U.S. and Cuba at Odds Over Exodus of the Island's Doctors

U.S. and Cuba at Odds Over Exodus of the Island's Doctors
By VICTORIA BURNETT and FRANCES ROBLES DEC. 19, 2015

As he came of age in Cuba, José Angel Sánchez enrolled in medical school
for the usual reasons: to help the sick and to make a better living than
most in his destitute eastern town. But he had another motive, too.

"It was also a way out of Cuba," said Dr. Sánchez, 29, who moved to the
United States in September, four years after he graduated as a general
practitioner.

Dr. Sánchez's escape route was set up by the United States government,
under a 2006 program that offers American residency to Cuban medical
workers posted overseas. It is a door through which thousands of Cuban
health workers have emigrated — and one that President Raúl Castro is
determined to close.

One year after Cuba and the United States announced their thaw, policies
like this, which hail from a more hostile era, show that diplomacy after
five decades of tensions will not be as easy as the raising of embassy
flags. The number of Cuban medical professionals who defected for
residency in the United States reached a record this year, putting a
crimp in the newly restored relations between the two countries and
forcing Cuba to scramble to stop the exodus.

The Department of Homeland Security fast-tracks residency for Cuban
medical professionals who defect, but it has been slowed by the swell of
applications, accusations of fraud and delays that left hundreds of
people like Dr. Sánchez stranded in Colombia for months this year.

In April, 18 months into his two-year medical posting in Venezuela, Dr.
Sánchez traveled to Bogotá, Colombia. There, he applied for the Cuban
Medical Professional Parole Program at the United States Embassy. But
the process, which normally takes four to six weeks, stretched to five
months. "I always planned to leave — somehow," said Dr. Sánchez, now a
medical assistant in Paterson, N.J.

Cuba denounced the program in recent weeks as the two nations met to
discuss American immigration rules that give Cubans special
opportunities to enter the United States and become residents.

With so many Cubans worried that the coveted status will melt away now
that diplomatic relations have been established with Havana, there has
been a wave of people from all professions leaving the island over the
past year.

That has created a migration crisis, the Castro government contends,
stranding thousands of Cuban migrants in Central America as they try to
make their way over land to the United States.

The issue is a potent reminder, analysts say, of the stubborn
differences that continue to divide the two governments despite the
thaw. Robert Muse, a Washington-based lawyer who specializes in United
States-Cuban law, called the medical workers program an "exploding cigar
left over by the Bush administration" that President Obama should
eliminate.

"No country is going to welcome engineered defections of its nationals,"
Mr. Muse said. The United States, he said, was "not acting in the spirit
of normalized relations."

Cuba's health system is a source of great international prestige for the
government, which provides free training to thousands of Cubans and poor
foreign students. The state offers universal, if far from perfect,
medical care to its citizens and has won praise — even from the Obama
administration — for sending medical brigades to help overseas.

Medical diplomacy is also an indispensable source of income: Cuba rents
out the services of tens of thousands of doctors, nurses and dentists to
other developing countries in exchange for billions of dollars' worth of
oil and cash.

Such rewards, though, are won on the backs of medical professionals who
work for little money in tough conditions, doctors say.

Dr. Lino Alberto Neira, an orthopedic surgeon who practiced in Cuba for
23 years before he left for Miami in 2013, said that his monthly salary
of $25 back home barely lasted four days. He got by with tips from
patients who worked in tourism, he said.

"Someone who cleans floors in a hotel is supporting you," said Dr.
Neira, speaking from Miami. "That's very humiliating."

Cuba more than doubled some doctors' salaries last year, to about $70 a
month. But faced with such small salaries at home, many doctors accept a
posting overseas to make extra money.

Still, they earn only a fraction of what the host country pays Cuba for
their work.

Dr. Mara Martínez, a dentist who is Dr. Sánchez's fiancée, said she was
a staunch supporter of the Cuban revolution but became disillusioned
when she arrived in Venezuela to find that she had to work six days a
week and sleep three to a room for a salary of $210 a month. Venezuela,
she was told by her supervisors, was paying $7,000 per month for her
services.

