San José, Costa Rica, since 1956

Cuban Doctors Bolster Guatemalan Health Care in Rural Countryside

USPANTÁN, Guatemala – A photo of Katiela Wong’s 8-year-old son sits atop the big screen television that she’ll be shipping back home to Cuba when she finishes her two-year stint at a rural hospital in Guatemala.

Wong heads a team of 15 Cuban doctors who work in Uspantán, an impoverished and remote municipality in the central mountains.

“It’s not easy leaving the whole family behind,” said Wong, looking at the photo of her son posing in a Cuban school uniform. But Wong says the sacrifice is worth it.

“Being able to help these people with these needs is a great achievement and source of pride for every Cuban doctor.”

Wong and more than 300 other Cuban health-care workers, mostly doctors, are onloan to Guatemala from their revolutionary government. They work in provincial hospitals and staff rural health clinics in some of the most remote corners of the country – places most Guatemalan doctors don’t want to go.

“Very few (Guatemalan) doctors want to work in the interior,” said Mario Gudiel, former director of Guatemala’s rural healthcare extension program.

In Guatemala, Cuban doctors fill a gap in public-health care, taking jobs that Guatemalan doctors don’t want because of their remote location and low pay. Some of the Cuban doctors working in remote health posts have to trudge six hours through the mountains to vaccinate children and attend to emergencies.

Still, for the Cubans, the salaries are better than what they would receive back home, providing them with extra cash to buy televisions, microwaves, radios and other items that they couldn’t afford on the island.

The Guatemalan government also benefits by having low-cost medical professionals; the public-health department pays Cuban doctors about half what it pays Guatemalan doctors.

But some experts worry that the public health system has grown too dependent on these foreign medical workers.

“The Cubans came to fill a health-care deficiency in the country, but this can’t be a permanent solution. They could leave any day,” said Juan Carlos Verdugo, a public health expert at the non-governmental organization National Health Platform.

At the hospital in Uspantán, Cuban doctors outnumber their Guatemalan colleagues two to one. All of the hospital’s five specialists are Cuban, and all outpatient consultations are conducted by the Island doctors.

At the same time, nearly three-quarters of Guatemala’s 12,000-registered doctors work in the capital and surrounding suburbs, even though less than a quarter of the population lives there, according to the Guatemalan College of Physicians and Surgeons. In addition, Guatemala isn’t producing as many doctors as it used to, despite its growing population.

“Fewer and fewer students want to study medicine,” said Enrrique Jacobs, president of the College of Physicians. Fields like law and business pay better, he said, and a growth in malpractice lawsuits scares-off potential physicians.

The Cuban government is trying to help the problem by offering free medical school to low-income students from Guatemala and elsewhere. The idea is that these new doctors will slowly take over the Cubans’ work.More than 12,000 students from 83 countries are now studying at the Latin American Medical School in Havana, Cuba.

Last August, the school graduated its first batch of doctors – including 187 Guatemalans. In exchange for the free tuition, these students promised to work in the Guatemalan public-health system for six and- a-half years after graduation.

But it remains to be seen if the Guatemalan government can afford to hire all the new doctors. Guatemala currently has one of the smallest public-health budgets

in Latin America, spending less than 1% of its Gross Domestic Product on public health.

“No one’s going to work in the mountains for a salary of $400,” said Carlos Flores, one of the graduating Guatemalan doctors, referring to the salary the Cuban doctors make in Guatemala. Plus, he added, there is no job security in the public-health department.

Flores, who was president of his graduating class in Cuba, said he and other Guatemalan graduates are forming an association to lobby the government for changes in the health system.

Their first goal, he said, is to secure a budget increase so that the government can afford to hire its own newly trained doctors.


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