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HEALTH: Doctors from the Developing South Helping the North

Mario de Queiroz

LISBON, Aug 24 2007 (IPS) - There are not enough doctors in Portugal’s public health system, because too many have left to enter the private sector. This has forced socialist Prime Minister José Sócrates’ administration to seek rapid and drastic solutions, one of which is to attract doctors from the developing world.

One hundred Uruguayan doctors will travel to Portugal in the next few months to fill vacancies in the National Health Service (SNS), following an agreement reached between Lisbon and Montevideo, Health Minister Antonio Correia de Campos announced early this month.

The agreement, which emerged from meetings of the Iberoamerican health ministers, will be signed in late September during an official visit to Portugal by Uruguay’s left-wing President Tabaré Vázquez.

“This is an interesting example of the South cooperating with the North, which we find unusual, because normally the so-called developed countries help the developing countries,” Dr. Franklin Sanches, who has many years of medical experience in Colombia, Brazil and Mozambique, told IPS.

The international aid expert could not resist comparing the health agreement announcement with “the irony that the South American country Uruguay, only a few days before, had given a helping hand to Portugal, a European country, by solving the problem of damage sustained by the training ship ‘Sagres’ in the Rio de la Plata (River Plate).”

He was referring to the graduation voyage of Portuguese midshipmen, which was unexpectedly interrupted when the Sagres’ engine broke down on the leg between Rio de Janeiro and Buenos Aires. The ship was towed to Montevideo by the Uruguayan navy and repaired there, and thanks to this was able to continue its journey.

The Uruguayan doctors will be posted mainly to the Emergency and Resuscitation Medical Vehicles (VMER), “one of the most stressful public health services, where many young Portuguese doctors refuse to work, or do so for only a short time, while they wait for an opening in the far more lucrative private clinics,” said Sanches.

“Why Uruguay?” journalists asked Correia de Campos. Without hesitation, the minister answered: “Uruguay is the Switzerland of Latin America, has a medical school of high quality, a health minister who sympathises with our problem, and a surplus of doctors.”

The future transfer of young Uruguayan doctors to Portugal to work on the front line of healthcare was an idea that arose at the Iberoamerican Health Ministers Conference, one of the meetings leading up to the Iberoamerican Summit held in November in Montevideo, which in fact focused on migration as its central topic.

Uruguay, with 3.2 million people and about 13,000 doctors, is experiencing a brain drain of professionals and people who are highly qualified in different fields.

Part of the compensation envisaged is postgraduate training for this group of doctors, who will arrive by stages and remain in Portugal for a two-year period, the national subdirector for Health in Uruguay, Gilberto Ríos, told IPS. But he said the agreement was still under review, and may eventually include provision of technical materials by Portugal.

Meanwhile, this solution to the shortage of doctors for the VMER, which are part of the National Institute for Medical Emergencies (INEM), may encounter opposition from the Portuguese medical profession, which jealously preserves its privileges.

At a meeting with foreign correspondents last month, Correia de Campos told IPS that Portugal has, rather than a scarcity of health professionals, “an asymmetric distribution, and the worst situation is found around the big cities.”

Asked about the government’s attitude to the possibility of letting more doctors into the country, the health minister was categorical: “We gladly welcome foreign doctors who wish to practise in Portugal.”

At present there are 25,099 doctors in Portugal to care for a population of 10.2 million, distributed over 92,300 square kilometres, including the mainland and the Atlantic archipelagoes of the Azores and Madeira. The ratio of doctors to the general population is much higher than the World Health Organisation recommendation, which sets a minimum ratio of one doctor for every 900 people.

Among the total number of doctors, the minister said that “around 2,000 are foreigners, and the latest to revalidate their medical degrees were a group of 105 Ukrainians, through a programme financed by the Calouste Gulbenkian Foundation,” a private Portuguese institution for the public good which promotes the arts, charity, education and science.

But most foreign doctors and dentists in Portugal are Brazilian or Spaniards from Galicia. There is no language barrier between Portugal and Brazil, and Portuguese is very similar to Galician.

However, the openness of the socialist government in Lisbon towards foreign doctors, and the evident goodwill on the part of the general public towards their “Brazilian brothers” and “Galician cousins,” has not been enough.

The Medical Association’s excessive zeal and its powerful influence in the country has developed into what many young doctors see as a corporatist attitude.

When foreign doctors and dentists first began to arrive in Portugal in larger numbers, from the mid-1990s on, the legal barriers to practising both professions, such as the examinations to revalidate their degrees, were almost insurmountable.

“But little by little this attitude changed, and today the situation is much better,” Brazilian doctor Rosaidea do Nascimento, a specialist in acupuncture and traditional Chinese medicine, told IPS.

Do Nascimento is part of a team headed by Dr. Pedro Choy, one of the most distinguished specialists in his field, which has expanded vigorously since many Portuguese-Chinese came to Portugal when Lisbon handed back the enclave of Macao to Beijing in late 1999.

As for the alleged medical corporatism in Portugal, do Nascimento said she only felt competent to comment “on what happens in my field, not about foreign doctors in general.”

When they run out of solutions, “many Portuguese doctors come to us for treatment of their own problems, or their relatives’, or even their patients’, and this has changed their relationship with us,” she said.

Among the most significant bottlenecks to enter the exclusive medical club are the obstacles to creating new medical schools, and the requirement for an average mark of 19.2 on a scale of 10 to 20 for a secondary student to be accepted by a medical school.

A major goal of the leaders of the medical association “is to maintain the market laws of supply and demand, so that by restricting the number of doctors, patients can be charged high prices,” Sanches complained.

Frustrated by their inability to get in to medical schools in their own country, many Portuguese students are going abroad to study medicine, especially to Spain and particularly to the universities of Salamanca and Santiago de Compostela. However, this has also created conflict.

Fifty Portuguese students enrolled in 2007-2008 at the Faculty of Medicine in Santiago de Compostela, taking up one-sixth of the available places. This “Portuguese invasion” was criticised “by the parents of Spanish students who did not get a place,” the correspondent for the Portuguese Lusa agency in Galicia reported earlier this week.

But in Portugal, if foreign doctors are not incorporated into the SNS, the consequences could be serious. In 2006 alone, over 600 doctors left the SNS to go into private medicine.

These losses would not be so alarming, but for the fact that the Portuguese population is ageing and does not have full access to health care, and the government is being forced to close increasing numbers of emergency rooms, maternity wards and first aid posts, and to reduce the number of INEM ambulances because of the shortage of doctors, psychiatrist Pedro Afonso said as early as May in a column in the Lisbon newspaper Publico.

In his conclusion, he described a stark contrast between “loyal” and “atheist” doctors: the former continue to believe in the SNS, whereas the latter are unfaithful to the public service, and end up being lured away by private sector profit.