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Fri Dec 14, 2018, 02:10 AM

Brazil's New President Isn't Even in Office Yet and He's Already Damaged Our Health Care

Brazil’s New President Isn’t Even in Office Yet and He’s Already Damaged Our Health Care
Our public health system is a jewel. Can it survive four years of recklessness?

By Vanessa Barbara
Ms. Barbara is an author and a contributing opinion writer based in Brazil.

Dec. 11, 2018

SÃO PAULO, Brazil — A few weeks ago, the Cuban government announced it would withdraw from the Brazilian medical program Mais Médicos, which sends doctors to remote, underserved areas in Brazil. It’s estimated that millions of citizens could be deprived of primary health care after the departure of roughly 8,600 Cuban doctors from the country. The decision was prompted by demeaning remarks made by Brazil’s right-wing president-elect, Jair Bolsonaro.

Mr. Bolsonaro has repeatedly questioned the qualifications of Cuban doctors: “We have no proof that they are really doctors and able to take on these functions,” he said recently. This is false: All foreign doctors working for the program need to present their degrees and their licenses to practice medicine abroad. However, they are exempt from taking a national exam to revalidate their degrees while serving in the program; Mr. Bolsonaro intends to remove this dispensation. He has also repeatedly questioned the ethics of Cuba’s doctors-abroad program, saying that the doctors should be able to bring their families to the country and that they should receive their full wages directly from the Brazilian government. (Because all Cuban doctors work for the state, the government keeps around 70 percent of their salaries, and families are only allowed to visit them.)

Mr. Bolsonaro’s objections are both idealistic and ideological: He may well want to see Cuban doctors get paid, although it’s difficult to believe that these humanitarian impulses don’t have something to do with his feelings toward Cuba’s Communist government. Perhaps, to some his requirements will even seem reasonable. But the problem is that the Cuban government, which understandably took Mr. Bolsonaro’s comments as “derogatory and threatening,” has already begun bringing health care workers home. As a result, Brazil’s indigenous population will reportedly lose 81 percent of its doctors. More than 1,500 municipalities could be deprived of all medical assistance. (As of late last month, the Health Ministry said it had filled many of the vacancies, though it was not clear that new doctors would be prepared to go into rural areas.)

Through his remarks, Mr. Bolsonaro, who has not yet taken office, has managed to damage a program that has been praised by two independent bodies and by the United Nations Office for South-South Cooperation for having “contributed to a lower infant mortality rate and a decrease in hospitalizations as a result of the availability of primary health care.” He has no plan to patch things up. Indeed, this may be the first official demonstration of Mr. Bolsonaro’s style of government: strong opinions, but no actual solutions. And when it comes to our health care system in particular, this style of governance is dangerous.


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