VZCZCXRO9636
RR RUEHIK
DE RUEHLI #0614/01 3411503
ZNR UUUUU ZZH
R 071503Z DEC 09
FM AMEMBASSY LISBON
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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