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Episode 76

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Mais Médicos

Every year, Cuba sends doctors across the world on humanitarian missions. They help with earthquakes, hurricanes, epidemics… and also assist poor and vulnerable communities. Alioski Ramírez was a young doctor who dreamt of going on one of those missions. His dream came true, but it would only be the beginning of another journey.

You can read a Spanish transcript of the episode.

You can also read an English translation, or a Portuguese one.

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Transcript

Translated by Patrick Moseley

[Daniel Alarcón, host]: Welcome to Radio Ambulante, From NPR. I’m Daniel Alarcón.

Today, we’re starting with this man, Alioski Ramírez…

[Alioski Ramírez]: Cuba is recognized in the world as a leader in… in health.

[Daniel]: And what Alioski just said, it’s a fact. Along with education, health services in Cuba are celebrated as one of the achievements of the socialist government. It’s a free and universal service, financed 100% by the State. This in spite of the fact that it’s a poor country and in spite of the US embargo against Cuba that has gone on for almost 60 years.

This context is important to tell today’s story. There are facts here, accomplishments that stand out. For example, Cuba has infant mortality rates that are comparable to developed countries. It has been recognized as the first country in the world to eliminate the transmission of aids from mother to child.

Of course, not everything is perfect, and yes, the health system on the island has its shadows and has been deteriorating in the later years. But, for Alioski, a family physician…

[Alioski]: That’s what doctors in Cuba are like: we come from, from a place of love, a desire to help people, from a sense that it’s one of the most noble professions in humanity.

[Daniel]: While he was studying, as he had been since he was a young man, he divided his time between medicine and political militancy.

[Alioski]: I didn’t consider myself communist, but I did consider myself very socialist. I did consider the power of the people, the right of the people to have the best.

[Daniel]: Not long after he started practicing his profession, the island started to feel small for him. He dreamt of leaving. It’s a pretty common dream.

[Alioski]: Cubans dream of a plane landing, taking them onboard and taking them away to another country. A Cuban who wants to leave Cuba would even go to the North Pole.

It’s doesn’t matter if you send them there without, without a coat. They’ll go without coat just to leave.

[Daniel]: Sometimes, those dreams come true. And a lot of time, when they do, another odyssey begins.

Alioski managed to get out of Cuba. But it all ended up being more complicated than he expected. His story illustrates a lesser known side of Cuban medicine.

Carola Solé tells the story…

[Carola Solé, producer]: Alioski began working in medicine in 2008. He worked at an outpatient clinic in Holguin, the province where he was born on the eastern part of the island. And little by little, he was taking note of the working conditions.

[Alioski]: Sometimes, the government doesn’t… doesn’t provide the minimum working conditions. However, it’s as demanding as if it provided 200% of the conditions that, that you need to work.

[Carola]: Sometimes they didn’t have certain medications, sometimes they didn’t have sheets, and sometimes they didn’t even have paper and pencils to write people’s medical records. The doctors had to get their own basic office supplies, or cleaning products, however they could.

[Alioski]: How is it done? Eh, committing what they call corruption offenses and illegalities. Someone, a friend, has to steal it from a center that does have it, to give it to the doctors, so the doctor isn’t complicit and doesn’t get punished. So, it’s a… a root problem, a root problem that has its origin in the government itself and that is resolved by robbing the government.

[Carola]: The system works like bartering. An exchange of favors. You give me what I need from your office and I give you what you need from where I work. Or maybe I offer you preferential treatment, for example, a consultation in exchange for some need you can help me fill. It’s what’s commonly referred to as “fixing”. And the government tends to turn a blind eye to it, as long as it isn’t anything very scandalous.

[Alioski]: And so that’s how we Cubans live, that… A lot of people say that Cubans live off of their wits. In Cuba you live off of your wits, the wit of stealing from the State.

[Carola]: Alioski remembers having done a juggling act to get all sorts of materials, especially paper for medical records.  He didn’t want to risk being penalized. Because…

[Alioski]: The worst punishment they have there, when you’re talking to a doctor is: “We’re taking away your right to go on mission.”

[Carola]: Go on mission: the right to leave and work in other countries with international cooperation programs, the government’s medical brigades.

The first time a Cuban medical brigade went on mission was in 1963. To Algeria.

(SPEECH SOUNDBITE)

[Fidel Castro]: One day I said that we could not and would never send them; we would never carry out preventative or suppressive attacks against any dark corner of the world…

[Carola]: Fidel Castro, fascinated by the independence the Algerian rebels achieved after a difficult war, wanted to help the African country by sending more than 50 medical professionals. And since then, nearly half a million doctors and medical technicians from the island have traveled all over the world. From Africa to Asia.

This is Fidel Castro in 2003.

(SPEECH SOUNDBITE)

[Fidel Castro]: But, rather, our country will be able to send the doctors they need to the darkest corners of the world (Applause, cheers).

[Carola]: Cuban doctors go on mission to help in emergency situations. Earthquakes, hurricanes and epidemics. But they also go to give basic medical services to poor isolated communities.

They basically go to work where no one else wants to.

