The history of social and political thinking in Latin American countries, especially Brazil, Argentina, Uruguay and Colombia, reveals that since the end of the 19th century until the first decades of the 20th century important segments of medical elites participated actively in the elaboration and promotion of racist campaigns. These campaigns were defamatory and of xenophobic character, directed against Asian and Arab migrantes, against blacks and natives. Hygenization and eugenics were systematically practiced against those groups to limit and control their presence on national ground. The racial preaching becomes evident in “The BrazilianDoctor”, a publication by the Medical Academy of Rio de Janeiro from 1904:

"No doubt an imbecile white man is inferior to an intelligent black man. We do not argue though with exceptions. When referring to a race we do not individualize types of that race. Thereby we can see that the black caste equals backwardness; the white caste stands for progress and evolution... Dementia affects the blacks to a bigger extent. One might say they become demented more frequently because of their condition than the whites. ...” (Quote from “The spectacle of the races” by Lilia Schwarcz. p. 223)

Those practices are intrinsically related to “racist racial politics” which referred to the immigration of white European workers – preferably “Nordics” like Germans, Swiss and English, who were considered as superior in comparison with the “Latinos”, Spanish, Greek, Portuguese and those from Southern Italy.

Equally they received strong support by the state and by private capital by big land owners with the aim to “whiten” the Brazilian population, composed of “blacks, natives and mestizos”.

At that time, apart from the eugenic thinking of the medical elite, Brazilian racial thinking contributed to a racial vision not only in Brazil but also in various other parts of the world.

One exampe for this was exposed by the British historian Henry Thomas Buck (1821-1862). Like all racist theorists of his time Buck had a pessimist opinion about the country, even though he had never been there. While praising its natural beauty, he despised its inhabitants:

“No other place shows such painful contrast between the magnificent outside and the poor inside. (...) even with the present improvements by many of European origin there are no real signs of progress...”. (Thomas Buck, in: SKIDMORE, T, Black in White).

In this historic context, those practices were not very different in Europe, especially in Germany and Austria in the 1930s and 1940s. The Nazi ideology counted on a strong corps of professionals from the medical field, like surgeons, biologists, pathologists and psychologists. These elites were of fundamental importance to justify and disseminate in the minds of the German and Austrian working class of that time the opinion that Jews, Gypsies, madmen, homosexuals, people with special needs and others were “inferior and degenerated” beings or races and therefore needed to be physically eliminated, preferably by “scientifically” legitimised methods, like the gas chambers.
The animalistic association of Jews with the infestation of rats and other curses was common and contributed to the politics of extermination of the Hitler government.

We might for comparison also recall the radical Hutus of Rwanda and Burundi, who called the ethnic minority of the Tutsi cockroaches, opening up the way to a genocide in great scale which with the use of machetes and axes killed thousands of people, including moderate Hutu in 1994.

In the Brazilian case, the course of time does not seem to have produced so much change in the social imagery of the elites. Private and well organized public schools and, consequentially, places of excellence frequented by the middle and upper middle class – practically all whites – continue to monopolize the access to higher education, especially to courses of “high social prestige” like medicine, law and engineering. Only in the past decade, has there been a slight change due to the implementation of politics of affirmative action in all universities of the country, especially racial and social quotas.

The racial disparity amongst professional doctors in our campi continues to be absurdly disproportianal. The carefree conversations in social media suggest that there is still an easy association between a white in a white tunic and a white doctor. Doctors belonging to other racial groups, especially blacks, are seen with astonishment, disdain and prejudice since they differ from the white hegemony which the racist imagery associated with the doctors. The Cuban doctors and indirectly all other black doctors from any place of the world would not fit into the racially limited and, certainly, racist framing of the Brazilian medical elites. We are not short of examples to corroborate this perception. Only some weeks ago, Micheline Borges, a journalist from Rio Grande do Norte, stated in a social network her surprise in the face of the Cuban doctors, who, according to the journalists appeared like ((classical)) domestic servants.

