[Marxism] Cuban Doctors Revolt: ‘You Get Tired of Being a Slave’

Louis Proyect lnp3 at panix.com
Fri Sep 29 06:47:54 MDT 2017

(I take anything written about Cuba in the NY Times with a grain of salt 
but still find this disturbing. With the growing dynamic toward market 
solutions in Cuba, is it any surprise that some of its citizens would 
want to exploit their labor power as a free market commodity?)

NY Times, Sept. 29 2017
Cuban Doctors Revolt: ‘You Get Tired of Being a Slave’

RIO DE JANEIRO — In a rare act of collective defiance, scores of Cuban 
doctors working overseas to make money for their families and their 
country are suing to break ranks with the Cuban government, demanding to 
be released from what one judge called a “form of slave labor.”

Thousands of Cuban doctors work abroad under contracts with the Cuban 
authorities. Countries like Brazil pay the island’s Communist government 
millions of dollars every month to provide the medical services, 
effectively making the doctors Cuba’s most valuable export.

But the doctors get a small cut of that money, and a growing number of 
them in Brazil have begun to rebel. In the last year, at least 150 Cuban 
doctors have filed lawsuits in Brazilian courts to challenge the 
arrangement, demanding to be treated as independent contractors who earn 
full salaries, not agents of the Cuban state.

“When you leave Cuba for the first time, you discover many things that 
you had been blind to,” said Yaili Jiménez Gutierrez, one of the doctors 
who filed suit. “There comes a time when you get tired of being a slave.”

Cuban artists and athletes have defected during overseas trips for 
decades, most of them winding up in the United States. But the lawsuits 
in Brazil represent an unusual rebellion that takes aim at one of Cuba’s 
signature efforts. Sending doctors overseas is not only a way for Cuba 
to earn much-needed income, but it also helps promote the nation’s image 
as a medical powerhouse that routinely comes to the world’s aid.

The legal challenges are all the more important because the doctors have 
lost a common backup plan: going to the United States. The American 
government, which has long tried to undermine Cuba’s leaders, 
established a program in 2006 to welcome Cuban doctors, with the aim of 
exacerbating the island’s brain drain.

But in one of his final attempts to normalize relations with Cuba, 
President Barack Obama in January ended the program, which had allowed 
Cuban doctors stationed in other countries to get permanent residency 
visas for the United States.

“The end of the program was a huge blow to us,” said Maireilys Álvarez 
Rodríguez, another of the doctors who sued in Brazil. “That was our way 

The end of the visa program means that the future of these doctors now 
rests in the hands of the Brazilian courts. They have mostly ruled 
against the doctors, but some judges have sided with them, allowing the 
doctors to work on their own and get paid directly.

The doctors’ defiance puts them at risk of serious repercussions by the 
Cuban government, including being barred from the island and their 
families for years.

The seeds of the rebellion were planted a year ago in a conversation 
between a Cuban doctor and a clergyman in a remote village in 
northeastern Brazil.

Anis Deli Grana de Carvalho, a doctor from Cuba, was coming to the end 
of her three-year medical assignment. But having married a Brazilian 
man, she wanted to stay and keep working.

The pastor was outraged to learn that, under the terms of their 
employment, Cuban doctors earn only about a quarter of the amount the 
Brazilian government pays Cuba for their services.

He quickly put her in touch with a lawyer in Brasília, the Brazilian 
capital. In late September of last year, she sued in federal court to 
work as an independent contractor.

Within weeks, scores of other Cuban doctors followed Dr. Grana’s lead 
and filed suits in Brazilian courts. The Brazilian government, which 
struck the deal with Cuba in 2013 to provide doctors in underserved 
parts of the country, is appealing the cases that doctors have won and 
thinks it will prevail.

“There is no injustice,” said Brazil’s health minister, Ricardo Barros. 
“When they signed up they agreed to the terms.”

Dr. Álvarez said that the stipend offered by the Cuban government to 
work for a few years in Brazil seemed appealing to her and her husband, 
Arnulfo Castanet Batista, also a doctor, when they signed up in 2013.

It meant leaving behind their two children in the care of relatives, but 
each of them would earn 2,900 Brazilian reais a month — then worth about 
$1,400, and now worth $908 — an amount that seemed enormous compared 
with the roughly $30 a month Cuban doctors earned at home.

“It was a pretty acceptable offer compared to what we made in Cuba,” Dr. 
Álvarez said.

