The Cuban hustle: Doctors drive cabs and work abroad to make up for
By ROB WATERS
FEBRUARY 8, 2017
HAVANA — He knew as a child that he wanted to be a doctor, like his
father. He went to medical school, became a general surgeon and
ultimately a heart specialist. He practiced at Cuba's premier
cardiovascular hospital, performed heart transplants, and published
articles in medical journals.
For this, Roberto Mejides earned a typical doctor's salary: about $40 a
It wasn't nearly enough, even with the free housing and health care
available to Cubans, to support his extended family. So in 2014, Mejides
left them behind, moving to Ecuador to earn up to $8,000 a month working
at two clinics and performing surgeries.
It's a common story here, where waiters, cabdrivers, and tour guides can
make 10 to 20 times the government wages of doctors and nurses — thanks
to tips from tourists.
"Doctors are like slaves for our society," said Sandra, an art student
and photographer's assistant who makes more than her mother, a
physician. "It's not fair to study for so many years and be so underpaid."
Cuba is proud of its government-run health care system and its skilled
doctors. But even with a raise two years ago, the highest paid doctors
make $67 a month, while nurses top out at $40. That leaves many feeling
demoralized — and searching for ways to improve their lives.
Some enter the private economy — by renting rooms to tourists, driving
cabs, or treating private patients, quasi-legally, on the side.
Thousands of others accept two-year government assignments to work as
doctors abroad, collecting higher salaries for themselves and earning
billions for the state, which helps keep the stagnant economy afloat. In
fact, health workers are Cuba's largest source of foreign exchange.
A few doctors, like Mejides, arrange foreign employment on their own,
putting at risk their future ability to return to a government job in
the health system back home.
"It's hard to migrate and be alone," Mejides said in Spanish, during a
video phone call from Ecuador to a reporter visiting Havana in October.
"It's stressful. I am in the wrong place. I should be with my family in
my country, working and being rewarded properly."
Still, with his Ecuador earnings, he was able to buy his wife, two
daughters, and two stepdaughters a $23,000 apartment in Havana, and he
sends them $300 to $500 a month.
Renting out rooms to make ends meet
While doctors back in Cuba grumble about their low pay, they usually
find ways to make do.
Sandra's mother, Nadia, a genetics researcher, earns about as much as
she pays a cleaning woman to maintain her three-bedroom Havana
apartment. Whenever she can, she rents one of those rooms to tourists
for $40 a night, making more in two nights than she does from her
monthly earnings as a doctor. She asked that her full name not be used
to avoid any problems with the government.
The rental income allows Nadia to have a modestly comfortable life and
to be able to buy fruits and vegetables at farmers markets. But a
restaurant meal is a rare treat, and traveling abroad is impossible.
Still, she loves her work and the intellectual challenge of her research
into genetic diseases. She said many Cuban doctors are committed and
provide excellent service, in part because of the ways they have learned
to overcome shortages of equipment and technology.
"We don't have all the electronic tools, so we have to learn to do
things other ways, to diagnose just by external examination," she said,
over a dinner of fish and rum at her apartment.
She'd like to earn more money, of course, and she understands why so
many doctors, including many she knows, have chosen to leave Cuba.
"I'm not ambitious for money," she said. "I get rent from visitors, and
I get to live in Cuba. I have a nice house, and I'm happy with what I
have. But I'm not a millionaire."
Cecilia, a 60-year-old former nurse who also asked that her full name
not be used, spent 25 years working in government hospitals and clinics.
To adapt to the shortages, she learned to make inventos medicos —
medical inventions — using a chair or bench to raise the back of a
patient's bed, for example, or cutting the tip off an intravenous line
to fashion an oxygen feed to a patient's nose.
But she became disillusioned by the chronic shortages and the stress she
saw in both her patients and colleagues.
"The material scarcity is so overwhelming that it keeps people from
dedicating all the passion, love, and brain power that they should to
their patients in need," she said, sitting in a rocking chair in her
third-floor Havana apartment. "I was the one who had to face the
patients and tell them we don't have the drug that you need. It was very
common. And I didn't want to do that any more."
Doctors and nurses "have the best intentions, but they face so many
obstacles, there are so many things on their mind," she added. "The
doctor might be treating a patient but they are actually thinking: 'When
I get home, at God knows what time, what am I going to feed my kid?'"
She quit nursing in the early 2000s and later began to pursue her
passion, doing hands-on alternative medicine that combines techniques of
massage, kinesiology, magnetic therapy, and so-called floral therapy,
which uses extracts of flowers and herbs as healing agents.
Her work with private clients, who come to her apartment, is permitted
under a license for massage, the only form of healing work included on a
list of government-approved private services and businesses. Working
three days a week, she earns almost $120 a month "if all my appointments
show up," she said. "I use to make that in six months working at the
A surplus of doctors
In the years after Fidel Castro seized power in 1959, Cuba invested
heavily in education and science, training tens of thousands of doctors,
nurses, and scientists. As a result, Cuba, a country of 11.2 million
people, today has 90,000 doctors, the most per capita in the world.
