Archive for Monday, September 2, 2013

Opinion: U.N. affiliate may sponsor ‘modern-day slavery’

September 2, 2013


The Pan American Health Organization (PAHO) is doing great things in Latin America, but I wonder whether its latest role as a middleman to help place 4,000 Cuban doctors in remote areas of Brazil does not amount to sponsoring slavery.

Under a deal between Brazil and Cuba that was brokered by the Washington-based PAHO, the Latin American branch of the U.N. World Health Organization, the Brazilian government will pay Cuba the equivalent of $4,080 a month — or nearly $49,000 a year — for each of the Cuban doctors.

The Brazilian government says the Cuban doctors are needed in remote areas of northern and northwestern Brazil, because no Brazilian physicians want to take those jobs. The first 400 Cuban doctors started arriving in the South American country on Aug. 24 amid public criticism from Brazil’s biggest physicians’ associations.

Brazil’s National Federation of Brazilian Physicians, Fenam, has said that “the Cuban doctors contracts have the characteristics of slave labor.”

Under the PAHO-brokered Brazilian program, called Mais Medicos (More Doctors), Brazil pays Cuba the entire amount of the Cuban doctors’ wages, and Cuba later pays a fraction of it to the doctors.

Here’s the problem: Neither Brazil, nor Cuba, nor PAHO are saying how much of the $4,080 a month per doctor will go to the doctors working in Brazil.

Solidarity Without Borders, a Miami-based organization that helps Cuban doctors around the world, says the Cuban government pays its doctors working in Brazil and other countries between $250 and $300 a month, or about 7 percent of the full amount it gets from the Brazilian government. The remaining 93 percent are pocketed by the Cuban government, the group says.

“It’s a modern-day slavery system,” Solidarity Without Borders President Julio Cesar Alfonso told me in an interview. “The only difference is that it uses highly skilled slave work.”

Asked how does he know the amount paid by Cuba to its doctors in Brazil, since it’s an official secret, Alfonso responded, “It’s very simple: there are about 30,000 Cuban doctors in Venezuela, and other tens of thousands around the world, and more than 5,000 have already defected. They tell us how much they were being paid by the Cuban government.”

Former Cuban ruler Fidel Castro created this doctors-for-export racket in 1982 as a way to earn cash for the country. Castro opened medical schools throughout Cuba to produce as many doctors as fast as possible. As Cuba’s economic situation deteriorated over the years, Cuba stepped up its doctors’ export business, Alfonso says.

Some of the Cuban doctors that are being sent abroad have not even graduated, Alfonso said.

“They are now exporting 5th and 6th-year medicine students to Venezuela, as part of their training to get their degree,” he said.

Cuban doctors who are sent to Brazil, Venezuela and other countries don’t complain about their pay: The $250-$300 a month that they can make in Brazil is nearly ten times more than the average of $30 a month that they make in Cuba. In addition, it gives them a chance to defect, Alfonso says.

“It’s a good business deal for Cuba, and it also serves as a way to export Cuba’s ideology to the poorest parts of the world,” Alfonso says, adding that Cuban doctors played a big role in helping late Venezuelan President Hugo Chavez win support in poverty-stricken parts of Venezuela. “In remote jungle regions where they never saw a doctor, the presence of a fifth-year Cuban medicine student is a godsend.”

When I called PAHO to ask how much the Cuban doctors in Brazil will be paid by Cuba, I was told that PAHO’s director, Carissa E. Etienne, was not available but that PAHO’s Brazil office would respond via email.

A few hours later, I got PAHO’s non-answer. It said that that “the Cuban doctors are Cuban government officials,” and that they will be paid their normal wages with “an additional salary” by the Cuban government “according to the laws of that country.”

As for the Brazilian doctor’s federation assertion that the deal amounts to “slave labor,” PAHO’s response was that, “This question has been examined by various departments of the Brazilian government and the country’s authorities do not agree with that assertion.”

My opinion: There is nothing wrong with Brazil hiring Cuban doctors who are willing to go to remote areas of the country, where Brazilian doctors allegedly refuse to go.

But the Brazil-Cuba deal whereby the Cuban government reportedly pockets 93 percent commission on the Cuban doctors’ salaries is scandalous.

Andres Oppenheimer is a Latin America correspondent for The Miami Herald.


Ron Holzwarth 4 years, 7 months ago

So, the author thinks that the Cuban government pocketing a 93 percent commission on Cuban doctors’ salaries is scandalous. The solution is simple, the United States could put an end to it by following Cuba's example of free tuition and books for medical students and sending American doctors instead. I commented on the fact that Cuba exports so many surplus doctors on on Jul 30, 2013.

And, as a side benefit of the free tuition and books for medical students, the health care available to the citizens of Cuba is better than that available for most Americans, according to the Central Intelligence Agency (CIA). Plus, it's free, there is no charge for health care in Cuba.

My comment appeared here:

"Example is the school of mankind, and they will learn at no other."
- Edmund Burke

I think the United States can learn a lot from the examples of other nations, of course not in all respects, but the ethnocentrism of so many Americans makes them think we are the best at everything. That is absolutely not the case.

deec 4 years, 7 months ago

"The $250-$300 a month that they can make in Brazil is nearly ten times more than the average of $30 a month that they make in Cuba. "

So how exactly does a job opportunity that pays 10 times more than the normal pay equal slave labor?

