Note from BW of Brazil: Health care, politics and prejudice are at the forefront of the latest controversy and debate in Brazil. As reported here on the blog previously, the Brazilian government decided to take steps to address the issue of the shortage of qualified doctors throughout the country by opening its doors to doctors from other countries. The result? What should be seen as humanitarian aid was greeted with prejudice and xenophobia as the arriving Cuban doctors were greeted with a round of thunderous boos from protesting doctors and Brazil’s medical establishment. OK. Let’s acknowledge one thing first: as critics have proven, this IS a political move on the part of President Dilma Rouseff. The move of the Dilma administration set off a round of protests by Brazilian doctors all over the country (see photos below). But beyond the politics, Brazil has more than 700 cities in which there is not ONE doctor available to serve the population. Foreign doctors come to help fill the void and this is the welcome they receive? Really? See the video and report below.
Cuban doctors booed by protestors in Fortaleza
The disease of prejudice
by Rodrigo Martins
The hostile reception to Cubans is a symptom of a mediocre political debate
The reception of Cuban doctors in Fortaleza (capital city of northeastern state of Ceará) leaves no doubt: sectors of the Brazilian middle class live a terminal state of stupidity and bad behavior. At other times, a program in the style of “Mais Médicos” (More Doctors), which provides for the hiring of professionals from abroad to supply the deficiencies in health care in isolated areas would be discussed in the light of reason, pros and cons, costs and alternatives. It’s not the first time, incidentally, that the country resorts to such Cuban “slaves”. At the end of the (President) Fernando Henrique Cardoso (1994-2002) (administration), they were also imported. At that time, the media that now incites the population against foreigners presented the initiative as the salvation of national health care.
Unfortunately, the ideological polarization has prevented a rational discussion of this and many other topics. There are many criticisms of the federal program and many reputable doctors, including the trio of columnists of Carta Capital (magazine), have serious restrictions to the option from Brasília (nation’s capital). On page 36, the neurologist Roger T. one exposes some. Even so, it is inconceivable the manifestation on Monday, August 26th against the Cubans. Organized by the Sindicato dos Médicos do Ceará (Association of Doctors of Ceará), the act has exposed the savagery and arrogance of those usually considered more civilized than the average population. The shouts of “Escravos! Escravos! Voltem para Cuba (Slaves! Slaves! Go back to Cuba)”, a mixture of xenophobia and exasperated anti-communism and uncalled for, besides intellectual fragility in the face of a clear political manipulation.
Not even after the countless expressions of condemnation of the act was there an apology, just cynical justifications. “When protesters chanted ‘slave’ it was not in the pejorative sense; it was in the sense of defense, of that they are subjected to slave labor and we are fighting to change that bond,” said José Maria Pontes, union president of Ceará.
The “victims” to which Dr. Pontes refers think differently. “We’re not slaves. We will be slaves of health, of sick patients, of whom we will at their side all the time,” responded the Cuban doctor Juan Delgado, featured in the opening photo of this report. “I don’t know why they said that we are slaves, we aren’t going to take their jobs.”
Before convening the foreigners, the Mais Médicos program opened registration exclusively for Brazilians willing to work on the outskirts of large cities, in the countryside or in remote areas. Even so, 701 counties remain without a single doctor. Hence the convening of professionals trained abroad
Note taken from Acesse Notícias
Brazilian doctors had priority in accepting the cities enrolled in the program. The cities are those that are long distances from big cities, or suburbs, where some have almost no resources or poor hospital infrastructure, to earn R$10,000 a month and work within the SUS system for 3 years.
None of the 1,753 Brazilian professionals enrolled chose cities that had no doctor, i.e., the 700 cities enrolled, who have no doctor will need foreign doctors, because Brazilian doctors enrolled in the program were not interested in them, as the Ministro da Saúde (Minister of Health), Alexandre Padilha, evaluated.
Until August 8, the ministry would select doctors from abroad who signed up for the the Mais Médicos program that will occupy positions dismissed by Brazilians. The list of foreigners who will be hired was to be published on August 13.
