The government of Brazil is considering offering medical students and young doctors debt relief in exchange for sending them to work in less desirable rural areas to replace the thousands of slave doctors Cuba is withdrawing from the country, O Globo reported on Wednesday.
The Brazilian newspaper suggested that the greatest difficulty in offering debt relief to doctors would be imperiling the sustainability of the government’s student loan program while potentially losing millions of reais in the program. Another reported alternative considered is establishing programs to send doctors to work in poor and rural areas for a year after graduation as part of social service to the country.
Since 2013, Brazil has filled its gaps healthcare availability in poor regions with a program called “Mais Médicos” (“More Doctors”) that imports thousands of Cuban doctors into the country in exchange for Brasilia paying Havana directly. The doctors earn only a “living stipend” that many complain barely covers food costs; relatives are banned from visiting them and they have no freedom in choosing where or how long they serve.
To put the plan into action, the socialist government of impeached former President Dilma Rousseff agreed with the Castro regime to circumvent Brazilian constitutional law and used the Pan-American Health Organization (PAHO) to override a requirement that the Brazilian Congress approve the deal, according to diplomatic cables published this week. Rousseff’s government believed the Congress would not approve the deal to fill Brazilian medical jobs with Cuban slaves, thus placing Brazilian doctors at a disadvantage.
Cuba definitively canceled the Mais Médicos program last year after conservative President-elect Jair Bolsonaro announced that he would demand 100 percent of salaries go to the doctors, not the Cuban regime, and that families be allowed to visit the doctors. Cuban doctors who wish to remain in Brazil to avoid retribution from the dictatorship at home will receive political asylum, Bolsonaro promised.
The current government of Michel Temer is now scrambling to replace the over 8,000 doctors believed to be departing as soon as possible, leaving a void during the Brazilian spring and in anticipation of summer, when mosquito-borne illnesses become an inflamed threat. Diseases like Zika virus and Yellow Fever become particular concerns as the weather warms in the Amazon region.
According to O Globo, there are currently 26,100 doctors with active debts to the National Development Fund for Education (FNDE), meaning doctors in Brazil who also received their medical educations in Brazil and relied on the federal government for loans to pay tuition. The Temer administration is considering offering these doctors a “discount” on their debts in exchange for taking jobs previously held by the Cuban doctors. The problem with this proposal, the newspaper notes, is that it jeopardizes the amount of money available to pay for new loans for current students; Ministry of Health officials are reportedly studying how much of a discount they can offer without diminishing the number of doctors produced in Brazil.
Another idea O Globo reports that the government is considering is engaging the nearly 28,000 medical students still active in the country, offering them a reduction in debt to work as doctors replacing the Cubans once they graduate.
Current Minister of Health Gilberto Occhi told reporters last week that he would propose to the Bolsonaro transition team to consider a student debt agreement to attract more domestic doctors.
“One of the proposals that we are going to present is this, like other proposals that we are working on, not only on the Mais Médicos issue but on other Health Ministry issues,” he reportedly said last Friday.
Temer’s government launched a “contest” for Brazilian-trained doctors to apply for Mais Médicos positions in Tuesday. The contest would prioritize Brazilian doctors trained in Brazil; should any vacancies still exist after that supply runs out, foreign doctors trained in Brazil would have the opportunity to apply. There are currently an estimated 8,332 positions open, subject to change if the Cuban doctors in those positions choose to apply for political asylum and stay in Brazil.
Bolsonaro has sternly condemned the Mais Médicos program for enslaving Cuban doctors, who last year sued the Brazilian government for the right to have a salary and see their families. The Brazilian government blocked those doctors from legally practicing in response to the lawsuit, depriving them of the little money the Cuban regime allows them to keep.
“We cannot allow Cuban slaves in Brazil or keep enriching the Cuban dictatorship,” Bolsonaro said this week. “Nor is it fair to confiscate 70 percent of a person’s salary,” as Cuba does to their doctors.
“We cannot be complicit in work that is analogous to slavery. This is a humanitarian issue,” he insisted.