[ The Latin American School of Medicine, or E.L.A.M., was
established by the Cuban government, in 1999. All of the students are
international. Many come from Asia, Africa, and the United States,
coming from low-income and marginalized communities.]



 Anakwa Dwamena 
 June 6, 2018
The New Yorker

	* [https://portside.org/node/17445/printable/print]

 _ The Latin American School of Medicine, or E.L.A.M., was established
by the Cuban government, in 1999. All of the students are
international. Many come from Asia, Africa, and the United States,
coming from low-income and marginalized communities. _ 

 E.L.A.M., a medical school on the outskirts of Havana, offers
international students who pledge to practice in underserved areas a
chance to pursue medicine without incurring catastrophic debt.,
Photograph by Adalberto Roque / AFP / Getty // The New Yorker 


In the countryside of western Havana, during the fall, rickety yellow
buses carry first-year medical students from the Latin American School
of Medicine. Wearing short-sleeved white smocks and stethoscopes, they
go door to door, doing rounds, often speaking to their patients in
broken Spanish. “Even people whose houses I wasn’t visiting
sometimes would ask me to take their blood pressure, because they just
saw me in the street,” Nimeka Phillip, an American who graduated
from the school in 2015, told me.

The Latin American School of Medicine, or E.L.A.M., was established by
the Cuban government, in 1999, after a series of natural disasters,
including Hurricane Mitch, left vulnerable populations in Central
America and the Caribbean in dire need of health care. This year, in
the aftermath of hurricane season, hundreds of Cuban health workers,
many of them E.L.A.M. graduates, will travel to some of the
hardest-hit areas of the Atlantic to treat the injured and sick. All
of the students who attend E.L.A.M. are international. Many come from
Asia, Africa, and the United States. The school’s mission is to
recruit students from low-income and marginalized communities, where
they are encouraged to return, after they graduate, to practice

In the U.S., black and Latino students represent approximately six per
cent of medical-school graduates each year. By contrast, nearly half
of E.L.A.M.’s American graduates are black, and a third are Latino.
“You would never see those numbers” in the U.S., Melissa Barber,
another American E.L.A.M. graduate, told me.

Barber is a program coördinator at the Interreligious Foundation for
Community Organization, in Harlem, which recruits American students
for E.L.A.M. Applicants with college-level science backgrounds and the
requisite G.P.A. go through an interview process with the
organization. Those who make the cut are then recommended to E.L.A.M.
The school accepted its first American applicants in 2001, a year
after a delegation from the Congressional Black Caucus, whose
leadership included Representatives Bennie Thompson and Barbara Lee,
travelled to Cuba and held talks with the Ministry of Education about
the need for doctors in rural black communities, and the financial
obstacles that make it difficult for low-income and minority students
to enroll in American medical schools. While some nations pay for
their students to attend E.L.A.M., Fidel Castro
[https://www.newyorker.com/tag/fidel-castro] decided that Americans,
like Haitians and students from poor African countries, should attend
for free.

Since 1987, no more than six per cent of medical students in the U.S.
each year have come from families with poverty-level incomes.
Meanwhile, the cost of medical school has skyrocketed; the median
student debt for the class of 2016 was a hundred and ninety thousand
dollars. Phillip, a first-generation college graduate, worked multiple
jobs and took out loans to pay for her undergraduate degrees in public
health and integrative biology, at the University of California,
Berkeley. She hoped to study “stress- and poverty-related illness”
in medical school, she told me, but the cost of tuition, along with
the pressure that would come from being one of the few minority
students in her class, discouraged her from applying.

After she graduated, she came across an online listing for an I.F.C.O.
event in San Jose, while researching alternatives to medical school.
At the event, there were a number of E.L.A.M. graduates who offered
testimonials, but she remembered being moved by Luther Castillo’s
story in particular. After graduating from E.L.A.M., Castillo returned
to his Afro-indigenous village, in Honduras, and built the area’s
first free, community-run hospital. Phillip was impressed by his
story, and by E.L.A.M.’s philosophy of offering a free education for
students who pledged to practice medicine in low-income, medically
underserved areas. After she applied and was accepted, she braced
herself for her six-year odyssey in Cuba.

