Why Cuba's training American doctors
As MARINA JIMÉNEZ reports, their presence is a political victory for
Fidel Castro

By MARINA JIMÉNEZ

Friday, June 17, 2005 Page A13

HAVANA -- With his mastery of Cuban slang, love of guavas and chess in
the parque central, Cedric Edwards could easily pass for a Habanero.
Only his name gives him away.

The young man from New Orleans is about to make medical -- and
political -- history.

This month, he will become the first American doctor to graduate from
the Latin American School of Medicine (known by its Spanish acronym
ELAM), a school that is exclusively for foreigners and is free.

"I'm not trying to make a political statement. I just wanted to become
a doctor," says Mr. Edwards, 32, with the dazed look of someone who has
just finished a 24-hour on-call shift at Havana's Salvador Allende
Hospital, where he spent much of the night treating patients with
cardiac failure, diabetes and leg ulcers.

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"It feels good, but it's a little scary at the same time to be the test
case. Sure, I'm worried there could be political repercussions in the
U.S.," says Mr. Edwards, who has avoided interviews until now. "But
people are misinformed about Cuba, and as they learn more about the
medical system, they will see its high standards."

The Cuban government opened ELAM in 1998, in a former naval academy 20
kilometres east of Havana, as part of an assistance program for
countries struck by Hurricane Mitch. The idea was to train doctors to
treat the poor of the Americas and Africa.

Today, 8,000 fully funded scholarship students from 27 countries are
enrolled in the Spanish-language program, including 88 Americans. The
U.S. economic embargo, in place since 1961, prohibits Americans from
travelling to the Caribbean island and the medical students have won a
hard-fought exception.

Their presence in Cuba is a political victory for Fidel Castro, the
Cuban ruler, who loves to invite them to demonstrations and to his
televised round tables, making the most of the irony of a small island
nation subsidizing the education of poor students from a superpower
that for years has engaged in economic warfare against Cuba.

Yet, at least some of the American students say they take a pass on
such political theatre. They prefer to see the school as an opportunity
to fulfill a dream that would be out of their reach in the United
States, where the price tag for medical school is as much as $200,000
(U.S.).

"I focus on my studies. At the same time, when you see the U.S.
blockade from this side, you see how stupid it is. A bunch of old men
with grudges," says Toussaint Reynolds, a New York native who gave up
his Dodge Intrepid, his television and his brand-name clothing to come
here and study to become an emergency-room physician. He hopes to
graduate in two years and do an internship in a hospital in Harlem or
the Bronx. "I think we are getting the last laugh," he says.

Mr. Edwards, who, like Mr. Reynolds, avoids political events, credits
ELAM with "literally saving my medical career." Distressed by one low
grade and a mounting debt, he dropped out of Louisiana State University
medical school in midstream, a decision he later regretted.

Whether the program is "a cunning move by one of the world's great
chess players or an extraordinary gesture of civic generosity or a bit
of both" -- as a December, 2004, article in the New England Journal of
Medicine put it -- it is definitely helping black and Hispanic
Americans enter a profession traditionally closed to them.

The article notes that while 25 per cent of the U.S. population is
black, Hispanic or native American, only 6.1 per cent of the country's
doctors have this background. Many poor Americans also do not have
access to medical insurance.

The New York-based Interreligious Foundation for Community Organization
recruits American students for the 500 spots at the school. While the
number of applicants falls far short, a spokesman said more and more
states have begun to express interest in the program. To qualify,
students must have completed two years of pre-medical courses, be from
poor communities and commit to returning to practise in those
communities.

To be sure, the program is not for Hilton-hoppers. At the ELAM campus,
students eat a beans-and-rice diet, are not allowed to leave during the
week without a special pass, and nobody, including family members, may
visit their dorms, for reasons not well explained by ELAM officials.

Mr. Edwards has endured mosquitoes, limited Internet access, and the
absence of hot water, toilet seats, Snickers bars and Pepsi. When he
goes back to New Orleans for his annual visit, he returns with a
suitcase filled with Neutrogena soap, Mennen deodorant, waxed dental
floss, cologne and boxes of gummi bears and Winterfresh chewing gum --
luxuries not often seen on stores shelves here.

Yet he has also developed a fondness for local pleasures: tropical
fruit drinks, mesmerizing son and casino dance music and Cuba's unique
patient-oriented system of care. He even married a fellow student from
Equatorial Guinea in a civil ceremony, celebrating with a small
reception and a Cuban layered wedding cake.

Cuba's sophisticated and public medical system is one of the
revolution's most notable successes. The country has one of the lowest
infant-mortality rate in the Americas and twice as many physicians per
capita as the United States, with a long tradition of sending doctors
to work in developing countries in Africa and Latin America.

The Cuban medical system focuses on preventive medicine and viewing
patients as human beings instead of clients, as several earnest
first-year students explain.

The country gets around the shortage of medications and high-tech
equipment by relying on traditional diagnostic techniques. Mr. Edwards
says there is a greater use of the stethoscope, vaginal exams to
determine pregnancy and plastic cups with a suction device to detect
fetal heartbeat.

"Cuba really challenges the way we think about health care and
health-care services. They approach it as a human right, whereas other
places approach it as a business," says Robert Huish, a PhD student
from Simon Fraser University and a scholar with the Trudeau Foundation
who is doing his thesis on the ELAM program.

"My question is, how much will the training, which reflects the needs
of the Cuban society, fit in with the needs of other societies?"

Mr. Huish will track the progress of this year's first graduating
class. Eliud Rivas, a 24-year-old Guatemalan who comes from a family of
peasant farmers with nine children, is thrilled with the opportunity to
become a doctor.

"I never dreamed I would be able to go to university, let alone medical
school," says Mr. Rivas, a first-year student who plans to return to a
job in Guatamala's public-health ministry.

While he describes himself as apolitical, Mr. Edwards says he is
against the U.S. blockade, and supports Cuba's recent crackdown on
democracy advocates, which has been criticized by human-rights groups.

But he insists he is most concerned about landing a residency in
internal medicine at a U.S. hospital. (He has already passed his U.S.
equivalency exams.) He would also love to practise in Canada, a country
with public medicare similar to Cuba's, he says. "Canada has no
blockade or political motivation to demonize the country," he said.
"It's still strange to me, why would a small country like Cuba want to
pay for me to come here?"

For the moment, ELAM is not open to low-income Canadian students
looking for scholarships in the Caribbean. But Dr. Gillian Jiménez,
with Cuba's Ministry of Foreign Affairs, is not opposed to the idea:
"If we had an application from Canada, we would evaluate it. The
program could be opened to include Canadians."