Health care suffers after Cuba pulls out its doctors
EMBU-GUAÇU, Brazil — The shiny plastic chairs all sat empty in a public health clinic, and the patients who staggered in were told to come back Thursday — the only day of the week now when a doctor is there.
This small Brazilian city, Embu-Guaçu, home to 70,000 people, recently lost eight of its 18 publicsector doctors, a devastating loss for the city’s network of free clinics, forcing hard choices about who gets care and when.
“It’s heartbreaking,” said Fernanda Kimura, a doctor who coordinates the assignment of physicians to the clinics for the local health department. “Like choosing which child to feed.”
The sick and the injured turned away that day in a working-class neighborhood of EmbuGuaçu represent only a tiny fraction of the estimated 28 million people across Brazil whose access to health care has been sharply curtailed, according to the National Confederation of Municipalities, following a confrontation between Brazil’s new president, Jair Bolsonaro, and Cuba.
In November, Cuba announced it was recalling the 8,517 doctors it had deployed to poor and remote regions of Brazil, a response to the tough stance against Cuba that Bolsonaro had vowed to take when he was elected in October.
The abrupt departure of thousands of doctors has presented Bolsonaro with one of his first major policy challenges — and has tested his ability to deliver on a promise to find homegrown substitutions quickly.
“We are graduating, I am certain, around 20,000 doctors a year, and the trend is to increase that number,” Bolsonaro said in November. “We can solve this problem with these doctors.”
But six months into his presidential term, which started in January, Brazil is struggling to replace the departed Cuban doctors with Brazilian ones: 3,847 publicsector medical positions in almost 3,000 municipalities remained unfilled as of April, according to the most recent figures available.
“In several states, health clinics and their patients don’t have doctors,” said Ligia Bahia, a professor at the Federal University of Rio de Janeiro. “It’s a step backward. It impedes early diagnoses, the monitoring of children, pregnancies and the continuation of treatments that were already under way.”
During his campaign for the presidency, Bolsonaro, a right-wing populist, committed to making major changes to the Mais Médicos program, an initiative begun in 2013 when a leftist government was in power. The program sent doctors into Brazil’s small towns, indigenous villages and violent, low-income urban neighborhoods.
About half of the Mais Médicos doctors were from Cuba, and they were deployed to 34 remote indigenous villages and the poorer quarters of more than 4,000 towns and cities, places that established Brazilian physicians largely shun.
“The willingness of Cuban doctors to work in difficult conditions became a cornerstone of the public health system,” said Bahia, the professor.