The child-mortality rate in Cuba is lower than it is in the U.S., and
life expectancy in both countries is about the same, even though
per-capita health-care spending
[https://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande] in
the United States is the highest in the world. In a certain way, Cuba
has America to thank for this. The U.S.-imposed embargo and the
dissolution of the Soviet Union led to an increase in the cost of
medical supplies; facing a crisis, the Cuban government turned its
attention to preventative care, seeking to eliminate much of the need
for surgeries and expensive procedures by early detection.

The vast majority of Cuba’s medical students go into primary care.
Many of them take up posts in _consultorios_—doctor-and-nurse teams
that live in the neighborhoods in which they practice. In the United
States, more and more graduates are choosing specialties—cardiology,
radiology, urology—over primary care, which pays less. Besides
driving up the cost of medical education, this has also exacerbated
physician shortages in rural parts of the country. Today, sixty-four
million Americans live in areas where there is only one primary-care
physician for every three thousand people. By 2030, according to a
[https://news.aamc.org/medical-education/article/new-aamc-research-reaffirms-looming-physician-shor/] commissioned
by the Association of American Medical Colleges, the United States
will be short at least forty thousand doctors, and perhaps as many as
a hundred thousand.

Medicare [https://www.newyorker.com/tag/medicare] and Medicaid
[https://www.newyorker.com/tag/medicaid] programs support residency
trainings, and the National Health Service Corps awards grants and
loans to medical students in exchange for service in needier regions.
But, in 2016, only two hundred and thirteen students received an
N.H.S.C. scholarship. According to Congresswoman Karen Bass, of
California, a supporter of E.L.A.M., funding is the main
problem—particularly under the current Presidential Administration.
Trump’s budget for the 2019 fiscal year will cut funding for
graduate medical education by forty-eight billion dollars. It is
“embarrassing,” Bass said, that “Cuba educates our students for

E.L.A.M. offered Phillip a chance to pursue medicine without incurring
catastrophic debt. As she put it, she would graduate with the
equivalent of car payments, while her peers in the United States would
be saddled with the equivalent of mortgages. Although the school was
lacking in creature comforts—the students slept in bunk beds; the
hot water and electricity were unreliable; there was little access to
the Internet or the phone—Phillip powered through. With help from
family, friends, and an organization called Medical Education
Cooperation with Cuba—which helps American students in Cuba prepare
for their homecoming with scholarships, tutoring for U.S. exams, and
connections to American medical networks—she returned home each
summer, gaining experience at hospitals in Minneapolis, Oakland, and
Washington, D.C.

In March of 2014, Phillip passed the U.S. medical-licensing exam, with
one year of Cuban medical school left. In 2016, she was accepted to a
residency program in family medicine at a hospital in Hendersonville,
North Carolina. “It’s one thing to recruit people that have high
skills,” Bryan Hodge, the director of the Hendersonville program,
told me. “More unique is when you find people that really have the
passion and heart for taking care of underserved patient populations.
These are the people needed to close the health-disparities gap.” As
Peter McConarty, a veteran family doctor who advises E.L.A.M.
students, put it, “A medical student in Cuba would have to actively
resist the idea that they were agents of public health and social
justice. In the United States, you have to actively seek it out.”

Phillip said that her biggest challenge since becoming a doctor in the
U.S. had been reading CT scans and MRIs, which are used sparingly in
Cuba, and that she has had to adjust to spending less time with
patients. Like many doctors of color, she has experienced moments of
prejudice, from patients referring to her as “girl” to an incident
with a young man wearing a Confederate-flag T-shirt. The Spanish she
learned in Cuba does come in handy—the hospital holds regular
clinics for migrant farm workers, in the local apple orchards and
tomato fields.

_[Anakwa Dwamena is a member of The New Yorker’s editorial

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