Cuban doctors and nurses have established themselves as a respected part of T&T’s health sector, but these men and women are yet to receive the similar respect from their government.
These health professionals, who leave Cuba hoping to earn higher wages, have limited control over their earnings and there are also limitations on their movements after 7 pm. Since the contracts only allow the health professionals to go to another country to work, their husbands/wives/families are left behind in Cuba as a form of guarantee they will return at the end of their missions—usually two years.
To the outside world, what they are forced to endure is tantamount to modern-day slavery. But to them, it is a way of life and the best option for them even though half their earnings are taxed. Ironically, the very injustices Fidel Castro fought against in the Cuban revolution are the very fundamentals his people are being forced to endure through this “humanitarian” mission that is spread around the world.
While members of the TT “Brigada Médica de Cuba” (Cuban Medical Brigade-which started in 2003 and is currently headed by Chief of the Brigade Dr Rody Cervantes Silva) earn the same salaries as local health professionals, they do not enjoy the same freedom with their earnings. Sunday Guardian tried to speak to Cuban mission staff about their employment, however they said they are not permitted to speak to the media or they will be sent back to Cuba.
One health professional, whose identity and job title has been withheld for his protection, confided in the Sunday Guardian that Cuban pharmacists are paid roughly $9,000 (TT) and some $2,000 (TT) is spent on accommodation. He explained that the remaineder of their salary—$7,000—is divided in half and one portion repatriated to the Cuban government. The other portion is kept by the pharmacist.
Out of that money, the pharmacist has to send money to his/her relatives in Cuba and survive until payday. At the end of the month, some have $3,500 per month. “The specialists receive between $25,000 to $30,000 and half of that is returned to Cuba. They say it is to pay for the oncology centre, the health system,” he said.
The health professional said even after the 50 per cent is deducted, the Cubans still earn more than they would have in Cuba. Currently, Cuban doctors earn between US$67 to US$80 per month, and that was a recent increase. Just a few months ago, they were being paid US$40. The basic minimum wage in Cuba is US$20. “For me it is good. I earn more than in Cuba,” he said.
When asked why he stays in the brigade, the health professional simply said, “I do not mind giving the 50 per cent because it is still better than getting the $67 I get paid in Cuba. Here (T&T) is very expensive, but you can find everything.” Based on calculations using rough estimates of the salaries and the number of Cuban medical personnel working here, some US$10,735, 800 is paid annually to the mission members.
This means that an estimated US$5,367, 900 is repatriated to Cuba annually per TT mission.
Mission chief: It’s humanitarian help, Cuba needs money
Silva, in an interview with the Sunday Guardian through an interpreter, denied that Cuban mission members were being oppressed nor were their earnings taxed. “It is a humanitarian help,” he said. Silva contended that it is at the request of the governments of different countries Cuba sends medical personnel.
“A brigade recently went to Nepal and Chile after the earthquake, in the three countries in Africa where there was Ebola in Liberia, Guinea in Conakry and Sierra Leone. There were Cuban medical brigades that helped to fight this disease to prevent it from spreading throughout the world. In the case of Trinidad, no, Cuba receives nothing,” he said.
However, Silva admitted that in certain countries mission members do have to send money back to Cuba. “Remember that Cuba is a poor country, from the third world, that needs the aid of ourselves. The ones that got out from Cuba with a signed contract agrees to do certain things and in those countries where it sends money, it goes to social programmes such as the fight against childhood cancer, leukemia, to the health ministry itself. But this is not our case (in T&T),” Silva said.
He explained that Cuba provides humanitarian aid to 69 countries with the aim of supporting and improving the quality of life for residents of these countries. At this time, 207 Cubans including doctors, pharmacists, nurses and entomologists are working here. Silva said another 307 Cubans are expected to be brought to T&T soon. He denied that doctors are sanctioned for breaking any contract rules nor are they prevented from working.
“No, we act in accordance to the law of this country. Nothing different from what happens here in this country. They have 14 days a year where they can stop going to work and get paid. They continue to receive their salary,” he said. He said the Cuban government cannot interfere with contracts since it is between T&T and that individual.
Silva added that nothing prevents a medical mission professional from returning to T&T to work independently after his or her contract with the mission is over. “In fact, there over 80 who were working in the brigade and then they have returned to work in Trinidad. If the Government gives them work, there are no problems,” he said.
He said the type of aid received by the Government of Trinidad from Cuba is called Compensated Technical Assistance which comes through a government-to-government contract arrangement. Health Minister Dr Fuad Khan has lauded the success of the programme which he assured was not an enterprise, but a mission.
Behind the white coat
Contrary to what Silva said, Cuban doctors based here in Trinidad strongly refused not to speak about their contracts or being part of the programme. They expressed fear that they would be sent back home for breaching the rules and persecuted in Cuba. Initially, they promised to speak to the Sunday Guardian through the help of Spanish interpreters, but at the last minute they cancelled because they said they were too afraid.
“If they know we are talking to anyone we will be sent back,” one of the doctors said. After much effort, the Sunday Guardian managed to speak with one of the local Cuban health professionals using a guise because it was the only way to get to the truth about the programme. The health professional explained that their contract operates differently in T&T. Money for their families back home in Cuba is not deducted from their salaries.
“If we want to send (to family in Cuba), we have to send it ourselves,” he said. The Cuban brigade has a sole administrator, referred to as the chief, who controls the money and keeps watch over the health professionals. He is assisted by a Cuban woman who is listed on the TT brigade’s blog as the “economic.”
