Cuba's Lucrative Medical Aid Programme

Cuba’s medical aid programme is a useful diplomatic and public relations tool for the government, and also brings in much-needed foreign currency. But some of the medics sent abroad are unhappy about having to hand over much of their wages to the Cuban government.

Those who join the “medical brigades” abroad enjoy higher wages, a more comfortable lifestyle and access to superior goods. At the same time, they have to surrender at least 50 per cent of their income to their government, depending on the rules that apply to the posting they are given.

In an investigation into the way the medical brigades operate, IWPR spoke to Cuban health professionals working in Trinidad and Tobago, who said that although they were paid directly by the host government, they had to deposit half their wages in an account in the name of the head of the medical brigade.

Although this payment was not stipulated in their contracts, brigade members said they were afraid they would be sent home or have their contracts suspended if they did not comply.

“They say that it’s for the oncology hospitals. It’s economic assistance,” said one doctor who requested anonymity for fear of getting into trouble. “If you don’t deposit 50 per cent of your salary, they send you back to Cuba.”

For many, this system is just part and parcel of working in the medical aid programme of a communist regime.

One Cuban nurse said he did not care what happened to the rest of the money.

“It doesn’t matter to me. I’m here on contract,” he continued. “For example, if my contract is for four pesos and they have to give me 40 pesos [in Trinidad and Tobago], the rest doesn’t matter, those 36 pesos. I focus on my four pesos. I want those four.”

According to Cuban health minister Roberto Morales, the country has 50,000 doctors working in more than 66 countries.

In 2014, the official newspaper Granma reported that the government would receive an estimated 8.2 billion US dollars from its medical workers abroad, making this the primary source of foreign-currency receipts.

PAYMENTS EITHER DEDUCTED OR “VOLUNTARY”

A Cuban medical professional who has worked in a number of countries spoke to IWPR on condition of anonymity about how the system operated in Venezuala.

She explained that before she signed up for the scheme, she was told her pay would go directly into a bank account, from which 70 per cent of would be deducted by the government. Her family would be able to draw on some of the remaining 30 per cent, and the rest would be held back until she returned to Cuba.

However, she ended up getting about 20 per cent of her wages rather than the 30 per cent she was promised.

She said her total salary came to 1,500 dollars a month. An individual she knew only as “the economist”, who ran the administrative side of the medical brigade, gave her 130 dollars a month as living costs.

The remaining 1,370 dollars were deposited in an account in “convertible pesos”. Known as CUC, this is an official Cuban currency operating in parallel with the normal peso and pegged to the US dollar at one to one.

Only 150 CUC of this monthly amount reached her own account in Cuba. Her family had access to 50 CUC a month and she was told she would receive the remaining 100 CUC upon her return home.

That meant she earned 280 dollars a month and the government 1,220 dollars from her work.

She said she had no choice in the matter, and in any case the money was still much more than she would have earned in Cuba.

Practices vary from country to country. In some cases, the Cuban government makes arrangements directly with the host nation. In Brazil, for instance, the authorities pay the Cuban government a lump sum, and it then decides how much the doctors receive.

This was highlighted in February 2014 with the defection of Dr Ramona Matos Rodríguez, who left the More Doctors for Brazil programme and asked for political asylum at the US embassy in Brasilia.

She claimed that she had been misled about the salary she would receive. She said she should have received half the 4,000 dollars a month the Brazilian government pays for each doctor, but instead she got only a quarter – 400 dollars in Brazil and another 600 dollars a month held in an account for when she returned home.

This system of bilateral deals also applies in other countries. An investigation by a Portuguese magazine Jornal i  uncovered contracts worth 12 million euro which Lisbon signed with Havana for medical services over six years. The magazine revealed that 80 per cent of health professionals’ salaries went directly to the Cuban government.

“IT’S ALL THEIRS”

In Trinidad and Tobago, more than 200 Cuban medical professionals have been hired under the Compensated Technical Assistance programme, a bilateral agreement in place since 2003.

Under this scheme, the Trinidad and Tobago government pays salaries directly to Cuban doctors, just as it does for local employees.

Rody Cervantes Silva, coordinator of the Juan Almedia Bosque Medical Brigade, the Cuban team in Trinidad and Tobago, said that 52 doctors, 137 nurses, 17 pharmacists and one entomologist were working there, and the total number was soon expected to rise to over 300.

Cervantes Silva acknowledged that Cuban doctors working abroad often gave part of their wages to the government.

“Cuba is a poor country in the third world, and of course it needs our help,” he said. “Whoever leaves Cuba has a signed contract and agrees to certain things. The money sent from other countries goes to the ministry of health and social programmes such as the fight against childhood cancer and leukaemia.”

He insisted, however, that the health professionals in his team did not pay anything to the government.

“It’s all theirs,” he said in a telephone interview with IWPR.

This claim was contradicted by other members of the medical brigade.

One doctor at a hospital in Port of Spain told IWPR that when she was recruited for the two-year programme, she was told she had to give 50 per cent of her monthly salary to the Cuban government.

