Latin America’s Doc Deficit: Brazil, a Continental Giant, Still Needs to
Import Cuban Medics
By Tim Padgett Sept. 04, 2013
A Brazilian prosecutor is investigating whether President Dilma
Rousseff’s government violated federal labor laws by recruiting 4,000
Cuban physicians this month to work in remote areas like the Amazon.
That’s just the latest wrinkle in Brazil’s acrimonious Cuban-doctors
controversy, which has everyone from Brazilian physicians in Brasília to
Cuban-American politicians in Washington, D.C., up in arms.
But there is a much larger problem involved here than Marxist medics —
and it’s one that plagues not just Brazil but most of Latin America.
Whether or not Brazilian judges eventually let the Cuban physicians stay
or order them to leave, it won’t solve Brazil’s doctor shortage,
especially in the medically deprived rural and favela (slum) zones the
Cubans are headed to.
If you’re wondering why Brazil was the site of sometimes violent street
protests this summer, this latest dustup offers one useful clue. Brazil
is now the world’s sixth largest economy and considers itself on the
doorstep of the developed world. Yet, as Brazilian demonstrators are all
too aware, its education system is widely regarded as abysmal,
especially science preparation. Brazilian physicians aren’t bad
practitioners, though Rousseff has a point when she says many are too
elitist to practice in the boonies. But while the medical community may
share much of the blame, critics say Brazil’s notoriously corrupt and
indifferent officialdom has done little to provide the infrastructure
needed to create and support enough doctors to serve the nation’s 200
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.
Spending on Brazil’s well regarded but underfunded national health
system accounts for little more than 3% of GDP, but the WHO urges at
least 5%. “Brazil is creating more spaces in its medical schools,” says
Katherine Bliss, senior associate at the Center for Strategic and
International Studies’ Global Health Policy Center in Washington, D.C.
“But increasing the number of medical professionals may take a
generation, since Brazil will need to ensure students are prepared, and
that means reaching back to strengthen or reform education at the
elementary and secondary levels.”
Rousseff launched Mais Médicos (More Doctors), the program that’s trying
to augment Brazil’s physician ranks, in response to protesters’ demands
for better public services. But the country’s National Federation of
Physicians is fuming that Cuban doctors aren’t trained well enough to
practice in Brazil — and by many accounts, Cuban medical training today
isn’t as high caliber as it once was — and the Cuban-American
congressional caucus calls the Cubans’ recruitment part of Rousseff’s
“complicit blindness” toward the island’s communist dictatorship.
But Cuba’s medical-diplomacy mission — which currently has 40,000
doctors serving abroad and, along with other medical services and sales,
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
As in Brazil, the region’s complacency toward science education is a big
culprit. That’s reflected in the fact that while Asia accounts for 30%
of the world’s technology research and development today, Latin
America’s share is 3%. “Latin America has a strong history of research
and collaboration in health sciences that dates back to the 19th
century,” says Bliss. “But it’s been a challenge for governments to make
sure there are sufficient opportunities for people from all social
sectors to engage in that kind of work.” Rousseff hopes her Science
Without Borders program, which is sending tens of thousands of students
to countries like the U.S., will improve things. But as experts like
Bliss point out, it could take at least a generation to get the South
American giant on track.
Still, Americans like the Cuban caucus members shouldn’t get too
self-righteous. The U.S., with 2.4 doctors per 1,000 people, has its own
doctor shortage; and like Brazil’s, it’s most acute in poor rural
regions. The Association of American Medical Colleges warns that the
U.S. may in fact face a deficit of as many as 100,000 doctors by 2020.
In Florida, 16 counties have fewer than one doctor per 1,000 residents.
Miami, one of the U.S.’s largest metropolitan areas (and where most of
the Cuban-American caucus is from), didn’t have a public medical school
That doesn’t excuse Brazil’s situation. But the U.S. does offer Brazil a
helpful warning — namely, that being a rich country is no guarantee of
adequate access to physicians. And that has nothing to do with Cuba.
Source: “Latin America’s Doc Deficit: Brazil Still Needs to Import Cuban
Medics | TIME.com” –