“#BemVindosCubanos (Welcome Cubans), the Brazilian population thanks your solidarity and apologizes for the racist and xenophobic acts of an elitist and conservative minority!” states UJS Rio de Janeiro on Facebook, sharing this cartoon by Carlos Latuff, “the first medical appointment of a Cuban Doctor in Brazil”, for the website Sul Vinte Um. The cartoon reads a Brazilian doctor screaming “slaves” and a Cuban doctor diagnosing symptoms of “xenophobia racism”.

[Since the publishing of the original version of this post in Portuguese on 6 Sept. 2013, an anti-racism wave has spread across Brazilian cyberspace with banners and messages of support for the Cuban doctors, such as the one above. All links lead to Portuguese-language pages unless otherwise noted.]

The first 400 Cuban doctors participating in the Brazilian federal government program Mais Médicos (More Doctors) have arrived in the country. Along with bags packed for three years of work in regions where medical assistance is lacking, they brought with them more debate surrounding the problems in Brazil's public health system.

The introduction of foreign doctors to Brazil's public health system has already sparked controversy and divided opinions, often marked by intolerant and racist positions.

1957, student Elizabeth Eckford arrives for her first day of class in a desegregated school in Little Rock, USA. 2013, Cuban doctor being booed by Brazilian doctors, Fortaleza. Image shared more than 39,000 times on Facebook.

The arrival of a student on her first day of class in a desegregated school in Little Rock, Arkansas, USA (1957), and the arrival of a Cuban doctor for the program Mais Médicos in Fortaleza, Brazil (2013). Image shared more than 39,000 times on Facebook.

However, the issue was seen in a new light after a protest by a group of doctors in Fortaleza, Ceará at the closing of a reception for the Cuban doctors on August 26, 2013. The attack against the recently arrived doctors by the group of protesters, with boos and hostile words, was recorded in a video that went viral on the Brazilian web.

A photo of the protest that shows a black Cuban doctor being booed by doctors (right), made the covers of newspapers and the Brazilian Facebook timeline (#MaisMédicos), becoming the official illustration of the discussion. During the week of the 50th anniversary of the March On Washington [en], in which civil rights leader Martin Luther King, Jr. gave his famous “I Have a Dream” speech, the image also served as a reflection on history, and helped to centralize the debate around racism.

In an interview, Dr. José Maria Pontes, president of Sindicato dos Médicos do Ceara (Doctor's Union of Ceara), or SimeC, denied that the attacks were directed at the Cuban doctors and that the shouts of “slaves” were a form of racist protest. According to Pontes, the protests targeted the Ministry of Health.

The minister of the organization Políticas de Promoção da Igualdade Racial (Politicians for the Promotion of Racial Equality), Luiza Bairros, expressed regret for the reception that was given to the Cuban doctors, affirming that “racism still exists and the place that blacks occupy in Brazilian society is questioned.”

#Mais Médicos

According to official government data, currently 80 percent of the Brazilian population depends on the service of the public health system, the SUS, or Sistema Único de Saúde (“the One Health System”). However, reality shows that, in spite of the increase of doctors graduating in the country in the past few years, the Northern and Northeast regions, especially in cities in the interior of the country, are suffering from a lack of professionals.

“We need you”. Illustration of doctor and artist Solon Maia on his blog, Meus Nervos (My Nerves) (CC BY-NC-ND 3.0)

For this reason, the idea for Mais Médicos was born, a program created by the federal government in order to “establish Brazilian and foreign doctors in the public health network.”

In the first stage of the program, the openings in the program were prioritized for Brazilian doctors. Or in other words, without taking away work from Brazilians, the foreigners will only work in 700 municipalities that would not attract the attention of any other doctor in the country. The Cubans, however, make up part of a distinct agreement between Cuba and Brazil's Ministry of Health, mediated by the World Health Organization [en].

The communist island is considered by the organization to be “the most developed in the world” in the health sector, with infant mortality rates lower than the United States and Canada thanks to the practice of preventive medicine. Fidel's country is superior in numbers, as shown in an article published by Vinicius Galeazzi on the website Sul 21:

No Brasil, há 1,8 médicos para cada 1.000 habitantes. Na Argentina, 3,2. O programa Mais Médicos visa elevar nosso índice para 2,5 médicos para mil habitantes: um incremento de mais de 170.000 médicos, quando nossas escolas de medicina formam cerca de 18.000 médicos por ano. Nesse contexto, não é aceitável que a corporação dos médicos brasileiros não concorde que se chame médicos de outros países para os postos carentes, onde eles não querem ir. Alegam que não há infraestrutura e, sem ela, os médicos não podem trabalhar, mas não lhes importa, parece, que pessoas adoeçam durante essa espera de infraestrutura.

In Brazil, there are 1.8 doctors for every 1,000 inhabitants. In Argentina, 3.2. The Mais Medicos program aims to raise our rate to 2.5 doctors per 1,000 inhabitants, an increase of more than 170,000 doctors, when nearly 18,000 doctors graduate from our medical schools per year. In this context, it is not acceptable for a body of Brazilian doctors to disagree with a call for doctors from other countries to help at the most deprived posts, where they don't want to go. They allege that there is no infrastructure, and without it, doctors cannot work, but none of it matters if people get sick while waiting for infrastructure.

“Bootlegging” doctors?

