The hidden world of doctors Cuba sends abroad

Although medical missions have been successful in many countries where they have provided medical care to the most disadvantaged areas, according to a new report, some doctors say that conditions can be a nightmare, under curfew, controlled by officials. and sent to extremely dangerous places.

This is the story told by journalist James Badbad.

For Dayli Coro, medicine was a vocation.

"I studied vocation medicine, I had the habit of sleeping between three and four hours because I studied a lot, I worked hard during my first year of practice, I was I took many extra shifts, and now, I can not be a doctor in Cuba, it's very frustrating. "

Dayli, now 31, wanted to be an intensive care specialist. He says that after graduating he would have been told that while he was going on a medical mission to Venezuela, he would gain experience in his field and that this period would count for the three years of his life. Mandatory social service that all graduates must complete in Cuba before they can access a full position. .

He agreed to join what Havana calls his "internationalist missions", following the path traveled by hundreds of thousands of Cuban doctors.

Since 1960, the work of doctors abroad is defended by the communist government, symbol of their solidarity with the peoples of the world. Fidel Castro called the doctors "army of white coats" of Cuba.

In addition to being a source of great pride and prestige, it is also an economic lifeline for the regime: according to figures from the Cuban government and university studies, the plan provides Cuba with about $ 8 billion a year. indispensable currency.

Strict conditions

With more than 30,000 Cuban doctors active in 67 countries, many in Latin America and Africa, but also in European countries such as Portugal and Italy, Cuban authorities apply strict rules to prevent citizens from living abroad. To give up once abroad.

The wages strongly prompted Dayli, from the small Cuban town of Camagüey, to join the initiative.

Starting from a salary of 15 dollars a month in 2011 for island doctors, Dayli collected 125 dollars a month in the first six months in Venezuela, which rose to 250 dollars after six months and $ 325 in his third year.

His family in Cuba also received a bonus of $ 50 a month.

According to a report by the Cuban Prisoners Defenders (CDP), a Spanish-based NGO that advocates for human rights in Cuba and is linked to the opposition group Patriotic Union of Cuba (Unpacu), doctors receive on average between 10% and 25% of the salary paid by the host countries, the rest being left to the Cuban authorities.

Dayli says that he voluntarily signed a contract for a period of three years, but that he did not have time to read it and that he did not have one. received personal copy.

Venezuela of destination

In October 2011, the young doctor was sent to a clinic in the Venezuelan town of El Sombrero, in the center of the country. This post was part of the Barrio Adentro program, distributed since 2003 to Cuban doctors from disadvantaged areas of South America, a symbol of Cuban support for the government of late President Hugo Chávez and his successor, Nicolás Maduro.

Venezuela pays for this and other services of Cuban workers with oil.

Dayli says he's practically found himself in a war zone, where he's used to being shot by a gun.

Venezuela was at the moment at the heart of a spiral of crime that led to a rate of 92 murders per 100,000 inhabitants in 2016, according to the NGO Observatorio de Violencia de Venezuela. The World Bank figures indicate the number of 2016 to 56 per 100,000, exceeded only by El Salvador and Honduras.

"There were a lot of criminal gangs," says Dayli.

"When they confronted us, they brought their wounded because the local Venezuelan hospital had a police presence and we did not have them.These guys brought a patient with 12 or 15 bullets into the body, they pointed their arms at you and told you that you had to save them.It was dying, you too, that kind of thing was happening every day, it was routine, "says -he.

The gang members she dealt with were often only teenagers aged 15 and 16, she says.

"I got one with a bullet in the heart, another with five in the head, some were alive, but you knew that if they were not operated in 20 minutes, they would die and we would The patients, there had to be four ICU doctors and there was usually only one in service. "

These patients were often transported by ambulance to a general hospital located 45 minutes away. Sometimes gang members ordered Dayli to get in the ambulance with them, he says.

"Once, a gang fired at an ambulance and killed a Venezuelan doctor and the driver," said Dayli.

"There was always a possibility that the rival gang was trying to kill the patient during the transfer.I had a situation where a rival gang arrived and shot the patient.I was 24, a In a place where there is so much violence, you develop an incredible emotional coldness. "

Medical missions were in the spotlight after Cuba's decision to remove its doctors from the "More Doctors" program in Brazil following the election of President Jair Bolsonaro last year.

