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HEALTH-PORTUGAL: Latin American Doctors Fill the Breach

Mario de Queiroz

LISBON, Jun 27 2008 (IPS) - Portugal is trying to fill the vacuum left by the departure of many of the 2,000 Spanish doctors who have been contributing to the normal functioning of hospitals and clinics in the interior of the country, with Argentine, Cuban and Uruguayan doctors.

Many Spanish doctors who spent years in Portugal weathering the storm of a lack of health posts in their own country due to an excess of medical school graduates are now responding to a call to return to Spain, issued by the government of socialist Prime Minister José Luis Rodríguez Zapatero.

As the Portuguese National Health Service (SNS) acknowledged, medical services, especially in border areas, are already suffering from the loss of Spanish personnel.

The most likely solution “lies on the other side of the Atlantic,” Dr. Rui Sousa Santos, head of the Beja Hospital in the capital of the southern region of Baixo Alentejo, one of the areas most affected by the exodus of Spanish doctors, told the local press.

In July, Uruguayan doctors are due to start working in Medical Emergency and Resuscitation Vehicles (VMER) under a cooperation agreement signed by Lisbon and Montevideo last year during Uruguayan President Tabaré Vázquez’s official visit to Portugal.

The solution to medical staff shortages in the VMER, which are part of the National Institute of Emergency Medicine (INEM), were 100 Uruguayan doctors, according to local press reports in August 2007, quoting then Health Minister Antonio Correia de Campos.

However, Pablo Porro, an adviser to the Uruguayan Embassy in Lisbon, denied the figure reported in the Portuguese press, and told IPS that “from Jul. 1, only 15 Uruguayan doctors will begin working for INEM, in accordance with the agreement signed in late September.”

In addition to the emergency personnel, “two or three teams of specialists, totalling some 10 doctors, will be coming to Portugal,” the diplomat said.

The Portuguese medical profession, jealous of its privileged status, was for once obliged to face the reality of a possible total collapse of the public health system if they continued to object to foreign doctors working in the country.

Poland and Ukraine have a surplus of doctors, but they are being absorbed by Germany, which offers more attractive salaries and is closer to their countries.

Sousa Santos predicts that Latin American doctors will provide the most viable solution, because medical schools in many countries in that region train thousands of good doctors, many of whom do not find work, “which makes it easy to hire them,” as was the case of Spanish doctors a decade ago.

In the late 1990s, Spanish doctors began migrating to Portugal, especially in border areas and particularly in the northern Portuguese regions of Minho and Trás-os-Montes, which border on the Spanish regions of Galicia and Castilla, and the southern region of Alentejo, which borders on Extremadura and Andalusia.

Carlos López Salgado, deputy head of the Association of Spanish Health Professionals in Portugal (APSEP), told the Lisbon newspaper Publico in an interview on Jun. 19 that he moved to Ponte de Lima, in northern Portugal, nine years ago because he was “fed up with the arduous task of practising medicine in Spain.”

There were so many medical graduates that most of them could not find work in the public health service, so many young doctors, especially Galicians whose language is very similar to Portuguese, came to Portugal where they could find stable employment. In 1999, nearly 20,000 candidates applied for 3,000 posts for doctors and nurses in the Spanish health services, whereas in Portugal that year, 900 people applied for 800 posts in the national health service (SNS).

However, Portugal now has a crisis on its hands, as Madrid has called on Spanish doctors to return, and is offering much more attractive salaries. In addition, according to the Portuguese doctors’ union, 800 doctors left the SNS between 2006 and 2007 for the private sector, where they can earn over twice as much.

The former steady flow of Spanish doctors into Portugal, especially from Galicia, Extremadura and Andalusia, “has virtually come to a halt,” said López Salgado, who explained that “now Spanish doctors are seeking job opportunities in their home regions.”

APSEP statistics indicate that in 2002 there were 3,000 Spanish health professionals working in the Norte region of Portugal, most of them at polyclinics. By 2007 their number had fallen to between 800 and 1,000. In the southern Alentejo region, where five years ago 400 doctors from Extremadura were practising, there are now under 150.

At present, although there are no official figures, APSEP estimates that there are about 2,000 Spanish health professionals in Portugal – 80 percent doctors and 20 percent nursing staff.

Pedro Nunes, the head of the Portuguese Medical Association, raised the alarm level by pointing out that in some areas of the Trás-os-Montes region, nearly half of all health professionals were Spanish.

Nunes painted a gloomy picture of the vulnerability of Portugal’s SNS if the contribution of Spanish doctors is withdrawn, citing as an example the emergency service at Ponte de Lima, where 14 out of the 16 staff doctors are Galician.

The north is the region that will suffer most when Spanish doctors return to their country, as there are high numbers of Galician doctors at health units in Chaves, Montalegre, Boticas and Miranda do Douro.

In other areas, too, the situation is worrying. Out of the 103 doctors in the Baixo Alentejo region, 38 are Spanish. In the southern Algarve region, 20 percent of the doctors are Spanish, as are 24 percent in the northern port of Viana do Castelo.

Why are doctors coming to Portugal from Argentina, Cuba, Uruguay and possibly other Latin American countries not yet named, rather than from Brazil, which seems the logical choice from the point of view of language and a degree of shared culture?

The Medical Association’s reply is that it considers those countries to offer an excellent university training, in contrast to many Brazilian universities.

Nunes called attention to the risk of hiring health professionals whose training is not up to Portuguese standards. He said that Brazil, for example, has close to 130 medical schools, but only 25 are of high quality, some of them being “even better than Portugal’s.”

However, while on one hand the Medical Association cannot ignore the crisis that would afflict the health system if foreign professionals are not hired, “on the other hand it is always eager to safeguard its privileges,” a young doctor who is also a civil society activist told IPS.

Speaking under condition of anonymity for fear of reprisals from the Medical Association, he said that “the idea that Portugal has the best doctors in the world has been generally accepted by the public for decades,” because in order to be selected by the medical schools, grades of 19 or 19.5 out of 20 are required.

However, “having been a good student in high school, and having a good memory in order to pass admission exams, does not make us the world’s best doctors, as can be seen from the high number of deaths due to medical negligence that occur every year in Portugal.”