The exodus of doctors: a reflection of Cuba’s health system

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In Cuba, emigration is producing a human decapitalization that is difficult to reverse, and one of the areas in which the country is losing the most professionals is Health.

According to data published by the National Office of Statistics and Information, in 2022 there were 12,065 fewer doctors, 7,414 fewer nurses and 3,246 fewer dentists on the island than in 2021.

In addition to the number of professionals who are no longer part of the health system, there are also those who work for the Government abroad. In 2023 there were 37,000, according to official figures.

Is there anything left of the health system in Cuba?

Not only is the number of professionals available to serve Cubans decreasing, but hospitals are seriously run down and out of supplies, and pharmacies lack medicines. Cubans bear witness to this reality on a daily basis.

In September of 2023 BioCubFarma, the business group of biotechnology and pharmaceutical industries, recognized that 251 domestically manufactured medicines were lacking in the country, 40% of them considered fundamental.

"There is no good health system if there are no medicines or resources. It doesn't matter how much a professional wants to do something if they don't have the means to do it. Those of us who trained and worked there dealt with the pain of having seen more than one patient die due to a lack of antibiotics, a suitable laboratory, or a ventilator," says Aliuska Hernández Rodríguez, 52, a specialist in Internal Medicine with a diploma in Intensive Care, residing in the United States after crossing over from Mexico

"Much of the world is deluded about the 'greatness of the Cuban health care system,' which is a mirage. It cannot be said that we have medicine to which the entire population has access when those who turn to it can die due to its deficiencies. It’s a health system where certain social classes - because differences do exist - have excellent medical care, and the rest do not."

Drug shortages mainly affect those suffering from chronic diseases, such as diabetes, hypertension, cancer and epilepsia. But hundreds of people are also waiting for operations that cannot be carried out on the island. Many have taken to social media to beg for help from other countries.

Eduardo Santiesteban Álvarez, 55, a specialist in Oncology, has lived in Colombia since 2014. Cuba "had a good system until it began to enslave and export doctors," he says. At that point "it made no sense."

"As for its healthcare professionals, they have my respect and admiration. Scarcity has sharpened their capacity for clinical thinking, where no one can match them."

According to José Antonio Santana Cazorla, 62, who specializes in Internal Medicine and has also resided in Colombia since 2014, the Cuban health system "is the best" in terms of its professionals.

What he does not agree with is how it treats its workers, which undermines it. "Wages are insufficient to lead a decent life, regardless of what they contribute to the health of the country."

Jacqueline Román Pastoriza, a 53-year-old neurologist, practices in Peru, where she has lived since 2015. She believes that Cuban professionals "are excellent, of great competence and love for the profession. In Cuba, you study medicine because it is a vocation, because it doesn't give you any other kind of compensation, only professional."

"The Cuban health system is already more of a myth than reality," says a 57-year-old doctor, a specialist in Family Medicine and Intensive Care, who asked to remain anonymous. "Professionals live very badly, the technology is usually obsolete, and there is cutting-edge technology at very few centers, where most people cannot access it, not to mention access to novel drugs, which does not exist," says this doctor residing in the United States, who escaped from a mission in Venezuela in 2012.

In Cuba, doctors work "magic"

Without basic resources and with hospitals in ruins, doctors in Cuba have to "work magic" to try to cure patients, according to the professionals consulted.

"My work experience in Cuba can be divided into two parts: the first years as a specialist I felt fulfilled, very happy with the work, and surrounded by excellent colleagues and teachers I learned a lot from. In more recent years I did not feel good about the poor care provided, in addition to our salaries and conditions, especially the 24-hour shifts," recalls Santana Cazorla.

"I love medicine and wherever I am, and can, I'm going to practice it," says Hernández Rodríguez. "In Cuba, you were always frustrated by the lack of resources. I left there in 2002, and the shortages were already dire."

"On the one hand, I enjoyed a profession that I love, but with many hardships along the way, from a very poor salary, that was not enough at all, and a lack of options. I had no right to choose another career path, and there was the stress of working under poor conditions, and being very mistreated by the Health System," says the specialist in Family Medicine and Intensive Care.

Emigration as a lifeline

The collapse of the health system, frustration at not being able to help patients, harsh working conditions, limited options for growth, and pressure from the authorities have spurred many health professionals to see emigration as the only way out.

For thousands of them, the way out has been Cuba's "international missions". In addition to the poor working conditions on the island, there was the galling fact that the Cuban Government retained at least 75% of what their destination countries paid in wages.

"I had returned from an international mission in Venezuela, and had no desire to work in the country again. Secondly, and more importantly, I decided to emigrate to see if it was possible to bring my daughters with me. I wanted them to develop professionally outside the system in Cuba," says Santana Cazorla, who was able to arrive in Colombia with a tourist visa.

