Every day, Cuban doctor Ramona Matos invented the names of as many as 30 patients she had never seen in San Agustín, a town in the Bolivian Amazon.
The doctor was part of Cuba’s medical mission in that country in 2008. But Matos realized that the Cuban government inflated the statistics related to the cooperation program when she was compelled to do the same for her supervisors.
On her first day at work in Bolivia, Matos called her boss to inform him that she had not seen any patients.
“He told me, ‘You have to invent names, invent diagnoses,’ and that’s what I did for a month. If not, he would send me to Cuba to be punished and without access to the money from my salary that they deposited in a bank account in Cuba.”
But Matos said that the greatest “horror” was the destruction of medications.
Cuban doctors in Bolivia not only made up the names and addresses of patients they had never seen, they also faked diseases and diagnoses, accompanied by drug prescriptions for treatments that never happened.
But those medications, sold by Cuba to the host government, ended up in the trash or the toilet, destroyed so it would appear they had been used by the fake patients.
“When the medicines were left over, you had to throw them away, incinerate them, bury them, make them disappear, because the Cuban government had to justify [the existence] of those 30 patients, whom they knew were fake, with drugs that were in the pharmacy and were there to be given to the patients for free,” Matos said.
She spoke during a press conference organized by the U.S. State Department last week to call attention to what the doctors called “forced labor” in the so-called medical cooperation missions of the Cuban government.
It is unclear how the Cuban government would benefit from manipulating statistics, but according to the testimony of three other doctors who spoke during the press conference and were interviewed by el Nuevo Herald, such fraudulent practices also took place in Venezuela, where Cuba maintains about 20,000 doctors and other health workers as part of an agreement to exchange their services for oil.
“I was on a mission in Venezuela between 2007 and 2014, and it is the absolute truth,” said Dr. Tatiana Carballo. “You had to invent the names of the patients and according to the disease, invent the statistics ... and destroy medicines even if they were not expired.”
Fidel Cruz, another doctor who was part of the official mission in Venezuela from 2011-14, said that all kinds of medicines manufactured or acquired by the Cuban government were destroyed, “from dipyrone to antibiotics, ampules, glasses and medicines that could not be found in Cuba.”
“Sometimes I would grab a bag [of medications] and distribute them house by house. We couldn’t have them” in the office, he added.
Meanwhile, Cubans were suffering from shortages of medicines, a situation that has become chronic. In 2016, 100 medications were in short supply in Cuba. In April of this year, 85 were missing from pharmacy shelves.
Cuban supervisors, officials of the Ministry of Public Health and state security agents were aware of the manipulation of statistics and the destruction of medications in the missions, the doctors said.
Cuba promotes the export of medical services as humanitarian cooperation missions, but they have become the country’s single largest source of income, $6.4 billion in 2018. Currently, Cuba has medical personnel in 65 countries, in a system controlled by Comercializadora de Servicios Médicos Cubanos, SA, a company under the Ministry of Public Health.
In recent years the irregularities that plague the system have surfaced.
Several doctors who have defected have said that the Cuban government pockets most of the money that foreign governments pay for their salaries. They have also testified that Cuban government officials and security agents retain their passports and control their movements in the countries to which they are posted, and force them to carry out political work with the local population.
In the elections of 2013 in Venezuela, “I had to go out to the streets to knock on people’s doors and encourage them to go to the polling stations and vote for [Nicolás] Maduro,” said Cruz. The doctor said he then had to write a report about the number of people he had taken to the polls and whom they had voted for.
State security agents in charge of surveillance over the doctors posed as advisers and “legal coordinators” of the missions, said Dr. Rusella Rivero. “The legal coordinator was like the maximum expression of Cuban state security; they were in charge,” she said.
In Brazil, where the government of then-President Dilma Rousseff negotiated the creation of the Mais Medicos program with the Cuban government, several doctors, including Matos, publicly denounced their meager salaries and the harassment by Cuban authorities, who didn’t want the doctors to bring their families from Cuba to live with them in Brazil.
The presence of Cuban “advisors” with doctors’ cover in Brazil also emerged in a leaked video of a meeting between members of the Brazilian government and Pan American Health Organization (PAHO) officials in the middle of an investigation in Brazil about the legality of Mais Medicos.
Cuba withdrew from the program at the end of last year when the new president of Brazil, Jair Bolsonaro, demanded, among other conditions, full payment of the salary to the doctors.
In addition to Matos, Caraballo, Cruz and Rivero also worked as doctors in Brazil. They claim that all these practices constitute “forced labor” and “human trafficking” in a lawsuit filed in Miami federal court against PAHO, which acted as an intermediary in the Mais Medicos program.
The doctors’ lawyer, Sam Dubbin, believes that PAHO, serving as an intermediary in a commercial agreement in which the Cuban government kept up to 85 percent of the doctors’ salaries, “acted beyond the limits of its authority” and should not be able to claim immunity as an international organization under the auspices of the United Nations system.
If the lawsuit succeeds, the case could establish in a federal court that Cuban government practices in those missions violate U.S. and international laws against forced labor and human trafficking.
But the case could take several years to resolve. Meanwhile, the Trump administration, which has increased pressure on the Cuban government for its support of Nicolás Maduro in Venezuela, has launched a campaign for other countries to stop hiring the services of Cuban doctors under such conditions.
On Monday, the State Department denied visas to the Cuban minister of public health and a delegation that planned to attend a high-level PAHO meeting in Washington.
“What Castro presented as a humanitarian program turns out to be a cash cow for the #CastroCronies,” State Department spokeswoman Morgan Ortagus wrote on Twitter. “We call on governments that currently engage with Cuba’s overseas medical programs to ensure safeguards against labor abuse and exploitation.”
Follow Nora Gámez Torres on Twitter: @ngameztorres