the poorest and most needy are, from across Amazonia to the periphery of cities like Brasilia, San Pablo, Bello Horizonte, Vitoria, Fortaleza, Bahía and others."

Daniel Carvalho, special correspondent for Folha de Sao Paulo, reporting from remote areas in Pernambuco, in an article about the lack of medical services in the region, wrote that Cuban doctor Teresa Rosales was surprised by the reception she was afforded by her patients in Brejo da Madre de Deus, in São Domingos, a poor region in the interior of Perambuco facing a severe drought. She noted that people were accustomed to getting down on their knees to thank god and the doctor. She saw 231 patients during her first month on the job as part of the federal government’s Mas Médicos program.

Something as natural for a Cuban doctor as performing a physical examination to make an adequate diagnosis is a wonder for some patients, as the reporter recounts.

"Over the last four years, the post did not even have the most basic element: doctors. Whoever walked kilometers through the mud to reach the clinic would always return home without treatment… the lines to see someone were long. It was god who sent this man, said 69-year-old Maria Inácia Silva, who had last seen a doctor in 2005. She was impressed by the way she was treated by the 44-year-old Cuban doctor Nelson López, new to the settlement of Capivara, in Frei Miguelinho."

Carvalho noted, "The difference in treatment begins with the way furniture is arranged. The patient sits on a chair beside the doctor’s table, so that the furniture is not a barrier between them…"

It is no surprise that Brazil’s President herself has recommended, on her Facebook page, an article published by the newspaper G1 in the state of Bahía, which details the work of Cuban doctors in the country.

WE WILL NEVER RENOUNCE SOLIDARITY

Cuban President Raúl Castro, speaking during the recent Federation of Cuban Workers Congress, emphasized the importance of medical services provided abroad given the income they generate for the economy and announced a salary increase for all health care workers, effective June 1.
Dr. Rodriguez commented, "I have repeated many times that, if medical collaboration abroad is the greatest source of income for the country, it is the result of the great vision held by our Comandante Fidel. I remember when he said that we didn’t have gold or oil, but that what we had was well-trained, well-educated personnel, with the capacity to help others. In reality, what a Cuban doctor does is not paid with anything, more so when we help in a very direct way, which I consider very just, although today we are living in another time, we will never renounce solidarity."

• With a surface area of more than 8.5 million square kilometers and more than 200 million inhabitants, Brazil has the world’s fifth largest population.

• There are 1.72 doctors and 2.4 hospital beds per 1000 inhabitants, according to the World Health Organization.

• Brazil’s extensive territory includes a great variety of ecosystems, including the Amazon tropical jungle, renowned as possessing great biodiversity and valuable resources.

• According to UNICEF, the infant mortality rate in Brazil has been reduced from 62 per 100 live births, in 1990, to 14 in 2012, although this rate is still considered high.

WE WILL WORK AS WE ALWAYS HAVE

DIOSVANY JUNCO BRINGA. 43 years of age, from Santa Clara, Comprehensive Family Medicine specialist with 20 years of experience. Former director of the XX Aniversario Polyclinic in his native city. Participated in medical missions to Belize and Venezuela.

"What I miss most is my family," the doctor said in the brief moment available after the departure ceremony, during which he was presented a Cuban flag as head of the contingent leaving for Brazil.

He has indelible memories of his previous two missions, equally significant, but very different. In Belize, he worked in the capital’s main hospital and said that learning the language was the greatest challenge, although he did manage, rising to the occasion.

"Venezuela was a great school for me," Diosvany said, " I began as a doctor in a community clinic in Maracaibo, in Zulia, then I was an advisor for the people’s doctors’ clinics and later I assumed other positions, including mission director in that state."

His expectations for Brazil? "This South American giant, like Venezuela, is a country of great contrasts, with an immense population, from the medical point of view, very underserved. There are a significant number of health professionals in the country but they are concentrated in the capitals, and don’t go to peripheral neighborhoods. That’s where we are going. We will do so, just as we always have.

I KNOW THE PEOLE WILL LOVE US

BELSYS ACOSTA CABRERA. Comprehensive Family Medicine specialist from Santa Clara, 32 years of age, doctor at XX Aniversario Polyclinic. Participated in Cuba’s medical mission to Venezuela for more than five years, with a focus on community work.

When Diosvany and I returned, we intended to start a family, since we don’t have children, but we postponed that for three more years. We’re young and we love each other; we have time.

We are preparing ourselves well with the language, although I don’t know where we’ll go, but, yes, that we will be working with people in the community and when we arrive, after the medical Portuguese course, they will evaluate us.

We’re not going to cities, but rather to rural areas and as always, I know the people are going to love us.