Longing for the Cuban doctor

In Bolivia, Brazil and Ecuador, many miss doctors expelled last year

The second week of November, days after the resignation of Evo Morales under military pressures, Dr. Maidalys Bravo Ramírez, specializing in genetic diseases and a member of the brigade of 700 Cuban doctors in Bolivia, received an unexpected visit to her apartment in La Paz. “My house was searched by armed soldiers; put me against the wall, hands on my head; of course, they didn’t find anything.” Seven other doctors living in La Paz had the same thing.

The new de facto president, Jeanine Añez, had announced that Cuban doctors – members of a program to support the weak Bolivian health system operational since 2006 – were complicit spies and terrorists of Morales in acts of sedition against the new government.

Two days earlier, three doctors had been arrested in the Aymara city of El Alto, 4,000 meters above sea level, near the operating room where Cuban ophthalmologists performed millions of cataract and other eye diseases. All three had 90,000 Bolivarians in cash, about 12,000 euros.

For the government, the money would have been used to pay pro-Morales activists in El Alto, who mounted blockades at the entrances of La Paz, down in the valley.

It was “pure manipulation”, bravo Ramírez summed up in an interview held last month at the National Genetics Center in Havana. “I was very close to that process; doctors took the money to pay more than a hundred employees; each charged 5,000 Bolivians.”

Doctora Maidalys Bravo Ramírez, especializada en enfermedades genéticas e integrante de la brigada de 700 médicos cubanos en Bolivia (Andy Robinson)

On 19 November, all Cuban doctors began to be expelled in Bolivia. “Bravo Bolivia!” replied the secretary of state in Washington, Mike Pompeo. “It joins Brazil and Ecuador in rejecting the serious interference in Latin America of the Cuban dictatorship.”

Five months later, already in the phase of accelerating the Panvid-19 pandemic, millions of Bolivians yearn for those years of Cuban health interference. According to official data, Bolivia had recorded only a thousand cases of coronavirus until 28 April and 50 deaths. But with only 52 tests conducted per million inhabitants as of April 25 – the lowest percentage in Latin America – many find the latest announcements from Añez reckless that quarantine can be lifted. (In Spain, 20,000 tests have been carried out per million inhabitants).

Cuban doctors, highly trained in areas such as primary care, contagious diseases and preventive health, would have been very useful not only in indigenous cities such as El Alto but in the isolated communities of the Andean mountain range or the Amazon.

Doctora Alina Montalvo, coordinadora de la misión en Brasil (Andy Robinson)

“We have more cases than the government recognizes and a lot of people here are calling for cuban doctors,” José Luis Quispe, leader of an Aymara community in El Alto, said in a telephone interview. It’s not just about the virus. Quispe’s mother has an eye disease that will soon leave her blind. “With coronavirus there are no resources or time for other things; If the Cubans were there, my mother would have gone to them.”

In distant indigenous communities, Cubans – as well as hundreds of other Bolivian physicians trained in Cuba – were solitary providers of health services. They’re gone. In the Tipnis, in the Bolivian Amazon, according to data provided by the specialized environment Mongabay environment, there is already only one doctor for 1,500 families. Cubans “were the only ones arriving in very remote rural areas,” says María Bolivia, a former health ministry official.

Bravo Ramirez – a genetic specialist – had started a research program for genetically transmitted diseases. “It is important in Bolivia because there are congenital diseases in isolated indigenous communities.”

Aerial image showing a burial in an area where new graves have been excavated in the Nossa Senhora Aparecida cemetery in Manaus, in the Amazon rainforest of Brasi (MICHAEL DANTAS / AFP)

On the other side of the border, in the Brazilian Amazon, Cubans are missed as well. The pandemic already extends from the Amazonian metropolis of Manaus – where mass graves are dug every day for the cv-19 dead – to the vulnerable jungle communities inside. Most of the squares in remote areas of Brazil have not been covered by Brazilian doctors following Jair Bolsonaro’s decision to force the departure of more than 8,000 Cuban doctors who he described as “slaves to the dictatorship”.

“Brazilian doctors don’t want to go to the most inhospitic places,” Dr. Alina Montalvo, mission coordinator in Brazil, who had worked first in a cattle town in the state of Sao Paulo, said in another interview in Havana. “Especially in the indigenous areas of the Amazon, the presence of Cubans made it easier for many indigenous people to have a doctor for the first time; they were now left homeless.”

