According to the World Health Organization (WHO), Brazil — despite its recent economic boom and constitutional guarantee of universal health care — has only 1.8 doctors per 1,000 people. (Cuba, despite its endless economic bust, has 6.7.) Almost two-thirds of all health care spending in Brazil is private, even though three-fourths of the population depends on public medical services.Coming from a self-styled worker's paradise, what exactly is in it for the Cuban physicians working in Brazil? Unfortunately, it appears the ratio of wages paid to these doctors relative to Cuba's remuneration from host states is very low:
But Cuba’s medical-diplomacy mission, which currently has 40,000 doctors serving abroad and brings the Cuban government some $6 billion a year (of which the doctors themselves get only a tiny fraction), is a fixture in the third world, and was generally praised for its work in Haiti after the 2010 earthquake. And it points up the fact that Brazil’s problems are hardly unique. In fact, six of Latin America’s seven largest economies have two or fewer doctors per 1,000 people. (The exception is Argentina, which has 3.2.)The Havana Times complains about this opaqueness over how much Cuba receives relative to what the physicians do:
In different comments, we read of “new slaves”, that the Cuban State is a kind of “foreman” and that Cuban doctors are “sheep” denied the right to demand their rights, individuals subjected to that which Jose Marti, when writing of a certain form of socialism much spoken of in his time, called “modern slavery.” Unfortunately, I do not know how much money will be paid directly to the doctors under the agreement entered into with the pertinent agencies of Cuba’s Ministry of Public Health. Our local and biased press has not published this detail, and we will have to find out from the doctors themselves [...]Call it Transparency, ah, Internationale. I too would love to know exactly what these Cuban physicians earn relative to the amount of treatment they give to better calculate the rate of exploitation, but alas, the Cuban government is perhaps not the best model of public transparency [!?] Rest assured though that economic necessity drives this increasingly controversial trade.
It is both just and necessary for the Cuban State to take in a reasonable part of the money paid by Brazil, in order to re-invest it in Cuba’s public health programs. This money represents investments in many areas, including the country’s educational system, capable of creating a highly qualified labor force. It is also both just and necessary to respect the individual rights of our medical professionals, to pay them a percentage of the earnings that will guarantee their professional and personal dignity, as well as that of their families (without which they will not be able to practice their profession adequately).
What we need is transparency, on the basis of broader democratic, socialist concepts, throughout the selection, hiring and other processes related to the work of our professionals beyond Cuban borders. If Cuban doctors working in Brazil, for instance, were entitled to openly discuss their payment conditions and to arrive at an agreement with public health authorities that isn’t simply imposed on them, then we would be wrong to speak of any kind of slavery.