Currently, there are about 50.000 professionals in more than 60 countries in the world. Sometimes Cuba takes on all of the costs, and in other instances, it shares the costs with the host country, but in a lot of cases it receives a good compensation for the services provided.

And a lot of people don’t realize how profitable this is for the Cuban State. The money Cuba receives for its exported medical services is one of the country’s main sources of foreign currency. The figures aren’t very clear, but a lot of people estimate that it’s ahead of even remittances and tourism. It was more than 11 billion dollars a year, between 2011 and 2015, according to the most recent public data from the government itself.

Going on mission really got Alioski’s attention.

[Alioski]: Yes, it’s the aspiration of seeing other places, because living on an island isolated from the rest of the world and separated by a sea as great as the Caribbean makes everyone dream. Cubans are very adventurous.

[Carola]: Although it wasn’t just leaving Cuba, but also because of what it implied in terms of salary…

[Alioski]: Twenty dollars was the base salary for a doctor in Cuba for a long time.

[Carola]: Today it’s around 60 dollars, though they get it in Cuban pesos. That’s double the median salary on the island. Being a doctor is prestigious, but it doesn’t necessarily pay the bills.

[Alioski]: Really in Cuba doctors work for love.

[Carola]: That love wasn’t in question for Alioski. But he had a family to support; a wife and then a daughter: bigger and bigger responsibilities.

[Alioski]: My daughter, the oldest, was born when I started practicing medicine. Then, with that salary it was impossible to support the girl and the marriage and the household…

[Carola]: In fact, his mother and stepfather were essential in keeping his family afloat. And leaving the country meant being able to earn a much larger salary. And in a foreign currency, in other words, in the equivalent in Cuban money or directly in the foreign currency. Something Alioski was starting to dream about. That’s why he gave it his all. Because for him, thinking about not going on mission was terrible…

[Alioski]: When you tell a young doctor you’re going to take away his right to go on mission, you’re telling them that… you’re going to punish them to a life permanently stuck on an… on an island where they won’t have any way to even buy a pair of shoes for their family. So, the…that’s the worst punishment you could give a person.

[Carola]: But after putting in a lot of effort, Alioski did it. When the government notified him in 2011 that he was going to go on mission, he wanted to jump for joy. He felt like it would be a way to solve some of his family’s financial troubles.

[Alioski]: That’s one of the most important moments in a Cuban doctor’s life. You want to burst with happiness, with excitement, that you’re going to leave, that you’re going to have opportunities…

[Carola]: But Alioski couldn’t let his joy show or celebrate his luck…

[Alioski]: I can’t show it because that would… it could be interpreted as a… as me wanting to emigrate from the country, like a more…a more materialistic than humanist desire.

[Carola]: Alioski still remembers the day he got on the plane. It was November 2011.

[Alioski]: That was a very tense day, because the Cuban character is so pessimistic that in moments like those you think you’re going to get off a plane and be let off back in… in the country again.

Until the plane was no longer in the air, far away from Cuba, we were… There was that tension. I could only shake it when the plane landed in… in Venezuela.

(SPEECH SOUNDBITE)

[Hugo Chávez]: It is an example for the entire world. There has never been anything like Barrio Adentro in the history of Nations.

[Carola]: Alioski was going to Mission Barrio Adentro, a program that Hugo Chávez created in 2003 with the help of the Cuban government, which consisted of placing small clinics in inaccessible regions that were far from hospitals. Practically all of the doctors that worked there were Cuban.

(SPEECH SOUNDBITE)

[Hugo Chávez]: And from here, many thanks to Fidel Castro, there in Cuba, that revolutionary Cuba, for his dedication, for his personal tenacity so that this mission could be established so successfully.

[Carola]: And Alioski was happy. He was excited to be able to experience Venezuela and help Venezuelans, especially because at that time…

[Alioski]: I was a follower of… of Chávez. I always followed Chávez in his… his speeches, in the way he acted…

[Carola]: Chávez was Havana’s main ally. And he paid for the Cuban doctors with oil. In other words, the doctors received their salary from the Cuban government and the government in Havana received an estimated 100,000 barrels of oil a day. The mission in Venezuela was a real lifesaver for Cuba after the crisis in the 90s. And it was good business for Venezuela too, because it showed that Chávez was concerned about the poorest people.

From the moment he arrived in the airport in Caracas, Alioski was surprised at the reception he and his Cuban colleagues were given…

[Alioski]: There in Venezuela they have, hmm, that logistics division. It starts inside the airport. Cubans arrive in a terminal that’s just for Cubans. That means no one is waiting for you. Only… only the representatives of Mission Barrio Adentro themselves are waiting for you, to welcome you and tell you what state you’ll be stationed in, and get you on a… a bus and send you to that state.

[Carola]: They sent him to a small municipality called Tinaquillo, about 300 kilometers from Caracas. He was lucky he didn’t end up in one of the dangerous neighborhoods where some of his collages had to go. And in Tinaquillo, he started his new life, far from his wife and daughter, who was two years old at the time.

[Alioski]: Most of the missions in… in Cuba just have one official. I left my family in Cuba and in Venezuela and lived in a family medicine clinic.