Bolsonaro questioned the qualifications of Cuban doctors in the country and described their contractual situation as "forced labor", claiming that they only kept 25% of the remuneration and that the rest went to the Cuban government.

In response, the Cuban authorities firmly rejected this qualification and declared that "it was not acceptable to question the dignity, professionalism and altruism" of its international medical staff.

By order of the doctor?

According to the report of the group related to the Cuban defenders' opposition prisoners, based on the direct testimony of 46 doctors experienced in medical missions abroad, in addition to public information extracted from the statements of 64 other doctors:

* 89% said they had no prior knowledge of their destination in a given country.

* 41% said that a Cuban official had withdrawn his pbadport upon arrival in the host country.

* 91% reported being monitored by Cuban security officers in their mission and the same percentage stated that they had been asked to forward information about their colleagues to security officers.

* 57% said they did not volunteer to join a mission but felt compelled to do so, while 39% said they felt strongly forced to serve abroad.

The BBC has repeatedly asked the Cuban government to know its opinion, but has received no response. Havana continued to strongly defend the program. Cuban President Miguel Díaz-Canel offered his support to the "Heroes of Cuban and Latin American Medicine" to commemorate Latin America Medicine Day last December.

"For those who struggle for life, the same is true in a modest Cuban neighborhood or in an Amazon village, more than doctors, they are the guardians of human virtue," wrote the Cuban leader.

Painful experiences

Although Dayli at least managed not to be a victim of violence in Venezuela, his compatriot and medical partner was less fortunate.

The 48-year-old family doctor wants to be identified by the pseudonym "Julia" to spare her family the knowledge of her ordeal.

During her five years of mission in Venezuela, Julia was in the state of Bolívar.

"I had the bad luck that the mission coordinator was interested in me and I did not give in to his repulsive suggestions, he even sent me in a series of projects. remote areas of rural areas, "he complains.

At one point, with another Cuban doctor, she was sent to a house with a clear plastic roof. One day, when they saw that someone had forced the door, they called the coordinator, but Julia said that she had not done anything.

"Then," he says, "I woke up one night while someone was closing my mouth." The doctor in the next room shouted, "There were two men armed with hoods."

Julia says that she was raped by both.

The mission coordinator came to take the two women out of the area, but according to Julia, he had no apparent consequence or official reprimand for exposing his team members to such danger.

Julia was transferred to Caracas, where she received anti-HIV medications and sessions with a Cuban psychologist. "The treatment was not the best, the goal was basically:" Do not tell anyone that this happened. ""

During a mission to Bolivia, Julia crossed the border with Chile and now lives in Spain, where she applied for asylum and is a surgeon badistant.

Maria (pseudonym) is another Cuban doctor who says that her bad has made her a target. She was a 26-year-old family doctor when she was sent to Guatemala for her first international mission in 2009.

During his trip to the state of Alta Verapaz, the mission coordinator began to talk to him about a rich man in the area, whom he described as "dangerous." "engineer".

María says, "She insinuated that she loved Cuban women." She says that they gave her a cell phone that "the engineer" started calling her every day.

"I did not answer and I even changed the number, but I still called," says María. "The coordinator told me that they would send me home as a punishment if I did not see this man, and said that everything was fine for me."

"My principles were at stake. I went there with the idea of ​​helping the poor on mission in my country, it was so frustrating, I was scared, but I could not run away. "

María explains that her Cuban mentors took her pbadport as soon as she arrived in Guatemala.

After two months of resistance to the pressure to see the man, Maria was transferred to another mission. A few months later, he learned that "the engineer" had been arrested during a military raid and accused of drug trafficking.

María spent two years in Guatemala, and then ran away from her next mission to Brazil to qualify for US parole, a special permit program canceled by former President Barack Obama and urging Cuban doctors to install immediately in the United States. .US.

Weekly goals

Dayli said that she and her team in Venezuela had to reach a series of weekly goals set by heads of mission and related to the number of lives saved, patients admitted and treatments for certain diseases.

The young doctor explains that she rejected what constituted for her an unethical interference in the honest principles of medical care.

"It was there that my problems started, because I was not going to lie," he says. "If a patient is ready to go home and take his medications by mouth, I will not admit him for five days with an intravenous line, I can not say how many patients will be victims of a heart attack during one week."

According to the CDP organization's report, more than half of the 46 physicians with experience in international missions who were interviewed admitted to falsifying statistics, inventing patients, consultations and non-existent pathologies.