For the Minister, the refusal of doctors in accepting Brazilian cities of the country’s interior, which have no doctor, explained itself with numbers, because for him and other members of the Federal Government, Brazil does not have doctors in a sufficient “number”: “We have new enrollments, new doctors and new municipalities will be able to sign up now. It ended almost confirming what we already had full awareness of, right? That we do not have enough doctors with the necessary provision to be acting at all locations,” stated the Minister.
Continuation of Carta Capital article
The medical entities are right, however, when they argue that the structure of most public hospitals, especially in the interior, is precarious, as Carta Capital demonstrated in two recent cover stories (issues #762 and #757). Or even demonstrating concern for the technical competence of professionals exempted from an examination of evaluation.
In fact, importation of foreign doctors is headed for a court battle. The Associação Médica Brasileira (Brazilian Medical Association) and the Conselho Federal de Medicina (Federal Council of Medicine) filed a suit of unconstitutionality in the Supremo Tribunal Federal (Supreme Court) to suspend the program. In the suit, the authorities claim the hiring of professionals trained in other countries without approval in the Exame Nacional de Revalidação de Diplomas (Revalida) (National Revalidation of Diplomas (Revalidate) is illegal. The Ministério Público Federal (Federal Public Ministry) of the Federal District has initiated an investigation to determine whether the conditions for work offered to Cuban doctors violate human rights standards.
Intermediated by the Organização Pan-Americana de Saúde (Pan American Health Organization), the employment agreement provides for payment of R$10,000 for the work of the Cubans to the Cuban government, which usually pass through to professionals a portion of the proceeds, usually 40% or 50% of the value. The same model was applied in more than 50 countries, including Ecuador, Venezuela, Haiti and Portugal.
Xenophobia. Those responsible for the grotesque protest didn’t present any excuses, just cynical justifications.
The Attorney General of the Union, Luís Inácio Adams, in turn, promised to prosecute the Regional Council of Medicine to deny provisional registration to the professionals, as required by law.
In the first battles, the government took the advantage. On Wednesday, August 28th, the Supreme Court Minister Marco Aurélio Mello, rejected the injunction request presented by Federal Deputy (or Representative) Jair Bolsonaro (PP of Rio de Janeiro) to suspend the program. Shortly before the Federal Court in Minas Gerais had refused a challenge presented by the local CRM (Conselho Regional de Medicina). The magistrate understood that there an was attempt to “market reserve.”
In spite of the sympathy of the media in 1999, the import of Cuban doctors by President Cardoso’s government ended up barred in court, after several lawsuits filed by medical organizations. Contracts were canceled and doctors were sent back to the Caribbean island.
“At that time, there were 60 Cubans working here. They received training, but could not stay because of the opposition of the CRM,” says Camilo Capiberibe, governor of the state of Amapá, the state with the second lowest concentration of doctors in the country (0.76 per thousand residents). “You have to face reality. There is a lack of doctors. Magnification of university vacancies will take time to bring results. Why not attract as many foreign doctors like so many countries do?”
Note from BW of Brazil: According to a 2011 report, for decades, 25% of doctors practicing in the United States received their training in other countries.
Former minister of the Lula government (2003-2010) and current director of Isags, the health arm of UNASUL (União de Nações Sul-Americanas (Union of South American Nations), José Gomes Temporão, points out a “clear prejudice” towards foreign doctors. “Of course, the correct proposal would be to submit all these professionals to revalidation. But, if the exam was required, the approved could practice medicine in any location and specialty, both in the public and the private. This goes against the government’s strategy of restricting the locations of exercise only to those defined municipalities in primary care and in the public sector.”
Note from BW of Brazil: The hostile reception to Cuban doctors in Fortaleza were not the only expressions of disapproval by Brazilian doctors. The “Mais Médicos” set off a wave of protests of Brazilian doctors throughout the country as can be seen in the photos below.
Source: Carta Capital, The Guardian