Building an ambulance in the most remote corners of Brazil is much easier than getting a doctor to settle there to take care of patients. President Luiz Inácio Lula da Silva on Monday announced the reactivation of a program called Mais Médicos, launched almost a decade ago with the aim of bringing medical care to the country’s most underserved areas. Since a large proportion of the specialists initially recruited were Cubans hired through an agreement with Castroism, the program was protracted by controversy and polarization until the agreement with Cuba was broken after the far-right Jair Bolsonaro came to power. Lula has announced the call for 15,000 places this year, with a preference for Brazilians educated at home, without closing the door on welcoming foreigners.
Lula and his health minister, Nísia Teixeira, relaunched the program during a ceremony at the Planalto Palace in Brasilia. “Only those who live on the outskirts of big cities, in small towns inland, know what the lack of a doctor is, when someone starts with a mild headache and dies because nobody gave them an appointment,” said the president, who lives in one of those places was born in the interior of the state of Pernambuco. Lula has stressed that the most important thing is that the patient is treated, not the nationality of the treating specialist.
Mais Médicos is one of the emblematic programs of the Workers’ Party (PT) and, according to the leader of the Brazilian left, its results have been a success. But it languished during the Bolsonaro era. In the early years, much of the Cuban professionals hired were the only ones to take the positions that the local doctors didn’t want, that were least desirable. There are currently 5,000 vacancies in the poorest of Brazil or in those far from urban centers and in the most hostile outskirts.
Some municipalities offer very high salaries to attract public health clinic talent. If the Brazilian government finds candidates for the 15,000 posts, the contingent of doctors, sent to the most remote places and least appreciated by professionals, will increase to 28,000 in a country twice the size of the European Union and 210 million Residents spread over more than 5,000 municipalities.
The hiring of Cubans has always displeased the local medical class, in part because that contingent was exempt from renewal of their title. Bolsonaro put him at the center of the political debate on behalf of the Cubans. When it came to power, the far-right government demanded that doctors be paid directly and not through the Cuban authorities, as was previously the case. A Cuban professional explained years ago that the regime keeps 70% of the wages. Havana refused the request and his specialists returned home. Cuba then reported that the 20,000 doctors dispatched over the years had treated nearly 120,000 patients in 3,600 communities, often in isolation. This is how they saw a specialist for the first time in remote villages that could only be reached by days of boat trips or long journeys on notorious roads.
The incentives included in the government’s call for 15,000 jobs include four-year contracts, special long-term grants, student debt payments and even 20-day paternity leave, the latter a step up from what Brazilian law provides
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“Anytime we talk about a social advance, someone seems to say it’s an expense,” lamented the president at the ceremony, whose Treasury Department is finalizing the proposal to control public spending that he will present to Congress will intend to replace the criticized and repeatedly violated spending cap
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