It is important to underline that, according to this logic, she was as well shocked in the face of a possible mix of these universes/colours/races/classes.

In this case, the Cuban female doctors are referred to with an even worse mix of racism and sexism. Being black, a woman and a doctor is regarded negatively in an imagery in which these characteristics were always linked to an inferior condition.

Apart from class, race and gender aspects which structure the vocational training of any medical specialists, it is important to take into consideration that the curriculum of these professionals, which hardly ever comprises topics like human rights, social inequality, racism, feminism, etc from the viewpoint of human or social sciences. As a result, many doctors simply learn indifference, rejection or disgust towards the population.

This partly explains the racial, xenophobic and schizophrenic reaction of doctors and medical students in Fortaleza and other cities in the Northeast of Brazil upon the arrival of Cuban doctors, many of who were black. As everybody knows, Brazilian doctors hardly ever want to work in the rural interior of the country. They do not like the idea of living far away from the big urban centres and of attending to the poor population. It is therefore true that the hospitals and health clinics in most small towns are in a poor state. It is also true that there is a lack of state engagement in regard to medical careers, but also in regard to other health related professions. There is a lack of everything. Yet, even if those hospitals were well equipped – and there are rare cases of hospitals in good conditions - those doctors would not go there. They would not even go when earning more then 15.000 reais per month.

The rejection of Cuban doctors upon their arrival by associating them with “slaves” and “domestic servants” reveals the racist and class-based imagery of Brazilian “medical Whiteness” and of the bourgeois press, closely related to the first.

As already shown in numerous reports, (white) Brazilian doctors had taken on jobs in public hospitals and soon after left – result of a complete lack of commitment and disregard of public health.

As a result there were sick people in agony, forgotten, humiliated, piled up in the corridors and operating theatres of the hospitals and health clinics.

(Micheline Borges in a facebook post: Please forgive me my predjudices, but these female Cuban doctors resemble domestic workers. Are they really doctors??? Oooh, that’s terrible. A doctor usually has posture, looks like a doctors, departing from the appearance... Our poor population. Do they ((the Cubans)) understand what is dengue? Or yellow fever? God help our people!)

Nobody can guarantee that the programme “More Doctors” by the federal government will successfully meet all expectations related to it. There are many controversies in regard to the efficiency of the programme, and certainly it is not enough to hire doctors from abroad to solve a problem which is equally structural as well as depending on recent developments. A complete reformulation of public health policies will be necessary, which implies higher investments in health as well as a requalification of the programmes of medical education.

Already, the programme “More Doctors” has stirred up simbolic, social, corporate and racial privileges of an elite who benefitted from economic capital by neglecting to attend to certain groups of the population.

Therefore, we should stimulate a debate about public health, a more qualified debate than the current one. A debate in which the voice of those using the public health service will be given space, visibility and standing. A debate that does not reduce or neglect the relevance of the structural weak spots and challenges of our society, including those that are related to race, gender and class. The importance of this debate is proven considering how much time it took to approve and implement racial quotas and work regulations for domestic servants.

Who knows if, in 50 years time, with consistent programmes and successful policies of affirmative action for negros, indigenous and all parts of society who live in conditions of exclusion, we will have a different scenario. A scenario in which female and male black doctors will be seen with naturalness and respect and assessed only by professional criteria.

* Marcio André dos Santos has a PhD in Political Science and works as professor at the UFPI, Brazil. Sheila Dias has a masters degree in Social Work by the ESS/UFR, Brazil, and works as a professor at the UFOP, Brazil. Pablo Mattos is currently doing his PhD in Social History at the USP, FFLCH, Brazil.

* This article was translated from Portuguese for Pambazuka News by Janna Grieve.

* THE VIEWS OF THE ABOVE ARTICLE ARE THOSE OF THE AUTHOR/S AND DO NOT NECESSARILY REFLECT THE VIEWS OF THE PAMBAZUKA NEWS EDITORIAL TEAM

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