Latin American School of Medicine: Bringing health to the world

Campaign News | Sunday, 25 March 2007

More than 14,000 students in Cuba and 3,000 graduates


Granma International staff writer

SOME 20 kilometers west of Havana, young people are sowing the seed of hope for a future of sturdy children and lively older adults, conspiring against the reigning dehumanization, with their white coats the banner of a better world. The Latin American School of Medicine (ELAM) is an institution that, in less than 10 years of existence, embodies that proposition and is showing the world what can be done when a genuine will exists.

Inaugurated in 1999 via an initiative of President Fidel Castro, this university has the fundamental objective of graduating young people - mostly from Latin America - in Medicine. Currently ELAM has 4,000-plus students on its campus and more than 10,000 distributed in other institutes throughout the island. The project involves 28 countries and has graduated 3,204 doctors, 530 of them specializing in General Medicine in the country. The ELAM also has 63 classrooms, 16 amphitheaters, 36 teaching labs and a roster of 508 professors.

Graduates still in Cuba have a doctors’ office for consultations and some of them have been motivated to study for a second specialty, either on the island or in Latin America. Recently graduated students have the option of doing a Masters Degree in Cuba by working in teaching hospitals, and they are guaranteed an account in convertible pesos (CUC), plus a salary in Cuban currency for their personal expenses.

Speaking to Granma International, Dr. Juan D. Carrizo Estévez, rector of ELAM, stated that the school "is a great achievement that speaks of a reality where Fidel’s dream of creating an institution to train doctors coming from various Latin American countries and from elsewhere has been made a reality."

The rector concedes much importance to the work with students that moves beyond academic training in the sense of imparting principles for confronting their professional work. For Carrizo, "one important achievement has been an integral education that leads to the students’ salvation, through concepts that focus on the ethical, moral, cooperative and internationalist values that are so necessary in a doctor, so that they receive a training and sensibility to be able to work in their own communities or with anyone who might need them."

Carrizo added: "We have seen that when we go to those countries and in the way that they work with our people in Cuba; what the people think of them - which is very good - and moreover, we have seem them raise their hands voluntarily to join the Henry Reeve contingent, a Cuban contingent that goes to any part of the world" to give medical assistance in the wake of natural disasters. "This is a new kind of doctor, educated in these new concepts," he affirmed.

The school is very aware of the diversity of beliefs, ideologies and religions of the students, because while it is basically made up of students without resources, the institution is not exclusive and welcomes people from various sectors.

Bearing in mind such characteristics, the ELAM is based on an ethical training without any political content in its curriculum. Carrizo notes: "The students have their religious beliefs, their ideologies and enter the school with a wide cultural heterogeneity. They have exceptional experiences depending on the country from which they come and the affiliations or parties to which they belong. We have different creeds that are totally respected. The school is lay and normally, the students go to their own centers of worship. There is no repression of anyone professing their beliefs in the school, but they are encouraged to do so in those places. We do not authorize that type of practices within the school."

Consideration does not solely rest on respect for their beliefs, but has its influence in student life; for example, in terms of differentiating meals in relation to religion and culture.

Carrizo affirms: "We work in such a way as to attain great harmony, one big family, without discriminating in terms of ideology, religion or ethnicity. Of course, the students gradually acquire a social, political culture; they absorb values from Cuban society, of solidarity, of internationalism. They soak up these concepts. It isn’t that we tell them how they have to be, but that they can compare systems and draw their own conclusions from their experiences."

The rector added: "The students say that this new kind of doctor is incredibly good. If they are in a country in which they see social justice and equality, if they find themselves in a country where everyone has the right to health, to sports, to live a dignified life, through those personal experiences, what politics do we have to give them here? They are living those politics, those are the politics that they see, the politics of our people, the politics of the Revolution. It is important to emphasize that we always tell them that our society is this one and not a crock of gold. Sometimes we are embarrassed by certain shortages that we have, and they tell us that doesn’t matter compared to everything that is done for them. And that makes us happy."

However, the school designed a discipline called History and Medicine, the only subject to cover issues related to current social problems. The ELAM is the only university in Latin America to include that subject.

The young people studying in Cuba have their housing, meals and classes in the center guaranteed free of charge in the first two years of the course, when they are taught Basic Science before being allocated to the island’s 21 Medical Science Faculties for the other four years. According to the rector, students in the provinces "make their living in the clinical areas with all the attention, the same concepts with which they enter this institution, with lodging in student residences, with full support from the faculties, and they participate in all the programmed activities." Throughout their career, these young people also receive a stipend in Cuban pesos as a means of support.

For the students involved in this project the change signifies a challenge in terms of culture, culinary habits, language. However the interest in studying and the health of their age smooth those difficulties along the way.

Honduran student Moisés Martínez, general secretary of the student executive at the school, testifies to these impressions and the coexistence achieved despite the differences.

"When we arrived here we felt both nervous and full of emotion. The first thing that we come up against is the food, because it is very different to ours. However, that happens in the first two weeks; then comes the culture shock: each country with its differences: dances, typical food, ways of talking. We are not used to that, but contact with other nationalities is what enriches your lexicon, your culture; moreover it strengthens your patriotic sentiments. You feel proud of your culture, of your nation, of what you have learned at home. In that way you can compare your thinking with the other students and, on that basis, create very strong friendship groups."