About 25,000 of these doctors, along with 30,000 Cuban nurses and other
health professionals, are working in 67 countries around the world. They
earn about $8.2 billion in revenue for the government, according to a
recent article in Granma, the official paper of the Cuban Communist Party.
The bulk of the doctors, about 20,000, are in Brazil and Venezuela. Over
the last three years they provided treatment to 60 million Brazilians,
mostly the rural poor, said Cristián Morales Fuhrimann, the Pan American
Health Organization's representative in Havana.
Cuba receives about $5,000 a month per doctor from Brazil, pays each
doctor about $1,200, and banks the rest, said John Kirk, a professor of
Latin American studies at Dalhousie University in Halifax, Canada, who
has researched Cuba's program of medical missions. Most of the doctors'
shares are deposited in their Cuban bank accounts, requiring them to
return home to collect it.
"Cuba has too many doctors, so their main source of hard currency is to
rent out medical services," Kirk said.
Once close allies of Havana, Brazil and Venezuela have been engulfed in
political and economic crises that will cause them to reduce their use
of Cuban doctors in the coming years.
That may lead Cuba to redeploy some doctors to other parts of the world,
including the Middle East. In Qatar, an oil-rich emirate about as far
from Cuba geographically and culturally as any place in the world, the
so-called Cuban Hospital is fully staffed by 400 Cuban doctors, nurses,
Cuba's dispatch of doctors not only generates revenue, it is also an
exercise in soft power that allows the country to spread its influence
around the globe.
"It's a major contribution to the health of the world," said Morales.
"They made a big difference in fighting Ebola in Africa, in the
aftermath of Hurricane Matthew in Haiti."
Some Cuban doctors working overseas have defected to the United States,
aided by a policy launched during the administration of George W. Bush
that permitted Cuban medical personnel to go to the US with their
spouses and children. In its last weeks in office, the Obama
administration announced it was ending the program.
Since the Cuban Medical Professional Parole Program began in 2006, more
than 9,000 medical professionals and their family members were approved
for admission to the US. In the past four years, the number of entrants
spiked, reaching almost 2,000 for the fiscal year that ended Sept. 30.
The Cuban government and the Pan American Health Organization protested
the policy as a form of poaching that undermined Cuba's health system
and impeded newfound cooperation between the US and Cuba. In a
statement, Obama acknowledged that the program "risks harming the Cuban
Cuban doctors are in demand internationally because they come cheap, are
well-trained, and work in a public health system that is highly
organized and well-run. In Cuba, primary care clinics are available in
every neighborhood. Specialists in cancer, immunology, genetic medicine,
and cardiovascular disease staff the hospitals. Life expectancy rates,
which two generations ago were at Third World levels, are today roughly
equal to those in the United States.
But the absence of so many doctors also provokes complaints from
patients, who say it keeps them from getting the best care. They also
grouse that they have to bring their own food and bedsheets, wait for
appointments or medications — and provide gifts to doctors to ensure
When the 61-year-old father of Concepcion, a young Cuban professional,
was diagnosed with prostate cancer last summer, she used personal
connections to enable her father to see a specialist promptly.
Concepcion, who asked that her full name not be used to avoid reprisals
or damage to her professional standing, also provided daily gifts of
food, cosmetics, and sometimes cash to doctors, nurses, and technicians
while her father was hospitalized for a month in Holguin, a city in
"Doctors are used to receiving gifts," she said. "You give the gift and
the attention starts getting better. If you stop and the attention goes
down, you go back to handing out gifts. You feel sorry for the doctors
because they work really hard under bad conditions and you always feel
like they're not being rewarded."
She estimated she spent about $500 on gifts and food, an amount she said
would have doubled had he been hospitalized in pricier Havana.
Jose dos Santos, a Cuban journalist who needs regular treatment for his
diabetes, said the care he receives is excellent. Bringing gifts to
doctors "has become a habit because we know that the job doctors do
needs to be better rewarded," he said. "We don't produce oil," he added,
"but we produce talent, and it makes sense that that talent is
acknowledged and rewarded."
In December, Roberto Mejides moved again, this time to Merida, Mexico,
where he plans to work for the next four years. His income will be
roughly the same as in Ecuador, but now he's just 90 minutes by air from
Havana. He hopes to bring his family to join him in the coming months,
"My hopes have always been the same, to work honestly and to provide my
family with an adequate life," he said. Someday, he added, he wants to
return to Cuba: "It's my country, my homeland."
Rob Waters can be reached at firstname.lastname@example.org
Follow Rob on Twitter @robwaters001
Source: Cuban doctors drive cabs and work abroad to compensate for
meager pay - https://www.statnews.com/2017/02/08/cuba-doctors-meager-pay/