Boticario is a town lost in the vast northeast of Brazil, in the municipality of
Santo Amaro de Brotas, close to the Aracaju coast in the State of Sergipe, more than 1,600 kilometers from the capital, Brasilia.
It is hard to say if the President-elect of the country, Jair Bolsonaro, has been here, or if he knows where this town is located on the map. It is even more unlikely that he knows the story of María, a humble, young woman, 29 years of age, to whom a Cuban doctor provided relief.
Without the diagnosis of Dr. Reymeri Valderrama Pimentel, she would never have been able to fight the lymphatic filariasisshe suffered, a chronic, very debilitating disease also known as elephantiasis.
“We Cuban doctors who work in this municipality, will never forget María’s face, before and after the diagnosis, and those of her family and neighbors, who everyday placed their confidence in us and allowed us to enter their lives, despite the language and cultural barriers, that only love, professionalism, and humility can overcome,” said specialist Dr. Valderrama, who gave this testimony at the Central Medical Cooperation Unit in Havana, on the occasion of the 55th anniversary of Cuba’s international medical cooperation.
It was in 2012 that the Brazilian Institute of Applied Economic Research (IPEA) announced terrifying findings: doctors were in short supply; waiting times for appointments were long; and the quality of assistance was poor. At that time, the ratio of doctors per inhabitant was 1.8 per 1,000, according to the Brazilian Institute of Geography and Statistics (IBEG), far below other countries on the continent and around the world. Thus the analysis concluded with the proposal to raise this ratio to 2.7 doctors per 1,000 inhabitants.
Considering these statistics, it is evident that the More Doctors program, launched in August of 2013, was an urgent necessity. According to former President Dilma Rousseff, initiator of the effort, the goal was not to bring more foreign doctors to Brazil, but to take health care to the country’s interior.
The declaration released by the Cuban Ministry of Public Health, announcing its exit from the program, stated, “The work of Cuban doctors in places of extreme poverty, in the favelas of Río de Janeiro, Sao Paulo, Salvador de Bahía, in the 34 Special Indigenous Districts, especially in Amazonía, was widely recognized by federal, state, and municipal governments of the country, and by the population, who supported their presence at a level of 95%, according to a study which the Brazilian Ministry of Health requested of the Federal University of Minas Gerais.”
This reality was emphasized during the 2015 International Health Convention in Cuba, when Arthur Chioro, Brazilian Health Minister at the time, said, “Brazil has an official history of more than 500 years, and this is the first time we have doctors in all indigenous villages. This people, some 800,000 brothers, were never guaranteed access to a health team.”
The More Doctors program reached populations in Amazonia, in semi-arid regions, remote rural areas, and the outskirts of large cities, Chioro noted, adding, “Millions of people live in Sao Pablo, and in its periphery, thousands of them have no medical assistance.”
Brazilian authorities, the Pan American Health Organization (PAHO), and the population expressed their satisfaction with the program many times.
“We are very satisfied because 90% of the Brazilian doctors participating in this experience tell their Brazilian colleagues to come to the program, that it is worthwhile. This environment of success, credibility, and quality, we are morally obliged to share with the Cuban government, the PAHO, and with doctors from 30 countries who also responded to our call and make a contribution to allow Brazil to provide universal health coverage,” Chioro said at the gathering.
At the same time, he expressed the necessity of strengthening primary care with the opening of more medical schools and scholarships for residencies, “We are transforming the structure of our health system so that in ten years we have the capacity to provide this program more Brazilian doctors. We always count on the cooperation of Cuba, because we know that this sister people takes a position of great solidarity and commitment with Brazil,” he said.
What occurred with the More Doctors program in Brazil went beyond supporting the family health strategy and guaranteeing primary care. The greatest contribution in this nation, in which Cuban doctors played an exemplary role, was a new way of taking care of the people’s health – that of disease prevention, of conceiving the individual as a bio-psycho-social being, not removed from the surrounding environment. Cuban doctors were healing, without neglecting the causes that determine the disease.Dr. Maritza Gómez Hernández told Granma International that she worked three years in Río Grande del Sur, the country’s southernmost state, “I worked with another Brazilian doctor and it was a wonderful experience to exchange knowledge, and that professionals from other parts of the world could see our point of view, the way of doing Cuban medicine and why it has prestige,” the doctor recalls, arriving in Havana at dawn on November 15, with her mission accomplished, as part of a group of 196 health collaborators who had been in Brazil, working in the More Doctors program.
