Global health crisis
Cuba walks the talk
Tomás Mac Síomóin
The role of Cuba in curbing the spread of the Ebola virus in west Africa is internationally recognised—albeit grudgingly by the United States. The central role of Cuban and Cuban-trained medical personnel in helping victims of the 21st-century earthquakes in Haïti has been less publicised. The doctors attending the protesters fighting against the profanation by an oil company of their sacred lands at Standing Rock, North Dakota, are mainly Afro-American graduates of Cuba’s famous Latin American Medical School, the Escuela Latinoamericana de Medicina.
These are a few examples of Cuba’s unmatched and continuing internationalist commitment in the area of community-based health care—where “community,” as understood by socialist Cuba, transcends national boundaries.
Two big storms prompted the creation of ELAM in Havana in 1998. Hurricanes George and Mitch had torn through the Caribbean and Central America, leaving 30,000 people dead and 2½ million homeless. Cuban medical personnel who volunteered to help were horrified to find whole communities with no health service, rural hospitals shut for lack of staff, and high infant mortality rates. Where would the trained personnel needed to take over from the Cubans come from? Where would they train?
President Fidel Castro, always alert to the internationalist vocation of the Cuban Revolution, came up with the solution. Following his directions, the premises of a former naval academy in the Santa Fe district of Havana was turned over to the Ministry of Health. Tuition, room and board and small scholarships were offered to hundreds of students from countries hardest hit by the storms.
The first students were ninety-seven Nicaraguans, in March 1999. Soon governments throughout the Americas sought scholarships for their own students. Hundreds of scholarships were granted to young people in the United States, mainly Afro-American and indigenous people.
Today ELAM claims 23,000 graduates from eighty-three countries in the Americas, Africa, and Asia. Enrolment has grown to encompass 123 countries. More than half the students are young women.
As prospective Third World students are not always academically prepared for six years of medical training through Spanish, an intensive pre-medical course introduces them to the physical and biological sciences, with Spanish an integral part of the curriculum.
ELAM is now the largest medical school in the world. It trains physicians for peoples most in need, including the billion who have never seen a doctor, who live and die in poverty. Students come from the world’s most underdeveloped regions to become the excellent doctors their communities desperately need. They commit themselves to practising their expertise and carrying their medicine to their place of origin, where not many doctors go: poverty-stricken and often dangerous drug-infested regions where armed gangs and gun-law rule.
These doctors are transforming access to health services and the way medicine itself is learnt and practised, and so they are pioneers in the battle for universal health coverage.
Thousands of community health projects prove the mettle of ELAM graduates. Honduran graduates organised for their communities their country’s first indigenous hospital. Helped by an architect, residents built it themselves, from the ground up. Receiving its first patients in December 2007, it has had almost a million visits since then. The Honduran government lauds the hospital as a model of rural public health.
Why have so many countries asked for these ELAM scholarships? The world needs between 4 and 7 million health workers just to meet basic needs; and the problem is everywhere. Doctors tend to be concentrated in cities, where half the world’s people live, not in shanty towns or rural areas, where the other half subsists. The “developed world” accentuates the problem. The United States, for example, is the main importer of doctors from developing countries; the health of populations abandoned by these medical professionals loses out.
Cuba’s own excellent health record, the product of strong primary care, attracts students. The Lancet, the prestigious British medical journal, places Cuba among the best-performing middle-income countries in health. Save the Children says Cuba has the lowest infant mortality in the Americas (the United States included). The life expectancy of Cubans matches that of the United States, though Cuban health spending per person is one-twentieth of that of the latter.
I can attest, from personal experience, to the efficiency and quality of Cuban primary care.
The fact that all health and dental services in socialist Cuba are readily available and absolutely free should be of interest in a neo-liberal Ireland, a much richer country, where primary medical care is expensive, the cost of specialist care beyond the reach of most, and hospitals are all too often overcrowded and understaffed.
Socialist Cuba clearly teaches us some important lessons.