Sunday, May 12, 2013

Cuban Doctors in Brazil

Vincent Bevins of the L.A. Times published a story about the Cuban doctors going to Brazil. There are all kinds of stories embedded within it.

First, it is yet another reminder that there are serious economic disparities in Brazil. Glowing reports of development mask a large urban/rural divide, for example. That is definitely true with regard to doctors.

Second, there is incredible indifference to those disparities. This quote really got me.

When asked if any doctor was better than no doctor, CFM President Carlos Vital responded in the negative.

“Pseudo treatment is worse than no treatment,” he said. “If you don’t have a doctor in your city, you can go to the next city and have a quality doctor.”

Sure, just go 100 miles to the next city if you don't have a doctor. Nothing to see here!

Third, more attention needs to be paid to the plight of Cuban doctors, who are paid almost nothing and deployed like soldiers. Thousands of them end up in the United States.

Fourth, even less attention is paid to the impact of aid on local markets. When a country is flooded with food aid, for example, prices plummet. That hurts local producers (though there is plenty of debate about the overall impact). If there are any local doctors, they cannot compete with free ones. If there are no local doctors, then obviously that's not a problem, but then there will never be an incentive for any doctor to start there.

Fifth, why is Brazil importing doctors rather than producing them on its own? That would eliminate problem #4. With financial and idealistic incentives, get Brazilian doctors to work in more remote areas (unfortunately as I write this I cannot get Northern Exposure out of my head).

In the end, though, with this program people are getting healthcare when otherwise they would receive little or none. We need to keep our eyes on that goal while also acknowledging the problems inherent in the way they are receiving it.


Anonymous,  12:05 PM  

About problem 4:

Brazilian governmentl already has such a program to make brazilian doctors to go to isolated areas. They pay 8.000 "reales" per month (more or less 4.000 dollars, which is a very very nice income in Brazil) to young doctors without specialization (they are not pediatricians, obstetricians; just plain doctors)... Problem is that the amount of doctors willing to go to those areas doesn't match with the government goals in universalizing medical care...

Another fact is that in Brazil it's not possible to think about medical care just in terms of markets. Everyone has the RIGHT to get free medical care. And in the areas where the government is intending to take the cuban doctors, the profit a doctor could make (taking into account the incomes of the target population of the program), wouldn be enough to make him stop from working in a private or public hospital in a bigger city.

Adam 3:19 PM  

What the above poster said. The Brazilian government offers additional salaries, but still no one wants to work in these areas.

There are occasional stories on Globo about it. See, e.g.,

Tendler's Good Governance in the Tropics addressed one attempt to solve this with community health agents in CE, but the problem is far from resolved.

Sorry don't have time to see if there are stats on availability. Probably IBGE.

Greg Weeks 4:31 PM  

Interesting, but actually those examples exactly describe a market, which exists even if there is a universal good (teachers in the U.S. change jobs according to salary, for example). But maybe this is similar to difficult jobs in the U.S. like picking lettuce, which citizens don't want and so an illegal market becomes inevitable. The Brazilian doctors obviously are not illegal, but filling the same type of employment hole. Up to this point, wages are not yet high enough to make native workers take the jobs.

Greg Weeks 4:42 PM  

It should be obvious, but I meant *Cuban* doctors in the second to last sentence.

Brooke Harlowe,  7:25 AM  

I'm following this with interest. Los cubanitos have been in Bolivia for years now, much to the dismay of the Bolivian health officials with whom I work. In Bolivia, at least, Cuban doctors are not working necessarily where Bolivian doctors won't. They are working in urban areas or areas with reasonably modern services, too.

In the Yungas, communities that asked for Cuban doctors got them (sometimes displacing the local nurse who covered the region in satisfactory fashion). A common commentary was, "The Cuban system of healthcare could be really useful here. We'd really like to learn from them. Instead, the Foreign Ministry invited them in to treat our patients. If they came to teach us, we would have been more accepting."

Some teams of Cubans were willing to coordinate with local health authorities (on which antibiotics to use, for example) while others did not.

I will be interested to see how the presence of Cuban doctors changes (or not) with the development of the SAFCI doctors (doctors trained in community medicine).

BobbleHeads 5:17 AM  

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