[Sept11] U.S. Doctors, Made in Cuba

[Larry Gross]

*U.S. Doctors, Made in Cuba
By Paul Nussbaum / 3 December 2006 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 Philadelphia.

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.

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 begin dealing with real patients in their very first weeks. 
Students spend more time
working in local clinics, seeing patients in their homes and conducting 
public-health
campaigns.

"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."

Holloway spent last summer in Philadelphia, studying to take a U.S. 
licensing exam. When
she returned to Cuba last month, she brought a cache of donated 
instruments: rubber
mallets, pen lights, tuning forks, blood-pressure cuffs, stethoscopes 
and thermometers.

African Americans, Hispanics, and Native Americans are 25 percent of the 
U.S. population,
but only 6 percent of doctors.

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 Georges 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 last week, 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 
spartan, blue-and-
white quarters of a former naval academy on the Cuban coast just west of 
Havana, where
there are now 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, as many as 
17 students to a
room. 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 the
focus on lucrative specialties.

"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 money."

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."

Since the program is so new, none of the U.S. students have graduated 
and been admitted
to a U.S. residency program, so the biggest question remains: Can they 
make it in the
United States?

(Last year, of 11,535 foreign medical graduates who received the 
requisite certificate to do
post-graduate training in the United States, 133 were graduates of Cuban 
medical
schools, according to the Educational Commission for Foreign Medical 
Graduates, in
Philadelphia. Also in 2005, 74 students from Cuban medical schools 
entered U.S.
residency programs; 18 of them were U.S. citizens.)

[Four years of medical school in the United States can cost $200,000. 
Students graduate
from U.S. medical school with an average debt of $120,000.]

Laurena White, 28, of Mohnton, Pa., in Berks County, has heard the 
question before: Are
you a propaganda tool for Fidel Castro?

White is a third-year med student in Havana. A 1996 graduate of Gov. 
Mifflin High School
in Shillington, Pa., she went on to graduate from the University of 
Virginia and has a
master's degree in public health from Johns Hopkins.

"Fidel Castro is doing more for me than my own president," said White. 
"If I am a
propaganda tool, that's what I am. I don't worry about that."

The U.S. students praise the Cuban model of medical education, with its 
focus on service
rather than what they see as an American model too driven by money 
(Cuban doctors earn
$20 to $40 a month). Many have joined their Cuban and Latin American 
colleagues in
political and social marches and celebrations. They are united in 
opposing the U.S.
embargo of Cuba, which has crippled the ability of Castro's government 
to get medicines
and supplies.

"We're caught in the middle of this war, even if it may not be a 
physical war," said Arabia
Mollette, a first-year student from the Bronx.

Lillian Holloway, the Philadelphia student, said, "If it's a ploy to 
give 100 poor black
students a chance to study medicine for free, that's quite a ploy. I 
feel it's very benevolent.
If the payback is that I'll come back and say it's not so bad in Cuba, 
well, that's just telling
the truth."

[The median income for doctors in family practice last year was 
$160,729, according to
the Medical Group Management Association. For dermatologists, it was 
$334,277, and for
cardiologists, $463,801.]

Before she went to Cuba, Holloway spent a year at the University of 
Pittsburgh but
dropped out after the first year: "My parents couldn't afford it." She 
went to Community
College of Philadelphia, became a certified nursing assistant, and 
worked in local nursing
homes and a mental-health institution.

"I never thought I'd be a doctor," she said. "I didn't know any doctors 
growing up. But I
always knew I wanted to help my community."

She had been to Cuba in 1998 for a student conference and met a doctor 
there who e-
mailed her when Castro announced his program. She called the Rev. Lucius 
Walker, head
of the Interreligious Foundation for Community Organization/Pastors for 
Peace, a New
York humanitarian organization that coordinates the program in the 
United States, and in
March 2003, she headed for Havana.

She took her first U.S. licensing exam in Philadelphia in October. If 
she passes, three more
licensing exams stand between her and a residency in the United States. 
She expects to
get her scores this month.

She hopes to practice family medicine, with an emphasis on preventive 
care. "I'm especially
drawn to West Philadelphia," she said. "I see the needs there, like when 
my sister spent
$100 at the emergency room for my niece's asthma attack."

In Havana, "one of my teachers was really hard on me, talking about the 
comparisons
[between the United States and Cuba]. She would say, 'I get paid $20 a 
month. I am aware
that you will make more in one week than I make in one year. So I want 
you to work hard.'

How To Apply To Cuban Medical School

Application to the Latin American School of Medical Sciences is 
coordinated in the U.S. by
the Interreligious Foundation for Community Organization/Pastors for 
Peace, a
humanitarian group in New York.

The group says students must be:

U.S. citizens.

Ages 18 to 30.

Physically and mentally fit.

 From the "humblest and neediest communities."

Committed to practice medicine in poor and under-served U.S. communities 
after
graduation.

Final decisions about admissions will be made by a committee 
representing the Cuban
Ministry of Public Health and the faculty of the Latin American School 
of Medical Sciences.

For more information, contact Ellen Bernstein at IFCO at 212-926-5757 or at
lasm at igc.org <mailto:lasm%40igc.org>. Web site: 
http://www.ifconews.org/MedicalSchool/main.htm. 
<http://www.ifconews.org/MedicalSchool/main.htm.>

To hear interviews with U.S. students in Cuba, go to 
http://go.philly.com/cubamed <http://go.philly.com/cubamed>

Q&A with program coordinator
http://www.philly.com/mld/philly/news/special_packages/inquirer_qa/qa_forum.htm? 
<http://www.philly.com/mld/philly/news/special_packages/inquirer_qa/qa_forum.htm?>
forumId=2989

Contact staff writer Paul Nussbaum at 215-854-4587 or 
pnussbaum at phillynews.com <mailto:pnussbaum%40phillynews.com>.
Tomorrow: Cuba, after Castro.

__._,_.___

* * * * * * * * * * * * * * * * * * * * * * * * * * *
* Larry Gross
* Professor and Director
* School of Communication
* Annenberg School for Communication
* University of Southern California
* 3502 Watt Way
* Los Angeles, CA 90089-0281
* [213] 740-3770  / FAX [213] 740-3913
* * * * * * * * * * * * * * * * * * * * * * * * * * *

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