When Cuba’s revolutionary government banned racially-based discrimination, it showed a dedication to social equality.  But unequal access to housing, education, employment and medical care can be subtle.
One of the best indicators of Cuba’s genuine commitment was the rapid broadening of medical services to everyone on the island. This was quickly followed by sending Cuban doctors to Africa, Latin America and the Caribbean. Today, the thousands of students coming to study medicine in Cuba is an unparalleled happening. These students are eager to share what their experience means to them.
Beginning in 1959
Afro-Cubans comprised about 40% of the population and received vastly inferior health care at the time of the 1959 revolution.  Medical services were concentrated in the cities, whose residents had more money and were more light-skinned. 
The revolutionary goal of full medical-care-for-all benefited millions of Cubans, but especially mulattos and blacks in the countryside. The number of rural hospitals went from 1 in 1958 to 54 in 1984.  Unlike the US, there are now virtually no differences in access to medical care by income or rural/urban living  Fully 99% of Cubans have ready access to medical services. 
Cuba has eliminated polio, brought malaria and dengue under control, and lowered child and maternal mortality to the same levels as rich countries.  The island nation currently has an HIV prevalence which is one tenth of the US and a life expectancy of 78.0 years, exactly equal to the US. 
What makes these accomplishments amazing is that they have occurred despite continual efforts by the US to isolate and destroy Cuba economically. Cuba continues to have an economy which is a tiny fraction of those in the West. Economic indicators suggest that Cuba is a developing country; but, by health care standards, it is a developed country. 
The building block of Cuban medical care is the neighborhood consultorio, which serves about 150 families. The primary health care model focuses on at-risk sectors of the population, such as the very young, the very old and those with common medical problems. It heads off medical crises before they occur.
Sanitation, potable water and immunization are essential components of Cuban health care. Since poverty creates bad health, the Cuban health system is intertwined with reducing differences in housing, income and education. 
Cuba proves that expensive technology is not necessary for good medical care. Its preventive and primary care system focuses on keeping people well. The vastly more costly fee-for-service system of the US focuses on sickness. This makes Cuban medicine an attractive model for poor countries of Africa and Latin America.
Beyond the borders
Cuba reached out to other countries at the same time that it was developing its own medical system. Its first health contract involved its sending a medical brigade to Algeria in 1963.  Cuba’s international health care solidarity is perhaps best known for the doctors and paramedics it sent to the Caribbean Islands and Central America during Hurricanes Mitch and Georges in 1998, as well as the Barrio Adentro (Inside the Community) program which brought 10,000 Cuban doctors to Venezuelan in 2003–04. 
Less well known is the medical aid that has gone to Africa. When its soldiers went to Angola in 1975 to support the newly independent government against the CIA-backed forces of UNITA (National Union for the Total Independence of Angola), 700–800 Cuban health professionals went also. Hundreds of doctors sent to Ethiopia about the same time comprised a second major African initiative. Medical aid to Mozambique followed in the 1980s. In 1978, 13% of Cuba’s 12,000 doctors were working overseas. The major area to receive aid was sub-Saharan Africa. 
Cuba’s medical assistance program was expanding so much that Fidel Castro proposed creating a medical school to bring students from around the world to Havana for their education. In 1999, the Latin American School of Medicine, ELAM (Escuela Latinoamericana de Medicina) opened its doors near Havana. With their educational costs covered by Cuba, students focus on learning how to practice medicine in underserved communities.
Just as ELAM was graduating its first class, Katrina slammed New Orleans in 2005. Castro mobilized hundreds of ELAM graduates and Cuban doctors to help. George W. Bush refused to even consider the gesture of good will.
But Cuba’s neighbor, Haiti, has had no trouble being one of the largest recipients of Cuba medical aid. There are 567 Haitian students in ELAM, which has graduated 550 Haitian doctors. Cuban efforts in Haiti have meant a greater than 50% decrease in infant mortality, maternal mortality and child mortality and an increase in life expectancy from 54 to 61 years of age between 1999 and 2007. Haitian President René Préval said, “You did not have to wait for an earthquake to help us.” 
Cuban doctors provided more medical care than any other country during the first three days after the 2010 earthquake. In addition to ELAM graduates already in Haiti, 184 Haitian students from ELAM (along with US ELAM graduates) came to assist. At the time that the US had 550 medical personnel in Haiti, there were 1500 from Cuba. They had treated 227,143 patients when the US had treated 871.  Within a few weeks, most non-military Americans departed and Haiti was out of the headlines. Just as they were present before the disaster, Cubans stayed afterwards —not only to treat patients but to help build a new health care system.
The new medical leadership
The thousands of international students who have graduated from ELAM do more than add another doctor to their countries. Returning home with a concept of preventive and community health, they have mastered an approach very different from that taught in Western schools.