Ron Holzwarth 4 years, 7 months ago

What this article is all about is a jab at Communism. The Cuban government spent a great deal of money to train the physicians, and the portion of the subsidy for the physicians working in Brazil that is kept by the Cuban government could obviously be considered to be a return on that investment. Is that really any different than what corporations in the United States do?

jafs 4 years, 7 months ago

Well, since $30/month is tiny, even a ten time that amount wage isn't great.

Have you tried to live on $300/month recently?

deec 4 years, 7 months ago

Nope, never been to Venezuela or Brazil, but minimum wage in Brazil is being raised to about $333 in U.S dollars. Do these doctors also get a housing allowance or other additional subsidies?

jafs 4 years, 7 months ago

I don't know.

So, doctors are getting paid minimum wage then? Not great for a very skilled job, is it?

deec 4 years, 7 months ago

But they are still making many times more in this program than they would be practicing at home. In Cuba minimum is "225 Cuban pesos ($9) per month; supplemented by the government with free education, subsidized medical care (daily pay is reduced by 40 percent after the third day of a hospital stay), housing, and some subsidized food[4] wiki.

Making more money isn't slavery.

voevoda 4 years, 7 months ago

If making a large profit off the labor of others constitutes "slavery," wouldn't that make the CEOs of major American corporations the worst kind of slaveowners?

Or take GTAs at KU for example. They receive about 15% of the tuition money their students pay. Is KU running a "slave system"?

Curveball 4 years, 7 months ago

I wonder what the quality of the doctors is like compared to the US. I have always thought that doubling or tripling the class size in medical schools would do a lot toward lowering medical costs, but I'm sure the AMA and MDs in general would oppose it. The doctors first priority is to get rich and stay rich.

kansanbygrace 4 years, 7 months ago

The effects of the Cuban (Marti School) health system are substantially more beneficial and cost-effective than the US system. All international assessments agree. They enjoy markedly better outcomes in nearly every category studied. Not a bad deal for the Brazilians and others who participate in the interchanges. Maybe we could talk them into sending some physicians to rural Kansas. We could sure use the upgrade.

Liberty275 4 years, 7 months ago

"the Cuban government pays its doctors working in Brazil and other countries between $250 and $300 a month"

That's better than the $30.month everyone else makes.

jafs 4 years, 7 months ago

Yes, and $30/month is better than $3/month.

Which is better than nothing.

Still not enough, though - imagine trying to live on $300/month.

jhawkinsf 4 years, 7 months ago

The cost of living in Lawrence is substantially different than say, New York or San Francisco. For all we know, the cost of living in Havana is substantially different than in rural parts of Cuba. $300/mo. in Cuba might well, represent a decent living wage while here it would put one far below the poverty level. This really is a case of comparing apples to oranges.

jafs 4 years, 7 months ago

Well, yes, we'd have to know about the cost of living.

But, I'm just pointing out that one can almost always say "This is better than that", but that doesn't mean it's good enough.

Lawrence Morgan 4 years, 7 months ago

There are many Chinese doctors who are doctors in China, but when they come to the United States they don't have a doctors status, because they can't always pronounce words perfectly. I know because I work with them here in San Francisco, and the test that they have to take is very long and complicated.

It would seem to me that the doctors I have worked with pronounce English pretty well, and of course Chinese or another Asian language perfectly.

Shouldn't we use these doctors here in the U.S. instead of their having to work in labs or at menial jobs here?

And I wonder... how much of the American doctors' medical education is paid for by the U.S. government? Shouldn't they give back some of this money to serve in less fortunate areas?

Ron Holzwarth 4 years, 7 months ago

In answer to your question about the portion of American doctor's education that is paid for by the United States government: The answer is virtually none, the only portion that is paid by the government is the amount of a Pell Grant that might be awarded. I addressed the cost of a medical education on this forum on July 16, 2013. This is a link to the article that I commented on:

This is the text of my comment:

One thing that would help a great deal would be for tuition for medical doctors and possibly nurses also to be free, that is, paid for by the government as it is in some other countries. Then, many more people would enter those fields, which would reduce health care costs, the burdensome hours that most physicians face every day could possibly be eliminated, and they would enter the workforce without a burdensome debt. A large part of a doctor's bill is going towards his or her student loans.

"According to the AMA, the average debt facing graduating medical students in 2009 was $156,000." Clipped from:

The figure of $156,000 was for a general practitioner, and that statistic states only the average debt, it is certainly the case that the families of many of the students made a contribution that is not reflected in that amount. And, those going into specialized fields such as surgery or psychiatry will have much higher student loans to repay. But even a general practitioner can have a horrific sized loan. The following is an example, the writer is not a person that is entering a specialized field. Of course, the cost will vary a great deal, depending upon the schools chosen.

The following is clipped from:

Annual cost of tuition: $48,000 Annual cost of attendance: $67,500 (Includes costs of books/supplies, loan fees, health insurance, licensure fees, living expenses, and transportation allowance)

Total balance after medical school: $270,000 Amount subsidized: $34,000 Amount unsubsidized: $236,000

Interest incurred during 3 years of residency: $100,000 Total balance after residency: $370,000

Monthly payment after residency: $3,370 (180 total payments) Interest incurred after residency: $237,000 Total repayment: $607,000
-end clip-

But, with the very recent interest rate hike on some student loans, the amount of $607,000 will very likely be much higher.

Ron Holzwarth 4 years, 7 months ago

So obviously, American doctors cannot possibly afford to work in Brazil.

Seth Peterson 4 years, 7 months ago

Replace Cuba and Brazil with Oakland and Jets, then replace doctor with player and you have an excellent article about what's wrong with modern sports.

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