MR INTERVIEW

Cedric Edwards, MD
First U.S. Graduate of the Latin American Medical School

By Michele Frank, MD

Cedric Edwards and Inmaculada Ncogo Allene

At the historic first graduation of Cuba’s Latin American Medical School (ELAM) on August 20th, young women and men from over two dozen countries received their medical degrees in the presence of fellow students, friends and family members, plus leaders from Cuba and abroad ( Top Story: Where There Were No Doctors: First MDs Graduate from Latin American Medical School). Cedric Edwards, MD of New Orleans, Louisiana, is the first to graduate among 65 U.S. students enrolled here. Dr. Edwards not only passed his Cuban licensing exams, but also his U.S. boards - the USMLE (U.S. Medical Licensing Examination) - required for admission to residency programs in the United States. On the eve of graduation, Edwards and his wife, another ELAM student, Inmaculada Ncogo Allene of Equatorial Guinea, spoke with MEDICC Review.

 MEDICC Review: Why don’t we start with you telling us a little bit about yourself.

Cedric Edwards: I am the oldest of three sons and I went to Middlebury College in Vermont, graduating with a degree in Molecular Biology and Biochemistry. Then I started medical school at Louisiana State University. Unfortunately there were some problems there, and I didn’t finish. I ended up going to Howard University Law School in Washington, D.C. I was in my first year there when I found out about the opportunity to study medicine in Cuba.

MR: How did that happen?

CE: I had a friend who knew that I was really interested in studying medicine. He knew somebody who knew somebody who knew about the program. At the time I was writing for the school newspaper at Howard, and I decided to do an article on this Cuba medical school scholarship program. After researching the article, I began to think, ‘Hey! maybe this is something I should seriously look into for myself.’ And that’s what I did: I applied and I was accepted and here I am.

MR: Why did you decide to apply to medical school after Middlebury?

CE: It was while I was at Middlebury that I decided I wanted to study medicine. During my first semester of my freshman year, my younger brother had a football accident, playing American football. He broke his neck. I went back home to help out my family with that whole situation. I was very disappointed with the medical care my brother received - there was really so little in terms of medical technology available for people with spinal cord injuries.

My brother is still paralyzed from the neck down. He’s been that way ever since his last year in high school. But he graduated, he went to college and to law school, and now he’s preparing to take his boards so that he can practice law.

After the accident, I started doing research on spinal cord injuries. Every year, every summer, I did research in neuroscience and neurosurgery. I talked with a lot of neuroscience people, with a lot of researchers, and they told me that if I wanted to continue as a researcher in the field - if I wanted to do serious clinical research - the best thing for me to do would be to get a medical degree.

So that’s what I decided to do. My plan was to go to medical school and then possibly go into neuroscience or neurosurgery. I found I really didn’t like neurosurgery at all, unfortunately. So then I decided that I would go into medicine and wait to decide on a specialty.

MR: Did you apply to a lot of medical schools?

CE: Yes, quite a few, and I got into most of them.

MR: What made you choose Louisiana? Was it because it was close to home?

CE: No not really, even though that was a positive factor. The main thing was that they offered me scholarships, and I figured that if I could go to medical school and not have to pay back all the loans, that would be a big advantage. I was accepted to Northwestern and I almost went there. I really wanted to go there, but I thought about being a hundred thousand dollars or even more in debt. It would have been really tough on me and my family, so that’s why I chose Louisiana. As it turned out, that wasn’t the best decision.

MR: Why? You mentioned earlier that there were problems at medical school in Louisiana. Would you mind talking about that a little?

CE: I definitely had some problems. What happened was I was studying very hard and everything was working out all right, but then there was almost like a sudden change in my grades. My grades were not reflecting my studying. I mean, for all the studying I was doing, all the work I was putting into it, the grades just weren’t coming in like they should have been. I got very discouraged and very frustrated. I didn’t have the kind of support that I needed, I guess, and I began to think that the best thing to do would be to take a leave of absence or maybe even drop out.

MR: Generally, ELAM students are expected, or asked directly, to make a commitment when they finish their training to work in underserved communities in the U.S. Did you make that commitment? How do you feel about being asked to do that kind of thing?

CE: Actually, I have no problem whatsoever with that. And the fact is, honestly, I would want to make a commitment because a lot of times when people talk about an underserved community, they’re talking about my community: African-Americans in the United States. So I want to go back to my community and practice there. I know first-hand what “underserved” means. I know the people, I know the culture and I know a lot about the problems that affect the community. I want to make a difference.

