With six-month pregnant belly, Jaqueline Teixeira Lopes, 23, is waiting for the arrival of little Pâmela in a climate of insecurity.
The Guaribas resident, in the rural Anguera area (155km from Salvador), visits the community health clinic monthly, after a prenatal calendar.
But he does not know how he will do it in the coming months – a doctor attending a health clinic is one in four Cuban programs More doctors working in the city and must leave Brazil by the end of this month after Cuba does not accept the conditions imposed by the elected president, Jair Bolsonaro (PSL), for reconstruction.
For Jaqueline, there is no other possibility. Four of the doctors in the primary health units in the city are Cuba, making Anguera one of the Brazilian cities that will be without a physician in basic care with the end of the contract between Cuba and Brazil.
To try to stop that impact, the federal government announced on Friday (16) that it would open a public notice to invite doctors and fill vacancies that were left without experts.
The National Confederation of Municipalities states that 1,478 cities have only Cuban doctors in their teams Doctors – but they can have doctors who are assigned or agreed in other programs.
The National Council of Utility Health Offices estimates 611 cities that could be without medical staff in the public network due to the lack of Cubans. Minas Gerais has at least 24 in this situation. Santa Catarina has another 23 completely dependent on Cuban doctors.
Bahia has 850 Cuban doctors in 311 cities. After leaving, 99 municipalities will lose at least 50% of primary health care doctors.
Another 11 Bahian cities have only Cubans in basic care and can be without a doctor next year. Along with Anguera, the list includes hinterland municipalities such as Nova Soure and Pedro Alexandre, and the Western Bahia, such as Correntina and Lajedão.
In Anguera, a city of 10,000, Cuban news reports are concerned about the inhabitants. He was afraid to return to the scenario five years ago when healthcare had no doctor.
At that time, most residents had to face a bus hour to reach the Feira de Santana, 45km.
Anguera's rural population, Sueli Gonçalves, 52, says it depends on doctors for treating a mother who is suffering from diabetes and Alzheimer's.
"They are always in the village to accompany my mother, I do not know how it will be without them," says Sueli, who criticized Bolsonaro: "He does the wrong thing, but God will not let our doctors leave," he says.
The wary neighbor, housekeeper Aurelina Oliveira, 47, is being treated for hypertension and remembers the difficulties due to the lack of physicians in the city: "The reality is that most physicians are in Salvador and do not want to come here," she says.
Presence of a doctor is also fundamental for pregnant women in the city.
Caretaker Simone Lima Ferreira, 22, had her son Samuela just seven days before and carried out all prenatal care at the health center in the urban area of Anguera.
"We do not understand why they go, I'm sad because they've always been very careful about us," says Simone.
In 2016, when he got a contract for the first meal of Cuban doctors who went to town, residents had a farewell party. "He was a goddamned cousin," recalls Rogério Brito, 55, radio station coordinator in the city.
Of the four physicians currently attending the city, two have established family ties in Anguera. One of them married the owner of the store.
City Health Secretary Anguera, Karine Ramos, says the Cuban experts of Mais Doctor will leave the city without supervision. And it takes the speed of the federal government to solve the problem: "Without a doctor, that will be a tremendous impact."
The situation is similar in other small towns in the country. According to the Pan American Health Organization, 35% of Cuban doctors working in Brazil are in municipalities where 20% or more live in extreme poverty.
This is the Lamarão case (188 km from Salvador), which has the 9th worst GDP (gross domestic product) per capita among 417 Bahia municipalities. Three out of four doctors are Cuban and must leave the city in the next few weeks.
In New Soure, which is also in the hinterland of Bahia, only four doctors – all Cubans – are concerned about the city's main focus, which has 25,000 inhabitants. "Without a strong doctor, there will be little demand in our hospital," says Nova Soure Health Secretary Ernesto da Costa Lima Junior.
Without being able to attend, residents of the city will have to travel to Ribeira to Pombal, 50km away: "It's the price for the city and the risk for patients," he says.
The distribution of Cuban doctors also indicates that at least 10% of the stock market is in the vulnerable regions, such as the semi-dense region, the Ribeira valley (SP), the Jequitinhonha (MG) valley and the Mucuri valley (MG). Another 6.5% is in one hundred cities with more than 80,000 people with low per capita income and high social vulnerability.
On this list are large centers such as Carapicuíba (SP), Belford Roxo (RJ), Cariacica (ES), Vespasiano (MG), Feira de Santana (BA), Caruaru (PE) and Altamira (PA).
Major cities and city areas also concentrate a good deal of Cuban doctors – 16.8%. In São Paulo there are 73 Cuban; 45 in Rio, 21 in Brazil and 15 in Fortaleza.
There is also a small percentage of Cuban doctors dedicated to caring for the indigenous population, 3.5% of the total but with immediate effect in some countries. In Bahia, 17 out of 18 indigenous communities attend exchange doctors and will be disbanded.
State Secretary of State Bahia, Stela Souza, defends the negotiating solution to alleviate the impact of a doctor's exhortation: "We must find a less painful way," he says.
The Cuban government's decision to call the doctors back was attributed to Bolsonar's positioning, which inter alia examined the qualifications of Cuban doctors and expressed intention to amend the agreement, requiring re-evaluation of diplomas and individual employment.