By exaggerating the effectiveness of the missions, the Cuban authorities may, according to the report, ask the host country for more money or justify the extension of the mission.

Reprisals

Dayli said that the conflict she had with her fellow doctors in El Sombrero due to instructions to inflate the treatment statistics had led her to be placed in a lower-level destination at San José de Guaribe, a more rural and quiet city.

But the pressures to work without medical equipment and sufficient controls to achieve artificial or impossible goals persisted.

Once a woman who gave birth arrived, remembered Dayli, but the clinic did not have the means to give birth. Again, he says that he had to insert a tube into a patient with the light of his phone because there was no fuel for the generator.

He added that his request for transfer of a man with lung cancer to Caracas had been denied to allow him to rely on the statistics of the clinic.

"The health of Venezuelans is not important for the mission," he said. "An 11-year-old boy died in my arms when I tried to wear a respirator that was not working."

Carlos Moisés Ávila tells a similar story. This 48 year old doctor joined one of the first missions to Venezuela in 2004.

"Each of us had to declare to have saved a life every day, so I sometimes had to take some one in good health and give him a way to get out of it," he says.

"The medicines arriving from Cuba were out of date, so we had to destroy them and bury them before including them in the inventory as they were used so that they could be charged." We received our pay of soldiers, who arrived sometimes late months and took medicine from the hospital, "he recalls.

Carlos claims to have joined the medical mission to improve his financial situation.

Instead of being satisfied with $ 20 a month in Cuba at that time, he started earning $ 300 in Brión, in the Venezuelan state of Miranda, although he claims that the Cuban government has received more than 10 times that amount. amount for each doctor in the country. Barrio Adentro program.

Dayli said that any socialization with Venezuelans outside of work was prohibited. Cuban doctors lived together and had to respect the curfew at 6 pm The coordinator of the mission was a Cuban security official.

"They asked you about your roommates in weekly interviews," said Dayli. "It had a network of paid local informants who would give any information about you to detect potential deserters," he adds.

"We were not allowed to have a drink with a Venezuelan or go to his house because you saved his life and wanted to know how he was going … If you fraternized with a dissident , they could cancel your mission. "

Political propaganda

Carlos explains that during his seven years in Venezuela, he found that medicine was used as a political tool for propaganda purposes, sometimes to the detriment of the doctors' code of ethics.

"During the 2004 reminder referendum campaign, we were sent to door-to-door doctors to give gifts and medications and get support for President Hugo Chávez at the time. ", did he declare.

"We also had lists of patients according to their political tendencies: the supporters of the Chavist government were listed as hypertensive patients and the opponents as diabetics, the first received a better treatment and all the information we had on the premises was transmitted to the coordinator. mission, a Cuban who controlled all our personal relationships and with whom we had the right to meet. "

According to an article in the American newspaper The New York Times last March, Cuban doctors in Venezuela explained that they had to persuade patients to vote for the ruling United Socialist Party of Venezuela (PSUV). especially by refusing treatment to their supporters. opposition and proselytism in homes with medicine gifts to bribe the undecided.

In response, the Cuban government refuted these accusations and said that its honorable doctors had saved nearly a million and a half lives in Venezuela, in addition to citing its involvement in the fight against Ebola in Africa and cholera in Haiti , among other examples.

Carlos also embarked on a Brazilian mission to the United States, where he rebuilt his life in Houston, Texas, as a medical badistant.

Now he can not go to Cuba for fear of being imprisoned for desertion.

In 2018, he applied for a humanitarian visa to visit his mother, who was diagnosed with cancer. He was refused and could not see her before his death.

"That's how they play by offering permits and gifts in front of you for people to access." I soon realized that our mission was more political than humanitarian.

Dayli came to the same conclusion.

She returned to Cuba in 2014, where she was badigned to a hospital without an intensive care unit, which clearly indicates that she did not have the favor of the authorities. Later, she was suspended from the practice of medicine for alleged absences from work, a charge she denies.

She says that they started treating her as a dissident, with a state security officer outside her home who followed her everywhere. His family and friends were harbaded. Finally, he could not stand it and is currently visiting relatives in Spain, where he could decide to settle.

"I wanted to be a doctor in Cuba, but now I gave up on that, I do not want to be a risk to my family, I said what I thought and that's the consequence they want soldiers, not doctors. "

BBC.