Cuba’s doctors are emigrating and quitting for lack of incentives.

CUBA’S DOCTOR DILEMMA

By Katarina Hall.*

Cuba boasts that it has one of the world’s best healthcare systems and that it provides some of the best doctors out there. But this hasn’t stopped the island’s doctors from leaving the country in droves and abandoning their careers for better livelihoods in other fields. What gives?

The main reason that Cuba’s doctors are emigrating and quitting is simple: a lack of incentives. They work very demanding jobs for low wages and are subject to a whole set of regulations created especially for them—they are not allowed to leave the country without special permits and they have to attend to anyone who seeks their help, on penalty of jail time.

After the Revolution of 1959, the Cuban Communist Party banned private enterprise and established centrally-determined prices and salaries for nearly everything on the island. They also took over the country’s healthcare system, making all doctors state employees.

Doctors’ salaries of about $40-50 a month are actually $10-20 dollars per month more than the average Cuban’s. But the long hours and stressful conditions make up for it. Anyway, with Cuba’s rising prices, $40-$50 a month isn’t enough for a comfortable life. That’s why most doctors have picked up a second job or left medicine altogether, usually for a job in the growing private sector or in the black market. Being a doctor is prestigious, but paying the bills is more important. In Havana you can meet countless taxi drivers, cooks, and street vendors who were once doctors.

Take for example Clara, the caretaker of my neighbor’s elderly mother. A cheery woman in her late 50s, Clara told me that she had been a dentist for many years but that the bad pay had led her to quit and take up her current job. Clara provides for her mother, who has been diagnosed with senile dementia. Her dentist’s salary couldn’t put food on the table for one, let alone for two. While taking care of another elderly person is not the best-paying job out there, it provides Clara with the money and the flexible schedule she needs to take care of her own mother.

For a doctor to take up another profession is normal, she told me. “There are a lot of doctors who have ended up baking and selling cakes. And they bake because there is nothing better to do. You can sell a cake for 10 or 15 pesos. So if you make two cakes per day, you make some money and you don’t have to deal with a nine-to-five job where you are pressured and where you can’t earn a living.”

The flexibility of Cuba’s growing private sector has allowed many to quit their jobs with the Cuban state and move to jobs that pay in Cuban Convertible Pesos (CUC)—the convertible currency that’s worth about one US dollar. Unfortunately, only a limited number of private sector jobs are permitted: driving a taxi, renting out a house, running a restaurant and hairdressing, for example.

One person who has benefitted from such a move is Rosy, one of my neighbors. Rosy was a doctor for 24 years, but now she rents her apartment to tourists. Rosy explained to me that she had quit mainly because her wages, which were paid in Cuban Pesos (CUP), were just too low. “You get paid six CUP for each shift you take. Six CUP. Do you know how much six CUP is? Twenty-five cents of an American dollar. That is just enough for your day’s lunch.” By renting her apartment, Rosy makes an average of $20-$30 a night.

Rosy finally decided to quit her job after being sent on a year-long medical mission in Angola. Cuba is known for sending doctors to developing countries to do social work, usually to other socialist-friendly countries such as Venezuela, Bolivia, Ecuador, and Nicaragua. “In just one year in Angola, I made more than I had in 24 years,” she said. What disappointed her most was that she didn’t even get paid all the money she earned: “In the whole year there, I made up to a quarter of a million dollars. I know that because I had to register every procedure I did because I got paid depending on what I did and how many times I did it. But I didn’t receive the amount of money corresponding to my work. I only received ten percent of every procedure. From that quarter of a million, I only got $450 a month.” Seeing how much she could make in a year and how much of her money the Communist Party of Cuba kept, she decided to quit.

Rosy also told me that Cuban doctors are expected to be Good Samaritans—or else. “If a neighbor tells you to please check their sick kid you can’t charge them anything. It has to be free. And if you don’t check them, then they are able to turn you in to the authorities and say that you denied them your attention and service.”

Manuel, the taxi driver I’ve mentioned in previous posts, told me that his daughter was a doctor. He was sad that someone as smart and dedicated as his daughter would never have a decent life. “With her doctor’s title and $40 she can’t feed herself. I have to give her food and clothing, because if not, she can’t live. And she’s a doctor! Doctors can’t live here. Where would they live? What can they buy with that amount of money? What are they going to eat? They can’t survive.”

 *Katarina Hall is a Research Associate for Victims of Communism Memorial Foundation. She is a graduate of Universidad Francisco Marroquin in Guatemala, where she studied economic history.

Source: Dissident

Liberation: Refers to another process of emancipation, which doctor, nurses and pharmacists must request to travel outside Cuba.

Liberation.

By. Yoani Sanchez.

This is not the chronicle of a woman who manages to escape from her abusive husband, nor the story of a teenager who runs away from authoritarian parents. The title refers to another process of emancipation – complicated and feudal – that doctors, nurses and pharmacists must request to travel outside the island. Under the significant name of “liberation,” there is a mandatory process that Public Health workers must complete to be allowed to leave, temporarily or permanently. Included in the record of the possible traveler is whether he owns his own home or car, because the State will confiscate those if he does not return within 11 months. The paperwork passes through numerous levels of authorization that can delay it a year or a decade. Many never receive a reply.

Mario saw patients in a specialized practice and began to be seen as a deserter when he announced a desire to reunite with his family across the sea. He was immediately punished by being assigned to a position of general practitioner in an emergency room far from his house. They reminded him every day that the degree hanging on the wall in his living room had been given to him by the Revolution, which he now was betraying. Forced to swallow it whole, he endured the four years of repeated jabs and investigation for his safe-conduct to leave the country, which the minister of his branch still had not signed. “We have many cases, we can’t cope,” the secretary repeated, and his exiled wife broke into tears on the telephone when he told her. His children, meanwhile, were growing up in some distant place without a father.

In the midst of his impotence, Mario came to reproach his mother for having encouraged him to study medicine. “Why didn’t you warn me!” he shouted one afternoon, when he could no longer bear the white coat that had become his shackles. When they finally allowed him to board the plane, a circle of baldness delineated the middle of his head and a nervous tick had taken control of his hands. To those who welcomed him in a distant airport, he was not the enterprising orthopedist from years ago, but someone who had decided to have nothing to do with hospitals. The agonizing process of “liberation” had taken away any desire to fix a knee or correct an ankle; he couldn’t stop thinking that it was that profession that had separated him from his family.

Source: Generacion Y