U.S. Doctors, Made in Cuba
Training is free to those who agree to practice in poor areas.
by Paul Nussbaum
Inquirer Staff Writer
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 email@example.com. Web site: http://www.ifconews.org/MedicalSchool/main.htm.
To hear interviews with U.S. students in Cuba, go to http://go.philly.com/cubamed