By MARINA JIMÉNEZ
Friday, June 17, 2005 Page A13
The Toronto Globe & Mail
HAVANA -- With his mastery of Cuban slang, love of
guavas and chess in the parque central, Cedric Edwards could easily pass for a
Habanero. Only his name gives him away. The young man from New Orleans is about
to make medical -- and political -- history.
This month, he will become the first American doctor to graduate from the Latin
American School of Medicine (known by its Spanish acronym ELAM), a school that
is exclusively for foreigners and is free.
"I'm not trying to make a political statement. I just wanted to become a
doctor," says Mr. Edwards, 32, with the dazed look of someone who has just
finished a 24-hour on-call shift at Havana's Salvador Allende Hospital, where he
spent much of the night treating patients with cardiac failure, diabetes and leg
ulcers.
"It feels good, but it's a little scary at the same time to be the test case.
Sure, I'm worried there could be political repercussions in the U.S.," says Mr.
Edwards, who has avoided interviews until now. "But people are misinformed about
Cuba, and as they learn more about the medical system, they will see its high
standards."
The Cuban government opened ELAM in 1998, in a former naval academy 20
kilometres east of Havana, as part of an assistance program for countries struck
by Hurricane Mitch. The idea was to train doctors to treat the poor of the
Americas and Africa.
Today, 8,000 fully funded scholarship students from 27 countries are enrolled in
the Spanish-language program, including 88 Americans. The U.S. economic embargo,
in place since 1961, prohibits Americans from travelling to the Caribbean island
and the medical students have won a hard-fought exception.
Their presence in Cuba is a political victory for Fidel Castro, the Cuban ruler,
who loves to invite them to demonstrations and to his televised round tables,
making the most of the irony of a small island nation subsidizing the education
of poor students from a superpower that for years has engaged in economic
warfare against Cuba.
Yet, at least some of the American students say they take a pass on such
political theatre. They prefer to see the school as an opportunity to fulfill a
dream that would be out of their reach in the United States, where the price tag
for medical school is as much as $200,000 (U.S.).
"I focus on my studies. At the same time, when you see the U.S. blockade from
this side, you see how stupid it is. A bunch of old men with grudges," says
Toussaint Reynolds, a New York native who gave up his Dodge Intrepid, his
television and his brand-name clothing to come here and study to become an
emergency-room physician. He hopes to graduate in two years and do an internship
in a hospital in Harlem or the Bronx. "I think we are getting the last laugh,"
he says.
Mr. Edwards, who, like Mr. Reynolds, avoids political events, credits ELAM
with "literally saving my medical career." Distressed by one low grade and a
mounting debt, he dropped out of Louisiana State University medical school in
midstream, a decision he later regretted.
Whether the program is "a cunning move by one of the world's great chess players
or an extraordinary gesture of civic generosity or a bit of both" -- as a
December, 2004, article in the New England Journal of Medicine put it -- it is
definitely helping black and Hispanic Americans enter a profession traditionally
closed to them.
The article notes that while 25 per cent of the U.S. population is black,
Hispanic or native American, only 6.1 per cent of the country's doctors have
this background. Many poor Americans also do not have access to medical
insurance.
The New York-based Interreligious Foundation for Community Organization recruits
American students for the 500 spots at the school. While the number of
applicants falls far short, a spokesman said more and more states have begun to
express interest in the program. To qualify, students must have completed two
years of pre-medical courses, be from poor communities and commit to returning
to practise in those communities.
To be sure, the program is not for Hilton-hoppers. At the ELAM campus, students
eat a beans-and-rice diet, are not allowed to leave during the week without a
special pass, and nobody, including family members, may visit their dorms, for
reasons not well explained by ELAM officials.
Mr. Edwards has endured mosquitoes, limited Internet access, and the absence of
hot water, toilet seats, Snickers bars and Pepsi. When he goes back to New
Orleans for his annual visit, he returns with a suitcase filled with Neutrogena
soap, Mennen deodorant, waxed dental floss, cologne and boxes of gummi bears and
Winterfresh chewing gum -- luxuries not often seen on stores shelves here.
Yet he has also developed a fondness for local pleasures: tropical fruit drinks,
mesmerizing son and casino dance music and Cuba's unique patient-oriented system
of care. He even married a fellow student from Equatorial Guinea in a civil
ceremony, celebrating with a small reception and a Cuban layered wedding cake.
Cuba's sophisticated and public medical system is one of the revolution's most
notable successes. The country has one of the lowest infant-mortality rate in
the Americas and twice as many physicians per capita as the United States, with
a long tradition of sending doctors to work in developing countries in Africa
and Latin America.
The Cuban medical system focuses on preventive medicine and viewing patients as
human beings instead of clients, as several earnest first-year students explain.
The country gets around the shortage of medications
and high-tech equipment by relying on traditional diagnostic techniques. Mr.
Edwards says there is a greater use of the stethoscope, vaginal exams to
determine pregnancy and plastic cups with a suction device to detect fetal
heartbeat.
"Cuba really challenges the way we think about health care and health-care
services. They approach it as a human right, whereas other places approach it as
a business," says Robert Huish, a PhD student from Simon Fraser University and a
scholar with the Trudeau Foundation who is doing his thesis on the ELAM program.
"My question is, how much will the training, which reflects the needs of the
Cuban society, fit in with the needs of other societies?"
Mr. Huish will track the progress of this year's first graduating class. Eliud
Rivas, a 24-year-old Guatemalan who comes from a family of peasant farmers with
nine children, is thrilled with the opportunity to become a doctor.
"I never dreamed I would be able to go to university, let alone medical school,"
says Mr. Rivas, a first-year student who plans to return to a job in Guatamala's
public-health ministry. While he describes himself as apolitical, Mr. Edwards
says he is against the U.S. blockade, and supports Cuba's recent crackdown on
democracy advocates, which has been criticized by human-rights groups.
But he insists he is most concerned about landing a residency in internal
medicine at a U.S. hospital. (He has already passed his U.S. equivalency exams.)
He would also love to practise in Canada, a country with public medicare similar
to Cuba's, he says. "Canada has no blockade or political motivation to demonize
the country," he said. "It's still strange to me, why would a small country like
Cuba want to pay for me to come here?"
For the moment, ELAM is not open to low-income Canadian students looking for
scholarships in the Caribbean. But Dr. Gillian Jiménez, with Cuba's Ministry of
Foreign Affairs, is not opposed to the idea: "If we had an application from
Canada, we would evaluate it. The program could be opened to include Canadians."