It might have been two young female doctors, interviewed in Costa Rica and part of the human flood flowing towards the US, who placed the issue in the spotlight. One of them, a young specialist, mentioned her "exceptional performance," as if her academic excellence exempted her from having to meet certain obligations towards those who paid for her career and specialization. Exceptional performance and the Talent Plan mean that doctors can directly go on to specialize after graduation, become residents and, after a few years, specialists in branch of medicine.
We have no idea how many doctors and medical personnel are among those Cubans stranded in Central America, but there can't be many, and there could have been many more if the Cuban government had not "coincidentally" published, on November 30, a statement reiterating its Decree 306, governing temporary leave for health professionals for personal reasons.
In all honesty, we must point out that the decree contains no new regulations. There was something similar to it years ago, which meant significant and unnecessary suffering for Cuban doctors and health professionals. In those days it was a regulation that few were able to see, and much less discuss, and one that usually separated families and doctors for more than five years.
Those were days of increased medical cooperation abroad, above all in Venezuela, with the Misión Barrio Adentro. In order for the regime to maintain thousands of doctors, hundreds of health workers were prevented from leaving. Many had family members in the US calling for them, or had won the Interests Section's lottery.
As the years passed many in these families had to emigrate, but the doctors remained, with all the consequences that this entailed. The response from officials was always the same, issued without a drop of compassion: the Ministry has not approved your release. "Release." What an appropriate word. But that sacrifice back in Cuba did not keep hundreds, perhaps even thousands of doctors from those missions in Venezuela, Brazil, Ecuador and Bolivia from becoming emigrants, or, as the regime calls them: "deserters." The best revenge: deserting.
In the interest of a balanced look at things, it must be said that if you live in Havana and Santiago de Cuba, and you take your child to the emergency room, and there's no cardiologist, or pediatric surgeon, or critical care physician present to save his life, you might very well agree with the Cuban government's regulation. Medicine is one of the most expensive fields of study all around the world. A medical specialization increases one's debt, and years are required to acquire the expertise necessary to handle severe heart disease, complicated surgeries, or patients connected to life support machines. It is a debt that must be paid. But that debt should not be eternal, or grant the lender a blank check. Before receiving their first class in Anatomy or Physiology, future doctors should know how much their studies and training are going to cost them, and how they are to pay it back. This is only fair, nothing more and nothing less than simple civic ethics and professionalism.
The historical plight of Cuban doctors is that things are almost never transparent, and rarely in their favor. This is what happens with their international missions, car and housing allowances, and job assignment locations once one has completed his service period. It works something like this: a decree is issued, and the bureaucrats decide when, how and where it is enacted. A decree, by the way, is not a law, because it has not been endorsed by the people or their representatives.
This is where the Hippocratic Oath falls apart. The Oath depends on the wills of nameless bureaucrats, the Government's policy commitments, and the egos of those who use their power to turn backpacks full of medication into boxes of bullets. The "chained physician" is trapped in an ethical dilemma: he feels entitled to break them, but, at the same time, it pains him to shirk the duty he accepted.
It turns out that Medicine, like Sports, is at odds with politicization. Medicine cannot be a business, nor can it be a political weapon, lest it lose its essence. Those who practice it in this way are degraded to the point that they do harm instead of curing. Humans are born with the intrinsic freedom to make decisions about their lives. And that right is not granted by any government, much less some civil servant. Nothing and no one can violate this principle without ultimately facing the consequences of their misdeed.
Thus, it is the Government's responsibility to ensure that its professional and technical human resources are able to make their own decisions, free of any political, ideological and even economic pressure, for when those who see to our health are confused, weary and poorly paid, their services reflect this lamentable state. Physicians also have the obligation to ensure that children, the elderly and pregnant women receive proper assistance, without excuses of any kind. In return our doctors and medical professionals do not deserve bags of food, or liters of gas, or reservations at the beach, but rather our respect for their dignity and recognition of their right, human and unassailable, to emigrate upon the fulfillment of their obligations towards society.