In the indigenous community, which inhabits the 2,500 islands on the Amazon River in the Marajó archipelago, with the worst rates of human development in Brazil, none of the open squares have been covered after the departure of Cubans. According to data from the Brazilian Ministry of Health, analysed by the BBC, the infant mortality rate in indigenous communities rose 12% in the first year after the Cubans’ march.

Gravediggers carry a coffin during a collective burial of people who died from coronavirus disease (COVID-19), at Taruma Park cemetery in Manaus (BRUNO KELLY / Reuters)

But the absence of Cubans is not only evident in the jungle. “This pandemic is already in the periphery phase and in the favelas of big cities such as Sao Paulo or Rio Cuban doctors provided unique primary care,” says Arthur Chioro, a physician and former vice minister of health of Dilma Rousseff’s government. “They would have been able to make an early diagnosis of transmission and get early treatment of respiratory problems.” Under the Mais medical program, 17,000 Cuban doctors treated 113.5 million Brazilian patients between 2014 and 2018.

Shortly after Bolivia’s decision to expel Cuban doctors, Ecuador did the same with the 382 doctors hired, under the governments of Rafael Correa. Like Eñez and Bolsonaro, the new president, Lenin Moreno, decided to put Ecuador back into the old orbit of the United States. And the Cuban doctors had to leave. But Ecuador is one of the countries hardest hit by the pandemic and, in Guayaquil, the collapse of the healthcare system has been reflected in dantesque scenes on the streets of the city. “First Brazil, then Bolivia and Ecuador; It seems like everything is planned,” Montalvo mused, sitting in a ramshackle health center in Havana, where she already works as a gp.

The plan was probably outlined in Washington and Miami. The Trump administration and Cuban exiles groups in Miami have been accusing Cuba of creating a “doctor business” to generate currency and thus bypass the U.S. blockade. In 2017, $6 billion was credited for Cuban doctors’ missions abroad.

Added to that is the accusation that doctors work as slaves. “They have been kidnapped by the Cuban dictatorship that pays a small portion of the proceeds to doctors,” says the Miami-based oenegé Cuba Archive funded by the Victims of Communism Foundation and the Global Freedom Alliance.


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In Brazil, Luiz Henrique Mandetta, The newly defended minister of health of Bolsonaro, was one of the architects of the campaign against Cuban doctors. “Mandetta circulated fake news that they were slaves because the Lobby of Brazilian doctors felt threatened,” Chioro said. A small group of Members of the Mais Médicos program applied for asylum in Brazil following the departure of their peers citing labor ill-treatment.

Until the special rapporteur of the United Nations Urmila Bhoola, dedicated to investigating cases of contemporary slavery, sent a letter to the Cuban government for the alleged violation of the regulations of the International Labour Organization. When asked by La Vanguardia if that was done under pressure from Washington, Bhoola’s office replied that “the rapporteurs are independent and receive no instructions from any member state.”

If they are slaves, the Cuban doctors interviewed by La Vanguardia don’t seem to have noticed. “We received our salary in Cuba and a stipend in Brazil that, in my case, it remained with the mayor who provides me with accommodation, food and transportation,” said Alina Montalvo, at the health center in Havana where she has worked since her return.

Brazil paid 12,800 reais per month – about 3,000 euros – for each of the 17,000 doctors. Of that, 3,800 reais was the stipend and the rest was bagged by the Cuban state (which still paid the doctor’s salary in Cuba).

As for the accusation that this is a business, the Cuban government pleads guilty. “We have different kinds of contracts; some don’t generate money, others do; are part of our export of services,” said Johana Odriozola, the Cuban government’s deputy economy minister, interviewed in Havana. “Leaving Brazil has had a cost to Cuba; leaving Bolivia will only come at a cost to Bolivia because we didn’t charge.” Proceeds from the export of medical services are used “to support the free Cuban public health system,” he explains.

The competitiveness of exports of Cuban medical services has been demonstrated during the current health crisis. 24 countries have signed contracts including Italy and Andorra, in Europe, Angola, in Africa, but mainly Latin Americans and especially Caribbeans, the poorest in the region who will hardly be able to adequately compensate for support. 170 doctors, 399 nurses and 15 technologists – including 388 women – joined the global battle against coronavirus at the start and are now more than 2000 health specialists. “Keep in mind that we are from a generation that believes in internationalism,” says Montalvo, who participated in his first mission at the age of 28 in Guatemala in 1998, following the devastating passage of Hurricane Mitch. “I still get wasapp messages from children in Brazil telling me they haven’t had such joyful days since the Cuban doctor left.”


source: La Vanguardia

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