someone slurred cuba's health care re AIDS, but left out any facts,
especially that nation's system regarding all, not just specific, health
issues. This piece contains the usual bows to propaganda as to ulterior
motives ( you'll find it), but nevertheless points out - to our shame -
significant differences in the attitude towards health care ...
fs



The New York Times                                      February 17,
2000

TO LATIN NEIGHBORS, CUBA PLAYS THE GOOD DOCTOR

        By David Gonzalez

HAVANA -- Nieves Dinora graduated from high school in Nicaragua
with good grades and no prospects. Since her father, a farmer, had no
money to send her to college, she figured marriage and motherhood
were her only options.
        “Like many of my friends there, I thought I would take the nine-

month career,” she said. “It does not cost anything, just nine months.
Easy, no?”
        But rather than having babies, Ms. Dinora is now learning how to

deliver them.
        She is among 1,900 students at the Latin American School of
Medical Sciences who are enrolled in a six-year program that is a
unique twist on the old concept of overseas medical schools. While
many people think a Caribbean campus is the last-ditch resort for for-
eign students with fat wallets but slim grades, this one is the exact
op-
posite, giving full scholarships to smart youths from poor rural areas
in
18 Latin American and Caribbean countries.
        The medical school is the Cuban government’s response to the
devastation from Hurricanes Georges and Mitch, which ripped through
the region in 1998, killing thousands as they destroyed villages and
spawned public health problems. While Cuba sent medical teams to
help, officials realized that it would be better in the long run to help

educate a new generation of doctors who would return to their impov-
erished countries and work in remote communities where medical care
was spotty and expensive.
        “Life has shown us some lessons that we cannot forget,” said
Juan
Carizo Estévez, the school’s rector. “That is the necessity of the right
to
health care that these countries have. We have a responsibility that
these students return to their own countries with a solid foundation for

dealing with the problems of public health they will find.”
        The new medical school is the culmination of the Cuban govern-
ment’s decades of reliance on its reputation as a medically advanced
society to burnish its international image. Starting in 1963, when it
sent
a team of doctors and nurses to Algeria, the government has gone on to
establish medical schools in the third world, send thousands of Cuban
doctors for long-term overseas assignments and offer scholarships to
study alongside Cuban students in the island’s medical schools.
        Medical aid was as important an aspect of President Fidel
Castro’s
aid to the third world as his nation’s training of guerrilla and
terrorist
groups was during the cold war. While cold-war conflicts have died
down, Cuba’s latest experiment in medical education is still tinged with

the passions from that era.
        “By doing good, particularly in the field of health and
education,
Cuba would look better than the United States,” said Julie Feinsilver,
author of “Healing the Masses” (Berkeley, 1993), which examined the
role of health care in Cuba’s foreign and domestic policy. “This is a
symbolic war, not that the U.S. looks at it that way. But Fidel said
when he finished the revolution, his real destiny was war against the
U.S. The war is not a material war, but a symbolic war. Anything that
Cuba does that enhances its prestige on the world stage, which medical
diplomacy and providing scholarships does, is a battle won for Cuba
versus the United States.”
        The school’s very location is a sign of the changing
battleground --
it occupies 82 blue-and-white buildings that hug the ocean along the
campus of what was an academy for naval officers and merchant mari-
ners.
        Students were selected through tests and interviews and are
mostly
chosen by their home countries. The first contingent, from Honduras,
Nicaragua and El Salvador, the areas hit hardest by the hurricanes, ar-
rived almost a year ago.
        Cuban officials said they started the school as a gesture of
interna-
tional good will, and that they did not intend to politicize the
students.
Still, many students spoke about how many doctors in their countries
were interested only in making money while the poor languished and
children died from preventable diseases, echoing a common Cuban cri-
tique of modern medicine.
        Edmundo Blandón, 20, recalled how his mother in Nicaragua suf-
fered from pains for years, being told all the time that she only had a
kidney infection. Unable to see a specialist, she suffered and waited
for
two years until her daughter took a loan from a co-worker.
        “As a child, you see how in your family there are needs for a
doctor
to help you,” Mr. Blandón said. “When she was 59, she finally learned
she had advanced cancer. She could not have had the medical tests
done earlier, because we did not have the money.”
        She died soon after he enrolled in the school.
        “She had felt bad because she thought I would leave this school
because of her,” he said. “But she told me that in the first place,
noth-
ing could be done for her. So, if I was left alone with nobody to look
after, I should take advantage of this opportunity.”
        The students begin with six months of pre-medical studies in
basic
sciences like physics, chemistry and biology. They proceed to two
years studying embryology, biochemistry and other medical subjects,
followed by four years studying and working in Cuban hospitals and
clinics.
        Teachers said they follow a curriculum that combines textbook
les-
sons with practical experience, with an emphasis on problem solving
and preventive care. It hews to the Cuban approach to health care,
which stresses community-based medicine and public health.
        Although students from the same country live together in
dormito-
ries to ease their homesickness, the classes have a cross section of
races and ethnicities, including a significant number of Indian youths
from Central America. Some students encounter other ethnic groups
from their own nation for the first time at the school.
        This month, 1,500 more students will arrive at the school, which

expects to enroll some 5,000 students ultimately. Already, workers
have been preparing new dormitories and lecture halls.
        The students, like those everywhere, grouse that the grind is
rough,
leaving them with little free time. But considering where they came
from, many said it was a small sacrifice for the chance to become a
professional instead of a cabdriver or farmer.
        Norlan López spent his high school years in Nicaragua getting up

at 4 in the morning to work as a fisherman. He was still doing that
when he was accepted into medical school.
        “I had more pressure on me when I was in high school,” he said.
        “It was a hard life that I would not wish on anyone. That is why
I
am happy to be here.”