Reaching out to promote health
• There 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 health services?
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 halted.
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 context?
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.

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 their records.

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.

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.