MR: What do you think about the medical education that you received here in Cuba? What is your evaluation in terms of the pros and cons?

CE: I like the fact that this medical school has so many students from other countries. I think that’s a very good thing because you get a chance to relate to other people from other cultures ( MR Feature: Profiles in Commitment: Conversations with ELAM Students). And of course in the U.S., there are also a lot of people from many different countries. I also like the fact that everything’s in Spanish. I think it’s very important to know Spanish in the U.S., especially for physicians. There’s a huge Spanish-speaking population in the U.S., yet most physicians don’t speak Spanish. It’s critical, really: how do you elicit the information you need from a patient in order to take a good history or make a diagnosis? How do you establish the doctor-patient relationship? The trust? The confidence that’s such an important part of successful treatment?

One of the things I definitely like and I think is very important is that here everyone has access to health care. I think it’s really a shame that in the United States so many people have to go to the Emergency Room for healthcare, in order to see a physician. I don’t think the Cuban people really appreciate this as much as I appreciate it, coming from the U.S., being one of the people who did not have access to health care. I also like the fact that the training here incorporates a lot of complementary/alternative medicine (CAM).

I received training here in disciplines like acupuncture, homeopathy and herbal medicine, which I didn’t receive in the States, nor was I ever aware of it being an integral part of any medical school curriculum in the U.S. Also, in Cuba, there’s more emphasis on community-based systems of care, preparation for international service, and disaster medicine - all of which seem to be lacking in U.S. training programs.

MR: And the cons?

Life is very different here from what we’re used to in the U.S. Living in Cuba is pretty tough; it’s easier living in the U.S. Some people, when they came down and saw how different the lifestyle is, decided to leave. There are a lot of things we take for granted in the U.S. that are problems here: access to books, communications, transportation, food variety, shopping and stores; even regular electricity and regular running water sometimes. But I decided from the beginning that I was going to take advantage of this opportunity to get a good medical education and a medical degree. So I have been very motivated to stay.

Of course Cuba doesn’t have the technology and abundance of resources that are available at U.S. medical schools. In Cuba they use what they have when they can, and since this is a resource-poor country in the general scheme of things, there’s a lot more reliance on thorough history taking, a good physical, good communication with the patient and family, diagnostic discussions with colleagues, etc. I think this is all good. We learn to use and rely on our clinical skills, clinical thinking, intuition and experience.

MR: Why is this greater emphasis on hands-on, clinical skills important for you – especially since you plan to return to the U.S. to practice?

CE: I think I’ll be a better physician for it. I don’t think technology is a bad thing, but still you don’t want to be dependent on technology and equipment. For instance, what if you’re in a rural area or in the midst of a disaster situation? You want to be able to do something, to help people, to provide medical assistance without having to rely on something that isn’t available. We have to be able to function as physicians in all circumstances, without being dependent on technology, because when you don’t have it, you believe there’s nothing you can do and that’s really never the case – or it shouldn’t be, at any rate.

MR: When you go back to the U.S. you may need to get updated in terms of the latest technology, new medications, etc. Do you feel confident that when you do go home to do the residency, you’ll be able to “catch up” in this regard?

CE: Oh yes. Actually we do have access to a lot of the latest from the States; at least theoretically, by books or online; and there are U.S. professors that come down regularly to give special courses for the boards. Also, Cuba uses a lot of the same textbooks we used there, except they’re translated into Spanish. One thing I should mention is that even though Cuba doesn’t have certain newer medications, for example, or a lot of modern equipment, the training still covers their use or application. It’s just that we don’t get the same level of practice as we might in another place.

MR: You’ve been studying and living side-by-side with people from many different countries and cultures. In fact, you’re married to Inmaculada from Equatorial Guinea. Inmaculada, let me ask you - are there many students from your country here?

INA: At the moment there are 52 of us. Most are studying in Pinar del Río Province. I’ve finished my 5th year and will begin the 6th/internship year in September. I came here to study medicine because of all the family members I’ve lost, all the people I’ve seen die - all of my life - due to lack of medical care. When I was 8 years old, I decided I wanted to be a doctor. My father didn’t have the money for me to study medicine so I went to nursing school. The year I was to graduate, I heard about these scholarship offers, so I applied and was accepted. That’s how I came here to study.