They landed at José Martí International Airport shortly after the Ministry of Public Health issued its statement announcing the end of Cuban participation in the Brazilian program.
The replacements they were to have will not be available to the Brazilian people, “given the actions of the new President who has not even taken office, but is taking ultra-right measures to place conditions on the medical mission in Brazil, and Cuba will not accept these conditions,” Dr. Anabel Mariedo Oropesa told Granma International.
“We return today, as our colleagues will, with all the dignity in the world, leaving behind a beautiful history written by all of us for this people, that so much needs it, and who learned to love Cuba and its doctors,” said the specialist who worked in the northeastern state of Tocantis.
“We welcome to the homeland, a bastion of courage and principles, all the doctors and internationalist professionals who completed their mission in Brazil and other countries,” said Deputy Minister of Public Health Regla Angulo Pardo, who congratulated the group for their commitment and effort, in the name of the ministry, the Party, and the Cuban people.
For Dr. Lisván Cala Rosabal, the attitude of Bolsonaro “shows that he has no knowledge of the reality of Cuban medicine and that of thousands of Brazilians for whom the More Doctors program allowed access to a right like health care. At the same time, he disregarded the dignity of the Cuban people.
“More Doctors was a great experience that allowed for the reduction of inequality in the Brazilian population and made access to a fundamental right possible, that is to health and life. More than 80% of the primary care doctors, in the municipality where I was placed, are Cuban,” said the Comprehensive General Medicine specialist.
And as they listened to the notes of the National Anthem, and were reminded of the explicit support given by doctors to the Revolution, no one could doubt that no conditions can be placed on integrity, health, or life.
THE BRAZILIAN PEOPLE WILL SUFFER THE CONSEQUENCES AND THE WORLD KNOWS IT
“With dignity, great sensitivity, professionalism, dedication, and altruism, Cuban collaborators have provided valuable service to the Brazilian people. Attitudes with such a human dimension must be respected and defended.”
These were the words tweeted by Cuban President Miguel Díaz-Canel referring to the decision by the Ministry of Public Health to end Cuba’s participation in the More Doctors program, in the wake of comments by Brazil’s President-elect indicating that he would make changes to the terms under which the program is organized.
In another tweet, he added, “With your heads held high, you are an unsurpassable example of humanism and dignity. Those who vainly think only in themselves cannot understand the essence of our internationalist convictions.
Similar condemnations of the President-elect’s position have been made in the Latin American, Brazilian, and international media, and on social media. Brazilian institutions, political figures, intellectuals, movements, and social organizations within and beyond the country have expressed their support for the work done by Cuban doctors over the program’s five years.
Gleisi Hoffmann, national president of the Workers’ Party (PT), denounced “the disrespect, threats, and violence with which Bolsonaro addresses Cuba, that have led to Brazil losing access to Cuban medicine, recognized by the World Health Organization as an example for the world.”
“In some time, with our struggle, we will return to being the country you, Cuban friends, came to know through your contact with our people. And I am sure that Cuba will not fail Brazil, as it has never failed any people of the world in need of Cuban solidarity,” said Manuela D’Avila, running mate of Fernando Haddad, the PT candidate for President in recent elections.
D’Avila, a member of the Communist Party of Brazil, described the end of Cuban participation in the More Doctors program as the first tragic victim of the ideological extremism and persecution against the left that is rampant in Brazil today.
Likewise, the President of the Brazilian chapter of the Network of Intellectuals and Artists in Defense of Humanity, writer Marilia Guimaraes, stated that she was greatly pained by the news, saying, “We don’t have any way now to change direction. But we have plenty of hope that new possibilities exist. I am very sad for the Brazilian people.”
The Landless Movement (MST) and the National Network of People’s Doctors referred to the work of Cuban medicine and the human, professional quality of its doctors, emphasizing that they are “an example of what medicine can be for all. An example that favelas and Amazonía can have doctors. An example that the poor and Black can be doctors. An example that the state must guarantee health as a right. An example of Latino love.”
But no doubt, those who will most feel the departure of Cuban doctors are the men and women, the children and elderly, who are indignant over the authoritarian, incoherent position of their future President, and will now be abandoned.
According to statistics from the Brazilian Ministry of Health, the More Doctors program currently has 18,240 posts in 4,058 municipalities. Close to 8,400 of these are occupied by Cubans, distributed over 2,885 municipalities.
More than 1,500 municipalities, the majority with less than 20,000 inhabitants, have only Cuban doctors, because they are located in remote, extremely poor areas, where Brazilian doctors do not want to work.