Cuba's Latin American School of Medicine

Following a catastrophic year in Latin America for natural disasters in 1998, Cuba recognized a lack of doctors being trained throughout Latin America. First, Hurricane Georges rampaged across Haiti in October of 1998, leaving over 400 dead (Kirk 2015). Only a few weeks later, Hurricane Mitch devastated Honduras, El Salvador, Nicaragua, and Guatemala. This storm left 1.8 million affected (Kirk, 2015). While initial Cuban efforts involved exporting medical staff to the affected areas, the Cuban government decided more had to be done. Cuba has a long history of supporting emergency relief abroad, especially when compared to countries of similar GDP. However, the decision to open the Latin American School of Medicine in 1998 and its subsequent opening in 1999 represented a departure from providing merely short-term relief, and a movement towards supporting sustainable medical empowerment across the globe. This choice reflected the larger principles within medicine which Cuba has established nationally, such as Universal Healthcare and an emphasis on primary care. Since Castro’s rise to power in 1959, Cuba has seen a strengthening and emphasis on healthcare and access (Cueto & Palmer, 2015). The school established in 1999 to expand this focus internationally has since grown into the largest medical school of the world, providing medical training for students of all backgrounds. The Latin American School of Medicine, or ELAM, through scholarships and recruitment of marginalized students, teaches an ideology of preventative primary care, empowering their students to go on and serve poor and neglected communities.

Notably, compared to other acclaimed medical institutions, ELAM provides full scholarships for all students enrolled in the university. The university not only covers tuition, but also provides textbooks, housing, food, medical supplies for training, medical insurance, and an additional stipend (Fitz, 2011). This makes ELAM accessible to students with few resources, including those from remote and underrepresented regions. The school caters towards this demographic, recruiting students from medically underserved areas across Central and South America, Africa, Asia, and even the United States (Feinsilver, 2006). In 2003, for example, the school had 13,945 students from 113 countries (Huish & Kirk, 2007). Granting access to medical school which students would otherwise not have reflects the ideology of the Latin American School of Medicine.

ELAM goes beyond providing students typical medical training focused on biomedicine, offering a special emphasis on primary healthcare and social determinants of health. The Latin American School of Medicine emphasizes “solidarity, humanism, ethics, and internationalism” (Kirk, 2015) in its curriculum. Therefore, medical students at ELAM receive extensive training in public health, including education on social, environmental, and economical determinants of health (Kirk, 2015). All courses are taught in Spanish; however, English is also included in the curriculum to enable students to engage with medical academic literature, which is predominantly published in English (Huish & Kirk, 2007). For students from outside Latin America, or those with indigenous backgrounds, this can present a challenge, and many students spend their first two years at ELAM studying Spanish rigorously alongside their other coursework. This not only trains them for their future studies, but prepares the students to be able to engage with individuals from different backgrounds, and to better serve their future patients. The diverse student body only further contributes to this multicultural understanding, where students are constantly engaged with classmates from different backgrounds. This interdisciplinary education beyond the usual scope of medical school reflects ELAM’s greater goals for these students. The school aims to train students to go on to represent the communities they come from, and provide care to those otherwise ignored areas.

Every scholarship at the Latin American School of Medicine is conditional on the student agreeing to provide care in underserved communities after their graduation. As Fidel Castro once reflected on the students of ELAM “The most significant (impact of ELAM graduates), however, will be their absolute devotion to the most noble and human endeavor, that of saving lives and preserving health. More than physicians they shall be zealous guardians of what human beings appreciate above all else. They will be apostles and builders of a more humane world” (Kirk, 2015). The university has now trained over 25,000 students and the vast majority have gone on to seek roles as medical professionals supporting marginalized communities (Gorry, 2015). Out of Haitian graduates from ELAM, only 13% in 2012 had gone on to work at private practices in their home country (Kirk, 2015). The majority sought positions working for Haitian public health, or collaborating with Cuban entities on the ground in Haiti. Graduates have gone on to serve as Ministers of Health in Costa Rica and Bolivia (“Graduados en La ELAM,” 2017), two countries with some of the most progressive and holistic health systems. They also hold positions as Vice-Ministers and regional directors of health (Graduados en La ELAM, 2017). This reflects a greater success of the Latin American School of Medicine, a success in encouraging students to go on and use their education to improve health in their home countries.

Despite the many successes of ELAM, it is not without critique. As Hirschfeld (2007) explains, Cuban health policy in general is often idealized and not portrayed accurately because of the difficulty researchers face when attempting to study Cuba’s national systems. Her own research revealed a general disconnect between depictions of Cuban health infrastructure and reality (Hirschfeld, 2007). Additionally, many have claimed that the school does not fully prepare students to become doctors in their home countries, as some recent graduates in Costa Rica and Chile have failed to pass examinations (Kirk, 2015). The Cuban system has also been maligned for overemphasizing politics within a medical education, and pushing the communist agenda on foreign students. However, perhaps these criticisms reflect not a fault in Cuban education but instead a lack of consideration of how social and political factors contribute to health, and a general overemphasis of science and biological pathways within conventional medical training.

Related Articles

• Cuban Medical Internationalism
• Universal Healthcare: the Costa Rican System
• Medical Tourism in Latin America
• Indigenous Medicine and Health in the Amazon

Additional Resources

Gorry, C. (2012). Cuba’s Latin American Medical School: Can Socially-Accountable Medical Education Make a Difference? Medicc Review, 14(3), 5-11.

Remen, R, & Holloway, L. (2008). A Student Perspective on ELAM and its Educational Program. Social Medicine, 3(2), 158-164.

References

Cueto, M., & Palmer, S. (2015). Medicine and Public Health in Latin America : A History (New approaches to the Americas). New York, NY: Cambridge University Press.

Feinsilver, J. (2006). Cuban Medical Diplomacy: When the Left Has Got It Right. Foreign Affairs en Español, 6(4), 81-94.

Fitz, D. (2011). The Latin American School of Medicine Today ELAM. Monthly Review: An Independent Socialist Magazine, 62(10), 50-82.

Gorry, C. (2015). Latin american medical school class of 2015: Exclusive with Cuban-trained US graduates. Medicc Review, 17(3), 7-11.

Graduados en La ELAM. (2017). Cubadebate: Contra el Terrorismo Mediático. Retrieved from http://www.cubadebate.cu/noticias/2017/12/26/graduados-en-la-elam-casi-29-mil-jovenes-de-90-paises/#.XM49wZNKjUQ.

Hirschfeld, K. (2007). Re-examining the Cuban Health Care System: Towards a Qualitative Critique. Cuban Affairs, 2(3).

Huish, R., & Kirk, J. (2007). Cuban medical internationalism and the development of the Latin American School of Medicine. Latin American Perspectives : A Journal of Capitalism and Socialism, 34(6), 77-92.

Kirk, J. (2015). Healthcare Without Borders : Understanding Cuban Medical internationalism. Gainesville: University Press of Florida.

Peña Pentón, D. (2015). Con tanta ciencia como conciencia. Impacto de la Escuela Latinoamericana de Medicina en el contexto internacional actual. Panorama Cuba y Salud, 10(2), 38-42.