He said that when he was recruited for the two-year programme, he was provided a list of rules and informed that he was to pay 50 per cent of his salary to the Cuban government each month to fund their health system. In Cuba, health care, medicines and education are fully funded by the government.
After graduation students have to work for three years at an assigned workplace and cannot quit or they lose their title. Each Cuban male has to join the army for two years by law. The Cuban government, he explained, cannot be challenged over their demand of 50 per cent because there is no evidence or written stipulation that they have to pay it.
“There was no written rule. It was told to you and if you did not pay, they would pressure you or send you back to Cuba,” he said. He said the health professionals in T&T earn a lot of money and many Cubans are happy to come to here, especially because of the labour laws. The health professional explained that brigade members are subjected to restrictions and pressured if they do not adhere to the rules.
A record, he said, is kept on each professional in the brigade to be sent back to Cuba for evaluation. One of the rules is that they stay indoors after 7 pm. The Cuban officials, he said, are not responsible for anything that happens to them after 7 pm. If anyone breaches the rule, it is kept as a bad mark against them and they may not get to come back to T&T. He said he sticks to the rules.
Every month, he said, the brigade chief has to make a report about the 50 per cent payments and if any doctor is late he/she is pressured to pay. “We have monthly meetings and at the meetings anyone who is late with their payments are called out during the meeting,” he added.
“The money is controlled by the chief of the brigade. In Trinidad the laws make the contract different from other brigades,” he added. The Sunday Guardian attempted to speak with Cuban Ambassador Guillermo Vazquez Moreno about the claims and programme, but his secretary said the ambassador was out of the country.
A former mission participant, a female doctor, who went to Venezuela, shared documents which listed the terms of her participation including stipulations about conduct and the government’s expectations. She confessed that what she experienced on the mission was far from what she expected.
For her protection, her name has been withheld because she could be prosecuted for speaking about the programme. She explained that she was recruited for the programme by the Ministry of Public Health in Havana. Before she signed the contract, she was told that she was going to be paid in a Cuban bank. She said from that account they sent 70 per cent of her earnings to the Cuban government and the 30 per cent was divided between the health professional and her family in Cuba.
Her passport was taken from her upon her arrival at the airport in Venezuela to prevent her from deflecting. She said she was paid US$1,500 per month, but the person who was appointed as the “economico” only gave her US$130 out of the salary. The US$1,370 was sent to a Cuban account where $150 CUC (Cuban Convertible Peso—Cuba’s main currency) was deposited into her account. From that figure, $50 was released to her family and the remainder was held in trust until her return to Cuba.
She said she had no choice in the matter because even with the low payment she received, she was still earning much more than she would have if she was in Cuba.
The T&T/Cuba connection
The Cuban doctors and nurses programme was started by the Patrick Manning-led People’s National Movement regime in 2003 under a government-to-government memorandum of understanding. Close to 30 health professionals came to T&T to fill the critical shortage of staff in the public health sector.
Since then, the programme has grown. At present, some 339 nurses, 80 doctors and 21 pharmacists are currently employed in T&T under two-year contracts with an optional third year. Khan, in an interview with the Sunday Guardian, said he plans to expand the programme to include ancillary medical personnel, such as radiographers and lab technicians.
He said he was pleased with the performance of the doctors who have been part of the Cuban brigade in the past and those currently here working in public health institutions. “The Cubans works much harder and more dedicated is what has come out of the programme. The only thing is that at the specialist level, there are very good specialists, it is just that they need a little more supervision, but we have put that in place and the work that we have happening is very good,” Khan declared.
David Constant—head of the ministry’s International Co-operation Desk, said UCCM— Unidad Central de Cooperación Médica—in Cuba recruits the staff for T&T. The UCCM, he said, is a government enterprise. Khan did not have the figures for how much was spent on the programme.
Cuban contracts ‘out of our hands’
When told the Cubans are not receiving a full salary, Khan and Constant distanced themselves from the health professionals’ contract with their government. “We have nothing to do with that,” they said. Contant said he could speak to the T&T government’s contract with the Cubans and assured they were being paid as any contract worker in the ministry. He said they are paid individually and on par with local medical personnel salaries.
“We do our part,” the minister added. Constant said he had information on the programme and the MOU between the two countries which he could share and promised to share a template of the contract the doctors sign when they are hired by the ministry. He promised to provide the documents but mere days later, he said it was “difficult” and he was too busy to provide the documents requested.
T&T health sector benefits
Former chairman of the South West Regional Health Authority, Dr Lackram Bodoe, lauded the decision by government to bring Cuban health care professionals to T&T. He said, in a statement to the Sunday Guardian, that the programme “has proven to be very beneficial and fruitful.
The Cuban health care professionals have been able to work in harmony and unity with the local health care personnel and have assisted local health care professionals to provide quality care to patients that come under the umbrella of the SWRHA by sharing their expertise, their knowledge, their technology, and their skills with the local health care workers.”
This view was shared by Dr Austin Trinidade, public relations officer of the T&T Medical Association. He admitted that initially there was some resistance to the programme in 2003 because of concerns raised over the language barrier.
However, he said, now the Cuban health professionals are welcomed and accepted locally. He said there was no question about their skills.
Estimated payments of current Cuban professionals in T&T
Nurses (339) US$1550 Total US$525,450
Doctors (80) US$4300 Total US$344,000
Pharmacists (21) US$1200 Total US$25,200
Total earned = US$894, 650
Total annually = US$10,735, 800
Total sent to Cuban Government= US$5,367, 900