Angelita Santos cried when she heard the doctors were leaving. The health director in a town in the south-eastern state of Sao Paulo, she was aghast to hear Cuba was pulling out medical staff that kept facilities in Brazil's neediest regions afloat.
"We were rocked by the news. The doctors called us that morning in tears, and we were in tears too," she said. Her town of Embu-Guacu had 19 doctors for its 70,000 residents only last week. Now, amid a diplomatic rupture between Havana and Brazil's new far-Right president-elect, it had been left with just two.
"We're praying that replacements come soon. We can't handle the demand of patients," she said.
Health centres around Brazil have been left severely short-staffed after the Cuban decision, prompted by repeated verbal attacks on the More Doctors programme by Jair Bolsonaro ahead of his January 1 inauguration.
The hard-Right politician, dubbed "the Trump of the Tropics", has upended relations between Brazil and Cuba, which for much of the last two decades have formed a strong regional alliance, along with countries such as Venezuela, Ecuador, Bolivia, Argentina and Nicaragua.
But that tide is now turning, with Bolsonaro flexing his muscles before even taking office. A staunch opponent of Cuba, Mr Bolsonaro promised at several campaign rallies to kick out the Cuban doctors.
The More Doctors programme employed 8,332 Cuban personnel, many of which have already left, leaving Brazil's primary healthcare system in crisis. The rest are expected to leave by December 10, amid what the Cuban health ministry has called a "lamentable situation".
Cubans accounted for almost half of the 18,240 doctors brought in from overseas under the programme, launched in 2013 to improve healthcare in poorer regions of Brazil.
Bolsonaro last week claimed that "there is no proof they are actually doctors", despite the submission of a valid medical degree being a prerequisite for the programme.
"It's a worrying situation," said Mauro Junqueira, president of the National Council of Municipal Health Departments. "The Cuban doctors were welcomed here, they did a great job," he said, adding that he hoped Brazilian replacements would fill the breach. On Tuesday, the Brazilian government hurriedly released an emergency tender to fill the jobs. As of Friday morning, health ministry officials said 84pc had been filled.
Last year, the health ministry posted 2,320 new vacancies within the programme, for which 6,285 Brazilian doctors applied. However, only 1,626 showed up to work, and one third resigned within their first year.
The perception is that the Cuban doctors filled the jobs that Brazilians do not want.
There is an average of 5.07 doctors for every thousand residents in Brazil's state capitals, but just 0.3 in towns of less than 5,000 inhabitants, according to official data. (Ireland has about 2.8 per thousand people.)
It is not the only blow to those living in Brazil's rural regions. Bolsanaro has back-pedalled on his promise to scrap the environment ministry but is set to name a deputy who will roll back protections against deforestation and loosen environmental laws. Bolsanaro's pick for foreign minister declared last year that climate change was "a Marxist plot".
Such moves could not come at a worse time for the Amazon rainforest, where deforestation has hit its highest rate in a decade, according to newly released government data. Deforestation grew by 13.7pc with 37,900 sq km of rainforest destroyed between August 2017 and July 2018.
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