‘It’s not just money – we are free here’
R ULYSES Ricardo Machado Sarda is living in one of the bleakest places in the world. And he’s chosen to be there. Originally assigned to the rough grey landscape of Dennilton in Limpopo as a Cuban diplomat doctor, Machado is about to become a South African citizen.
“Everything is in the hands of Home Affairs now, but I am a permanent resident. I live in Groblersdal,” says the paediatrician who came to SA in 1998.
He’s hasn’t been back to Cuba in years. And although he loves his country, it’s unlikely he will return, having made the decision to stay in SA permanently once his contract had expired.
“The first year was very difficult, but the second year was not so bad. The problem came with the contract after three years. The government realised that it needed us, and so it wasn’t so easy to release us because of the hospital shortages. And, for many of us, we were no longer the same doctors who came from Cuba.
“The Cuban government started putting pressure on us to go back. Sometimes, if you took a holiday, it would be hard to come back. Everyone was worried because they had now bought a house, their children were at school.”
Machado decided in 2004 that he might never again leave South Africa. He knew the consequences could hurt.
“My mother died in March. She was in ICU, but I couldn’t go and see her. It was a price I had to pay, but it’s okay. I think I have accepted I may never see some of my friends in Cuba again. The thing is, my family is all happy here.”
His children are aged 19 and 23, his daughter an LLB student at Pretoria University.
“They are South Africans. They don’t know Cuba. They speak Afrikaans and English. It’s been 14 years of their life.”
Dennilton’s Philadelphia public hospital is a large institution with about 300 beds. Machado says it is one of the most vulnerable places he has ever seen.
“There always was a conflict here. When I arrived, it was part of Mpumalanga and then, after everyone battled each other, it was changed to Limpopo. But it is an area where nobody wants to look. There are no tar roads, there’s no water. Peo-
Dple have to collect water from outside with a bike.
“And as for health, it’s worse now than it was when I first arrived. Medically speaking, that’s because of the problem of the HIV rate, which is climbing. And in my area, we struggle even with small things, like no nappies for babies and some medications that are not available. We’ve even had to have collections among staff just to provide for patients.”
Machado says premature babies are the most important issue as a paediatrician trying to save the children of poverty in Dennilton.
“This is because of the number of teenage pregnancies. Oh, there are a lot. It’s our main problem, with the second problem HIV and associated illnesses like TB, gastro, malnutrition and pneumonia. These are paramount here, and the people need a lot of help. They’re not receiving enough at all.”
Machado says doctors, even foreign-qualified doctors, represent much more than just medical advice to a community such as Dennilton. There’s a peculiarly African, village quality to the culture among patients and their relatives.
“It’s totally different to Cuba. The one main problem in South Africa is that people are not properly educated. You can see it when parents don’t ask questions, whether you save their baby’s life or the baby dies.
“In Cuba, you have that pressure of parents who are always supervising you. You have to explain everything. I’ve found that here, even if I explain, people don’t always react.
“Their confidence is in their culture. When they come here to us, it’s the last resort. They go first to see an inyanga and then we ask, why did you delay? Many times, they get to the hospital too late or very late. And that’s one of the most important things now, that primary-level care.”
When Machado arrived at Dennilton, there were nine other Cuban doctors. Today, he’s the only one left. Only 25 doctors work at the hospital, but in Cuba he was one of 14 paediatricians in one institution.
“If you are thinking you will make money working like this, you are going to be disappointed. You have to love this. You don’t become a doctor to make money with all the effort put in here.”
However, one of the reasons why a number of Cuban doctors stayed in SA after their contracts ended was because of money. Machado agrees. He’s earning up to three times here what he would have made in Cuba, but he says it’s not only an “economic problem”.
“There are many things that are good about South Africa, especially freedom. I felt in South Africa that I was free, that my family was free. We can do whatever we want.”
He is also well liked by a community that trusts his white coat.
“I think they are so grateful. They don’t see me now like I am from Cuba. They always tell me, don’t go. Don’t go.
“I just wish the people we see knew their rights. If you want to know medicine, you have to come to Africa. In Cuba it is very rare, for instance, to see children with HIV. Everything is in place to avoid that child to be sick. I have fulfilled almost everything I could think of, medically. I cannot imagine finding what I know here in Australia, Canada, Europe. The picture is totally different.
“My sadness is that the process of growing children is delicate. You need a safe environment, and this environment is no good for children.”