[Carola]: Here I have to say that the lives of Cuban doctors in Venezuela are, generally, a mystery. I worked as a correspondent in Caracas from 2010 to 2013 and it was almost impossible to learn about them. They are forbidden from speaking to the press.

Alioski tells me now that his days basically took place within the four walls of his clinic, where he worked and slept.

The “doctor’s house”, which is what they call the residential area, was shared with other Cubans. And not just doctors. There were also athletes with Mission Barrio Adentro Sports living there, who were in charge of encouraging the growth of sports in poor regions of Venezuela.

Initially, Alioski shared the house with a chess player…

[Alioski]: But then I lived in one with four people, which was me and… two other doctors and a physiatrist.

And it was very crowded, very crowded. Sometimes eight people lived in a house that was meant for two people.

[Carola]: His salary, about 200 dollars, was deposited in a Cuban bank account every month. And he was only able to touch it at the end of the mission, after two or three years. In the meantime, in Venezuela, he received a small “stipend”, in bolivars, for day to day expenses, like buying food at state-run supermarkets. That stipend was about 1,800 bolivars which, in 2011, was equal to about 200 dollars on the black market.

But we all know about the hyperinflation that exists in Venezuela, right? Well, by the end of 2013, that 200 dollar stipend was worth less than 30 dollars.

[Alioski]: So, it was a difficult, complex situation for Cuban doctors and professionals, or anyone who found themselves working in Venezuela.

[Carola]: On top of that, the discipline at the mission was absolute. And the threats of punishment were constant. If they didn’t want to have part of their salary suspended or even be sent back to Cuba, the doctors in Cuba couldn’t, for example, leave the house after 6 pm.  It was never clear to Alioski if it was for safety reasons or to control his life. They were also not allowed, for example to have, quote, “inordinate” relationships.

[Alioski]: Inordinate relationships are the kind of relationship you have with a person who is not Cuban and goes beyond what the government considers normal.

[Carola]: That also includes couples.

[Alioski]: The first one to know if you were going to have a girlfriend was the government, even before the girlfriend herself. It’s a thing people say and… and they don’t believe it.

[Carola]: In fact, the punishments weren’t just for people who didn’t follow the rules. The doctors that didn’t report the infractions to their superiors were punished too.

[Alioski]: You realize then that what you dreamed was going to be an adventure, is turning into a prison. And it’s much worse than being in Cuba.

[Carola]: Officials from the Cuban government are the ones who supervise Mission Barrio Adentro on site with the backing of the Venezuelan government. The government in Havana uses safety to justify these kinds of rules, because the doctors are often in dangerous regions where criminals may kill someone just to steal their phone. In fact, on more than one occasion, Cuban doctors have been the victims of the unsafe conditions in Venezuela, one of the most violent countries in Latin America.

[Alioski]: A lot of doctors, a lot of athletes were killed in Venezuela. So, the situation in terms of security… a lot of CDIs were, eh, attacked by vandals according to information from the government.

[Carola]: The CDIs are the Centros de Diagnóstico Integral [Comprehensive Diagnostic Centers], the clinics were the Cubans were working.

[Alioski]: They set whole CDIs on fire. So, it means that the risks there… are high.

[Carola]: On top of that, the presence of Cubans in Venezuela is controversial. They’re loved by Chavism and hated by the opposition.

And of course, included in “inordinate” relationships, it was…

[Alioski]: Totally forbidden to have a relationship with someone who opposed the government.

[Carola]: Because of the polarization, some Venezuelans see the Cuban doctors as evidence of solidarity from a brother nation they admire, while others see them as spies infiltrating even the highest spheres of power.

What’s true is that no one loses sight of the fact that the Cuban mission isn’t only medical. Alioski was in Venezuela for four elections. Two of them were key: the presidential election in October 2012, in which Chávez, who was sick with cancer, won. And after his death, the presidential elections in April 2013, which his successor, Nicolás Maduro, ended up winning. And Cuban doctors, Alioski says, had to do a rather uncomfortable job during those elections.

[Alioski]: What made the job difficult was the political work that went along with it.

[Carola]: In each election, the doctors went out to do community work. And they had to pass some messages to the population.

[Alioski]: I didn’t have to tell them: “Vote for Chávez. Vote for Maduro.” But you did have to tell them: “We’re here thanks to them. And if not for them, we’ll be pulled out of here tomorrow and you’re going to be left without doctors, without athletes.” So, Venezuelans also became very dependent on the Cuban doctors and athletes in their communities. So, thanks to that they also got a lot of votes and to this day are getting lots of votes.

[Carola]: And there was another aspect that bothered him: the Cuban government’s “generosity” toward Venezuela.

[Alioski]: The first, the first shock I… I had in Venezuela was seeing that the medication that I was able to give out in… in… my clinic included Cuban medications that Cuba “made available” in Venezuela, to give out to Venezuelans, when we didn’t have those same medications in Cuba, or patients in Cuba didn’t have access to them, they had to buy them in Venezuela.

[Carola]: Similar reports have been made by other doctors. I contacted the Cuban government through CPI —the Center for International Press, by its Spanish initials—, but they refused to give me an interview or answer the questions I sent via mail.