So they said goodbye to their children and boarded flights to Brazil, 
joining the first wave of Cuban doctors greeted at airports with welcome 
signs and Che Guevara T-shirts.

At the time, Brazil’s leftist government, led by President Dilma 
Rousseff, saw expanding access to health care as crucial to its goal of 
building a more equitable society. Flush with cash from a commodities 
boom, Brazil imported thousands of doctors from Cuba and a few other 
countries to provide primary care in remote, impoverished areas under a 
program called Mais Médicos, or More Doctors.

The World Health Organization, a United Nations agency, helped broker 
the deal. Under it, Brazil pays Cuba roughly $3,620 a month for each 
doctor, or nearly four times what Cuban doctors earn through the 
arrangement. Approximately 18,000 Cuban doctors have done stints in 
Brazil; roughly 8,600 remain in the country.

The United Nations has called the program a success story, noting that 
it has lowered Brazil’s infant mortality rate and extended care to 
indigenous communities.

“The More Doctors Project is replicable and would potentially be 
beneficial in any country that decides to adopt it,” the United Nations 
Development Program said in a report last year.

Doing so, some Cuban doctors contend, would perpetuate an injustice. 
Soon after arriving in Santa Rita, a poor village in the northeastern 
state of Maranhão, Dr. Álvarez and her husband began to feel uneasy 
about the terms of the contract they signed, particularly after 
befriending doctors from other countries.

“We began to see that the conditions for the other doctors were totally 
different,” she said. “They could be with their family, bring their 
kids. The salaries were much higher.”

Hundreds of miles away, in Minas Gerais State, Dr. Jiménez, 34, found 
the work rewarding, but also began to harbor feelings of resentment.

“You are trained in Cuba and our education is free, health care is free, 
but at what price?” she said. “You wind up paying for it your whole life.”

Months before their three-year tour was up last fall, some Cuban doctors 
who had married Brazilians were offered the chance to extend their stay. 
Others, including Dr. Álvarez and her husband, were told to prepare to 
head home.

Cuban doctors unhappy with their situations formed a group on WhatsApp. 
André de Santana Corrêa, a Brazilian lawyer, said his cellphone began 
buzzing constantly as Cuban doctors across the country started to text 
him seeking help.

After analyzing their contracts, Mr. de Santana concluded that the 
agreements were at odds with the equality protections in Brazil’s 

Late last year, judges issued temporary injunctions in some cases, 
granting Cuban doctors the right to remain as independent contractors, 
earning full wages. One federal judge in the capital denounced the Cuban 
contracts as a “form of slave labor” that could not be tolerated.

But the federal judge who handled Dr. Grana’s case ruled against her, 
finding that allowing Cuban doctors to walk away from their contracts 
posed “undue risks in the political and diplomatic spheres.”

Soon after the first injunctions were issued, Cuban supervisors in 
Brazil summoned doctors who had filed suits and fired them on the spot, 
several doctors said. Each was given the chance to get on a plane to 
Cuba within 24 hours — or face exile for eight years.

Cuban officials did not respond to requests for comment, but a post on 
the Medical Brigade Facebook page includes an oblique reference to the 

“Many of us seem to have forgotten, when we embarked on this mission, 
the contract we signed,” the post says. “That’s why you get weaknesses 
and errors that start eroding the worthy values our parents raised us with.”

When it became clear that a majority of the doctors were losing in 
court, the WhatsApp group became a place for doctors to strategize and 

“We keep one another strong,” said Dr. Jiménez, who says she has been 
unemployed since being fired in June and is now barred from re-entering 
Cuba for eight years.

Dr. Álvarez and her husband were among the lucky ones to keep their jobs 
and get what amounted to a huge pay raise. They also managed to bring 
their children to Brazil.

“It’s sad to leave your family and friends and your homeland,” she said. 
“But here we’re in a country where you’re free, where no one asks you 
where you’re going, or tells you what you have to do. In Cuba, your life 
is dictated by the government.”

Mr. Barros, the Brazilian health minister, said the Cuban doctors should 
not feel as if they were being poorly compensated, because their 
salaries were similar to what Brazilian doctors earned during their 

“None of them, to this day, has come to me to complain about their work 
conditions,” he said.

Mr. de Santana, the lawyer, says he hopes Brazil’s Supreme Federal Court 
will take up the case. But because Brazil’s top court is so backlogged, 
a definitive ruling may take years.

Lis Moriconi contributed reporting.

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