Thousands of Cuban doctors have been working in Brazil since 2013 as part of an aid programme helping disadvantaged communities. But Cuba recently decided to cut short the programme, after the newly elected Brazilian president Jair Bolsonaro threatened to upend the agreement between the two countries. We spoke to one doctor who is worried about what will happen to his patients living in a remote village in the Amazon.

Former Brazilian president Dilma Rousseff launched the ‘Mais Médicos’ (‘More Doctors’) programme in 2013 to do something about the shortage of doctors in rural, disadvantaged or remote regions of the country.

Both Brazilians and foreigners can apply to the More Doctors programme, which brought thousands of Cuban doctors to Brazil. For each doctor that it sent to participate in the programme, Cuba received around €3,600 – 30 percent of which was given to the doctor, the rest going into Cuba’s national budget.

During his campaign, Bolsonaro, a staunch anti-Communist and far-right candidate who won the Brazilian presidential election on October 28, had threatened to stop or modify the programme. On November 14, he announced that he thought it would be possible to continue the agreement with Cuba, on the condition that Cuban doctors passed further tests and received 100 percent of the portion of their salaries that was paid by Brazil.

After Bolsonaro’s announcement, the Cuban health minister said that he would suspend the programme, saying that the Brazilian leader was being “scornful” and that he was violating the agreement between the two countries.

It is unacceptable to call into question […] the professionalism and altruism of Cuban doctors […]. In five years […], almost 20,000 of them have looked after 113,359,000 patients, across more than 3,600 municipalities. […] Thanks to this, more than 700 municipalities had a doctor for the first time in their history.


According to the Pan American Health Organization (an agency of the World Health Organization), around 8,300 Cuban doctors were working in 2,800 Brazilian municipalities before the programme’s end.

"Before I arrived, no doctor had set foot in this village for a year"

Arnaldo Cedeño Núñez is a 38-year-old Cuban GP. He worked for two years in Bona, a village in the Amazon forest that is part of the Almeirim municipality, in the northeastern state of Pará. On November 15, he found out that his contract was terminated.

I had practised in Venezuela between 2012 and 2015 and I wanted to discover a new country and work with an indigenous community.

I arrived in Brazil in July 2016. Once I was there, they suggested I go to Bona. At the beginning, I was a bit scared: I wasn’t sure if I was going to be able to hack the amount of work that was needed, because there are bad diseases there like malaria… But under the programme, you could always switch where you worked, if it wasn’t working out.

"In Bona, there’s no electricity, no telephones, no internet, no running water”

Bona is a village in the middle of the forest, on the edge of a river, with six or seven hamlets surrounding it. Around 1,100 people live there, and most of them are indigenous Wayana-Apalaï. There is no electricity, no telephone, no internet and no running water.

In Bona, the health centre is tiny. Inside, there is a little room with a bed – where I slept – and a little kitchen. The medical equipment available is basic: a thermometer, a blood pressure monitor, scales, equipment for doing stiches and for delivery (scissors, cotton swabs, surgical pliers, a scalpel, compresses). In terms of medicine, there was only medicine to treat pain, infections and some chronic illnesses like diabetes.

 

The health centre in Bona.
 

Before I came, no doctor had set foot in Bona for a year. Only nurses regularly came to the village. But sometimes no one would come for three months.

I would stay 20 days in Bona and then go to rest for 20 days in Macapá [one of the largest towns in the state of Amapá, about two hours away by plane]. In Bona, there was almost always a nurse with me. And when I wasn’t there, there would always be a nurse that stayed. We also had to have a local translate for us, because not all of the residents spoke Portuguese. Gradually I earned the villagers’ trust, including the women, who are very shy.

 

A nurse (on the right).
 

 

Arnaldo Cedeño Núñez dealt with deliveries in Bona.

 

 

Arnaldo Cedeño Núñez examining a young pregnant woman.
 

"I left without saying goodbye to the villagers and without finishing what I’d started"

On November 15, I had left Bona to go to Macapá as usual. When I got there, I found out that I wasn’t going to go back to the village. Honestly, I didn’t think that they would stop the programme so abruptly. I thought I would be able to stay at least until January, or even until the end of my contract this summer. So I was really upset at first, because I’d left without saying goodbye to the villagers and without finishing what I’d started. There are patients, particularly pregnant women, who need to be monitored, and I’m not going to go back.

 

"The last photos of my dear Bona, taken from the air, the day I left without saying goodbye”.
 

"My indigenous children. I left you without saying goodbye. I had no idea what was going to happen. I’m sorry I didn’t say goodbye.”
 

Having said that, I understand our government’s decision, because what the Brazilian president said was really hurtful. He damaged our image. In terms of our skills, there is already a procedure in place when we arrive in Brazil to check our qualifications. And for the salary, we know exactly what we’re going to be earning before we come, and it was enough to cover expenses. Finally, our families were already able to join us.

"I had to learn how to treat people with the little that I had"

This experience in Bona taught me a lot, both professionally and personally. The residents of Bona don’t have anything, but they never complain. It taught me to appreciate and realise the value of what I had, as a doctor and also personally. For example, I had to manage to treat people with the little I had, whereas it’s a lot easier to practise in a hospital when you’re surrounded by colleagues. I also learnt a lot about malaria.

At the moment there are two nurses in Bona. I don’t know if they’ve arranged for another doctor to be there. In general, Brazilian doctors don’t like working in difficult areas. As for me, I’m still in Macapá, and I will return to Cuba by mid-December.

 

Arnaldo Cedeño Núñez, next to a nurse and teachers who come once or twice a year to Bona.
 

According to the Pan American Health Organization, all of the Cuban doctors are supposed to leave, progressively, before December 12. Some of them have already returned to Cuba.

Cuban doctors make up about 80 percent of the workforce in the More Doctors programme, which means that when they leave, thousands of people living in remote or rural areas won’t have regular access to medical care, as many Brazilian doctors don’t want to go to those areas.

According to the Secretariat for Indigenous Health, part of Brazil’s Ministry of Health, indigenous communities are likely to be the first to be affected by the end of the partnership with Cuba.

This article was written by Chloé Lauvergnier (@clauvergnier).