Hernández Rodríguez left Cuba at the age of 30. "There he worked in Intensive Care, and left work to sew or embroider to make ends meet. Most days I was frustrated and disenchanted with Medicine, because I had a limit as a doctor, and watched people die due to the lack of resources."

"I decided to emigrate to another country because, despite being at the top of my profession, and having devoted my whole life to studying and improving myself as a professional, I couldn't live. I was insolvent. I couldn't buy a pair of shoes for my daughter," says Román Pastoriza.

Despite the fact that in 2024 apparent salary improvements were introduced in the Health sector, which took into account night shifts, years of service, and the complexity and risk of the work, salaries remain abysmally low in the face of the constant growth of inflation in Cuba.

"Freedom and the right to be able to live better were the fundamental reasons for emigrating. I wanted to give my children an opportunity to live with dignity," said the doctor who spoke to us on condition of anonymity.

Starting over

Being a doctor has not spared these Cubans from adapting to new realities. "The hardest thing, to get back to work, was the computer system. When I arrived in Colombia, at the age of 52, I knew nothing about it, and here all the consultations, medical histories, the issuances of tests, lab work, everything is done on the computer. Little by little, I got used to it," says Santana Cazorla.

Román Pastoriza had to start from the bottom. "Despite having professional experience, a Master's degree, and a certain category, I had to start from square one. It was almost as if I had just finished my studies," she says.

Forming part of the health system of another country entails, for doctors, a process of homologation, professional level tests, and securing a work permit. Not everyone can do all these things.

"I feel professional and personal fulfillment, because from a young age I wanted to become a specialist in Internal Medicine, and be like my professors. I achieved this and held positions as the head of service in the Intermediate Care Unit at the Provincial Hospital of Matanzas, which I was very proud of. At this time I am helping to oversee an Internal Medicine service. I am very proud of what I am achieving," says Santana Cazorla.

"I am currently a computer clinician, and yes, emigrating was worth it. Being free is everything. In these years I've lived and enjoyed life much more than I did in Cuba. I like my job and I see a future in it. In my opinion, communist Cuba is hell," says the specialist, who asked not to be identified.

Hernandez Rodriguez says that he continues to achieve professional and personal goals. "I like my work and can devote time and energy to enjoying life. I am currently an Internal Medicine and Geriatrics doctor, and I have my own office. I do primary health care," she explains.

"I have my family, my husband and a son to whom we have been able to give love and education. He was born in a place where he can achieve whatever he wants. He'll be the one to determine his goals and limitations. I've helped my family to tread the same ground, so that they can realize their dreams," adds this doctor.

Reasons that make a difference

"The difference between practicing Medicine in Cuba and elsewhere is that, simply, in the latter case you can achieve your personal and economic goals," says Román Pastoriza. "You can have a normal life, you can have economic solvency, travel, attend conferences in other countries with your own money. You don't have to wait for anyone to invite you or pay you. You feel fulfilled, you are independent, you don't need anyone's crumbs, like in Cuba," argues the neurologist.

On many occasions Cubans' aspiration to emigrate is frustrated by the authorities' refusal to grant doctors a release letter. In September of 2022, however, the Ministry of Public Health stated in a statement that professionals in specialties such as Comprehensive General Medicine, and recent graduates, were not subject to this regulation.

According to Santana Cazorla, "the main difference between practicing medicine in Cuba and outside the country is the salary that health workers earn. In Cuba, to do this selfless work, with 24-hour work schedules and no Saturdays or Sundays off, the salary is not even close to being worthy of a professional."

A doctor's average salary varies depending on the country where he or she lives. But in all the nations mentioned here it exceeds $10 an hour.

In Cuba that would be an average monthly salary (taking into account all the sectors of the economy and the exchange rate on the informal market).

"The Colombian health system is a business, the patient is not the most important thing, and I have been shocked by the poor medical preparation. Professional excellence abounds in Cuba, but what is frustrating is the scarcity of diagnostic resources, medicines and supplies, and it is not the blockade that causes his," said Santiesteban Álvarez.

In the United States "there is a health system where prevention is done; you have to pay, but it is preferable to not having what it takes to save yourself," says Hernández Rodríguez. "It depends on your capacity: if you have very little, it is the Government that pays, and if you earn more, you pay more. We all have access to the same thing. Of course, it has flaws, but there's a better chance of survival if you get sick."

"The main difference is the resources available. Here I can do everything I should for my patients, from medications to using the most advanced diagnostic means. And we are compensated for our services. I don't have to sew or embroider when get off work to feed my family."

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