Cuba boasts that it has one of the world’s best healthcare systems and that it provides some of the best doctors out there. But this hasn’t stopped the island’s doctors from leaving the country in droves and abandoning their careers for better livelihoods in other fields. What gives?
The main reason that Cuba’s doctors are emigrating and quitting is simple: a lack of incentives. They work very demanding jobs for low wages and are subject to a whole set of regulations created especially for them—they are not allowed to leave the country without special permits and they have to attend to anyone who seeks their help, on penalty of jail time.
After the Revolution of 1959, the Cuban Communist Party banned private enterprise and established centrally-determined prices and salaries for nearly everything on the island. They also took over the country’s healthcare system, making all doctors state employees.
Doctors’ salaries of about $40-50 a month are actually $10-20 dollars per month more than the average Cuban’s. But the long hours and stressful conditions make up for it. Anyway, with Cuba’s rising prices, $40-$50 a month isn’t enough for a comfortable life. That’s why most doctors have picked up a second job or left medicine altogether, usually for a job in the growing private sector or in the black market. Being a doctor is prestigious, but paying the bills is more important. In Havana you can meet countless taxi drivers, cooks, and street vendors who were once doctors.
Take for example Clara, the caretaker of my neighbor’s elderly mother. A cheery woman in her late 50s, Clara told me that she had been a dentist for many years but that the bad pay had led her to quit and take up her current job. Clara provides for her mother, who has been diagnosed with senile dementia. Her dentist’s salary couldn’t put food on the table for one, let alone for two. While taking care of another elderly person is not the best-paying job out there, it provides Clara with the money and the flexible schedule she needs to take care of her own mother.
For a doctor to take up another profession is normal, she told me. “There are a lot of doctors who have ended up baking and selling cakes. And they bake because there is nothing better to do. You can sell a cake for 10 or 15 pesos. So if you make two cakes per day, you make some money and you don’t have to deal with a nine-to-five job where you are pressured and where you can’t earn a living.”
The flexibility of Cuba’s growing private sector has allowed many to quit their jobs with the Cuban state and move to jobs that pay in Cuban Convertible Pesos (CUC)—the convertible currency that’s worth about one US dollar. Unfortunately, only a limited number of private sector jobs are permitted: driving a taxi, renting out a house, running a restaurant and hairdressing, for example.
One person who has benefitted from such a move is Rosy, one of my neighbors. Rosy was a doctor for 24 years, but now she rents her apartment to tourists. Rosy explained to me that she had quit mainly because her wages, which were paid in Cuban Pesos (CUP), were just too low. “You get paid six CUP for each shift you take. Six CUP. Do you know how much six CUP is? Twenty-five cents of an American dollar. That is just enough for your day’s lunch.” By renting her apartment, Rosy makes an average of $20-$30 a night.
Rosy finally decided to quit her job after being sent on a year-long medical mission in Angola. Cuba is known for sending doctors to developing countries to do social work, usually to other socialist-friendly countries such as Venezuela, Bolivia, Ecuador, and Nicaragua. “In just one year in Angola, I made more than I had in 24 years,” she said. What disappointed her the most was that she didn’t even get paid all the money she earned: “In the whole year there, I made up to a quarter of a million dollars. I know that because I had to register every procedure I did because I got paid depending on what I did and how many times I did it. But I didn’t receive the amount of money corresponding to my work. I only received ten percent of every procedure. From that quarter of a million, I only got $450 a month.” Seeing how much she could make in a year and how much of her money the Communist Party of Cuba kept, she decided to quit.
Rosy also told me that Cuban doctors are expected to be Good Samaritans—or else. “If a neighbor tells you to please check their sick kid you can’t charge them anything. It has to be free. And if you don’t check them, then they are able to turn you in to the authorities and say that you denied them your attention and service.”
Manuel, the taxi driver I’ve mentioned in previous posts, told me that his daughter was a doctor. He was sad that someone as smart and dedicated as his daughter would never have a decent life. “With her doctor’s title and $40 she can’t feed herself. I have to give her food and clothing, because if not, she can’t live. And she’s a doctor! Doctors can’t live here. Where would they live? What can they buy with that amount of money? What are they going to eat? They can’t survive.”