In my first year here, my father died – he died because the nearest medical post was too far away, they couldn’t get him there in time – he had a heart problem that shouldn’t have killed him. My brother’s death was also due to lack of medical attention. He died from an acute gastro-intestinal problem because there were no doctors available to operate, no surgeons in the country. Rush arrangements were made to fly him to Spain for surgery but he died on the plane. I have nephews and nieces, little children, who have died of dehydration…there are so many preventable deaths in my country.

MR: Inmaculada, have you been able to go back to your country since you’ve been here?

INA:Yes, I went back for my father’s funeral and I went back for my brother’s funeral. It was terrible. Thank God I had met Cedric. I had decided that I wasn’t going to continue my medical studies, but Cedric is a very positive, understanding and optimistic person. He talked with me a lot and he always said, ‘Look, your father wanted you to study medicine. He was proud that you were doing this, he wanted this.’ Cedric gave me lots of support which I really needed – it would have been just too difficult otherwise.

MR : And what about you, Cedric? You talked about not having good support when you had problems in medical school in Louisiana. Do you feel you received adequate support this time around? I know this is an issue for many ELAM students – it’s hard to be so far from home and in such a different environment and then to be studying medicine on top of that.

CE: I think one of the most important things for me is my brother. I mean, he was paralyzed from the neck down, and he went to college and then law school. I’ve used this to find strength in myself. It’s a motivating factor to help keep things in perspective.

But that’s not the only thing. Here in Cuba I have received a lot of support from many people, especially from the Cubans. The Cuban medical school system here is set up in such a different way. There’s built-in support almost. Also, in general, Cubans are very, very optimistic: if there’s a problem, you invent a solution. If you have a problem, people are willing to help out, they’re willing to talk with you, they check in on you. That kind of thing has helped me get through the tough times. Medical school is hard, it’s demanding, the standards are high, it’s not easy to get good grades, but you feel like most people want you to succeed, and they’re willing to help and support you. I’m not saying there aren’t things that drive me crazy or anything like that! You know, there’s always something, but hey…

MR: The other thing I wanted to talk about with you is the fact that you are the person representing the U.S. students – you are the first U.S. graduate from the Latin-American Medical School. You’ve also passed the USMLE. How do you feel?

CE: Well, before I was the first U.S. student to graduate, I was the first U.S. student that was expected to graduate, since I had already done some medical school in the States. I’ve been going through the whole process of taking the exams, checking out residency options, trying to open doors, and finding out how things work. In all honesty, it’s been pretty scary – really, from the beginning, for me, each step of the way has been scary. It’s all working out, I guess, but I’ve made a lot of mistakes along the way, not knowing what is the right way to do things, and learning as I go. I hope it will be easier for the other U.S. students.

Probably the thing that’s most unsettling for me now is that nothing’s settled yet! I know I like Internal Medicine, but…Also, since I’m coming from Cuba, I don’t really know how that might affect things - positively or negatively. I guess it depends on the program, and maybe whether they know much about Cuba and the Cuban health care system.

When I first received the opportunity to study here, part of me was worried. When I talked to family and friends, everyone was saying negative things about Cuba. It’s mostly because so many folks in the U.S. just don’t know much about Cuba. I guess a lot of people may automatically think negatively about Cuba and the medical system here, but hopefully as more people learn more, it will change opinions and people’s outlook.

MR: I’ve found that there is a lot of openness to learning more about the Cuban health care system in the United States, about the unique things that are done here, interest in joint research initiatives and exchanges that might be beneficial to both countries.

CE: Listening to you reminds me that there’s something else I wanted to say…While I’ve been here, I’ve tried not to get involved in politics. I really came here to study, and being a medical student is a lot of work - you really have to spend just about all your time studying. But I do want to say that I disagree with the blockade. Not only do I think it’s wrong, but I think regardless of what your feelings are about it, it’s ineffective.

What I’m saying applies to both sides. Cuba has a lot of vaccines and medical products, for example, and it doesn’t make any sense that U.S. people can’t have access to them because of the blockade. Just like it makes no sense that Cuban people don’t have access to medicines and technology from the U.S. I think this is wrong.

MR : What plans do you both have for after you graduate?

CE: Well, for now I’m going back to the U.S. to apply for the match, to get into a residency program. I’m looking for an Internal Medicine program and then I would like to go into Cardiology.

INA: I want to do a residency. I think I’d like to specialize either in Pediatrics or Geriatrics. I know it sounds funny, but I love children and I love old people! But I don’t know what will happen. There are no residency programs in my country. If I can continue my studies here, I will, or wherever I am offered the opportunity.