Millions of Brazilians may be left without access to doctors due to the end of a program that brought Cuban physicians to rural and dangerous areas in Brazil, the former health minister who helped create the initiative said Thursday. 

The Cuban government on Wednesday said it would end the program after Brazilian President-elect Jair Bolsonaro said it could only continue if several conditions were met. 

Bolsonaro, a former army captain, campaigned in part on promises to take a hard line against left-leaning governments. As a congressman, the far-right leader often complained about the Cuban doctors’ program and tried to end it.

In a phone interview, former Health Minister Alexandre Padilha said the decision to pull out would leave millions of Brazilians without access to doctors. 

Padilha said Cuban doctors were in 2,800 cities and towns — and they were the only doctors in 1,700 of those towns. Padilha said the initiative was launched in 2013 because local doctors could not be found for many positions. 

“This will have an immediate and terrible impact on the health care system,” said Padilha. “Cuban doctors are in the most vulnerable areas. They are in the Amazon, rural towns and in slums.”

Brazil, which includes the largest portion of the Amazon basin, is a vast country, a little bit larger than the continental United States. Many areas, particularly in the Amazon and historically poor Northeast region, are sparsely populated and lacking basic infrastructure.

After Cuba’s announcement Wednesday, Bolsonaro made a blistering critique of the program. Frequently referring to the Cuban government as a “dictatorship,” he said the program was “slave work” because the Cuban government keeps 70 percent of doctors’ salaries. He also said Brazil had no way to verify if the doctors were truly qualified. 

Neither Bolsonaro nor the Cuban government has said when the estimated 8,500 Cuban doctors currently in Brazil would be leaving. Bolsonaro said Cuban doctors who asked for asylum would get it, though he stopped short of saying Brazil would provide that to any Cuban who asked.

Bolsonaro, who takes office Jan. 1, said he had signaled the program could only continue if doctors directly received their salaries from Brazil, were able to bring their families during their assignments and had their credentials verified. 

“We have no proof that they are really doctors and able to take on these functions,” Bolsonaro said. 

Padilha said the program, passed by Congress, already includes an evaluation of the doctors’ credentials and language training; Brazil’s national language is Portuguese and Cuba’s is Spanish. 

The former health minister said the doctors were not only highly qualified, but specialists in rural medicine, something that Brazil’s health system badly lacks. He said the salary structure was something the Cuban government had worked out with more than 60 countries that participate in the program, and not something specific to Brazil. 

“Bolsonaro doesn’t understand that a doctor doesn’t just practice medicine for money,” said Padilha. “Doctors who work in the poorest areas are not just thinking about money.”
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