Mario de Queiroz
LISBON, May 15 2008 (IPS) – Cuba s offer to provide cataract operations for people who have been on waiting lists for years at Portugal s public hospitals triggered a reaction by the government and doctors, who may finally begin to provide a solution to this problem that affects thousands of elderly people.
Five Portuguese municipalities signed agreements with the Cuban government in order to avoid bureaucratic delays in the National Health Service (SNS), which was simply turning a deaf ear to the suffering of low-income elderly people who were on the brink of going blind.
The repercussions at the level of the socialist government of Prime Minister José Sócrates and the Medical Association, and among conservative politicians and heads of public hospitals and private clinics, followed almost immediately on wide local press coverage of the agreements this month.
Portugal could not bear the international embarrassment of having a so-called Third World country, often referred to disparagingly as banana republics by Europeans, provide the solution to a problem in a country in the industrialised North by making inroads into the backlog of patients waiting for eye operations.
The protocols with Cuba were signed between September 2007 and April this year by the mayors of the southern Portuguese municipalities of Alandroal, Aljezur, Castro Marim and Vila Real de Santo Antonio, and by that of Santarem, in the centre of the country.
The first to lash out at the five mayors who signed the agreements was the head of the conservative Medical Association, Pedro Nunes, himself a renowned ophthalmologist, who said sending patients to Cuba is pure political propaganda.
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The leader of the nationalist rightwing People s Party, Paulo Portas, seized the opportunity to join the chorus of condemnation, accusing Health Minister Ana María Teodoro Jorge of inertia for failing to prevent the new fashion of sending elderly people for surgery in Cuba.
The minister reported to parliament in April that nearly half a million people are waiting for appointments at Portugal s public hospitals, of whom 120,000 need ophthalmology services a situation she described as unacceptable.
After a meeting with the Christian charity Uniao das Misericórdias Portuguesas (UMP), Portas said that 15 UMP hospitals, financed by the national lottery, were capable of carrying out 3,000 cataract operations a month, and could solve the problems of 29,000 elderly people on waiting lists.
According to Teófilo Leite, the head of the Portuguese Association of Private Hospitals, there are agreements with the state to reduce the eye surgery backlog, but the SNS has cut down on the number of patients sent for private treatment.
A first appointment with an ophthalmologist can take up to four years, and there are 100,000 people on the waiting list, said Leite in an interview published May 3 by the Lisbon newspaper Público.
One elderly man who is almost blind told a television reporter last week that he had been waiting seven years for an appointment.
Given the delays in the SNS, the mayor of Aljezur, Manuel José Marreiros, decided to gather information on people suffering from cataracts in his municipality. He told IPS that he had found people who had been waiting for years for a simple appointment, and for surgery that only takes a few minutes.
For humanitarian and social reasons, we took the initiative of sending them to Cuba for the operation. It s not right that people should go blind just because they can t afford to pay for the operation in a private clinic, he said.
When Nunes called these initiatives political propaganda, he took a very unfortunate position on these humanitarian cases, in a desperate attempt to cover up the medical profession s possible responsibility in this matter, Marreiros said.
Before the patients went to Cuba for surgery, we never saw the Medical Association voicing their concern in public, he complained.
Marreiros also said that what was reported in Barreiro Hospital (on the outskirts of Lisbon), was humiliating for Portugal and its doctors. Several ophthalmologists at the hospital performed two operations a week, but when they hired a Spanish doctor he performed 234 operations in five days.
Nor did Nunes explain why an operation done by Portuguese doctors costs double the fee charged by the Spanish doctor, said the mayor, who said he thought the market is being dominated by practices intended to protect certain interests.
Around 10,000 people a year travel from Portugal to neighbouring Spain for operations, but we never heard Dr. Nunes talk about this phenomenon, which has been going on for years, said Marreiros, who concluded with a question: Why is the Medical Association so upset about Cuba? Could it be politics?
Joaquim Salazar Coimbra, the head of the health section of UMP, echoed Nunes, saying he thinks that the municipalities signed agreements with Cuba for political reasons. He also questioned the high costs to the municipality, of 1,800 dollars for each operation in Cuba, in addition to the 1,300 dollars for air fare.
Cuba s entry into the global market for ophthalmology services has driven prices down in Portugal, said Santarem Mayor Francisco Moita Flores of the conservative Social Democratic Party (PSD), in statements that were given wide coverage in the local press.
One illustration of this was provided by Ana Paula Gonçalves, administrator of the Faro Hospital in the far south of the country. She said she obtained a quote in October from a medical team in Lisbon which cost three times as much, but now that the Cubans are on the scene, I get quotes for the same price as it would cost in that Caribbean island nation.
I m talking about humanity, and he s talking about business, said Mayor Moita Flores, referring to Nunes.
Before Moita Flores entered politics, he was a police chief, magistrate and professor of criminology. In his view, the problem is about social and human rights. In my municipality there are people who are on the verge of going blind, because they don t have money for the operation, he stressed.
After receiving a recommendation from the mayor of Vila Real de Santo Antonio last September, Moita Flores compared prices and reached the conclusion that sending extremely poor elderly people to Cuba was much cheaper. In late April he signed the protocol with Havana.
Health Minister Teodoro Jorge gave the Portuguese Red Cross Hospital the go-ahead this month to carry out 2,900 cataract operations this year, twice the number performed in 2007.
Meanwhile, UMP head Manuel Lemos offered to carry out 3,000 cataract operations a month for the SNS in order to slash waiting lists, at a price that is competitive because, he said, they forget to include the air fare.
At that point Moita Flores counter-attacked. I m not talking business, but about people in need, who can t afford medicines, least of all in hospitals where even the bottled water has a price tag, as if it were an airport.
The advantage of sending patients to Cuba, according to the five mayors, is that during the post-operative period, when the elderly people stay in a hospital-hotel for two weeks, they are given a complete clinical examination and personalised nursing care, at no extra cost.
Antonio Freire, a young doctor, remarked ironically to IPS, I m against all antis, but the positive effect on health of anti-communism in this situation is amazing.
Ultimately, he said, it seems that anti-communism and the antibodies it has generated against Cuba have shaken up our government and the conservative Medical Association, so that two antis turned into a prescription for a speedy cataract operation at a much lower cost, and in Portugal.