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When the Cuban government announced the departure of the country from the "More Doctors" program earlier this month, recalling that more than 8,000 doctors had sent to Brazil media, doctors and public health specialists were alarmed.
The fact that Cuba's decision was triggered by renewed impetus from President-elect Jair Bolsonaro only added to the concerns. Bolsonaro not only offended Cuba by accusing it of promoting forced labor – retaining about 70% of the medical costs incurred while preventing their family from joining them in Brazil – and had no plans to reserve to replace the services rendered. Millions of poor patients would be released, it was said, and could trigger a public health disaster. "It's a sad day for Brazil's health and foreign policy," said former Health Minister Alexander Padilha.
Official Journal: An agreement reached in the shadows
Two weeks later, predictions seem to have missed the prognosis. Although Brazil must really endeavor to replace imported aid, filling vacancies in the health sector turns out to be a little less daunting. Shortly after the government issued help announcements, replacement requests began to appear; On November 26, the Ministry of Health announced that it had filled 97% of vacancies in approximately 2,800 counties.
The real loser, as far as it seems now, is Cuba. To identify the coup d'etat in Havana, consider the vital signs of the island. Forget about luxury sugar, cigars and luxury resorts on the Malecón: doctors have become the most famous global brand in Havana.
Charity with the hat of others
In the last fifty years, doctors in vocational training have been the most formidable calling card of the Castro. They helped spread primary care and take care of emergency situations in poor societies around the world. development. At a recent count, 37,000 Cuban doctors were providing primary care, performing surgeries, giving birth, providing vaccines, and training local medical staff in 77 countries.
This mission brought Havana goodwill and a power of exchange. Even because most of Cuba's global clients pay almost nothing and their visiting doctors are treated like heroes. International health experts and international media praised Havana and named "medical diplomacy" as the island's main export product.
It turns out that Cuba was doing charity with the hat of others. For decades, the governments of Fidel and Raul Castro have been able to provide free medical services, largely thanks to the vital support of the former foreign sponsor of Havana, the Soviet Union.
However, the generosity of the cold war has long since disappeared. The economy of the island, in difficulty, has more and more recourse to the payment of customers to obtain a precious change. According to the calculations of the Cuban economist Pavel Vidal, who teaches at the Pontifical University Xavieri de Cali, Colombia, professional services accounted for 55% of total exports of Cuban goods and services between 2013 and 2017 Medical services were at the top of the list.
Cuban medical internationalism has reported an average of $ 9.6 billion annually between 2011 and 2016, according to the estimate of the Economist Intelligence Unit (EIU). According to Vidal, more than three quarters of this reward came from only two markets: Brazil and Venezuela.
According to Mark Keller, of EIU, the end of the agreement "More doctors" with Brazil would deprive Cuba of an amount between 400 and 500 million dollars a year (nearly $ 2 billion). That's more than Cuba wins every year with its main commercial product, sugar (which earned $ 371 million in 2016).
It is a fact that more than 21,000 Cuban doctors are still in Venezuela in exchange for cheap oil loans. More than 500 doctors have been sent to Caracas this month, evidence of their resilience. However, with the Bolivarian economy in ruins and the decline in oil production, it is unclear how long this source of revenue will last. "Under Nicolás Maduro, Venezuela is no longer a stable country," Keller said. "If the government changes, it would be catastrophic for the Cuban economy."
The fortune of the island already seems pale. In the past four years, the flow of professional-led professional services exports has fallen from $ 10.2 billion to $ 7.7 billion, according to Vidal. This deficit, he said, has aggravated the already poor results of Cuban foreign trade. According to data compiled by the Observatory of Economic Complexity (OEC), the negative balance of the island would have reached 5.55 billion dollars in 2016.
In addition to the lack of diversity of exports and From lower standards in education, Cuba's national economy will appear even more precarious. Doctors returning from Brazil will be transferred to the Cuban public health system, where salaries in local currency make the lowest salaries appear abroad, seemingly grandiose, perhaps waiting for the next post abroad. "Cuba still has well trained health professionals, but in a normal country, you would not send your doctors overseas to get money," Keller said.
Some diseases, even the best doctors, can not cure.
* Margolis is an editorialist for Bloomberg Opinion and covers Latin America. He was a journalist for Newsweek and is the author of "The Last New World: Conquering the Amazon Frontier".
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