"It's modern-day slavery," said Dr. Martínez, 25, who left Venezuela
with Dr. Sánchez.

Many of the doctors in Venezuela are stationed in cramped quarters
without air conditioning, overwhelmed by the country's soaring inflation
and deteriorating economy. "It was worse than Cuba," said Dr. Dailanis
Barbara Martínez Peralta, a general practitioner who after leaving
Venezuela waited seven months in Colombia to come to the United States.

More than 7,000 Cubans have been approved for residency since the
program began almost a decade ago, according to United States
Citizenship and Immigration Services.

According to Homeland Security statistics, 1,663 Cuban medical
professionals posted overseas were accepted to enter the United States
in the 2015 fiscal year, a 32 percent increase from the year before. The
number of doctors admitted to the program has more than tripled since
2011, when 386 people were approved.

Cuban officials have repeatedly assailed the medical parole program as a
"reprehensible practice" aimed at "stealing" Cuban talent. A State
Department official, who spoke on the condition of anonymity, said the
United States "does not recruit Cuban medical professionals," but simply
gives them a voluntary route to residency.

In the spring, American approvals of doctors seeking asylum through
Colombia slowed considerably, in what analysts took to be a gesture of
good will as the United States prepared to open an embassy in Havana.
The State Department denied any connection between the delays and
warming relations, and said there were no "immediate plans" to scrap the
parole program.

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The Department of Homeland Security suggested that the delays were the
result of the increased number of applicants. Dr. Martínez said that out
of a group of 250 or so medical workers who were stranded, along with
her and Dr. Sánchez, all but a dozen were eventually given residency.

An American official who was not authorized to discuss the issue
publicly said that the program had been held up because some applicants
had presented fraudulent credentials, which caused the government to
rigorously review documents.

The Cuban government said it raised the issue of the program during
migration talks with American officials late last month, but Cuban
officials did not respond to emails or calls requesting further comment.

The day after the talks, Cuba announced that starting Dec. 7, specialist
doctors would have to get permission to travel abroad, reverting to a
restriction lifted two years ago and deeply angering many medical
professionals on the island. The move came just three months after the
Cuban government issued a call for doctors who had defected to come
home, promising them the opportunity to attend conferences and resume
their careers.

Jorge Duany, director of the Cuban Research Institute at Florida
International University, said the decision to restrict travel was "part
of the chess game," intended to put pressure on the United States to end
the program and revise other regulations that offer residency to almost
any Cuban who makes it to a United States border. One surgeon in Havana
who asked that his name not be used said that the Cuban government's
restrictions had not surprised him because "so many doctors are leaving."

"It's been a long time since you can live off a doctor's salary," he
said, adding, "Those who aren't leaving — it's because they can't get
the money together for a plane ticket."

According to the United Nations, Cuba has one of the world's highest
rates of physicians per capita. But with so many deployed overseas,
medical workers are fewer and less experienced than before the large
overseas deployments began in the early 2000s, health workers and
ordinary Cubans complain.

Medical professionals from any country who migrate to the United States
often find that their credentials are inadequate and that the jobs that
are available pay poorly.

In Miami, Dr. Neira is caring for an older Cuban man and studying to be
a nurse because his Cuban qualifications are not recognized. In
Paterson, Dr. Sánchez, who works on a ragged downtown strip in a job
that pays $15 an hour, said he planned to do the same. First, though,
Dr. Martínez, his fiancée, will try to get her dentistry license.

There are days, said Dr. Sánchez, especially weekends, when Paterson
gets him down. "You start to think about family," he said. "About your
neighborhood. About what everyone would be doing on a Sunday. About the
baseball game."

Still, he enjoys his freedom and appreciates how Americans mind their
own business. He would like to move to Miami, where there is year-round
sunshine and a big Cuban population. "We depend on our own efforts, on
getting our careers off the ground," he said. "We're going to make it."

http://www.nytimes.com/2015/12/20/world/americas/us-and-cuba-at-odds-over-exodus-of-the-islands-doctors.html?_r=1