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Where There Were No Doctors:
First MDs Graduate from Latin American Medical School

Text and photos by Gail A. Reed

Over 1,600 jubilant graduates unfurled their parchment Doctor of Medicine diplomas, eyes on the balconies of the hall packed with their parents and relatives on August 20th in Havana. The moment was the culmination of six years of study for the first graduates of Cuba’s Latin American Medical School (ELAM), and once just a dream for most of these families from developing countries.

At the commencement ceremonies, 1,610 students from 28 countries received their medical degrees, including 1,498 enrolled in the ELAM and another 112 Caribbean graduates enrolled under different Cuban MD programs.

The School was originally established by the Cuban government as a sustainable response to dual hurricanes that struck Central America and the Caribbean in 1998 ( Spotlight: Doctors for the (Developing) World). That year, the door was opened wide - with full scholarships primarily for low-income students - in exchange for a pledge to practice in underserved communities upon graduation. Since then, the program has expanded to enroll 10,500 students from Latin America, the Caribbean, North America (65 U.S. students) and Africa; the total number of foreign medical students in Cuba is now nearly 12,000 from 83 countries.

Latin American Medical School
Commencement, 2005

Dignitaries attending included: Cuba’s President Fidel Castro and other Cuban leaders; Panama’s President Martín Torrijos; Venezuela’s President Hugo Chávez; Prime Minister of Antigua and Barbuda Baldwin Spencer; Prime Minister of Dominica Roosevelt Skerrit; Prime Minister of St. Vincent & the Grenadines Ralph Gonsalves; Prime Minister of St. Kitts-Nevis Denzil Douglas; Prime Minister of Grenada Keith Mitchell; Vice President of Ecuador Alejandro Serrano; Deputy Prime Minister of St. Lucia, Mario Michel; Samuel Rudolph, Foreign Minister of Barbados; Marco Tulio Soza, Health Minister of Guatemala; Camilo Alleyne, Health Minister of Panama; Higher Education Minister of the Dominican Republic Ligia Amada de Melo; Assad Shoman, special envoy from the President of Belize; and Rev. Lucius Walker, Director of Pastors for Peace, USA.

Graduates from 28 countries: Antigua and Barbuda, Argentina, Belize, Bolivia, Brazil, Colombia, Costa Rica, Chile, Dominica, Dominican Republic, Ecuador, El Salvador, Grenada, Guatemala, Haiti, Honduras, Jamaica, Nicaragua, Panama, Paraguay, Peru, St. Vincent & the Grenadines, St. Lucia, St. Kitts-Nevis, Trinidad & Tobago, Uruguay, Venezuela and the United States.

Over the years, these new MDs are expected to replace some 25,000 Cuban doctors serving in the most remote villages and poverty-stricken slums of their countries - the objective being to dramatically increase accessibility to health services by underserved populations and strengthen health systems in poor countries. At the August graduation, Cuban President Fidel Castro told the class that their community-oriented commitment was just what the doctor ordered: “You are the kind of physician that millions, billions of poor people in the world desperately and urgently need.”

His observation is underscored by the appalling lack of physicians in most of the countries represented among the graduates, and the concentration of the health workforce in the cities and private sector. Factoring in a second crop of foreign students who will graduate with over 1,900 Cubans in September, Cuba has graduated this year nearly 1,800 new physicians for 47 developing countries plus the United States. Those 47 - many in Africa - have an average physician-population ratio of 0.98 physicians for every 1,000 inhabitants, compared to Europe which averages over 3, the U.S. at over 5, and Cuba nearly 6.

“We are faced with the challenge of our doctors and nurses being recruited by richer countries, and we can’t compete,” Dominica’s Prime Minister Roo sevelt Skerrit told the ELAM Class of 2005. “There is always a temptation to acquire wealth,” he counseled, “but our people are waiting for you to return home. That is the only way you can make a contribution to your communities and to the world.”

The evening’s most dramatic announcement came from President Hugo Chávez of Venezuela, who revealed his government’s decision to establish a second Latin American Medical School, so that jointly with Cuba, the two countries will be able to provide free medical training to at least 100,000 physicians for the Global South over the next ten years, including 30,000 new places for low-income applicants from Latin America and the Caribbean. Given the spiraling cost of medical education internationally, this commitment would amount to a US$20 to 30 billion contribution to developing countries.

Innovative Cuban programs, piloted by the flagship Latin American Medical School in Havana, speak to efforts to apply world-class teaching standards to give students a first-hand understanding of the specific health problems they will encounter in their communities and inspire the social commitment needed to tackle them. Thus, during the spring of 2005, 300 of the graduates spent the last six months of their internship back in their home countries, mentored by Cuban physician-instructors serving there. In Guatemala, a group received in-service training in a program against river blindness (oncocercosis) jointly organized by Guatemalan health authorities, Cuba and the Carter Center in Atlanta, Georgia. In Honduras, students served in the Mosquitia, and in Haiti, they joined forces to provide desperately needed health services. “We lived with our (Cuban) professors,” Haitian graduate Dr. Jean Pierre Brizmar told the commencement audience, speaking on behalf of the graduating class. “And during that time, we saw 773,000 patients. We donated our own blood when necessary, and nobody went home unattended.”

August 20th Medical School Commencement
For International Students

ELAM Graduates 1,498
Other Graduates 112
Total Graduates 1,610
Average Age 26 years
% Women 45.9
Ethnic representation 33 indigenous populations
Social Origin 71.9% working class or rural
Academic Results 1,143 or 74.7% GPA over 4.0 (of 5)
Graduating with Honors 180 (12% with GPA over 4.75)
Promotion/Graduation 84.6% of originally enrolled graduated

Source: Dr. Juan Carrizo, Rector, Latin American Medical School, Havana.

Some of the region’s public health systems are already providing for the insertion of the new graduates, offering them posts in poor and especially indigenous, communities; in others, IMF agreements freezing public health jobs will make it tougher for them to practice. Finally, many of the new MDs are considering yet another option just announced: to continue their studies in Cuba with residency programs combining family medicine with a choice of pediatrics, ob-gyn or internal medicine.

Cleofes Castillo, father of Garifuna graduate Luther Castillo of coastal Honduras, expressed the hope of many parents at the ceremonies, clad as they were in Sunday best: “I’ve worked all my life for my children, so they can be at least a little bit better than I am, have a little more opportunity. But I never dreamed Luther would be the doctor our village has always needed. I never dreamed I would see a commencement like this one, with so many indigenous and Black graduates. Now it’s up to them to go and make a difference.”

 
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