She said that Cuban staff members went to the bank every month to transfer half of their salaries to an account in Cervantes Silva’s name.

“There was no written rule,” she explained. “It was just stated that you have to pay this and if you don’t, they will pressure you, or send you back to Cuba.”

She said that Cervantes Silva controlled the money and issued a monthly report on payments. Any doctor who did not make the contribution on time was pressured to pay.

She acknowledged that net wages, working conditions and hours in Trinidad and Tobago were better than in Cuba.

“I don’t mind giving 50 per cent because it’s still better than the 67 CUC they pay me in Cuba. This [life in Trinidad and Tobago] is very expensive, but you can get everything.”

Following a recent raise, doctors in Cuba currently earn between 67 and 80 dollars per month. The average monthly wage is around 23 dollars.

The doctor said while some specialists were on 25,000 to 30,000 Trinidad and Tobago dollars (TTD), a month, most brigade members were paid around 9,000 TTD, worth about 1,370 dollars. Of this total, 2,500 TTD went on accommodation and the remaining 6,500 TTD was divided in half between the recipient and the Cuban government.

“They say it is to pay for the oncology centre, the health system,” she said.

Trinidad and Tobago health minister Fuad Khan told IWPR that his department hired foreign staff through an intermediary and that they were paid similar wages to locals.

David Constant, director of international cooperation at the health ministry, added, “We don’t know what agreement the Cuban health professionals have with the Cuban government.”

Austin Trinidade, head of public relations at the Trinidad and Tobago Medical Association (TTMA), said he was surprised to learn that the Cubans were obliged to hand some of their wages over to their government.

“I don’t know the details of their contracts or the arrangement that they have with the Cuban government. We heard about how they have to send all of their money back to Cuba; I don’t know exactly,” Trinidade said.

He added that the TTMA would be willing to help the Cubans receive their full payment, but that it could not intervene unless they asked for help.

“If a group of Cubans send us something that says that they are working in the same conditions as the locals and they are receiving the same salary, but they do not have access to their payments… then we could probably do something,” Trinidade said. “I don’t know if the Cuban government would listen to us… We can’t act on our own account.”

IWPR contacted the Cuban embassy in Trinidad and Tobago but was told that no one was available for interview as all staff were on holiday.

There are other advantages to working in Trinidad and Tobago. Cubans are allowed to visit without a visa and remain in the country if they have an invitation to work. Some staff on medical missions manage to obtain new contracts independent of the Cuban government, and can then remain in country or return to take up their new posts.

Although the government tries to prevent this happening, Cervantes Silva confirmed that the practice existed and around 80 Cuban nationals were currently working on private contracts in Trinidad and Tobago’s health sector.

INTIMIDATION AND SURVEILLANCE

Cubans deployed abroad are subject to tight controls intended to deter them from defecting. Before leaving Cuba, they attend lectures warning them of the supposed multiple dangers of life in their destination country.

The doctor whom IWPR interviewed about her experiences in Venezuela said that when she arrived there, her passport was taken away to stop her defecting or requesting asylum at a United States embassy.

In Trinidad and Tobago, a Cuban doctor said everyone’s behaviour was monitored. They were told it was inappropriate for them to go out after work as the Cuban authorities could not be responsible for their safety after seven pm.

Anyone who broke the rules received a bad report and was threatened with being sent back to Cuba or never again being selected for a medical brigade.

Team members are also instructed to keep watch over one another. If individuals defected or broke a rule, the person assigned to monitor them was also sanctioned.

There are written regulations to the effect that team members must “inform their superiors of any violations of disciplinary standards they are aware of, as well as inappropriate conduct that is detrimental to the prestige of the mission”. It is also considered a disciplinary infraction to “maintain friendships or relationships of other kinds with Cuban citizens… or foreigners who hold hostile views, or are against the Cuban Revolution”.

The regulations make it difficult to interview Cuban health professionals working abroad. The rules say it is an infraction to “articulate opinions or views to the press, radio or television that compromise the Cuban collaboration [with host nations], or that concern internal situations in the work centres where they provide their services or in the country where they are based, without prior instructions and authorisation on these matters”.

One Cuban doctor in Trinidad and Tobago said that she could not comment because she was “not authorised to talk to the press”.

Another agreed to be interviewed, only to change his mind shortly before the meeting. He said IWPR should contact Cervantes Silva. Asked why he did not want to be interviewed, he answered, “I can’t. I don’t want them to send me back to Cuba,” and hung up immediately.

The same story happened with various doctors and nurses in the Trinidad and Tobago cities of Port of Spain and San Fernando. Many referred all enquiries to Cervantes Silva.

Asked about this reluctance to be interviewed, Cervantes Silva replied, “It’s always good to see what the purpose of the interview is.”

He denied that he was the only person authorised to speak.

“There’s no problem. They tell me, and there’s no problem,” he said.

Julio C.A., Pablo P. and José Luis P. are Cuban journalists. Reshma Ragoonath is a journalist in Trinidad. Cuban journalists Luzbely E., Ernesto P., Osniel C. and Augusto César S.M. also contributed material to this report.