On September 6th, the World Medical Association issued a condemnation of the program.
I don’t want to repeat everything from the May article, but instead relate some new developments (some of which are also mentioned in the WMA statement). However, I think it is important to repeat one thing, since it bears directly on the matter. That thing is that no one who reflects on the conditions in the interior of Brazil is surprised by the shortage of doctors in the interior. There is a shortage of all professionals, indeed, middle class people in general, in the interior. Few want to live there. Those that can afford to live in, or move, to the cities.
The bottom line is that the problem is not the physicians, as some like to claim, but much larger and much more complicated. To expect physicians to behave differently than other people is simply not reasonable. And, to be fair, because of the size and scale of the problem, we should probably not be surprised that the government offered what was at best a half-assed solution. (To be fair some more, given the disparity between 6,000 bargain doctors without validated medical educations and what needs to be done, Mais Médicos is about 3% assed.)
As more details of the program have emerged and the doctors themselves have arrived, it has become clear that Mais Médicos is not just a weak solution that exploits the doctors, but a lie. It was accurate to call it a fig leaf a couple months ago, but it’s not even worth of that anymore. Fraud would be a better word.
Beyond the issues listed in the May article (the salaries, most of which go to the Cuban government; the absence of solutions for the wider problems; the lack of the legally required revalidation of the diplomas), it has come to light that:
- In some areas at least the majority of Mais Médicos doctors are being deployed in or near urban areas, not in the hinterlands as was expected.
- Brazilian doctors have been fired so their jobs could be given to the cheaper MM doctors.
- The doctors’ passports are held at the Cuban consulate (to make it more difficult for them to defect).
- Their families back in Cuba cannot leave the country, their passports have been confiscated.
The first two points make a complete lie out of the program. If the interior really needs these doctors, we would expect the majority of them to be deployed there. If there is a shortage of doctors, we would not expect Brazilian doctors to be replaced.
The second two points make an absolute mockery of any country that purports to be a free and democratic country.
Perhaps the fact that Cuba is justifiably paranoid about these people and their families defecting ought to be a clue to the Brazilian government that tossing money at a country who had even more money tossed at it by the Soviet Union as well as a lot of cheap oil from Venezuela was a bad idea. At the very least some strings regarding economic and human rights reforms should have been attached!
Now couple points 3 and 4 with the amount of money the dictatorship in Cuba is getting out of this (it comes to a couple hundred million US dollars a year) and one can see where the ideological heart of Brazil’s ruling party lies. It has contrived to prop up a dictatorship whose former leader’s personal fortune of 20 billion dollars ranks right behind the king of Saudi Arabia’s on Forbes’ list of rich folks. (What a paragon of Communism you are, Mr. Castro.) Brazil is ignoring its own labor laws and paying the doctors a fraction of their fair wage and allowing them to be held hostage and spied upon. (It’s like a little bit of autocracy, they’ll feel like they’re back in Cuba!) Brazil is ignoring its own laws regarding the validation of the doctor’s education and competency. (Please ignore the statistics on how Cuba-educated doctors fare on foreign doctor evaluation versus doctors of other countries.)
Needless to say, because of the illegal aspects of the program, the lawsuits have already started.
Brazil’s public health care has serious problems and needs a serious solution. Mais Médicos is not a serious solution. It is at best a fig leaf that wastes taxpayers’ money supporting a country whose leaders main concern is keeping its people oppressed.
It is a fraud. What else can you call a program that at best poorly addresses only one problem of the set of problems that need to be addressed and funnels most of its money to prop up a dictatorship whose leaders have amassed huge person fortunes while their country’s economy is a shambles?