ELAM has 9675 students from 100 countries in the Havana area. The 7777 students from 15 Latin American countries account for over 80%. But Africa has the largest number of countries (36) represented. They are from Angola, Benin, Burkina Faso, Cameroon, Cape Verde, Chad, Congo, Djibouti, Equatorial Guinea, Ethiopia, Gabon, Ghana, Guinea Republic, Guinea-Bissau, Kenya, Lesotho, Madagascar, Malawi, Mali, Mauritania, Mozambique, Namibia, Niger, Nigeria, Sao Tome Principe, Sarhawi Arab Democratic Republic, Seychelles, Sierra Leone, South Africa, Swaziland, Tanzania, Togo, Tunisia, Uganda, Zambia and Zimbabwe.
African students are 9.1% of those at ELAM, followed by the Caribbean with 7.3%. A much smaller portion of the student body is made up of those from Asia (0.7%), Europe (0.1%), the Middle East (0.5%), Canada/US (1.2%), and the Pacific Islands (0.7%).
During three trips to Havana in 2009 and 2010, I spoke with administrators, professors and students at ELAM. What several students told me of their experiences follows:
Amanda Louis explained “Cuba gives people like me an opportunity to study medicine that we would never have anywhere else.” Her father is a taxi driver and her mother is a food vendor. Amanda is a 26 year old first year student from St. Lucia, a Caribbean island.
After receiving her medical degree, Amanda would like to focus on kidney disorders. She reported that there are enough general practitioners and OB/GYNs in St. Lucia, but only 1 oncologist and 1 ear, nose and throat doctor. Amanda will have to work for the government for five years or else reimburse it for money it fronted for her transportation and incidental funds.
Though St. Lucian physicians think that a degree from Cuba is not as good as other schools, Amanda thinks it is better. “Here, they give us more hands on work with patients at the consultorios and polyclinics.” Amanda feels that after being at ELAM students will return to St. Lucia with a different way of looking at people. “Cuba shows how people can have simple things and be happy.” .
Lorine is an 18 year old premed student from Kisumu in western Kenya. Her family has to pay for her transportation and she can only visit them once during her six years of study. Before graduating, she may get to spend a summer in Ghana with the Organization of African Doctors.
Lorine speaks Swahili, English and Spanish and has long wanted to be a doctor. In high school everyone took the same subjects; so, she was not able to take more science courses. Her father, an accountant, and her mother, an occasional printer, were very happy that she would be coming to Cuba. The Kenyan government gives students loans for medical school, which are paid back by deductions from paychecks when they become doctors.
Lorine thinks that ELAM gives a better medical education than she would have gotten in Kenya, where the state university has small classrooms. Professors often cannot see all the students and rarely have multi-media presentations. At ELAM, she can hear what professors are saying, she can ask them questions, and they often call on students in class. The private university in Kenya is good but it is far too expensive for her.
Yell is from Trinidade, a city in the African island country of São Tome Principe. He speaks Portuguese and is learning Spanish during his pre-med year at ELAM. When he was 18, the government told him that, based on his grades and exam scores, he was accepted for medical school, but they could not tell him where. Shortly before leaving home he learned that he would be coming to Cuba.
At ELAM, he finds it a struggle to master the science courses he is taking during pre-med. Since there are plenty of general practitioners in São Tome Principe, he plans to study a medical specialty, but he is not sure what it will be. Yell will be required to work for three years in a government job to pay back the cost of his transportation to and from Cuba.
Keitumetse Joyce Letsiela
Joyce is an 18 year old first year student from rural Lesotho. After talking with a doctor she knew and seeing an advertisement for ELAM, she completed an application during her last year of high school. Her mother, a teacher, was both happy and scared she would be studying so far away. The Lesotho government loans her money for transportation which Joyce must pay back after graduating.
Joyce speaks Sesotho and English but found ELAM hard at the beginning because she is having to learn Spanish. She misses home and is becoming used to Cuba after getting to know Lesotho students and other friends.
What she likes best about ELAM is meeting people from all over the world. She sees ELAM students as independent and serious. Cuba was Joyce’s first choice for medical school. Since there is no medical school in Lesotho, the main option is studying in South Africa. But very few go because of the cost.
Mostly, she would like to help people who are now without medical care. Joyce says that there are only two doctors in the public hospital near her home.
Dennis lived the first 13 years of his life in Bo, Sierra Leone where he spoke the regional Mende language as well as Krio. When civil war ripped the country apart and his cousins were killed, his family made its way to neighboring Guinea in 1997. In 2001 they moved to Jonesboro, Georgia where his brother had been living.
