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

JP-CUBADOCTORS-master675Dr. José Angel Sánchez, now in Paterson, N.J., saw his medical school training as a route out of Cuba to the United States. Credit Bryan Anselm for The New York Times

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.

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 duringmigration 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.”


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