2023-06-19 10:00:00
I
inaugurated in november 1999 In what was once a naval academy, even from afar, the Latin American School of Medicine (ELAM) is impressive. Located 25 kilometers from Havana, Cuba, it has the sea on one side and the Santa Ana River on the other. The institution covers 120 hectares and is made up of 28 buildings, 130 classrooms and laboratories, amphitheatres, dormitories and dining rooms. Since its foundation, more than 30,000 students from 120 countries have graduated, a global reach that is palpable when entering through the entrance where dozens of flags, photos of students in their typical costumes and various crafts show the national and ethnic origins of his students.
The ELAM project was born out of a tragedy – rather, Cuba’s refusal to remain passive in the face of a tragedy. In 1998 the hurricane Mitch, the second deadliest in Atlantic history, devastated Central America. In addition to the 22,000 dead and missing it left in its wake, floods and landslides destroyed the region’s already fragile infrastructure and devastated its agriculture. In Honduras, 20 percent of the population was left homeless. Fidel Castro declared that they would take revenge for the hurricane, first by sending hundreds of doctors, nurses and technicians to the region, second by offering scholarships to Central American students to study medicine in Cuba, and finally by establishing a medical school that would be the total consecration to the most noble and human of trades: saving lives and preserving health.
Eloquent logic of the president. In the speech he gave at the inauguration of ELAM, he explained, the television images of thousands of corpses floating on the water or wrapped in mud move the world. These are the days of generous offers and millionaire figures. The impact disappears in a few weeks. Soon everything is forgotten. Big promises are never fulfilled. Systematic death continues to quietly take more lives each year than are killed by all natural disasters combined. Thanks to ELAM, almost 23 years later, the impact of Cuba’s solidarity continues.
The ELAM student body is like no other. Unlike most medical schools in the rest of the world that train middle- and upper-class students (and in countries like the United States that are disproportionately white), ELAM trains poor students from countries of the so-called global South for free. . Observing this characteristic during her visit to ELAM in 2009, Dr. Margaret Chan, then director of the World Health Organization, declared: I don’t know of any other school that offers so much to its students and at no cost. I am not aware of any other medical school that gives first priority in its admissions policy to applicants from poor communities, who know firsthand what it means to live without access to health care. For the first time, if you are poor, a woman or an indigenous person, you have an advantage.
The medical degree at ELAM lasts six years. Non-Spanish speaking students start first with intensive Spanish courses. From there they study two years of medical sciences and from the third they join clinical cycles in teaching hospitals in Cuba. The sixth year is an internship where internal medicine, pediatrics, obstetrics/gynecology, surgery and integrative medicine are rotated. From the beginning of their career, students are trained under the logic of comprehensive general medicine that is characterized by its close relationship with patients and knowledge of their family and community environment, in addition to dispensing, continuous monitoring of patients and implement a classification system to identify chronic diseases and risk factors.
One of the main characteristics in the selection process of students for ELAM is the commitment that, upon graduating and returning to their countries of origin, they will work in places where doctors are most needed. This principle of solidarity is reinforced in various ways in the training they receive there. Most of the ELAM faculty have participated in medical brigades that Cuba sends to the neediest areas of the world. They know firsthand the challenges of caring for patients in remote places where there are no hospitals or clinics, even where people have never been seen by a doctor. In this sense, ELAM graduates are prepared to deal with the main challenge that the world faces regarding health. This is not, Chan also expressed, the use of the latest techniques with the most recent high technologies and procedures. The biggest challenge is getting essential care services to those who don’t have them.
From the hundreds of thousands of medical personnel that the island has sent to Africa, Asia and Latin America, to the doctors that while on those continents they have helped train, to the Henry Reeve brigade whose members care for the victims of natural disasters, Cuba has provided medical attention to those in the world who do not have it. This has been done for six decades; ELAM, the world’s largest medical school, is another component of this effort. In addition to training those who would not have been able to access a medical career, it reverses the pernicious brain drain that also plagues poor countries.
To say that this is an impressive feat for a small, poor country under constant siege from the most powerful nation in the world is an understatement. It is above all an example of what a humanist, supportive and internationalist ethic can achieve.
*Professor-researcher at the Massachusetts Institute of Technology. author of the book Unexpected lessons from the revolution. A history of rural normals, next to be published with La Cicada.
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