Health

Doctor vacancies remain unfilled in indigenous areas after Cuban doctors leave Brazil

Remote and poor areas served by More Doctors program suffer major setback as government tries to fill vacant positions

In indigenous areas, only 29 Brazilian doctors had applied to fill positions left vacant by Cubans; 63 positions remained unoccupied / Mário Vilela / FUNAI

As thousands of Cuban doctors who were part of Brazil’s More Doctors program left the country following "deprecating" and "threatening" remarks made by president-elect Jair Bolsonaro, towns were left with no care and the government had to rush to call for doctors to fill their vacant positions.

In the North, where the Brazilian Amazon is located, the state of Amazonas has the lowest number of positions filled in the program, where 14 cities still had vacant positions as the application deadline approached, on Friday, Nov. 7.

In indigenous areas in Amazonas, only 29 Brazilian doctors had applied to fill positions left vacant by Cubans; 63 positions remained unoccupied last week. The government is calling to fill 230 positions in towns and 92 jobs in indigenous areas in the state – 322 total.

The Mais Médicos – or More Doctors – program was first established in 2013 by then president Dilma Rousseff to tackle the lack of health professionals in poor and remote areas of the country, entering into cooperation agreements with foreign countries, including Cuba, to take doctors to areas where Brazilian health professionals wouldn't go.

North

Brasil de Fato contacted the Ministry of Health to investigate which north states are still facing a critical shortage of doctors.

Not only Amazonas, but also Pará and Amapá are facing the issue. The Ministry of Health informed that, in Pará, seven cities are still waiting to fill their positions.

In Amapá, 26 of 49 doctors who applied as of last week will not be able to hold the position due to incompatible schedule.

On Wednesday, Dec. 5, the Ministry of Health announced that 200 doctors opted out of the More Doctors program, and the positions they were assigned to had to be reopen.

Indigenous health

Only one candidate had applied by last Thursday to work in a district located in the Vale do Javari indigenous territory, in Atalaia do Norte, western Amazonas – five doctor positions were still open.

Neon Solimões Paiva Pinheiro, an anthropologist working in the Vale do Javari, argues that the low number of applicants to work in the area is due to a number of reasons, including distance from urban areas, the wages (roughly US$3,000 a month in a country where the minimum wage is US$245), endemic diseases such as malaria, hepatitis, and tuberculosis, as well as Brazilian doctors’ lack of knowledge about the ethnic and cultural diversity of indigenous peoples.

Pinheiro says the Vale do Javari indigenous territory is the second largest indigenous area in the country, home of 54 communities and an estimated population of 6,000 indigenous people.

All the doctors who worked in the area were Cuban. After they left, only one doctor applied to one of the vacant positions, and Pinheiro fears they may eventually opt out.

“So there is also the risk of this person coming here, seeing this reality, and backing out, [because of] the hardships in the dry river, sometimes we sleep on the beach; sometimes they have to stay too much time in the village for lack of logistics conditions; or boats that cannot reach it [the village]. So there is a number of reasons, when we present the reality of our mission, for people to back out.”

Commitment

Despite the hardships, the anthropologist, who has been working in the area for a year, points out that “the Cuban doctors have always embraced the cause.” “They were always available, always motivated and so committed to us, and they really did a good job.”

Fransciso Loebens, a member of the Missionary Council for Indigenous Peoples (CIMI) in the state for 40 years, says that the low number of Brazilian applicants to work in basic indigenous health care reflects the fact that medical doctors are not ready to accept new challenges facing many of these areas.

“The expectation when someone graduates medical school is that they will serve the people, and that is often left on the back burner. We know how local governments struggle, sometimes offering a lot of money – even leading to financial problems to them – to get doctors to go to hinterlands, and they still won’t go,” Loebens says.

The director of the Federation of Indigenous Organizations of the Negro River (FOIRN), Marivelton Baré, said the state of Amazonas has a big number of indigenous peoples, who suffered the most after the Cuban doctors left the country.

Baré said the Michel Temer administration is responsible for the issue and criticized president-elect Jair Bolsonaro for his statements comparing indigenous people to zoo animals.

“You can’t compare [us] to animals at a zoo. We’re at our home, we’re in our territory. What we expect of him is that he really fulfill his duty towards indigenous peoples. And, as we see it, they don’t. They misrepresent us. They do this to make us vulnerable, to claim that all this is an obstacle to development, and that’s why it’s like that. But we’ll keep mobilizing and fighting for our right,” he said.

Before Cuba severed the agreement with Brazil, the Amazonas health department informed the state had 508 medical doctors working for the More Doctors program; 318 of which were Cuban and most of them worked in indigenous areas.

Edition: Pedro Ribeiro Nogueira