Havana (AFP)

In one year, 9,000 Cuban doctors employed abroad had to return home after the cancellation of their contracts, applauded by Washington denouncing a slave system and politicized: for the island, it is a political and financial hard blow .

After Brazil in 2018, El Salvador, Ecuador and Bolivia ended the program, one of Cuba's most emblematic, which has since 1963 sent more than 400,000 health professionals to 164 countries.

For Havana, the culprit is obvious: Donald Trump. "The US government's crusade against Cuba's international medical cooperation is an insult," Foreign Minister Bruno Rodriguez tweeted on Thursday.

US Secretary of State Mike Pompeo also congratulated the countries concerned "for refusing to allow the Cuban regime to benefit from the trafficking of doctors", of which "75% of the salary" is kept by the Cuban authorities, according to the Undersecretary Michael Kozak.

The United States accuses the socialist government of "exploiting a slave labor force" and sometimes using these doctors as political activists in their country of assignment. Their ally, far-right Brazilian President Jair Bolsonaro, says that among the ranks of the doctors had infiltrated intelligence agents.

But Cuba also suffers from the political reconfiguration of Latin America, which has largely swung to the right.

- Main source of income -

In the case of Bolivia and El Salvador, sending doctors was a service provided free of charge by the island to its allies.

"Thousands of patients find themselves without medical services," said Dr. Luisa Garcia when she returned from La Paz. She and her colleagues were welcomed as heroes by an official delegation at the airport.

In Ecuador, however, the 382 professionals whose contracts were broken were paid by the local government, as were the 8,000 doctors who left Brazil at the end of 2018.

The bill of these forced returns? It does not yet appear in official statistics, which reported receipts of $ 6.398 billion in 2018. This sum makes it possible to finance the free health system.

The sending of doctors abroad "remains the main source of external revenue for the economy, and these are contracts difficult to relocate because they depend on agreements with governments, very sensitive to the political cycles", observes the Cuban economist Pavel Vidal, Javeriana University in Colombia.

In an interview with AFP, Dr. Michael Cabrera, deputy director of the Central Medical Cooperation Unit - a state agency that oversees the sending of Cuban doctors abroad - is confident.

"We knew we were not going to continue in Brazil and we have prepared (2019) according to this reality (...) We are in line with our forecasts, with the exception of Brazil which obviously represents a percentage among all our operations, "he explains.

- Low desertion rate -

While Washington denounces the threats against professionals wishing to leave the program, Dr. Cabrera recalls that a doctor working abroad gets "better profits than he can get in Cuba": he receives for his food 300 to $ 900 per month, depending on the country, in addition to his salary, about $ 50, which he continues to touch on the island.

Upon return, he finds his job and can easily import appliances.

In 2018, 34,000 Cuban health professionals worked in 66 countries, with a low rate of desertion according to Dr. Cabrera. Usually "more than 95%" of them come back, "99%" since 2016.

By the end of November, there were 29,071 in 63 countries, including 22 where the program is free, funded by Cuba.

First receiver: Venezuela, which hosts 20,070 health professionals, including 5,322 doctors.

In the future, Cuba hopes to boost its quota in China, Saudi Arabia, Kuwait, Vietnam and South Africa.

By encouraging countries to give up Cuban doctors, the United States, which has strengthened its embargo against the island, in force since 1962, continues their "economic aggression against Cuba, such as (sanctions against) tourism and sending money from Cubans from abroad ", with the aim of" depriving Cuba of income ", explains the political scientist Esteban Morales.

The next step could be to reactivate the program "Word", suspended in 2015, which welcomed Cuban doctors deserting abroad: the policy of Trump "has been increasing and we can expect it," according to Morales.

© 2019 AFP