Despite everything, Alioski remembers those years in Venezuela fondly.

[Alioski]: It was magnificent from a professional and human standpoint…

[Carola]: And it was also important from a personal standpoint.

[Alioski]: Because that was when I discovered that not everything they had taught me was… was true: that socialism is a utopia, just like communism, and that we were being sel… selfishly taken advantage of in the interest of those governments and it wasn’t really in the interest of the people.

Today, the political discourse, the political discourse coming from… from the government is that Cuba has the most supportive, most humane doctors in the world. Maybe. But is the government the most supportive and humane government in the world? No. It goes where there’s money for the taking.

[Daniel]: All the same, Alioski was taking on more responsibilities, like the state-level coordination within the program. Did he have any other option?

After the break, Alioski leaves Venezuela and starts a new adventure. We’ll be right back…

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[Daniel]: We’re back with Radio Ambulante. I’m Daniel Alarcón.

Alioski had achieved his dream of going on a medical mission outside of Cuba, but he was surprised by how difficult it was. Now he had a new opportunity.

[Alioski]: Then, it appeared they were going to take the doctors who were most experientes, the doctors with… with the melhor professional training to Brazil.

[Daniel]: Brazil, the golden dream for many Cubans.

Carola Solé continues the story.

[Carola]: For a lot of Cubans, Brazil is… Let’s just say it’s special. Alioski explains it like this.

[Alioski]: It’s a dream because Brazil… Brazil is in the genes of the Cuban, inside Cubans’ genes is Brazil, because we grow up tuning in to, watching Brazilian novelas and dreaming of going to Rio, and Christ the Redeemer, which is in all of the Brazilian novelas.

[Carola]: Brazil started accepting Cuban doctors in 2013…

(NEWS SOUNDBITE)

[Presenter]: A group of nearly 200 Cuban doctors arrived in Brazil at noon on Sunday. They are part of the first delegation of health professionals that make up the government program Más Médicos

[Carola]: The program was like the Venezuelan mission, but Brazil was paying in cash. It was called “Mais Médicos” This is the then-president Dilma Rousseff.

(SOUNDBITE FROM DILMA ROUSSEFF)

[Dilma Rousseff]: Mais Médicos nos postos de saúde, mais médicos na atenção básica, vai significar sempre menos doença. E é essa a equação política fundamental. Mais médicos, menos doença.

(More doctors in health stations, more doctors in basic care, will always mean less sickness. That is the fundamental political equation. More doctors, less sickness).

[Carola]: More doctors: that’s what the country needed in poor and isolated areas. The program was presented as a medical residency for Brazilians and foreigners. But at first, the majority of the around 18.000 participants were experienced Cuban doctors who had been trained for years but didn’t have a revalidated license in Brazil.

Groups of doctors in the country saw them as a threat. They believed that the Cubans didn’t have the level of qualification that Brazil needed and that they were destabilizing the profession.

This is how some Brazilian doctors greeted the first Cubans:

(PROTEST SOUNDBITE)

[Brazilian doctors]: Escravos, escravos. Escravos, escravos. Escravos, escravos. Escravos, escravos.

(Slaves, slaves. Slaves, slaves. Slaves, slaves. Slaves, slaves).

[Carola]: Perhaps you can’t hear it that well, but after the booing they shout “Slaves! Slaves!” Because the Brazilian doctors thought that the Cubans who were coming to Brazil were being exploited, in disgraceful conditions.

Sections of the Brazilian right didn’t have a good opinion of the participation of Cubans in Mais Médicos. They felt that the Worker’s Party of Luis Inácio Lula de Silva and Dilma Roussef was complicit with the Cuban regime. They were especially critical of the fact that the Cuban government got almost all of the money that Brazil was paying for the doctors. The way they saw it, Brazil was financing the Castro regime, while the Cuban doctors were left in squalor, and even bringing communism into the country.

The president-elect of Brazil, the far-right Jair Bolsonaro has been one of the biggest critics of the program. In August of 2016, not long after Dilma Rousseff’s removal was formalized, he spoke about the topic in parliament. Bolsonaro, who was a representative at the time, was furious. He couldn’t believe that Michel Temer’s new government was upholding the Cuban program, just as the left had negotiated it.

(SOUNDBITE OF BRAZILIAN DOCTORS)

[Jair Bolsonaro]: Um trilhão e 300 milhões de reais para a ditadura cubana. A cada acordo desse firmado e prorrogado são quatro bilhões de reais…

(One point three billion reals for the Cuban dictatorship. In each agreement signed and extended, that’s 4 billion reals…).

[Carola]: 1.3 billion reals, nearly 400 million dollars are going to the Cuban dictatorship, Bolsonaro says. In fact, in 2017, it was 1.8 billion reals. More than 550 million dollars at the average exchange rate that year. And Bolsonaro warns the new government that it’s introducing a “rattlesnake” into its house because, according to him, there will be Cuban soldiers and agents that infiltrate the program who will be able to catch the country off guard with destabilizing acts.