The agreement signed by the Brazilian government to regulate the performance of the Cubans in the country, prohibiting them from, for example, moving from their cities or practicing medicine outside of the scope of the exchange program, exempts them from the medical diploma revalidation program in national territory, Revalida. A faction of Brazilians maintain that “attracting a foreign doctor to Brazil without validating his diploma, is not importing him, but bootlegging him”.

Nearly 84 percent of Cuban professionals, or Cuban graduates, that will work in Brazil already have more than 16 years of experience, as R7 points out. In past years, the first positions of Revalida were filled by medical students from Venezuela and Cuba.

A nurse prepares an anti-venom injection. Many challenges exist in the placement of health care professionals in local communities in the Brazilian Amazon. During the rescue of a Rio Negro resident bitten by a snake (Surucucurana), it took eight hours to get to the nearest hospital in Novo Airao. Photo: Marcio Isensee e Sá copyright Demotix (11/04/2013)

Novo Airao, Brasil (March 11, 2013): A nurse prepares an anti-venom injection. Many challenges exist in the placement of health care professionals in local communities in the Brazilian Amazon. During the rescue of a Rio Negro resident bitten by a snake (Surucucurana), it took eight hours to get to the nearest hospital in Novo Airao. Photo: Marcio Isensee e Sá, copyright Demotix

Two medical entities, the Associação Médica Brasileira (Brazilian Medical Association, AMB) and the Conselho Federal de Medicina (Federal Council of Medicine, CFM), reached the point of filing lawsuits to try to suspend the program, alleging that contracting doctors without diploma revalidation is illegal. But they were blocked. In the state of Minas Gerais, the president of the Regional Medical Council even threatened to arrest doctors practicing without registration. The minister of health, Alexandre Padilha, protested on his Twitter account:

Negar socorro e atendimento,não se sustenta em nenhum código de ética médica.Ñ acredito q os médicos de MG seguirão tal recomendação

— Alexandre Padilha (@padilhando) August 25, 2013

Denying help and service is not sustained by any code of medical ethics. I don't believe that the doctors of MG [Minas Gerais] would follow such a recommendation.

Doctors, divided

The Brazilian medical field ended up divided. Many doctors against the arrival of foreign colleagues took advantage of the moment to point out the problems faced by doctors in the country, mainly the lack of structure and low wages. Dr. Rodrigo Fontoura, who has worked for seven years in the Sistema Unico de Saude (One Health System, SUS) used his Facebook to let it out:

Não me aborreça depois de uma dia de plantão no SUS quando vou para casa triste e frustrado pensando que não fiz o meu melhor para alguns pacientes, porque não tive recursos básicos.
Não me faça ter pena da sua ignorância sobre o real motivo das vaias aos cubanos, portugueses, espanhóis ou brasileiros do Mais Médicos.
Essas vaias não são para os seres humanos que ali estão, e sim para o que eles representam.
Eles são a representação do descaso com a saúde, com todos os profissionais (médicos, enfermeiros, téc. Enfermagem, etc) que diariamente lidam com a mazela da sociedade, sem recursos.

It doesn't bother me that after a day on shift at SUS, when I go home sad and frustrated thinking that I didn't do my best for some patients, because I didn't have basic resources.
It doesn't make me have pity on you for your ignorance about the real motive for the booing of the Cubans, Portuguese, Spanish, or Brazilians of Mais Médicos.
These boos were not for the human beings that were there, but for what they represent.
They are the representation of the negligence of the health system, of all the professionals (doctors, nurses, nursing techs, etc.) that deal with the illness of society on a daily basis, without resources.

On the other hand, there are doctors that are receptive to the idea. David Oliveira de Souza, a member of the organization Doctors with Borders, published an open letter to the foreigners on his blog and in the newspaper Folha de São Paulo, where he points out the many problems of Brazilian population's health that could be resolved just with access to service, and declares:

A sua chegada responde a um imperativo humanitário que não pode esperar. Em Sergipe, por exemplo, o menor Estado do Brasil, é fácil se deslocar da capital para o interior. Ainda assim, há centenas de postos de trabalho ociosos, mesmo em unidades de saúde equipadas e em boas condições.

Their arrival is a response to a humanitarian necessity that cannot wait. In Sergipe, for example, the smallest state in Brazil, it is easy to move from the capital to the interior. There are hundreds of posts of idle work, in health units that are well-equipped and in good conditions.

Beyond helping with the problems with health in Brazil, it is hoped that the initiative will also expand opportunities and the profile of who has access to the practice of the profession. Cases such as student of medicine Cintia Santos Cunha, who comes from an impoverished community, and emigrated to Cuba to become a doctor:

Among controversies and debates that are still developing, one truth was pointed out by political commentator Bob Fernandes, in a video with more than 20,000 shares on social networks:

Milhões que moram nestas cidades (sem médicos) não querem saber se o médico é baiano, sueco ou cubano. Querem médicos. E medicina. Sabem que um médico é melhor do que nem um médico. A boa medicina será cobrada, e muito, nesse caminho. O resto é o jeito de cada um enxergar a vida.

Millions that live in these cities (without doctors) don't want to know if their doctor is from Bahia, Switzerland, or Cuba. They want doctors. And medicine. They know that a doctor is better than no doctor. Good medicine will be covered, and more, on this path. The rest is the way that each individual sees life.

The video above was translated and subtitled in English by Vitor Visconti.

]]>