When Cuban doctor Eduardo Rodriguez arrived at Pedreira, inside São Paulo, there were no others like him there. It was in the mid 1990's and he worked alone to distribute a family health system in the region. It was only twenty years after Rodriguez saw his compatriots arriving as members of the Más Doctores program – 300,000 people were one of the first to get third-party professionals. Since then, in criticism of classmates and other controversies, Rodriguez has noted decreasing levels at healthcare and heard compliments from Cubans visiting patients at home.
Now, with Cuba announcing that he will leave the program, Rodriguez says he is not afraid of the future of the three Cuban doctors working there. Not for quarries in itself. His concern is far, in Brazil's interiors, where foreigners are the only options for a necessary population.
"I think this decision will discontinue the health system, there are places that only have Cuban doctors, and the mayors trust it if the prefects themselves have to pay the doctors' salary, how are they doing?" Said Rodriguez, now Head of Health at Pedreira .
Cuba's decision to leave Mais Medicos, a program created by the government Dilma Rousseff 2013, was reported on Wednesday in a statement from the public health organization published in the Granma newspaper. In the text, the Ministry quotes "direct, abominable and threatening references" made by President Jair Bolsonaro about the presence of Cuban professionals in the country. In August, at a rally, Bolsonaro said he would use Revalida Diploma Validation Exam – to "expel" Cuban doctors.
"We will put an end to the São Paulo Forum. We will expel Cubans from Brazil with Revalida," said the then candidate.
Five years ago, Cuba sent doctors to work in the Unified Health System as a way to serve poor regions and alleviate the difficulty of hiring Brazilians. The bill was criticized by medical associations because they would open a crime against professionals whose education was not approved by competent bodies in the country.
Rodriguez, in addition to filling in staff shortage, Cubans Mais Medicos reinforced a more welcome approach to care, where the patient's listening processes are valued, following Cuba's social medicine model.
"They are well-qualified, like me. They have this workout, the usual smile, worry about listening carefully to the complaint."
He claims that the main consequence of leaving cubes will be the reaction of patients who will miss care even more where they experience the presence of physicians for the first time.
"This is very difficult, especially in the northeast, where sometimes the cube is the first doctor. We must remember that there are cubes in native communities, in quilombos."
As for Pedreira, he says he does not know how the remuneration of the three doctors will be resolved, but predicts that residents will get the news badly.
"Family physicians go to people's homes when they are bedridden, and the worst thing that will happen is the needy population who, apart from economic shortcomings, will lack love and care."
But there are also practical difficulties. According to Pedreira Health Secretary Ana Goulart, a charter is the first result of Mais Medico's departure from Cuba, which tends to worsen the lack of professionals.
"My closest, Jaguariúna, has 11 Cubans, the whole region will look for," says Goulart, who has been responsible for 13 years between the commands and the gifts.
For her, it is a great challenge to find Brazilians to fill vacancies. In her experience as a secretary, she says that she has always had trouble finding people who are willing to attend healthcare for 40 hours a week as family doctors.
"It's hard to find someone who wants to spend 40 hours the three Cubans do today. We have more facilities with specialists like cardiologists, gynecologists, who can work for 20 hours."
The little interest for Brazilian doctors to work in remote and poor regions is among the reasons the Dilma government quoted to encourage foreigners to foreigners in SUS. Today, 18,340 vacancies in the program are occupied by cubans, according to information from the Ministry of Health. According to the Ministry, the coming days will be called public notice to occupy the open positions.
Pedreiras secretary says she has not yet talked with Cuban doctors that she leaves the city. The statement released Wednesday does not tell you about the date when professionals will leave the program. For Goulart they are missing in Pedreira, where their work is well seen and helped reduce the queues for service.
"The people accept their service well and they are very good, on time."
Eduardo Rodriguez dries the choir: The Cuban women are friendly, prepared and received a lot of society, where he settled in 1995.
"We are Cuban because we divide ourselves in numbers, but we are morenos as brazilians, we like rice and beans, picanha, they are already very well adapted."
With the announcement to leave Cuba, a doctor responsible for covering the other people's holidays must enter one of the Cuban women's place, but two vacancies are open. Such absence, says Goulart, should increase the waiting for consultation.
Lack of transparency in payments
Despite the problems with the end of the partnership with the Caribbean country, the secretary said that development was not unexpected at all. Bolsonaro's statements during the campaign, when he declared he would "expel" Cuban doctors from Brazil on the basis of the renewal of a doctorate, revitalization of trained doctor abroad, Revalida, has already been awake. What amazed the secretary, however, was the decision to leave Cuba and not the Brazilian government.
"For Cuba, it was good, right because Brazil sent a greater value to them and they paid less for doctors."
According to a technical term signed between the Ministry of Health and the Pan American Health Organization (PAHO), the World Health Organization Army for America, every program doctor receives a $ 10,000 US $ monthly contribution from the federal government. The money is paid by the Brazilian government to Opas, which transfers it to Cuba. The Cuban government, in turn, returns a portion of the value and pays the remainder to the country's doctor. However, there are no official figures on how much goes on. During the five-year program, participants complained that no appeal was sent.
Last year, the Federal Court of Auditors recommended to the Ministry of Health to correct errors and give greater insight to the economic review of Opas. Before the court, the ministry should require the organization to be responsible for payments to the participants of Mais Doctors.
At the same time, TCU presented data that indicates the effectiveness of the program. According to federal government figures for 2017, more than 63 million people were assisted by Mais Doctors. In addition, in the 2116 municipalities that received doctors in the first and second cycles of the program, there was a 33% growth in the monthly average of consultations.
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