Millions of angry Brazilians have taken to the streets this summer to demonstrate against their government and political class. And right now we’re seeing a vivid example of why: the controversy over Brazil’s recruitment of 4,000 Cuban doctors to work in its remote regions.
Brazilian doctors are up in arms, insisting the Cubans aren’t trained well enough to practice medicine in Brazil. Brazilian President Dilma Rousseff’s administration says the Cuban docs are needed because Brazil’s are too elitist to serve patients in poor rural areas. And U.S. politicians complain the plan reflects Brazil’s “complicit blindness,” as the Cuban-American congressional caucus puts it, toward communist Cuba’s repressive regime.
But making Cuba the issue in this dispute misses the point -- and ignores a problem that plagues not only Brazil but Florida and the U.S.
It’s true that Cuban medical training is no longer regarded as exemplary. And as the Miami Herald’s Andres Oppenheimer points out this week, exported Cuban doctors are virtual slaves since the Cuban government pockets more than 90 percent of the money foreign countries pay them. (They’ll get $4,000 a month in Brazil). What’s more, Cuba’s continuing cholera epidemic makes its doctors-for-international-hire service -- 40,000 Cuban health workers are stationed abroad, earning Cuba $6 billion a year -- look more cynical than charitable.
Even so, the fact that Brazil has to import those physicians says more about its flaws than it does about Cuba’s. Brazil is now the world’s sixth largest economy, yet it has only 1.8 physicians per 1,000 people compared to 6.7 in cash-starved Cuba, according to the World Health Organization. That’s one reason (among many) for the Brazilian protests, which in turn compelled Rousseff to create the Mais Médicos (More Doctors) program that invited the Cuban physicians, who started arriving this week.
That doctor shortage is a symptom of how fecklessly Brazil’s leaders have neglected science education and rural healthcare, despite the country’s decade-long economic boom and its constitutional guarantee of medical services. Says Debora Rosenn, a São Paulo native and Miami photographer who has led Brazilian ex-pat demonstrations here this summer, “If there aren’t enough doctors in rural Brazil it’s because the government has provided almost no medical infrastructure there.”
But before Americans, and especially Floridians, scold Brazil, we should consider our own looming and inexcusable physician shortage. Florida, in fact, might as well be Brazil. When the state legislature approved a medical school at Florida International University in 2006, it pointed out that Miami was then the nation’s second largest metropolitan area without a public medical school. Florida needed to license 2,500 new physicians annually to keep up with demand, yet it graduated only 500 medical students a year.
The situation hasn’t improved much today: 16 Florida counties still have fewer than seven doctors per 10,000 residents compared to 22 per 10,000 for the U.S. as a whole. But don’t think the country isn’t in trouble, either.
According to the Association of American Medical Colleges, the U.S. is staring at a shortage of 100,000 physicians by 2020. The problem will be especially acute in poor rural pockets. Not coincidentally, the Philadelphia Inquirer recently reported that the number of medical scholarships offered by the federal government’s National Health Service Corps has dropped from 6,159 in 1981 to 250 today.
I wouldn’t suggest we alleviate the U.S. shortage by recruiting Cuban doctors (though it’s always amused me how U.S. pols like those in the Cuban-American caucus vilify the quality of Cuban docs who work abroad but then suddenly extol their skills when they defect). But railing at Cuban doctors doesn’t fix our problem, either -- just as recruiting them won’t solve Brazil’s problem.
Brazil has apparently decided that a Cuban doctor out in the Amazon is better than no doctor at all out in the Amazon. But that’s a lame healthcare policy -- and Florida and the U.S. need to be mindful of that too.