Posted on Sun, Mar. 05, 2006

GUATEMALA
Cuban doctors bring relief, but controversy mars work

Cuban doctors offer needed help to such poor countries as Guatemala, but
their presence is a source of controversy at home and in the Americas.
BY JILL REPLOGLE
Special to The Miami Herald

USPANTAN, Guatemala - At the hospital in this central Guatemala mountain
town, Cuban doctors outnumber their local colleagues two to one. And all
the five specialists are Cubans, including the surgeon and anesthesiologist.

Eight other Cuban doctors live and work in remote health posts in the
region, sometimes trudging up to six hours on foot to vaccinate children
and attend to emergencies.

''It's a beautiful, unique experience,'' said María Josefa Herrera, a
Cuban general practitioner who works in Uspantán. ``Often the patients
have never been treated by a medical professional.''

Herrera is one of the thousands of Cuban medical personnel sent abroad
by Cuban leader Fidel Castro in a campaign to alleviate health crises,
support his political allies and earn badly needed hard currency -- a
campaign that also has angered some Cubans on the communist-ruled island.

Recent media reports from Havana have noted that Cubans are increasingly
resenting the absence of physicians once provided free of charge by a
totally government-run system whose strength was in a massive network of
neighborhood doctors, and not in its hospitals or technology.

One recent U.N. mission to Cuba found a clinic in the eastern city of
Santiago where 60 of the 140 staff doctors were abroad, according to the
Interamerican Dialogue, a think tank in Washington. And it's not just a
problem for Cubans.

LAWSUIT, COMPLAINTS

In Venezuela, the doctors' association sued the President Hugo Chávez's
government for using doctors unlicensed to practice in that country. The
program continued despite a court ruling backing the association. And in
Honduras, the Professional Association of Honduran Doctors has
complained over the presence of Cuban healthcare workers there at a time
when 1,500 recent Honduran medical graduates are out of work.

Cuba touts its medical missions as a show of solidarity with the world's
needy that it can well afford, with one of the highest doctor-patient
ratios in the world -- one doctor for every 165 residents, according to
the World Health Organization.

But there are more palpable benefits for the island. Cuban medical
personnel sent abroad earn hard currency for their perennially
cash-strapped government, and the estimated 20,000-22,000 deployed in
Venezuela are being paid in part with cheap oil.

In Guatemala, the Cuban medical deployment also has its ups and downs.

For its part, the Guatemalan government has gained 285 physicians and
128 other medical personnel at very low costs, with government public
health officials saying the Cubans earn about $400 per month -- less
than half a typical Guatemalan public sector doctor's salary. Last
October, Cuba sent 600 extra medical personnel to Guatemala after
Hurricane Stan, but they have since returned home.

Yet that $400 is also about 16 times the average salary of a doctor in
Cuba, so the Cubans here have been using their comparatively huge
salaries to buy refrigerators, stereos and other items that they
couldn't afford in Cuba. They take the goods home when they finish their
work here.

SALARY DISTRIBUTION

Guatemalan officials say the full $400 goes to the Cubans here, who have
to pay for their own housing, food and local transportation. No part
goes to the Havana government, they said, although in many other
countries the host government pays the Cuban government, which then
passes part of the money to the medical personnel. It's not clear why
the Guatemalan arrangement is different.

And for that kind of money, the Cubans are willing to toil under harsh
conditions in remote areas where local doctors are not available or
don't want to work. Almost three-quarters of Guatemala's 12,000
registered doctors work in the capital and surrounding suburbs, and
about one-third of the country's municipalities don't have a single
resident doctor, according to the Guatemalan Association of Physicians
and Surgeons.

``It's difficult finding Guatemalan doctors to work in the most isolated
areas,`` said Alvar Pérez, director of Guatemala's rural health
extension program.

Some experts worry, however, that the public health system has become
too dependent on the Cuban medical personnel.

''The Cubans came to fill a medical need,'' said Juan Carlos Verdugo of
the National Health Platform, a nongovernment organization that focuses
on public health issues. ``But this can't be a permanent solution . . .
they could leave any day.''

To gradually replace the island's doctors, the Cuban government has been
offering free medical school to low-income students from Guatemala and
other countries. More than 12,000 students from 83 countries are
studying at the Latin American Medical School in Havana and Castro has
predicted that it will graduate 100,000 in the next 10 years.

The school's first graduation last August included 187 Guatemalans.

In exchange for free tuition, those students promised to work for the
Guatemalan public health service for up to 6 ½ years after graduation.
The government also requires foreign-educated doctors to work for one
year for free in rural health posts and hospitals.

But many of the new graduates have said they're not willing to work for
a Cuban's salary.

''No one's going to work in the mountains for a salary of $400,'' said
Carlos Flores, one of the new doctors.

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