Medicine had been in Dennis’ mind for years, but he couldn’t bear the thought of graduating with a huge debt. In 2006, looked up ELAM on the web. He applied in 2007 and began his studies in 2008. He took Spanish during his pre-med year. At 26, Dennis is currently finishing his second year at ELAM.
He would like to take board exams in the US after graduating, but spend most of his time in Sierra Leone. Most communities are underserved in Sierra Leone, which has a national health care system that controls the hospitals even though there is simultaneous private practice.
After ELAMs third class graduation, the Student Congress proposed creating projects during summer vacation months. The faculty approved and students began designing Brigadas Estudiantiles por la Salud (BES, Student Health Brigades).
A good example of BES projects is the Yaa Asantewaa Brigade (YAB), whose key organizers include Omavi Bailey and Ketia Brown.  YAB will carry out the “African Medical Corp — Ghana Project.” It was designed by the Organization of African Doctors (OAD), a group of African and African-American medical students founded in 2009 on the ELAM campus.
Currently, the “brain drain” of African doctors getting jobs in Europe or the US leaves Ghana with just 1 doctor for every 45,000 residents. The 2010 phase of the Ghana Project plans to begin with ELAM students traveling to Ghana to meet with Cuban-trained doctors already there. In the communities they visit, ELAM students intend to:
1. Perform an access assessment of the sources of health care that residents already have; 2. Create health groups to do physical exams and learn Ghanaian traditional medicine; and, 3. Hold community meetings to strengthen ties with Ghana residents by finding out their desires for health care.
If successful in 2010, the YAB hopes to create an internship so that sixth year ELAM students can complete their medical training in Ghana. It is no accident that the YAB aims to look at Ghanaian access to services, beliefs about health care, and desires for change rather than using a pre-determined model that may or may not fit the life of an African village. Training at ELAM places heavy emphasis on the evolving social context of medicine, a model that applies particularly well to tight-knit communities.
Even though natural medicine is often ridiculed in the West, it is the major type of prevention and treatment for most African people. Using methods of community health care taught at ELAM, YAB will build on African traditions.
Ketia Brown sees her experiences at ELAM and in Ghana as critical for her medical education. After getting her degree, she would like to continue her work with high school students and practice natural and spiritual medicine. She would like to open a wellness clinic emphasizing the changes people need to make in their lives.
“ELAM is the revolution realized,” Ketia told me. “It is a reflection of what can be done with medicine.” She strongly believes that “We must attempt to have a revolutionary project in a capitalist world.” For her, ELAM is such a project. Its new medical consciousness is a part of the struggle to redesign global health.
Don Fitz produces Green Time TV in St. Louis, Missouri and is editor of Synthesis/Regeneration: A Magazine of Green Social Thought. He can be reached at firstname.lastname@example.org.
The author would like to thank ELAM Rector Juan Carrizo, Director of International Relations Nancy Remón Sánchez, General Secretary of Project ELAM Wuilmaris Pérez Torres, and Assistant Professor of MGI Dr. Raul Jorge Miranda for explanations of the Cuban medical system, data on ELAM, and help with contacting students.
Discussions with students Amanda Louis, Lorine Auma, Yell Eric, Keitumetse Joyce Letsiela, Dennis Pratt, Ketia Brown and Omavi Bailey occurred May 26 – June 2, 2010 on the ELAM campus.
1. Sweig, Julia. (2009). Cuba: What everyone needs to know. New York: Oxford University Press, pp. 53–54. 2. Kirk, John M. & Erisman, H. Michael. (2009). Cuban medical internationalism: Origins, evolution and goals. New York: Palgrave Macmillan, pp. 7, 25–34, 45, 72–75. 3. Whiteford, Linda M. & Branch, Laurence G. (2008). Primary health care in Cuba: The other revolution. Lanham: Rowman & Littlefield Publishers, Inc., pp. 2, 7–10, 59, 83. 4. Brouwer, Steve. (January, 2009). The Cuban revolutionary doctor: The ultimate weapon of solidarity. Monthly Review, 60 (8), 28–42. 5. Kirk, Emily J. & Kirk, John M. (Fall, 2010). Cuban medical aide to Haiti: One of the world’s best kept secrets. Synthesis/Regeneration: A Magazine of Green Social Thought. No. 53. 6. Information on the YAB was obtained from the interview with Ketia Brown and the document provided by Omavi Bailey: Yaa Asantewaa Brigade. (August 15–September 5, 2010). African Medical Corps — Ghana Proposal. Latin American School of Medicine, Carretera Panamericana 3 ½ KM, Santa Fe, Playa, La Habana, Cuba CP 19142. For information on the Organization of African Doctors, see www.africanmedicalcorps.com. Donations can be made to the Ghana Project at www.birthingprojectusa.org.