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Cablegate: Cuban Doctors in Portugal

VZCZCXRO9636
RR RUEHIK
DE RUEHLI #0614/01 3411503
ZNR UUUUU ZZH
R 071503Z DEC 09
FM AMEMBASSY LISBON
TO RUEHC/SECSTATE WASHDC 8004
INFO RUEHZL/EUROPEAN POLITICAL COLLECTIVE
RUEHME/AMEMBASSY MEXICO 0079
RUEHCV/AMEMBASSY CARACAS 0001
RUEHBR/AMEMBASSY BRASILIA 0408
RUEHMN/AMEMBASSY MONTEVIDEO 0001
RUEHPD/AMCONSUL PONTA DELGADA 0644
RUEAUSA/DEPT OF HHS WASHDC
RUEHUB/USINT HAVANA 0059
RUEAIIA/CIA WASHDC
RHEFDIA/DIA WASHDC

UNCLAS SECTION 01 OF 02 LISBON 000614

SENSITIVE
SIPDIS

E.O. 12958: N/A
TAGS: SOCI ECON PGOV PO
SUBJECT: CUBAN DOCTORS IN PORTUGAL

LISBON 00000614 001.3 OF 002


SUMMARY
-------
1. (U) Portugal's thirty-year-old public health system is facing
organizational and administrative changes as part of the
government's health care reform. One of the biggest challenges is
the shortage of family physicians, particularly in rural areas.
Recruiting foreign doctors is a temporary solution, but the arrival
of 44 Cuban doctors has generated some opposition from Portuguese
health professionals. We do not view this as a change in Portugal's
policy regarding Cuba but rather as a practical short-term solution
by the Portuguese government to Portugal's continuous shortage of
family practitioners. End Summary.

SHORTAGE OF DOCTORS
-------------------
2. (U) In 2005 Prime Minister Jose Socrates initiated reform of
Portugal's public health system with the aim of improving primary
care services. After four years, however, the number of family
physicians is still insufficient. In 2007 Portugal had 38,399
physicians, according to the Portuguese Medical Board; OECD
registered 3.5 physicians per 1,000 people. With a population of
10.6 million, the challenge is even greater due to an anticipated
significant decrease in the total number of family doctors over the
next few years.

3. (U) Most of the physicians are concentrated in the metropolitan
areas of the country, leaving rural areas largely unattended. Two
of the regions suffering most from a shortage of doctors are rural
inland Alentejo and southern coastal Algarve. Both regions have low
population density and low socio-economic levels.

RECRUITING FOREIGN DOCTORS
--------------------------
4. (U) With an inadequate number of Portuguese family practice
doctors, the Government has turned to recruitment of foreign
doctors, as recommended by the Lisbon Regional Health Authority's
Hospitals Governance Report released earlier this year. The report
also recommended that the Health Ministry promote the return of
Portuguese doctors practicing abroad, encourage delay of retirement
of practicing family doctors, re-hire retired doctors, and increase
the annual number of vacancies for hospital internships in family
medicine.

5. (U) The number of foreign doctors is increasing. According to
the Portuguese Medical Board, in 2007, Portugal had 3,656 foreign
doctors, most of them from the European Union. (Many are Spanish
due to the close border, language, recognition of Spanish medical
degrees in Portugal, and ease of certification.) Portugal also has
Uruguayan and Brazilian doctors.

CUBAN DOCTORS ARRIVE IN PORTUGAL
--------------------------------
6. (U) Under a cooperative agreement signed June 2009 between
Portugal and Cuba, 60 Cuban doctors arrived in August 2009. Of the
60, 44 have completed the bureaucratic process of obtaining local
certification, including official recognition of their medical
degrees and certification by the Portuguese Medical Board. They
have been placed in southern health care centers: 24 in Alentejo, 18
in Algarve and two in the Lisbon metropolitan area.
7. (U) The agreement establishes employment contracts of up to three
years with a 40-hour work week and the option of up to 24 hours per
week in the ER. The Portuguese government pays 1,500 to 2,000 euros
per month per doctor directly to a Cuban state service provider,
which in turn pays the doctors' salaries to their families in Cuba.
(The Cuban doctors are not accompanied by their families in
Portugal.) Portuguese municipalities provide fully furnished
housing, while the Regional Health Authorities pay for all
utilities. Upon their arrival, the doctors took Portuguese language
classes and health information systems training. They each receive
between 300 and 500 euros per month which is deducted from their
monthly salary. (The current minimum salary in Portugal is 450
euros per month.)
8. (SBU) Antonio Camilo Coelho, former mayor of Odemira municipality
in Alentejo, confirmed that the doctors' arrival was welcome given
Odemira's aging population (he estimated that 65 percent of the
population is over 40 years old). He noted that Odemira, after four
unsuccessful recruitment efforts in 2008, finally managed to recruit
17 doctors, including five Cubans, to fill the 23 slots allocated by
the Alentejo Regional Health Authority. According to Coelho, the
doctors were well received and are successfully integrating into the
community, are pleased to be working in Portugal, and have no plans
for family members to join them.

LISBON 00000614 002.3 OF 002


9. (U) The arrival of the Cuban doctors generated considerable local
media attention, most of it positive. However, doctors and medical
students associations and the Portuguese Medical Board warned the
Portuguese government that the doctors may lack qualifications to
practice family medicine despite their ten years of experience. The
Portuguese Medical Board argued that bringing in Cuban doctors was
not the most appropriate solution. In early November, an
independent doctors union sent a letter to PM Socrates demanding
clarification of the Cuban doctors' labor contracts.

COMMENT
-------
10. (U) Portugal does not have strong commercial or cultural ties to
Cuba but follows the EU policy on engagement with Cuba. The
recruitment of Cuban doctors does not appear to be an attempt to
strengthen or otherwise alter its relationship with Cuba but rather
represents a practical arrangement to address a shortage in the
Portuguese health care system. We note that Portugal has
successfully sought doctors from other countries, including Spain,
Brazil, and Uruguay, but that Cuban doctors may be a more attractive
option due to their lower expectations and demands, including
salaries, relative to doctors from other countries. Recruitment of
Cuban doctors has helped alleviate the problem of the shortage of
family practitioners, at least in the short term. But despite its
seven medical universities, Portugal continues to face a long-term
shortage, particularly in rural areas. A broader solution will
require greater investment in health education to generate more
home-grown doctors, who will be key to full implementation of the
GOP's national health reform program.
BALLARD

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