[Jair Bolsonaro]: Está aí o novo governo Temer, que chegou para deixar tudo como está. Vocês estão botando dentro da cozinha de vocês uma cascavel com este programa.

(That’s the new Temer administration, which came to leave everything as it was. You are letting a rattlesnake into the kitchen with this program, ).

[Carola]: That’s how a good portion of the right sees the Cubans in the country…

[Alioski]: They think that we’re… A lot of them think we’re secret agents, that we’re infiltrators, that we’re being used, and this program is a farce.

[Carola]: But Alioski arrived in Brazil a year after the program started, in March of 2014. And people’s attitudes had calmed down a little by then.

[Alioski]: At least our group was received with a lot of love.

[Carola]: Alioski wasn’t lucky enough to be sent to Rio de Janeiro. But he wasn’t sent to the remote communities in the Amazon rainforest or the dangerous towns in the Northeast either. Again, he was sent to a small, peaceful municipality. To Valparaíso de Goiás, a commuter town on the outskirts of Brasilia. That was where I went to meet him, and where he has been talking to me up to now.

[Alioski]: Considering how dangerous Brazil is, we can consider this a pretty calm, pretty safe town.

[Carola]: Brazil is attractive to Cuban doctors even though they live in conditions that a doctor from any other country probably wouldn’t accept. In fact, while the Argentine or Spanish doctors in the program receive a salary of around 11.500 reals (about 3.000 dollars), a Cuban doctor only makes 2.900 reals (about 700 dollars).

[Alioski]: The Cuban government keeps, takes more than 70% of each of its doctor’s salary.

[Carola]: Remember I mentioned how lucrative the missions are for the Cuban State? Well, that’s why. Because of contracts like the one Cuba has with Brazil. The Brazilian government has a hard time justifying such a large disparity in salary. But it covers itself by saying that it pays directly to the Cuban government, and that it can’t control how Havana distributes that money. This is one of the coordinators of Mais Médicos at the Ministry of Heath, Paulo Ricardo Silva.

[Paulo Ricardo Silva]: The information we have is that those doctors study, não pagam (they don’t pay) in their country. There is a health system in Cuba that needs da contribuição (the contribution) so it can continue what it always does which é (is) educating novos médicos (new doctors) to practice in other countries.

[Carola]: But, all that aside, he says that the Cuban doctors should be happy.

[Paulo Ricardo Silva]: Look, if you knew the reality in Cuba as we conhecemos (know it) I… I’ve been in Cuba for more than 20 years, I know the difficulties that there are, and I’m telling you frankly, that what the Cuban doctors recebem (get) in Brazil, I don’t think there aren’t any that don’t have a dignified life in Brazil.

[Carola]: In fact, their salary is much higher than in Venezuela. And it goes right into the doctor’s pocket. On top of that, Brazil gives them another 2.500 reals (nearly 600 dollars) each month for food and lodging. And most importantly: the Cuban government doesn’t control their lives here.

[Alioski]: We were always used to arriving, and the government was the one who told us: “You’re going to live here, you’re going to live with this person.” However, here the… the Brazilian government gave us the money. They said here’s the money, go out and buy things and look for a house.

I chose where I was going to live. I chose who I was going to live with and on top of that I chose what I was going to buy.

Imagine a Cuban showing up and saying: I’m going to buy that TV now. I’m going to buy that fridge now. I’m going to buy that stove now. I’m going to buy that bed now and I’m going to pay for all of it now. It was the first time.

[Carola]: He was starting a new adventure. In a new language. At first, Alioski spoke basic Portuguese. Which he had learned in a few courses in Cuba and at the Mais Médicos intensive training. He remembers his first consultations like this.

[Alioski]: At first it was, bom demais, as they say. Communication with the patients… I asked them if… if they had understood me and they would say yes. They would say: “No, yes, yes, I understood.” And right when I would leave, I would hear them say to the nurse: “Nurse, translate for me. Translate what the doctor said because I didn’t understand anything he told me.”

[Carola]: But his communication became more and more fluent and Alioski quickly earned not only the affection of his patients, but also their trust.

[Alioski]: They called me “Dr. Cuban”, “Dr. Cuban.” Besides, my name is even hard for me. And for them… for them it’s rather hard, too.

[Carola]: Alioski felt happy in his job. Though, sometimes it was impossible not to think about how his life in Brazil had an expiration date that came from the Cuban government: at most, three years.

But he had come with an open mind. Alioski had divorced his wife in Cuba before coming to Brazil. They barely saw each other one month out of the year, which Cuba gives its doctors as vacation to return to the island. And once he was in Brazil, he met Siria.

[Siria]: Our life together is like that. Because sometimes I come home, and I tell him he needs to eat first because his health isn’t good. I… I would get home at 10 at night, so, waiting for me isn’t fair.

[Carola]: Siria is a Cuban doctor who was in the same Mais Médicos Portuguese classes as Alioski.

[Alioski]: They placed us together to work in this state, in Goiás, and at the same they placed us together to work in the same town. I said, now they just need to put together us in the same house! We’re going to place ourselves together and (Laughs) and it was… that’s how we solved it and…

[Carola]: The months went by peacefully. Alioski was getting used to changing out salsa for samba. Ropa vieja dishes with churrasco. And changing out baseball for soccer.

