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“When you leave Cuba for the first time, you discover many things that you had been blind to,” says Yaili Jiménez Gutierrez, one of the program’s doctors, in a New York Times profile. “There comes a time when you get tired of being a slave.”

The Cuban doctors began noticing the disparity in their government’s “take” from the Brazilian government—nearly four times their own salary—as well as the higher wages and greater freedoms enjoyed by their fellow “export doctors” from other participating countries.