Free Cuban med school trains US docs

Expert argues it's more than a Fidel Castro
publicity stunt. Could Canadians be among
future grads?

By Peter Woodford

After Hurricane Mitch devastated the region in 1998 the fiscally enfeebled communist state decided to open a med school called the Escuela Latinoamericana de Medicina (ELAM) in the outskirts of Havana especially for disadvantaged foreigners. And how much is tuition? Nada.

All but Fidel Castro's harshest critics would be hard pressed to find fault with this altruistic endeavour — particularly when you compare this to the swashbuckling Cuban foreign policy of the 1970s and 80s which saw the state export violent revolution instead of medical knowledge. Some members of American government must surely be humiliated by the fact that 89 US citizens, for whom homegrown med schools were financially out of reach, are currently enrolled at ELAM. Many American doctors now graduate with a debt load of between $115,000 and $150,000 US.

US TOO?
Because of a Bush administration policy of barring US citizens from visiting Cuba, it was initially rather tricky for Americans to study at ELAM. But in 2004 a group of 27 members of Congress, led by Harlem Democrat Charles Rangel, successfully petitioned Secretary of State Colin Powell to exempt ELAM students from the ban. A few American ELAM graduates have already headed home and passed US equivalency exams. The grads report the facilities aren't exactly deluxe (the menu consists mainly of rice and beans and students sleep together in large dormitory rooms), but otherwise the program gets a thumbs up.

So far no Canadians have enrolled in ELAM, but Dr Gillian Jiménez, of Cuba's Ministry of Foreign Affairs, told the Globe and Mail: "If we had an application from Canada, we would evaluate it. The program could be opened to include Canadians." Considering Canadian med students routinely graduate $100,000 in debt, it could become an attractive option.

We know that Cuba is far from ideal when it comes to remunerating physicians (see "New NS mentoring program to speed up IMG accreditation" Vol 2, No 12 for one Cuban immigrant doctor's story) and advanced medical technology on the island is decidedly lacking. But there are aspects of Cuban healthcare that are undeniably successful, such as its infant mortality rate which is similar to Canada's and lower than the United States's.

FIRSTHAND ACCOUNT
To get to the bottom of this most unusual med school, we spoke to Trudeau Foundation Scholar Robert Huish. Mr Huish, a PhD candidate at Simon Fraser University, has visited ELAM to research his dissertation on the institution.

NRM: Where does Canada fit in the ELAM picture?

Robert Huish: Canada is the only country in the hemisphere that doesn't have representation at the school. Perhaps if Canadian students attended the school, it would be a clear admission to our national human resource for health crisis, what with BC alone losing 400 physicians a year, and UBC only graduating about 220 students annually.

NRM: Do potential students need to speak fluent Spanish to apply to ELAM?

RH: No. There are hundreds, if not thousands of ELAM students who enter the program without speaking Spanish. In fact, the program dedicates part of the first two years to training in language skills and biosciences.

NRM: What was your impression of the Cuban healthcare system up close?

RH: There are many attributes in the Cuban system that would astound most physicians here in Canada. Because Cuba's doctor to patient ratio is about 1:160 there is an abundance of human resources for health, which makes for greater accessibility and lessened wait times to see a physician or a specialist.

NRM: Cuba clearly can't afford advanced medical technology, how can it compensate?

RH: Cuban healthcare is a human-resource strong, patient-focused system of prevention at the community level. Early diagnosis of chronic and degenerative diseases is common thanks to the frequency of consultations and the accessibility to community clinics, despite the lack of high-tech diagnostic resources.

NRM: Even if you ignore the paltry doctor salaries, Cuban healthcare does seem to deliver a lot of bang for its healthcare buck. Are there lessons for Canada?

RH: When Canadian doctors entertain new ideas on how to improve our system, I would strongly encourage them to take note of the Cuban experience, and realize that we may have more possible solutions than once imagined — solutions that come from the investment in human empowerment.

From what I've seen first hand, Cuban patients spend most of their time in the healthcare system personally interacting with their physician and receiving treatment — consultations routinely go well beyond the 15 minute time-frame that we are used to in this country.