[Alioski]: I learned to be a supporter of… of the Brazilian national team, because before I supported Argentina, but I had to change or the patients would kill me here.

[Carola]: But…

[Alioski]: On April 12th, 2017, I’ll never forget that date because it marked me forever…

[Carola]: A little after 7 in the morning two officials came to his house, one from the Cuban embassy and a Cuban representative from the Pan-American Health Organization, the specialized agency of the Inter-American System and also the regional office of the World Health Organization, which mediates between Cuba and Brazil in Mais Médicos.

[Alioski]: And I was accused of having applied to obtain an individual contract.

[Carola]: An individual contract to break ties with the Cuban government and work directly with the government of Brazil. In short, deserting. Alioski told me very emphatically that he had not, but apparently his name or one that looks a lot like his supposedly appeared on a list from the Cuban government. I wasn’t able to corroborate this information independently.

At that time, he had already completed the three-year term of his contract. But Alioski and other doctors remained in Brazil because the Cuban government had asked them to stay a little longer because of issues with replacing them.

And it’s true that some Cuban doctors started to feel uncomfortable with the idea of having to go back to Cuba. They were comfortable in Brazil. They had freedom, the country needed doctors and on top of that it paid well. And yes, a few Cubans had initiated the legal process to stay in Brazil on their own. Legally speaking, they argued that they should have an equal agreement: have the same rights as the other foreigners in the program to renew their contract with the government of Brazil directly and receive their complete salary. Alioski confessed to me that he had thought about the possibility…

[Alioski]: I thought about it, I wanted to, at one point, if I had had the opportunity, if it had been legal, legal according to Cuba, I would have done it because I don’t want to lose my connection with… my connection with Cuba because my family is there but I was unfairly accused because I didn’t do it.

[Carola]: And he wasn’t the only one. Since what he had supposedly done was considered a “serious indiscipline”, the representative from the embassy, according to Alioski, told him that the government in Havana had decided to suspend him from the program. And started telling him everything that would happen when he was returned to the island.

[Alioski]: And he threatened that once I returned to Cuba, they were going to… uh, my license was going to be suspended. I wouldn’t be able to practice medicine, that I was… and that if I was going to practice, then it would be in inaccessible areas, that I was going to see where they would place me to work.

[Carola]: Like we said before, the Cuban government declined to comment on the issue. The Pan-American Health Organization said they had no knowledge of this kind of situation. But what is certain is that in that moment, Alioski made a radical decision.

[Alioski]: With the blood we Cubans have Cubans don’t have cold blood, we have very hot blood, with the same sincerity that I told him that I hadn’t made any claim in court, with that same sincerity, I told him he could screw off to Cuba. I was never going back to Cuba.

[Carola]: In other words, he was going to desert.  For Alioski, it was a matter of principle.

[Alioski]: Martí said it: Free… Freedom and rights are not begged for, they are taken.

If to uphold my principle, to uphold my moral integrity and my freedom I have to live outside of Cuba, I’m going to. No, I don’t plan on going to Cuba to live with me head down, hung low for anyone.

[Carola]: Alioski shared everything that had happened to him on his Facebook.

[Alioski]: Last Wednesday, April 12th at 7:15 in the morning, I got an unexpected visit from the coordinator of OPAS in the state of Goiás…

[Carola]: In his post, he wrote about the threats he received, how he felt used by the Cuban government and the reason behind his decision to desert. And it ended like this:

[Alioski]: Those people who may consider me a traitor today, will understand my motives one day. Goodbye to my land, my friends and my family.

[Carola]: The message was shared more than 20 times and commented by dozens of people.

[Anibal Díaz]: Forward, brother. Nothing is ever written about cowards.

[Bárbara San Juan]: Brazil was the mission that took away our ideological blindfolds.

[Jany Bárbara Ruiz González]: We’re on the same path. I decided to stay in this country too, because I don’t want to keep being cheap labor.

[Alioski]: So, people who I thought were hyper-communist called me and gave me encouragement. I said, OK, it seems like we’re on the right path and seems like I’m not the only one who is thinking this way.

[Carola]: Alioski is now considered a deserter. Officially, he is being accused of “treason against his country.” “The most serious of all crimes,” according to the Cuban constitution. And carries with it “serious punishments.” The main punishment for those who abandon their missions is that they are banned from entering Cuba for eight years.

The government made their migration laws more flexible toward the end of 2017, allowing the so-called “illegal emigrants,” like the balseros [the people who left the country on rafts], to return to the island. But citizens who abandon their missions are excluded from that possibility.

Alioski isn’t the only doctor to desert. Siria, his new wife, also deserted. And many others, before and after him.

Several Cuban doctors in Brazil put their testimonies up on YouTube, some of them speaking in Portuguese…

(SOUNDBITES FROM DOCTORS’ TESTIMONIES ON YOUTUBE)

[Eva María Arzuaga]: My name is Eva María Arzuaga. I want to… to… to congratulate the creator… the coordinator of the idea of… of doing this global census of deserting doctors, or supposed deserters, because we are not soldiers. We didn’t come to win any battle. We aren’t escaping any war.

