Cuba is doing more than any other country in the world to reverse the “brain drain” of doctors abandoning impoverished areas. A physician who leaves Sierra Leone for South Africa can earn 20 times as much. Higher pay in English speaking countries lures medical graduates from India (10.6% of doctors), Pakistan (11.7%), Sri Lanka ( 27.5%), and Jamaica (41.7%). Only 50 of 600 doctors trained in Zambia remained there after independence. There are more Ethiopian doctors in Chicago than Ethiopia. 
The Cuban alternative is the 11 year old ELAM (Escuela Latinoamericana de Medicina, Latin American School of Medicine). With their educational costs covered by the Cuban government, students focus on returning as doctors to underserved communities in their countries.
The more than 20,000 medical students in Cuba receive much, much more than a free education — they are participating in a project to build a new model of medicine for the world’s poor . Students are well aware that they represent 1 of 100 countries, each of which has a unique relationship to the yoke of imperialism.
ELAM students learn the Cuban model of Medicina General Integral (MGI). A literal translation is “General Integral Medicine,” but a conceptual translation is “public health and primary care.” MRI emphasizes the wholeness of biology, sociology, economics and politics in establishing the context of health and disease. In Cuba, it is impossible to separate efforts to create a new medical awareness from the struggle to improve health care. This article describes how ELAM affects the medical consciousness of 13 of its students.
Exa Gonzales, Photo by Don Fitz.
Of all the ELAM students I spoke with, Exa (25) is the only one I met in the air over the Gulf of Mexico. Exa was sitting next to me on the plane as I told her of my hassles getting to Cuba to visit my daughter at ELAM. She let me know “I’m a sixth year students there.”
Exa is from the town of La Paz in Baja California, Mexico. Though her mother speaks Spanish and English, Exa speaks Spanish and French, as does her father, who teaches social sciences. Both of her parents have been active in the Mexican Partido de Trabajo, (PT, Workers Party). In 2001, her father took Exa and her mother on two trips to Cuba with the group Amistad Entre Cuba y México (Friendship between Cuba and Mexico).
In high school, Exa was interested in art and took courses in film. But she had been interested in helping people since she was a child. She also knew that Cuba had sent doctors to Central America to aid in hurricane relief.
On her second trip to Cuba, Fidel Castro spoke to her delegation and described ELAM. That changed her life. She decided that the best way to fulfill her childhood goal would be to become a doctor. When she entered ELAM at 19, she had to spend several months studying biology and chemistry in pre-med.
Like most students from Latin America and Africa, Exa began medical school right after high school. She described her first year at ELAM as her sad year, when she found herself in a culture very different from Mexico and felt so alone that she wanted to leave. But her mother continuously encouraged her and she decided to stay. When we spoke, Exa was completing her final year at ELAM.
Anmnol Colindres, Photo by Don Fitz.
Anmnol (22) was waiting outside the Consultorio Médico No. 17-2 in Havana with ELAM students from the US, Chile, Brazil and Venezuela when he told me of life in Honduras. His entire family was affected by the June 28, 2009 coup against then President Zelaya which destroyed jobs throughout the country.
His father had been a forestry worker. But with the economic devastation following the coup, the market for lumber crashed and he lost his position. He is working for lower pay as an agricultural director at a farm.
Anmnol’s 20 year old sister lacked one semester of completing school but had to drop out when grants disappeared after the coup. She hopes to be able to reenter school if the economy stabilizes. Anmnol’s 17 year old brother planned to study engineering in Venezuela; but, those hopes were dashed as the new Honduran regime showed its hostility to the Chavez government.
Anmnol had long wanted to be a doctor, but the expense was out of the question for his family. After studying for a year and a half to be a teacher, he heard of ELAM. According to Anmnol, Honduran students are selected for ELAM by a mixed system of exam scores, lottery selection and recommendations. The socialist and revolutionary parties are so small that they only recommend a handful of students.
His high exam scores gained Anmnol approval to attend ELAM in 2006. But he did not have the money to fly to Cuba; so, he had to work for a year in a company making small boxes.
Under Zelaya, Cuban-trained doctors could work in Honduras. Graduates from ELAM had begun a clinic to offer free medical care but they were shut down after the coup and thugs attacked the medical students and doctors.
Honduran doctors tend not to want to work in areas which have the greatest need, leading to a bad distribution of medical care. The Honduran Colegio Médico (analogous to the American Medical Association) would like to privatize government-based medical care and supports the coup. There is a real danger that it will not recognize doctors trained at ELAM. It may be necessary for students graduating from ELAM to form their own medical association when they return to Honduras.
One of the largest shortcomings of medical practice in Honduras is too few specialists. After graduating from ELAM Anmnol would like to get a grant to study cardiology in Spain before returning to poor areas of Honduras.
Ivan Angulo Torres
Ivan Angulo Torres, Photo by Rebecca Fitz.
In 2002, Ivan (28) was studying technical administration of hotels in Lima, Peru. He says that it would have been impossible—a crazy idea—for him to even think of studying medicine. Only 100 students per year are admitted to medical school in Peru and even with his father being director of a secondary school, his family could not have afforded it.
But his father is also a member of the Partido Socialista Revolucionario (PSR, Socialist Revolutionary Party), one of that left parties can nominate young people to attend ELAM. Ivan became the first PSR-recommended student at ELAM.
When he arrived in Havana, Ivan began to meet students from all over Peru, each with different backgrounds and experience. But adjusting to ELAM was a challenge. He found Cuban Spanish to differ from Peruvian Spanish and it was a full six months before Ivan felt he could understand Havana speakers.
Ivan just completed ELAM’s six year program. New Peruvian doctors must work for a year in rural areas where there is a shortage of all services, including medical care. There is also a shortage of medical specialists in Peru and Ivan would like to study orthopedics. He hopes to practice in either in Peru’s jungles or in the province where his family lives. He does not see the Peruvian government as having particularly good or bad relations with Cuba and expects his degree to be treated as if it were from any other country.
Ivan Gomes de Assis
Ivan Gomes (23) is a second year student at ELAM from Salvador City in the state of Bahía, Brazil. After finishing his studies, he taught math and statistics in high school, largely because he felt that math could show people how to understand the corruption that is rife in the government.
His father is a lawyer and Ivan’s family participated in progressive activities such as assisting people in receiving medical care despite their inability to pay. When he was 20, he learned of ELAM through the internet and was impressed that the school did not focus on teaching students to become wealthy doctors. He decided that practicing medicine would be the best way to work with Brazil’s poor.
Brazilians are typically admitted to ELAM through left parties and Ivan had no history with the left. But he interviewed with Cuban embassy staff, who endorsed his admission. When he finishes medical school, he would like to study orthopedics and practice in rural areas of Brazil where there are few specialists.
Ivan finds school at ELAM difficult, partly because the US blockade makes it hard to access the internet. He feels ELAM is a great school, but prefers to study independently and does not like making a lower grade if he skips classes. He also is not used to working in groups as much as ELAM requires.
Ivan is concerned about the way Brazilian doctors fit into the country’s corruption and gross inequality. The Brazilian medical association is independent of the Lula government and does not want doctors trained in Cuba to receive certification or practice medicine in Brazil. Ivan expects a continuing political struggle over the role of Cuban training but is confident that he will find a way to practice medicine with the poor.
Walter Titz, Photo by Rebecca Fitz.
Walter (23) is a second year student from São Paulo, Brazil. He dreams of creating Cuban-type community medicine in Brazil. Ever since he was in high school, Walter thought that a career in medicine would be important. He went to the Catholic University of Santos and studied journalism for