Like many of the other students, Moisés is very grateful for the opportunity to study offered by the Cuban government and talks with emotion of his good fortune. "What most of the students here desire above all else is to become doctors; that is their dream. We chose to become doctors to help people, to help cure the diseases existing in our countries. That is the essential point of the students here, apart from the fact that we do not have the economic possibility in our countries because of the dominant system that blocks any possibility of studying for a career as important as that of medicine, one of the strongest and most expensive. This is the situation of all the students here. For a person of scant resources it’s impossible. So we decided to avail ourselves of the Comandante en Jefe’s project: a school that is going to train us to a high scientific level and solidarity. We are very moved by that because it is a unique opportunity, it is a project unique in the world."

Moisés affirms that the pre-medical course is ideal for attaining complementariness. This prior preparation takes place because the student representation in the school is very heterogeneous and their training very varied. As part of the system of the school, the course was designed to create an even level among all the students before beginning the career. Moreover, it involves Spanish classes for all students who need it.

According to Brazilian student Lucas Demetrio, leisure activities are also an incentive at the school, and the diversity is an appropriate framework for cultural galas where young people display the traditions of their various countries, in dance and drama; music and painting workshops have been set up; and political discussion groups. For the rector "it is the life of a grand university, as if it was a town." On the other hand, Lucas highlights tours of Havana and other cities on the island that have brought them close to the people.

Talking of her particular impressions, Guatemalan student Clara Cabrera affirms. "Cuban people in general show a lot of solidarity, they help you if they see you have a problem. It’s not like in my country; as opposed to my country Cuban society is much more open."

Despite the achievements of the school eight months on from its founding, there were a large number of obstacles to be smoothed out along the way. First, converting the former naval officers’ training college into a medical school. That feat was carried out in less than three months. Another challenge, although there were precedents for teaching foreign students, was to establish an institution with an adequate social cohabitation, where a integration of countries could be achieved and the project grasped in different countries due to its detractors: making it understood what the school is, what its objectives are.

For the rector of the institution, "with the passing of time, the ELAM has consolidated itself and I don’t think that anyone doubts that this is a great medical university graduating students as top-quality doctors."

Carrizo emphasizes that despite all the uncertainties the school is known throughout the world, enjoys positive prestige and is channeled toward teaching methods more in tune with new pedagogical practices being developed in Cuba. For him: "new projects have emerged because the mass education of doctors today must take into account as a basic element for creating this better world that we all say is possible, but that has to be constructed with more health personnel. Thus, this project is going to train some 10,000 doctors in 10 years."

The new projects are considered as conceptually more advanced. The ELAM began with its traditional plan, but new modifications are being assessed to raise levels and train doctors en masse.

On the other hand, the rector does not attach so much importance to the school’s expenses in training young doctors, given that he believes that it is more relevant to think in terms of what it contributes rather than what it costs. Nonetheless, the school is part of the country’s higher education system and its gross domestic product.

Although one might assume that the institution is made up of young people solely from underdeveloped countries, that is not currently the case. In countries as developed as the United States itself, the cost of a career in medicine is so exorbitant, that some of its youth do not hesitate to make the ELAM a positive option. Sasha Yurgionas is from Chicago, but her luck changed when she had the opportunity of joining the contingent of youth training to be doctors in Cuba. "I came here because in my country, although medical education is of a high quality and very good, the cost of going to medical school is very high: $200,000 for four years. That does not include personal expenses like buying food and lodging. If you don’t come from a very rich family with a lot of resources it’s very hard.

"I would like to work with people in need in the United States, who do not have life insurance. My country is highly capitalist and everything costs. If you want an appointment with a doctor you have to pay. Currently there are some 45 million people in the United States without health insurance and for me it is a human duty. I want to participate in an education system that values medicine as a human right.

"In my country there are many people who go into medical school to earn a high salary, and that is the only reason. The emotional value, the value of being a doctor to help and serve humanity is not important, only "the bucks."

The professors have a very good impression of the students and are surprised at the interest that they have in all aspects of educational life. History Professor Daniel F. Fernández says: "The majority of students are motivated by the career; they are students who make a lot of effort. Some of them come with deficiencies in their training because they haven’t studied for four or five years and take them up again here and, of course, we have to confront differences in curriculum design. But students who come with motivation make a great effort and in that, they can count on the help of all the professors. In general terms they get good results.

"We take students who are considered as high performance, with differentiated attention according to those characteristics, but also individualized attention for students who are having difficulties. The results are highly positive. The students are very respectful and educated, they meet all the educational standards; they are disciplined and moreover, have something important: a degree of creativity."

Although many students clearly express their idea of returning to their countries to work in the least-favored communities, their countries’ commitment in this context is very heterogeneous, as is full recognition of their degrees. The Cuban government tries to make the graduate diplomas equivalent, and there has been progression in that context, but with more battles to be won. Many of these students are having difficulties validating their degrees, such as having to take further examinations.

In any event, there is no doubt that the Latin American School of Medicine is a Cuban achievement in terms of health. The initiative adopted by President Fidel Castro almost 10 years ago is bearing fruit in a successful way and has raised the prestige of Cuban higher education. It has also been one more contribution to the health of peoples south of the Rio Grande and in other nations of the world. The ELAM is a dream come true that could go down in history for its unquestionable support to human development and represents a recognition of the noble causes and ideals that are still in the hearts of people of goodwill in the world.

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