South
Africa's Latest Cuban Import: Doctors
Cubans help stem brain drain but face
complaints of preferential treatment.
By Chris Gaither
JOHANNESBURG, South Africa
For the last five years, more than 400 Cuban doctors have brought
medical care to South Africa's most impoverished rural areas, They answered
an international cry for help in plugging a brain drain that is depleting
the nation's public health ranks.
To supporters, the Cuban medical
presence here signifies the island nation's solidarity with South Africa's
black leadership, first expressed during the anti-apartheid struggle and
today continuing under majority rule.
But critics, including many
other foreign physicians here, say such solidarity is coming at an increasingly
high cost. They charge that Cubans enjoy unusual luxuries and rights not
available to others. Indeed, foreign physicians, many of whom were toiling
in outlying regions long before the Cubans arrived, are leaving in droves.
"We have no problems with
the Cubans being here, but (health officials) should not bring anybody
here at the expense of our existence," said Ahmed Sharif, a Bangladeshi
physician who chairs a labor association of 1,200 foreign doctors, excluding
Cubans.
Despite a constitution which
promises open government, South African health officials refused to provide
information on the Cuban partnership.
The Cuban embassy also turned
down repeated requests for comment. Doctors contacted by The Herald said
they were too afraid to speak without the embassy's permission.
Fueled by soaring crime rates
and fears of racial integration, South Africa has suffered from a severe
"white flight" since shortly before the black majority took power in 1994.
A recent independent study found that more than 230,000 South Africans
many of them middle-class professionals emigrated between
1989 and 1997. As many as 2,000 medical posts have stood vacant.
The doctors who do stay mostly
work where the money is treating wealthy whites and Asians in private
practice. Sixty percent of local doctors cater to only 20 percent of the
population, according to Mark Sanders, a professor of public health at
the University of Western Cape.
Into the void stepped the
Cubans, whose work Sanders called valiant and indispensable. In the KwaZulu-Natal
region, for example, a rural clinic that has been without a doctor since
1993 suddenly received four Cubans, who arrived with a preventative health
plan and an ultrasound machine.
"Many of them are doing a
quite good job in very difficult conditions," said Sanders, who trains
physicians in rural clinics. "Here you have doctors working in areas where
South African doctors aren't going. If they weren't there, you wouldn't
have anyone."
German has a similar partnership,
but has only posted a handful of doctors. Cuba has the manpower: Called
"symbols of the revolution" by Fidel Castro, many of these doctors are
trained specifically for export to developing countries.
But more than any feelings
of proletarian responsibility, Cuba's internationalist missions are prompted
by a need for cash both by the doctors and the government who sends
them. So argues Julie Feinsilver, author of "Healing The Masses: Cuban
Health Politics at Home and Abroad" (University of California Press, 1993).
The Cuban government takes
30 percent of its doctors' salaries, which range from the equivalent of
$20,000 to $60,000 less than their South African peers, but several
times their salaries in Cuba, where doctors are paid on par with school
teachers. And Feinsilver says international aid workers receive political
brownie points on their return to Cuba, in the form of better jobs, housing
and material goods.
"Today, hard currency is a
necessity in Cuba," she said. "Those who have access to it, no matter
how insignificant the quantity, live better."
Since the Cubans began work
in South Africa, the number of non-Cuban foreign doctors has plummeted
from 2,300 to 1,200, as South African health officials instituted harsh
new regulations. In 1995, the government placed an indefinite moratorium
on the registration of new foreign doctors and refuses to grant job security
through extended work permits.
"On 24-hours notice, we can
be told, 'We don't need you. You must go,'" said Pakistani physician Safdar
Malick, head of anesthesiology at a 300-bed hospital about 75 miles south
of Johannesburg.
In contrast, Cuban doctors
and their spouses receive free airfare, lavish welcome banquets, several
weeks of training, and free housing and transportation, according to government
documents. A memorandum obtained by The Herald outlines a long list of
goods with which regional health departments must equip each Cubans' apartment,
including a television with satellite dish, an entertainment center, a
pine dining room set and a 3-piece upholstered lounge set.
"We came here during apartheid
and catered to the needs of the more oppressed areas," said a doctor from
central Africa, who has practiced here for 11 years. "The Cubans came
here and were given the red-carpet treatment and champagne."
Though probably overstating
the reality of the Cuban program, this doctor's sentiment is common. Cubans
frequently complain that their work goes unappreciated. They live in remote
areas, use inadequate equipment and receive less money than their peers,
yet the medical community and local press have accused them of everything
from poor English skills to medical malpractice.
Doctors working in the outback
must be jacks-of-all-trades, ready to handle anything from a breech birth
to tuberculosis. While some Cubans are trained in primary care, Sanders
said, many others imported to South Africa are schooled almost exclusively
in specialized fields of medicine and ill-equipped for general treatment.
In the late 1990s, 21 malpractice
claims were filed against six Cuban doctors in the Northern Cape, the
country's largest province. One anesthesiologist was sent home after four
patients died when he failed to follow proper procedure. The other doctors
were cleared of the charges, and supporters blamed the malpractice allegations
on anti-Cuban politics.
The Cubans are an effective
stopgap remedy, Sanders said, but South Africans cannot rely on them forever.
Health officials have instituted a mandatory community service program
for recent medical school graduates, which places more South Africans
in rural clinics. But though the personnel shortage is reduced, the program
fails to solve the shortage of experience.
"When they get out to rural
areas without all the fancy equipment and fancy tests and chain doctors
above them, they have to have skills," Sanders said. "That kind of doctor,
unfortunately, is not being produced by our system."
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