AND Cuba leaving the Doctors program, recently announced by the Cuban government in response to criticism of President-elect Jair Bolsonar, will be a major blow to exports of health services from the socialist island – its main source of international income.
Much more advantageous than the export of island-based products such as sugar, tobacco, rum or nickel, the mission of medical professionals abroad is $ 11 billion from $ 14 billion, which Havana collects from exports of goods and services every year, according to the World Trade Organization and the Cuban State Press.
Fraga: Bolsonaro freed Cuban doctors from semi-slavery
Following the end of an agreement concluded in 2013 with former President Dilma Rousseff, the Cuban regime must lose $ 332 million (or more than $ 1.1 billion) a year. This figure is higher than cigarette exports (according to the Massachusetts Institute of Technology $ 259 million a year) and creates another economic challenge for this country, under the age of 56, with heavy US embargoes.
Cuban economist Mauricio De Miranda Parrondo, a professor at the University of Pontificia Javeriana de Cali, Colombia, estimates the detriment.
"Alternatives (to the economic loss of Mais doctors) are very rare," says Parrondo in an interview with BBC News Brazil. "The most visible options appear in Cuban tourism, but it is not expected to be covered by the income vacuum from Brazil."
Bolsonaro asks the human rights of Cuban doctors
Traditional local trucks, the sugar and nickel industry suffer from a crisis that has worsened in recent years. Tourism currently pays $ 2.8 billion a year to the island, but is under the watchful eye of US President Donald Trump, which included last Friday 16 Cuban hotels on a list of Cuban companies that Americans can not do business with.
To cover the hole that remained at the end of Mais Médicos' contributions, Cuban tourism will have to grow by 10% – an impossible goal if there are US sanctions, experts say.
Medical rentals, slavery or export services?
The Americans first commented on the diplomatic exit between Brazil and Cuba.
In a new gesture of sympathy, the White House congratulated Bolsonar on Friday for "opposing the Cuban regime for violating the human rights of its people, including doctors hired abroad under inhuman conditions."
If the American describes the offer of health services as a "rent", the new Brazilian government goes further and talks about "slavery", argues that the Cuban government gets 75% of the over $ 3,000 paid by every doctor for a month.
"This is a slave job, it could not have been compact," Bolsonaro said. Elected Vice President General Hamilton Mourão also raised the Twitter ball. "In the future, when Cuba is free, the books will tell the story of a man who freed 8,000 Cubans from slavery: Jair Bolsonaro, Just."
Bolsonaro guarantees asylum to Cuban doctors who want to stay in Brazil
International analysts estimate that the proportion the Cuban government has gathered in the services provided by its doctors in the 67 countries of America, Africa, Asia and Europe ranges from half to three quarters of the salaries depending on the country (part of the services provided by Cuba is free – that it means that doctors get directly from the Cuban government, while the aided country has nothing to pay – as in the case of natural and humanitarian disasters).
But in a technical term signed between the Ministry of Health and the PAHO (Pan American Health Organization), a United Nations agency that acts as a mediator when sending funds from the More Doctors program, there are no official percentages actually transmitted to Cuban doctors in Brazil.
According to the agreement, doctors are officials of the Icelandic Government, which in turn provides services to Brazil.
Even with discounts, the pay gap earned by professionals in Brazil is much higher than that of those working on the outskirts of Havana: Cuba's median income is estimated at $ 25 to $ 40, equivalent to R $ 94 and R $ 150.
Totality and general health
For the Cuban NGO Cuban NGO, the Cuban model of export of health services is "only possible in a totalitarian government."
"With the state as the only employer, health workers can not leave the country without permission, and when they are sent to a foreign mission, they have to leave their families as hostages for their return," says the institution that opposes socialist rule.
The US Council praises Bolsonar for "positioning" against Cuba
Cristian Morales, a representative of Opas in Havana, publicly defends the proposal and says he "allows Cuba to acquire important international resources to ensure the functioning of its own universal health system."
An interview with a group of researchers from universities in Brazil, Germany and Spain in 2016 had a Cuban doctor in the middle.
"Everything is free in Cuba, the population does not have to pay for studies, sports or even medical services. To achieve this, the money has to come from anywhere, and that's why we are like people in our country," he said.
"But we can clearly have this commitment to help our people, but it's also not fair to accept 30% (wages) for the rest of our lives […] I worked in Haiti and got 20% […] People must also understand that we must live, we also have our dreams. "
"I set my whole house"
If Brazil has a prestigious career in medicine, and its professionals can get salaries well above the national average, what is the social status of doctors in Cuba?
"Doctors are experts highly recognized by Cuban society," says Cuban economist Mauricio Parrondo. "This recognition is not related to their income through wages that are insufficient to meet basic needs, as is the case with other workers who receive from the Cuban state." High prestige has to do with the meaning of the sentient population.
Experts say that many experts working abroad on the basis of state treaties eventually lead the life of "excessive savings" to send funds to the family and improve living standards on the island "which would not be possible with their earnings in Cuba."
In an interview with the BBC in 2013, the year of launching the program, the Cuban doctor illustrated this work. "I did not have anything to do with the mission, I moved my whole house."
Paradox of Cuban Health
The importance of medicine in Cuban society takes on a discussion known as the "paradox of Cuban health" and is often illustrated by the popular language on the island: "We live as poor, but we die as rich."
It is that, despite moderate GDP and financial isolation sponsored by the United States, Cuba has managed to maintain a higher life expectancy than Americans (around 80), even investing less than a tenth of what Americans spend on health. According to the World Bank, Cuba spends $ 813 per person per year with health services while the United States spends $ 9,400.
But this proposal will change, taking into account the percentage of GDP invested in health: Cuba invests 10.57% of its wealth in the sector, which is much higher than Americans or Europeans such as Germany and France.
Besides the welfare of the population, the investment priority is justified by the diplomatic perspective of health as part of the economic and cultural integration between Cuba and the rest of the world since the Cold War.
An illustration of the partnership that now ends with the Brazilian government means that Cuban "medical diplomacy" guarantees the entry of powerful currencies such as the dollar, important for the country's reserves, as well as power of influence and legitimacy abroad.
In the last 55 years, Cuba graduated and trained free of charge over 35,000 healthcare professionals from 138 countries. According to the Department of Public Health, the island carried out 600,000 public health missions in 164 countries, including significant contributions to the fight against the Ebola virus in Liberia, Sierra Leone and Guinea against Latin America and the Caribbean cataract, and against cholera in Haiti.
In 1985, Cuba was the first country to develop an effective vaccine against meningitis B. It later innovated the lung cancer vaccine.
By 2015, it became the first nation in the world to remove the transmission of HIV and syphilis from mother to child.
Today, 8,322 of the 16,000 physicians working in Mais Médicos are Cubans. While Brazil is organizing a working group to employ professionals who want to replace them in the poor and remote areas of the country and maintain quality of care (according to UFMG research approved by 95% of patients), Cuba tries to face a more important economic hurdle in its recent history – other sources of income to compensate for the loss of mead with the Brazilian government.
BBC News – BBC News – BBC News – BBC News