U.S. doctors being made in Cuba
Many aspiring doctors are leaving the United States to receive free
medical training in Cuba.
BY PAUL NUSSBAUM
The Philadelphia Inquirer
HAVANA - Lillian Holloway picked her way through the darkened streets of
Havana, skirting a pile of discarded pork bones, an unfinished
construction trench, and fresh dog dung, on her long journey back to
Past faded colonial facades looming out of the night like so many old
ghosts, she crossed to a building with a worn sign: Hospital Pediátrico
Docente del Cerro.
This children's hospital in a rundown section of Havana is Holloway's
next step toward her own medical practice in Germantown or West
Philadelphia. She is one of nearly 100 U.S. medical students enduring
the hardships of life in communist-run Cuba for a free education and the
hope of an eventual medical residency back home.
''This reminds me of North Philly. There's a lot going on,'' Holloway
said, waving at bustling sidewalks illuminated by light spilling from
once-grand buildings southeast of Old Havana, near the Latin American
Baseball Stadium and the Plaza of the Revolution.
HER FOURTH YEAR
Holloway is in her fourth year as a medical student here. Six feet tall,
with a model's looks and fluent in Spanish, she's a pioneer in a bata,
the short white lab coat worn by medical students here. She's a long way
from 50th and Westminster Streets in West Philadelphia, where she grew
up, and from Upper Merion High School, where she graduated in 1997.
The United States ''is in dire need of family physicians,'' and will
need 139,500 by 2020, up from 100,400 this year, according to the
American Academy of Family Physicians.
In the children's hospital, several young patients sit in the allergy
ward, inhaling directly from hoses attached to industrial-size oxygen
tanks. Down a dimly lighted hall smelling faintly of sewage, an
examining room is busy with parents bringing in their children.
One boy has a stomachache. He gets a vial of drops. Another boy has
asthma. He is sent to the allergy ward.
Holloway confers often with the doctor and with the other medical
students. This night is not as busy as Sunday, when she evaluated two
children with kidney problems, one with chronic diarrhea and another
with a respiratory ailment. She talked to the parents, gathered the
family histories, and did the initial write-ups for the examining doctor.
Cuban medical training is long on patient exams, short on high-tech
tests. The country has chronic shortages of almost everything,
especially technical equipment. So students learn to do without.
Cuban medical training is very hands-on, compared to that of the United
States. Students here deal with real patients in their very first weeks.
''We rely a lot on physical signs and symptoms,'' Holloway says. ``We
don't want to run a whole range of tests for something they don't have
-- we're not fishing . . . And unlike in the U.S., you may not have
everything at every hospital.''
Fidel Castro created the Latin American School of Medical Sciences in
1999 to provide free medical training for Honduran, Nicaraguan, Haitian
and Dominican Republic students after Hurricanes Mitch and George
ravaged those countries.
Castro, who is widely believed to be terminally ill and who was too sick
to attend his belated 80th birthday celebrations in Havana this month,
made medical diplomacy a centerpiece of his regime. He dispatched Cuban
doctors throughout the third world, and he soon expanded the free
medical school offer to other Central American, South American,
Caribbean and African countries. And in 2000, during a visit to Cuba by
members of the U.S. Congressional Black Caucus, Castro offered free
medical scholarships to U.S. students, too, if they agree to return to
poor, underserved U.S. areas.
The first U.S. students arrived in the fall of 2001. They moved into the
quarters of a former naval academy on the Cuban coast west of Havana,
where there are 3,300 students from 29 countries.
They were expected to spend the next six years (compared to four in a
U.S. medical school) enduring blackouts, water shortages, an endless
diet of rice and beans, long lines for everything, little phone or
Internet contact with the rest of the world, and long months between
visits home. They had to know (or take a 12-week course to quickly
learn) Spanish. For the first two years, they live in dormitories. They
receive a monthly stipend of about $4.
Why would anyone do that?
Most of the more than 90 U.S. students here are African American or
Hispanic. Many graduated from top-tier U.S. colleges but couldn't go to
medical schools in the U.S. because of the high cost or because of low
scores on admission exams or a lack of prerequisite courses. Others
didn't apply to U.S. medical schools, put off by the cost or focus on
''To tell the truth, I got turned off by med students,'' said John
Harris, who graduated as a biochemistry major from the University of
California, Santa Barbara. ``A lot of them were in it to make a lot of
Now in his fifth year in Cuba, Harris is something of a hero to his
fellow students because he scored a 95 (out of a possible 99) on his
first licensing exam in the United States (75 is the lowest passing
score). He says a secret to success here is discipline.
``You need to be extremely independent. It's good to have experience
with limited resources and comforts; it's better if you've lived in a
third-world country before. Many people get here, and they're just
shell-shocked. They're not used to the food or no hot showers. I've seen
a lot of people drop out.''
On the plus side, Harris said, ``I don't have one-tenth of the
distractions here. I don't have any bills to pay. I don't have to worry
about rent. I have no desire to watch TV, because with just three
government channels, there's nothing interesting to watch.''
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