The introduction of many Cuban doctors to Venezuela as a result of political ties between the two countries is leading to strong resentment of the foreign doctors among members of the Venezuelan medical profession.
Doctors at the sixth medicosocial conference of the Venezuelan Medical Council (Federación Médica Venezolana), which took place recently in Cumaná, questioned the quality of training and competence of the 20 000 Cuban doctors who work in their country.
An agreement was drawn up in 2001 between Venezuela and Cuba to improve the delivery of medical care in the poorest regions of Venezuela, through a project called Misión Barrio Adentro (BMJ 2006;333:464; doi: 10.1136/bmj.333.7566.464).
According to Jesús Mantilla, a Venezuelan health minister, the project reaches 95% of the population. He says that its doctors have provided more than 278 million consultations and have saved an estimated 74 000 lives.
But Douglas León Natera, president of the Venezuelan Medical Council, which is equivalent to the UK General Medical Council, claimed recently that the Cuban doctors are practising illegally.
In an article published in the Venezuelan newspaper El Universal he said, “They are not doctors, they practise medicine illegally and have created a serious public health problem because they are not familiar with the tropical diseases of Venezuela and lack adequate plans to control . . . contagious diseases” (www.eluniversal.com, 29 Jan, “9 años en conflicto permanente con los medicos”).
The law states that to practise medicine in Venezuela a doctor needs to have a degree from a Venezuelan university or must pass an exam to get their foreign qualification recognised. Doctors then need to register with a medical college. But the Cuban doctors are not registered, and their degrees have not been legalised. They are, therefore, working illegally, says Dr León Natera.
In 2003 a Venezuelan tribunal ruled that the Cuban doctors had to pass an exam to practise in the country, but the decision was ignored by the government. Despite the criticism from the Venezuelan Medical Council and international medical bodies, such as the World Medical Association, nothing has changed.
Two Cuban doctors who are now working in Spain, and who preferred to remain anonymous, told the BMJ that they understood the frustration of the Venezuelan doctors. But they pointed out that Cuban doctors are internationally renowned for their professional training and competence and that Cuban medical degrees are widely recognised.
They said that the Venezuelan Medical Council should have been involved in the negotiations that led to the 2001 agreement, which resulted in the Misión Barrio Adentro, but that the Venezuelan doctors should now focus on the legal battle with their government for the regularisation of foreign medical professionals working in the country instead of attacking the reputation of Cuban doctors.
The Venezuelan health system has poor infrastructure; lack of equipment and staff; and threats of infectious diseases, such as dengue fever, malaria, and tuberculosis.
Dr León Natera blames the government of the president, Hugo Chávez, for the deterioration of public health in the country: “This government has not got a public health plan and has refused all the proposals from the Federación Médica Venezolana to create a public health programme. There is no promotion of health, and the money from the oil business has been invested in political pacts.”
“Venezuelan doctors are second class doctors in their own country,” he added.
The situation is prompting Venezuelan doctors to leave the country, he claimed. In the past three years, about 45% of residents and specialist doctors have emigrated to the United States or Europe.
Dr Jesús Aguirre, the vice president of Spain’s Organización Medica Colegial, the Spanish organisation responsible for the registration of doctors, said that more than 1200 Venezuelan doctors have registered with the organisation in the past four years, and the figures have been increasing every year (www.cgcom.org/notas_prensa/2008/08_02_08_venezuela.html).
He stated in an article published on the organisation’s website that the Venezuelan Medical Council has publicly questioned the quality of the training and competence of Cuban doctors working in Venezuela.
He said, “The Federación Médica Venezolana believes that Cuban doctors have come to work in Venezuela out of political pacts rather than health needs, and this goes against the regulation of the medical profession.”
Many dissatisfied Venezuelan doctors have decided to leave clinical medicine altogether, Dr León Natera added. “The saddest part is that there are many doctors who have decided simply to work in . . . the informal economy, as taxi drivers, or street vendors, where they manage to earn much higher wages than the meagre salaries in hospitals.”
See the Venezuelan Medical Council at www.federacionmedicavenezolana.org.