Cuba’s medical missions were created in the 1960s and have deployed over 400,000 doctors to some 164 countries, Cuba says. They have become the communist country’s biggest export. In 2018 alone, they earned Cuba $6.3 billion, according to the Washington Post’s reporting. But the missions also have been controversial, particularly over Cuba’s treatment of its doctors.
One mission to provide Cuban doctors to Brazil’s ‘Mais Medicos’ (More Doctors) program has been the subject of much scrutiny. In June, the U.S. State Department – which, under President Donald Trump, has ramped up its attacks against the Castro regime – pressured the Pan American Health Organization (PAHO) to review its involvement in Mais Medicos.
In particular, how “it came to be the middleman in a scheme to exploit Cuban medical workers in Brazil,” why the group sent $1.3 billion to Cuba, why it didn’t seek the approval from its executive council for involvement in the Brazilian program, and what PAHO did with $75 million it collected from Mais Medicos.
PAHO – which of its regional funding from the U.S. – agreed to conduct the review. U.S. Secretary of State Mike Pompeo .
In response, the Cuban Ministry of Foreign Affairs (MINREX) , the official communist party newspaper. It criticized PAHO’s review:
“The alleged concerns of the United States about Cuba's cooperation, in this case about the ‘More Doctors’ program, are neither legitimate nor pertinent to be discussed at PAHO.”
The ministry’s statement is misleading.
Over the years, Mais Medicos did provide help for some of Brazil’s most medically needy populations. But the ministry’s response sidesteps the controversy and complaints of Cuban doctors.
Mais Medicos was created in 2013 by Brazil’s then-president, Dilma Rousseff. It was an emergency response to a campaign by Brazilian mayors to call attention to the difficulty of hiring and keeping doctors in the country’s marginalized communities. Brazil is the fifth-largest country in the world in land area – bigger than the continent of Australia.
Despite Mais Medico’s ambitions to reform and expand basic healthcare centers, place medical professionals in 4,058 Brazilian municipalities and help doctors pursue specializations, it only managed to fill 900 of the 18,240 vacancies.
: The country filled most of the remaining 17,000-plus vacancies with Cuban doctors. The program provided with access to family doctors and free healthcare for the first time.
At its inception in 2013, some Brazilian politicians Mais Medicos as an agreement with “a dictatorship.” But it was approved, and PAHO was tapped to . PAHO monitored the program’s results and impact, keeping 5 percent of the program’s funding for itself through administrative fees.
Doctors in Mais Medicos initially were paid around R$10,000 (Brazilian reals) per month (around US $4,167) from Brazil’s federal government. However, Cuba’s government kept for itself approximately 70 percent of the salaries of the participating Cuban doctors.
This changed after February 2014, when a Cuban doctor broke with the program over these payment terms and Brazilians learned of them. Brazil’s then-health minister, Arthur Chioro, then the Cuban doctors would start being paid about $1,250 (US) a month.
In the years that followed, however, hundreds more Cuban doctors spoke out in complaint about salary being withheld. in 2017, at least 150 Cuban doctors had sued in Brazilian courts, demanding to be treated as independent contractors.
This was the case for Anidys Carrandi, who left Cuba (and her two sons) in 2014 to join the program. She stayed until 2017, working in Itamonte, a city in the south of Minas Gerais state. When her contract expired, Carrandi, who had married a Brazilian and brought her sons to the country, sought to renew it directly with Brazil’s government.
She eventually won the right to work as an independent contractor and did so for two more years. “Cuba saw this as a betrayal to the country, and I received an unannounced visit from the coordinator and Cuban consul. They came here and told me, ‘You know you won’t be able to return to Cuba for eight years?’ ”
Carrandi now is the president of the nonprofit association Doctors Reserve (founded in August) with a goal of organizing medical missions of Cuban doctors who “deserted” their homeland.