HAVANA — He knew as a child that he wanted to be a doctor, like his father. He went to medical school, became a general surgeon and ultimately a heart specialist. He practiced at Cuba’s premier cardiovascular hospital, performed heart transplants, and published articles in medical journals.
For this, Roberto Mejides earned a typical doctor’s salary: about $40 a month.
It wasn’t nearly enough, even with the free housing and health care available to Cubans, to support his extended family. So in 2014, Mejides left them behind, moving to Ecuador to earn up to $8,000 a month working at two clinics and performing surgeries.
It’s a common story here, where waiters, cabdrivers, and tour guides can make 10 to 20 times the government wages of doctors and nurses — thanks to tips from tourists.
“Doctors are like slaves for our society,” said Sandra, an art student and photographer’s assistant who makes more than her mother, a physician. “It’s not fair to study for so many years and be so underpaid.”
Cuba is proud of its government-run health care system and its skilled doctors. But even with a raise two years ago, the highest paid doctors make $67 a month, while nurses top out at $40. That leaves many feeling demoralized — and searching for ways to improve their lives.
Some enter the private economy — by renting rooms to tourists, driving cabs, or treating private patients, quasi-legally, on the side. Thousands of others accept two-year government assignments to work as doctors abroad, collecting higher salaries for themselves and earning billions for the state, which helps keep the stagnant economy afloat. In fact, health workers are Cuba’s largest source of foreign exchange.
A few doctors, like Mejides, arrange foreign employment on their own, putting at risk their future ability to return to a government job in the health system back home.
“It’s hard to migrate and be alone,” Mejides said in Spanish, during a video phone call from Ecuador to a reporter visiting Havana in October. “It’s stressful. I am in the wrong place. I should be with my family in my country, working and being rewarded properly.”
Still, with his Ecuador earnings, he was able to buy his wife, two daughters, and two stepdaughters a $23,000 apartment in Havana, and he sends them $300 to $500 a month.
While doctors back in Cuba grumble about their low pay, they usually find ways to make do.
Sandra’s mother, Nadia, a genetics researcher, earns about as much as she pays a cleaning woman to maintain her three-bedroom Havana apartment. Whenever she can, she rents one of those rooms to tourists for $40 a night, making more in two nights than she does from her monthly earnings as a doctor. She asked that her full name not be used to avoid any problems with the government.
The rental income allows Nadia to have a modestly comfortable life and to be able to buy fruits and vegetables at farmers markets. But a restaurant meal is a rare treat, and traveling abroad is impossible.
Still, she loves her work and the intellectual challenge of her research into genetic diseases. She said many Cuban doctors are committed and provide excellent service, in part because of the ways they have learned to overcome shortages of equipment and technology.
“We don’t have all the electronic tools, so we have to learn to do things other ways, to diagnose just by external examination,” she said, over a dinner of fish and rum at her apartment.
She’d like to earn more money, of course, and she understands why so many doctors, including many she knows, have chosen to leave Cuba.
“I’m not ambitious for money,” she said. “I get rent from visitors, and I get to live in Cuba. I have a nice house, and I’m happy with what I have. But I’m not a millionaire.”
Cecilia, a 60-year-old former nurse who also asked that her full name not be used, spent 25 years working in government hospitals and clinics. To adapt to the shortages, she learned to make inventos medicos — medical inventions — using a chair or bench to raise the back of a patient’s bed, for example, or cutting the tip off an intravenous line to fashion an oxygen feed to a patient’s nose.
But she became disillusioned by the chronic shortages and the stress she saw in both her patients and colleagues.
“The material scarcity is so overwhelming that it keeps people from dedicating all the passion, love, and brain power that they should to their patients in need,” she said, sitting in a rocking chair in her third-floor Havana apartment. “I was the one who had to face the patients and tell them we don’t have the drug that you need. It was very common. And I didn’t want to do that any more.”
Doctors and nurses “have the best intentions, but they face so many obstacles, there are so many things on their mind,” she added. “The doctor might be treating a patient but they are actually thinking: ‘When I get home, at God knows what time, what am I going to feed my kid?’”
She quit nursing in the early 2000s and later began to pursue her passion, doing hands-on alternative medicine that combines techniques of massage, kinesiology, magnetic therapy, and so-called floral therapy, which uses extracts of flowers and herbs as healing agents.
Her work with private clients, who come to her apartment, is permitted under a license for massage, the only form of healing work included on a list of government-approved private services and businesses. Working three days a week, she earns almost $120 a month “if all my appointments show up,” she said. “I use to make that in six months working at the hospital.”
In the years after Fidel Castro seized power in 1959, Cuba invested heavily in education and science, training tens of thousands of doctors, nurses, and scientists. As a result, Cuba, a country of 11.2 million people, today has 90,000 doctors, the most per capita in the world.
About 25,000 of these doctors, along with 30,000 Cuban nurses and other health professionals, are working in 67 countries around the world. They earn about $8.2 billion in revenue for the government, according to a recent article in Granma, the official paper of the Cuban Communist Party.
The bulk of the doctors, about 20,000, are in Brazil and Venezuela. Over the last three years they provided treatment to 60 million Brazilians, mostly the rural poor, said Cristián Morales Fuhrimann, the Pan American Health Organization’s representative in Havana.