[Woman]: I am demanding that my right to go where I chose be respected.

[Woman]: Stop the violations of our human rights. We’re doctors, not trash.

[Woman]: Não sou desertora, hoje sou cubana livre e quero trabalhar sem amos.

(I’m a not a deserter, today I am a free Cuban and I want to work without masters).

[Woman]: We only discovered the path to freedom.

[Woman]: Eles me sancionam oito anos sem eu poder entrar a Cuba a visitar mi familia… (Cries)

(They are punishing me eight years without being able to go to Cuba to visit my family).

[Carola]: And here, one of the first deserting doctors in Brazil is being interviewed in early 2014.

(SOUNDBITE OF AN INTERVIEW WITH A DESERTING CUBAN DOCTOR)

[Journalist]: Agora você quer morar aqui no Brasil. Você considera que isso era um trabalho escravo?

(Now you are saying you want to live here in Brazil, do you consider that was slave work?)

[Doctor]: Eu penso que sim, que era um trabalho escravo porque os escravos trabalham por nada ou por pouco.

(I think so, that it was slave work, because slaves work for nothing or for very little).

[Carola]: Slaves, she says. Which is ironic considering that the Brazilian doctors met their colleagues shouting that same word.

(SOUNDBITE OF BRAZILIAN DOCTORS)

[Brazilian doctors]: Escravos, escravos. Escravos, escravos. Escravos…

(Slaves, slaves. Slaves, slaves. Slaves…).

[Carola]: Alioski uses it too.

[Alioski]: We’re slaves because that’s how they treat us. They treat us like, like slaves.

If I have to do what you tell me to do and if I don’t do it, you’re going to punish me… only slaves are punished like that. So, it’s a form of modern slavery. It’s a slavery without shackles, but we have a disciplinary resolution to fulfil.

[Carola]: But it goes even further than that.  

[Alioski]: Losing their slaves is the Cuban government’s biggest fear, because it’s the bargaining chip the government has to negotiate with… with other countries. If Cubans, Cuban doctors, Cuban professionals abandon Cuba, what bargaining chip will the government have?  They won’t have any.

(SOUNDBITE SOMEONE KNOCKING ON THE DOOR)

[Jaqueline]: Ahhh, ele está vivo!

(Oh, he’s alive!)

[Alioski]: A Jaqueline!

(Jaqueline!)

[Jaqueline]: Tudo bom, colega? Como é que vai?

(Everything OK, colleague? How are you?)

[Alioski]: Tudo bem…

(Everything OK)

[Jaqueline]: Você não ficou milionário não, né?

(Did you become a millionaire?)

[Alioski]: Não…

(No…)

[Jaqueline]: Más vai ficar.

(But you will).

[Carola]: I went along with Alioski to the Mais Médicos clinic, where he worked until June 2017. The nurses, who are happy to see him after months, joke around, surprised that he’s alive and ask if he’s become a millionaire.

[Jaqueline]: O famoso cubano, que todo mundo pergunta por ele… todo mundo pergunta cadê Alioski?

(The famous Cuban doctor, who everybody asks for… everybody asks: Where’s Alioski?)

[Maria]: O que que você andou fazendo, Dr. Alioski?

(What have you been doing, Dr. Alioski?)

[Carola]: Everyone is asking about you. “What have you been doing, Dr. Alioski?,” they ask. The answer isn’t simple.

After Alioski deserted, he found himself in a totally unfamiliar situation. What was he going to do? How was he going to live with Siria in the coming months? He felt very vulnerable. But he still had one option. Because, toward the end of 2016, aware of the fact that his time in Brazil was coming to an end and seeing that he was starting to get minor threats and warning signs from the government, Alioski did something to protect himself, the only thing he could see to do without the Cuban government getting involved.

[Alioski]: I asked for political asylum because I really was threatened. I was threatened by Cuban officials in my house here in Brazil. I don’t… I don’t think my basic rights as… as a human being will be respected in Cuba.

[Carola]: This allows him to stay in Brazil legally until his asylum request is resolved and it allows Siria to work too.

A doctor applying for asylum.

[Alioski]: It’s absurd… The world is full of absurdities. A group of soldiers governing an island of more than 11 million people, so the world is full of absurdities…

[Carola]: What’s even more absurd is that, since he can’t legally be a doctor in Brazil now, Alioski started working as a bus conductor in order to bring some money home.

[Alioski]: So, a lot of times, I have to sell tickets to my own patients. When they see me, they say: “Oh, doctor.” I’m not a doctor, here I’m a bus conductor. So, it was a little… a little frustrating as well.

