CUBAN DOCTORS SERVING POOR TO BE EXPELLED FROM HONDURAS.

The Honduran government, pressed by the country's medical establishment, has taken steps to expel Cuban doctors working in areas where local doctors have declined to serve. In May, a tripartite commission composed of officials of the Colegio Medico, the administration of President Ricardo Maduro, and the Facultad de Medicina of the Universidad de Honduras made the decision to rid the country of the foreign doctors. The move has provoked strong popular disapproval at a time when polls are showing that nearly half the electorate considers the Maduro government to be more corrupt than previous governments.

Health Minister Merlin Fernandez said the services of the 300 Cuban doctors have amounted to a donation of almost US$1 million annually since they first arrived following Hurricane Mitch in 1998. "Obviously," said Fernandez, "we are not going to leave these communities on their own, we will look for mechanisms to generate more resources so that Honduran doctors can substitute for them."

The medical establishment is apparently not too concerned with those communities. The president of the Colegio Medico said she expected that new Honduran doctors just graduating from Cuba's Escuela Medica de Latinoamerica (ELAM) would fill their positions. This will serve the dual purpose for the Colegio of covering areas unattractive to private practitioners and government doctors while reducing the threat of competition to Colegio members. "The students, when they come to Honduras, will occupy the places that at the moment the Cubans have," she said.

According to Honduran figures, 215 Hondurans were graduated with the first ELAM class and are to return shortly (see NotiCen, 2005-08-25). About 700 are currently in various stages of the program there.

Ever mindful of distorting market forces, Fernandez said that in the future Honduras would not be accepting any more free scholarships from ELAM. Hondurans already have about 700 such scholarships. They have a high number relative to the size of the country because ELAM opened in response to the need for doctors occasioned by Mitch.

Following the announcement of the departure of the Cubans, however, none have left. Foreign Minister Rosa Bautista told the media in June, a month later, that she had heard nothing from Fernandez. She said, "There is no official decision to request that the Cuban medical brigades leave."

The reason for the silence from the administration rested with the Congress, where the membership unanimously voted for the Cubans to stay. The deputies were quite taken with the free coverage, which includes equipment and supplies, and with the fact that the Cubans earn about US$100 a month with which they pay for their own food. Honduran doctors would earn US$700, plus expenses and medical supplies.

The bill to halt the removal of the Cubans was introduced by a deputy of Maduro's own Partido Nacional, Antonio Flores, who said, "It is incredible that they make campaigns against those who come to serve my country, because the Cuban doctors are not in the cities, but in the places where Honduras' marginalized are, where our Honduran doctors don't want to go."

The Congress passed a resolution asking Maduro to instruct Bautista to extend the agreement under which they practice in the country, which expires in December.

The Cubans will almost certainly become an electoral issue. Ramon Villeda Bermudez, a deputy of the opposition Partido Liberal (PL), guaranteed that, if his party wins the November elections, the Cubans would stay. He extolled the Cubans for "their generous and solidaristic labor in favor of the most poor, since they bring medical assistance to inhospitable and forgotten places."

As the administration struggles in solidarity with the medical establishment to improve the prospects for their own doctors, evidence that the state is falling down on the job of providing health services has surfaced. Two watchdog agencies, representing consumer and human rights groups, have completed an investigation into the availability of drugs in the hospitals. They have discovered that the medicines most in demand are in short supply in major areas, among them La Ceiba, La Paz, Yoro, Comayagua, and Francisco Morazan. The drugs in short supply include the most important antibiotics, and those specifically used for children.

The Health Ministry said the investigation supports what they have always said, that the demand for drugs is enormous and supply is impeded by logistical problems. An unidentified worker at the Almacen Central said that drugs have been sent to the departments but that they were not distributed to health centers because of inadequate transportation, with the result that the medicines had spoiled.

Fernandez assured the media that the government has put the problem out to bid and all will be well when a distribution program is up and running.

Government's position stirring protest

Putting health problems out to bid will not, however, solve the political problems the government's stance toward the Cubans is brewing. Workers, students, mayors, and health professionals have begun planning a series of protests against the administration.

After the Congress acted, the government backed off somewhat, claiming it was negotiating an agreement with Cuba to channel its doctors and technicians into work that fits better with the bourgeois medical model and away from primary care for the most needy. Under this regimen, the Cuban presence would be reduced by half and reassigned to specialty niches.

This retrenchment did not sit well with the disgruntled. Juan Barahona, coordinator of the Bloque Popular (BP), in reiterating the argument for retention of the Cubans, added one more to the list of reasons for leaving the system to function as it has. "They have gained the affection, the confidence, and the respect of the most humble of Honduras," he said.

The vice president of the Asociacion de Municipios (AMHON), Jesus Hernandez, roundly castigated the Colegio Medico and Fernandez, and said the BP, composed of 30 separate organizations, "intends to block the highways and occupy the public hospitals to prevent the government from removing the Cubans." He said, "To reduce the brigade from Cuba would be a crime against humanity by the government and against its own poor people."

Hernandez is mayor of Colinas, about 200 km west of Tegucigalpa. Almost 300 mayors like him comprise the AMHON membership, and Hernandez is certain they will fight. "With this measure the government is trying to leave more than 2.5 million Hondurans without medical services, and the mayors will battle so that this doesn't happen."

AMHON is prepared, said the official, to prevent the departure of the doctors by whatever means necessary. He predicted a "social convulsion" if the government does not give up on its plans.

AMHON and other organizations were further infuriated by a recent statement from Foreign Relations Minister Mario Fortin that the Cubans were going to leave.

In Cuba, President Fidel Castro demanded that Honduran officials notify his government before Sept. 1 if they no longer want the doctors. "I asked that they tell us the day for us to proceed to organize the immediate withdrawal of our doctors. We are awaiting a reply." Castro said he was angry that he had to learn of all this from a newspaper. Castro's reaction puts in doubt Maduro's contention that he has been in negotiations with the island regarding the redeployment of the medics. [Sources: Notimex, 06/20/05; Spanish news service EFE, 08/23/05; El Tiempo (Honduras), Nuevo Herald (Miami), World Data Service (Cuba), 08/26/05; Agence France-Presse, Associated Press, 08/27/05]