To Latin Neighbors, Cuba Plays the Good Doctor

NY Times, February 17, 2000

HAVANA JOURNAL

To Latin Neighbors, Cuba Plays the Good Doctor

By DAVID GONZALEZ

   HAVANA — Nieves Dinora graduated from high school in Nicaragua with good grades and no prospects. Since her
father, a farmer, had no money to send her to college, she figured marriage and motherhood were her only options.
“Like many of my friends there, I thought I would take the nine-month career,” she said. “It does not cost anything,
just nine months. Easy, no?”

But rather than having babies, Ms. Dinora is now learning how to deliver them.

She is among 1,900 students at the Latin American School of Medical Sciences who are enrolled in a six-year
program that is a unique twist on the old concept of overseas medical schools. While many people think a Caribbean campus is the last-ditch resort for foreign students with fat wallets but slim grades, this one is the exact opposite, giving full scholarships to smart youths from poor rural areas in 18 Latin American and Caribbean countries.

The medical school is the Cuban government’s response to the devastation from Hurricanes Georges and Mitch, which ripped through the region in 1998, killing thousands as they destroyed villages and spawned public health problems. While Cuba sent medical teams to help, officials realized that it would be better in the long run to help educate a new generation of doctors who would return to their impoverished countries and work in remote communities where medical care was spotty and expensive.

“Life has shown us some lessons that we cannot forget,” said Juan Carizo Estévez, the school’s rector. “That is the necessity of the right to health care that these countries have. We have a responsibility that these students return to their own countries with a solid foundation for dealing with the problems of public health they will find.”

The new medical school is the culmination of the Cuban government’s decades of reliance on its reputation as a medically advanced society to burnish its international image. Starting in 1963, when it sent a team of doctors and nurses to Algeria, the government has gone on to establish medical schools in the third world, send thousands of Cuban doctors for long-term overseas assignments and offer scholarships to study alongside Cuban students in the island’s medical schools.

Medical aid was as important an aspect of President Fidel Castro’s aid to the third world as his nation’s training of guerrilla and terrorist groups was during the cold war. While cold-war conflicts have died down, Cuba’s latest experiment in medical education is still tinged with the passions from that era.

“By doing good, particularly in the field of health and education, Cuba would look better than the United States,” said Julie Feinsilver, author of “Healing the Masses” (Berkeley, 1993), which examined the role of health care in Cuba’s foreign and domestic policy. “This is a symbolic war, not that the U.S. looks at it that way. But Fidel said when he finished the revolution, his real destiny was war against the U.S. The war is not a material war, but a symbolic war. Anything that Cuba does that enhances its prestige on the world stage, which medical diplomacy and providing scholarships does, is a battle won for Cuba versus the United States.”

The school’s very location is a sign of the changing battleground — it occupies 82 blue-and-white buildings that hug the ocean along the campus of what was an academy for naval officers and merchant mariners.

Students were selected through tests and interviews and are mostly chosen by their home countries. The first contingent, from Honduras, Nicaragua and El Salvador, the areas hit hardest by the hurricanes, arrived almost a year ago.

Cuban officials said they started the school as a gesture of international good will, and that they did not intend to politicize the students. Still, many students spoke about how many doctors in their countries were interested only in making money while the poor languished and children died from preventable diseases, echoing a common Cuban critique of modern medicine.

Edmundo Blandón, 20, recalled how his mother in Nicaragua suffered from pains for years, being told all the time that she only had a kidney infection. Unable to see a specialist, she suffered and waited for two years until her daughter took a loan from a co-worker.

“As a child, you see how in your family there are needs for a doctor to help you,” Mr. Blandón said. “When she was 59, she finally learned she had advanced cancer. She could not have had the medical tests done earlier, because we did not have the money.”

She died soon after he enrolled in the school.

“She had felt bad because she thought I would leave this school because of her,” he said. “But she told me that in the first place, nothing could be done for her. So, if I was left alone with nobody to look after, I should take advantage of this opportunity.”

The students begin with six months of pre-medical studies in basic sciences like physics, chemistry and biology. They proceed to two years studying embryology, biochemistry and other medical subjects, followed by four years studying and working in Cuban hospitals and clinics.

Teachers said they follow a curriculum that combines textbook lessons with practical experience, with an emphasis on problem solving and preventive care. It hews to the Cuban approach to health care, which stresses community-based medicine and public health.

Although students from the same country live together in dormitories to ease their homesickness, the classes have a cross section of races and ethnicities, including a significant number of Indian youths from Central America. Some students encounter other ethnic groups from their own nation for the first time at the school.

This month, 1,500 more students will arrive at the school, which expects to enroll some 5,000 students ultimately. Already, workers have been preparing new dormitories and lecture halls.

The students, like those everywhere, grouse that the grind is rough, leaving them with little free time. But considering where they came from, many said it was a small sacrifice for the chance to become a professional instead of a cabdriver or farmer.

Norlan López spent his high school years in Nicaragua getting up at 4 in the morning to work as a fisherman. He was still doing that when he was accepted into medical school.

“I had more pressure on me when I was in high school,” he said.

“It was a hard life that I would not wish on anyone. That is why I am happy to be here.”

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