[Carola]: He did that for a few months. At the moment, his wife, Siria, works in a pharmacy and he was looking for work for a time, and since June of this year, he works in naturopathy, mainly giving herbal remedies. Though it’s clear to him…

[Alioski]: I want to be a doctor. Why in Brazil? Because Brazil is where I am. Brazil is where I have a constitutional guarantee to the right to asylum and Brazil provides the opportunity. It’s a big country, with more than 200 million residents, so it’s a country with a high demand for medical professionals…

[Carola]: It’s common to read news about Cuban deserters, but most of them are athletes or artists. A doctor’s work is more discrete and a lot of those who have deserted don’t want to speak out. They’re afraid. In fact, I contacted other Cuban doctors who stayed in Brazil, but Alioski was the only one who agreed to talk to me. There is a very significant sense of vulnerability and fear that there may be reprisals against their families in Cuba. Alioski has two young daughters there now, they are 9 and 5, as well as his mother and step-father. That’s the collateral damage of his decision. Alioski has to live with that now.

In order to practice medicine in Brazil again, Alioski has to pass the ‘reválida,’ the test that doctors who studied outside of the country need to take in order to work. He says it’s ironic that Cuban doctors can work in the country under the umbrella of the Mais Médicos program, but they have to pass an exam when they aren’t in it. The test is very hard, it condenses information from the entire curriculum, and it doesn’t have a fixed test date. An indeterminate number of months can go before you can take the test. Alioski has already nearly passed the test twice. The last time, it seems, he missed by one point.

[Alioski]: But I’m not discouraged by that, on the contrary, what that does is strengthen even more now, strengthen my decision to study. If before, uh, I set aside 8 hours to study and I missed it by a point, now I have to set aside 12 hours, so I can beat it by 10 points.

[Carola]: Pending all this, all Alioski has now is an asylum application kept in a drawer. The journey he started seven years ago has had more bumps in the road that he anticipated, and the end is uncertain. But now, his maxim is:

[Alioski]: Wherever you’re useful, that is your country. Do I miss Cuba? Yes. But if I’m useful in Brazil and in Brazil my freedoms are guaranteed, then, eh, I consider Brazil my country.

[Daniel]: In March of 2018, the Brazilian government renewed the contract with the Pan-American Health Organization and the Cuban government so Cuban doctors can continue to participate in ‘Mais Médicos’ until 2023.

However, the ultra-right president-elect of Brazil, Jair Bolsonaro, changed everything.

Bolsonaro is an avowed anticommunist and, in an interview, he threatened to break relations with Cuba. But, at the same time he declared that he would keep the Cuban doctors in the Mais Médico program, if they all passed the test to validate their license in Brazil. Otherwise, to him they were only, and I quote, “people with white robes.”

He also said that, once they passed the test, the Cuban doctors could work in Mais Médicos provided that they received their salary in full and could bring their families with them. In other words, breaking all the rules of the Cuban government, who would no longer receive a cent for all those doctors.

In response to these statements, last Tuesday, November 14th, Cuba announced they were withdrawing from the Mais Médicos program. Which means that the almost 8.500 Cuban doctors that are currently in Brazil will leave the country. The administration of Miguel Díaz-Canel said that Bolsonaro’s words were “unacceptable” and disrespectful, because they questioned the skills of their doctors and violated the agreements made with the Pan American Health Organization.

In the poorest and most remote locations in Brazil, they’re afraid that they will be left without primary health care services, since practically only Cuban doctors went to those places.

Associations of mayors and local health organizations have asked Bolsonaro to reconsider, stating that more than 3.000 municipalities and more than 29 million Brazilians will be affected by these actions.

For now, the Brazilian Health Ministry has announced that it will open a call to fill these positions, prioritizing Brazilian doctors.

The people most shocked by all of this are of course Cuban doctors.

We asked Alioski what he thought of everything that had happened:

[Alioski]: And you, for us, the Cubans that are here… we benefit, because they’re positions that will be left open and we are willing to work where… wherever they place us. To work not only decently, but also be paid and work with… with love and solidarity for Brazilian patients.

[Daniel]: We will see how this story continues… and what else is in store for Brazil starting January 1st, when Bolsonaro is sworn in as the new president.

Carola Solé has been a correspondent in Venezuela, Mexico and Brazil for the EFE and AFP for more than 10 years.  Now she is an independent journalist.

This story was edited by Camila Segura and me. The mixing and sound-design are by Ryan Sweikert. Our intern Andrea López Cruzado did the fact checking.

Many thanks Sabrina Duque for her help, and for reviewing and translating the audios in Portuguese.

The rest of the Radio Ambulante team includes Andrés Azpiri, Jorge Caraballo, Remy Lozano, Miranda Mazariegos, Patrick Moseley, Ana Prieto, Laura Rojas Aponte, Barbara Sawhill, David Trujillo, Elsa Liliana Ulloa, Luis Fernando Vargas and Silvia Viñas. Our interns are Lisette Arévalo and Victoria Estrada. Carolina Guerrero is our CEO.

Radio Ambulante is produced and mixed on Hindenburg Pro.

Do you follow us on Instagram? We want to follow you back. Publish in one of your stories a video of you listening to Radio Ambulante or recommending the podcast to your friends and tag us as @radioambulante.  Today we will follow back the accounts who mention us. Remember, @radioambulante in Instagram. Thanks!

To hear more episodes and learn more about this story, visit our web page, radioambulante.org.

Radio Ambulante tells the stories of Latin America. I’m Daniel Alarcón. Thanks for listening.

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