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  • I want to tell you

  • how 20,000 remarkable young people

  • from over 100 countries

  • ended up in Cuba

  • and are transforming health in their communities.

  • Ninety percent of them would never

  • have left home at all

  • if it weren't for a scholarship to study medicine in Cuba

  • and a commitment to go back

  • to places like the ones they'd come from

  • remote farmlands, mountains, ghettos

  • to become doctors for people like themselves,

  • to walk the walk.

  • Havana's Latin American Medical School:

  • It's the largest medical school in the world,

  • graduating 23,000 young doctors

  • since its first class of 2005,

  • with nearly 10,000 more in the pipeline.

  • Its mission, to train physicians for the people

  • who need them the most:

  • the over one billion

  • who have never seen a doctor,

  • the people who live and die

  • under every poverty line ever invented.

  • Its students defy all norms.

  • They're the school's biggest risk

  • and also its best bet.

  • They're recruited from the poorest,

  • most broken places on our planet

  • by a school that believes they can become

  • not just the good

  • but the excellent physicians

  • their communities desperately need,

  • that they will practice where most doctors don't,

  • in places not only poor

  • but oftentimes dangerous,

  • carrying venom antidotes in their backpacks

  • or navigating neighborhoods

  • riddled by drugs, gangs and bullets,

  • their home ground.

  • The hope is that they will help

  • transform access to care,

  • the health picture in impoverished areas,

  • and even the way medicine itself

  • is learned and practiced,

  • and that they will become pioneers in our global reach

  • for universal health coverage,

  • surely a tall order.

  • Two big storms and this notion of "walk the walk"

  • prompted creation of ELAM back in 1998.

  • The Hurricanes Georges and Mitch

  • had ripped through the Caribbean

  • and Central America,

  • leaving 30,000 dead

  • and two and a half million homeless.

  • Hundreds of Cuban doctors volunteered for disaster response,

  • but when they got there,

  • they found a bigger disaster:

  • whole communities with no healthcare,

  • doors bolted shut on rural hospitals

  • for lack of staff,

  • and just too many babies dying

  • before their first birthday.

  • What would happen when these Cuban doctors left?

  • New doctors were needed to make care sustainable,

  • but where would they come from?

  • Where would they train?

  • In Havana, the campus of a former naval academy

  • was turned over to the Cuban Health Ministry

  • to become the Latin American Medical School,

  • ELAM.

  • Tuition, room and board, and a small stipend

  • were offered to hundreds of students

  • from the countries hardest hit by the storms.

  • As a journalist in Havana,

  • I watched the first 97 Nicaraguans arrive

  • in March 1999,

  • settling into dorms barely refurbished

  • and helping their professors not only sweep out the classrooms

  • but move in the desks and the chairs and the microscopes.

  • Over the next few years,

  • governments throughout the Americas

  • requested scholarships for their own students,

  • and the Congressional Black Caucus

  • asked for and received hundreds of scholarships

  • for young people from the USA.

  • Today, among the 23,000

  • are graduates from 83 countries

  • in the Americas, Africa and Asia,

  • and enrollment has grown to 123 nations.

  • More than half the students are young women.

  • They come from 100 ethnic groups,

  • speak 50 different languages.

  • WHO Director Margaret Chan said,

  • "For once, if you are poor, female,

  • or from an indigenous population,

  • you have a distinct advantage,

  • an ethic that makes this medical school unique."

  • Luther Castillo comes from San Pedro de Tocamacho

  • on the Atlantic coast of Honduras.

  • There's no running water,

  • no electricity there,

  • and to reach the village, you have to walk for hours

  • or take your chances in a pickup truck like I did

  • skirting the waves of the Atlantic.

  • Luther was one of 40 Tocamacho children

  • who started grammar school,

  • the sons and daughters of a black indigenous people

  • known as the Garífuna,

  • 20 percent of the Honduran population.

  • The nearest healthcare was fatal miles away.

  • Luther had to walk three hours every day

  • to middle school.

  • Only 17 made that trip.

  • Only five went on to high school,

  • and only one to university:

  • Luther, to ELAM,

  • among the first crop of Garífuna graduates.

  • Just two Garífuna doctors had preceded them

  • in all of Honduran history.

  • Now there are 69, thanks to ELAM.

  • Big problems need big solutions,

  • sparked by big ideas, imagination and audacity,

  • but also solutions that work.

  • ELAM's faculty had no handy evidence base

  • to guide them, so they learned the hard way,

  • by doing and correcting course as they went.

  • Even the brightest students

  • from these poor communities

  • weren't academically prepared

  • for six years of medical training,

  • so a bridging course was set up in sciences.

  • Then came language:

  • these were Mapuche, Quechuas, Guaraní, Garífuna,

  • indigenous peoples

  • who learned Spanish as a second language,

  • or Haitians who spoke Creole.

  • So Spanish became part

  • of the pre-pre-med curriculum.

  • Even so, in Cuba,

  • the music, the food, the smells,

  • just about everything was different,

  • so faculty became family, ELAM home.

  • Religions ranged from indigenous beliefs

  • to Yoruba, Muslim and Christian evangelical.

  • Embracing diversity became a way of life.

  • Why have so many countries

  • asked for these scholarships?

  • First, they just don't have enough doctors,

  • and where they do, their distribution

  • is skewed against the poor,

  • because our global health crisis

  • is fed by a crisis in human resources.

  • We are short four to seven million health workers

  • just to meet basic needs,

  • and the problem is everywhere.

  • Doctors are concentrated in the cities,

  • where only half the world's people live,

  • and within cities,

  • not in the shantytowns or South L.A.

  • Here in the United States,

  • where we have healthcare reform,

  • we don't have the professionals we need.

  • By 2020, we will be short

  • 45,000 primary care physicians.

  • And we're also part of the problem.

  • The United States is the number one importer

  • of doctors from developing countries.

  • The second reasons students flock to Cuba

  • is the island's own health report card,

  • relying on strong primary care.

  • A commission from The Lancet

  • rates Cuba among the best performing

  • middle-income countries in health.

  • Save the Children ranks Cuba

  • the best country in Latin America to become a mother.

  • Cuba has similar life expectancy

  • and lower infant mortality than the United States,

  • with fewer disparities,

  • while spending per person

  • one 20th of what we do on health

  • here in the USA.

  • Academically, ELAM is tough,

  • but 80 percent of its students graduate.

  • The subjects are familiar

  • basic and clinical sciences

  • but there are major differences.

  • First, training has moved out of the ivory tower

  • and into clinic classrooms and neighborhoods,

  • the kinds of places most of these grads will practice.

  • Sure, they have lectures and hospital rotations too,

  • but community-based learning starts on day one.

  • Second, students treat the whole patient,

  • mind and body,

  • in the context of their families, their communities

  • and their culture.

  • Third, they learn public health:

  • to assess their patients' drinking water, housing,

  • social and economic conditions.

  • Fourth, they are taught

  • that a good patient interview

  • and a thorough clinical exam

  • provide most of the clues for diagnosis,

  • saving costly technology for confirmation.

  • And finally, they're taught over and over again

  • the importance of prevention,

  • especially as chronic diseases

  • cripple health systems worldwide.

  • Such an in-service learning

  • also comes with a team approach,

  • as much how to work in teams

  • as how to lead them,

  • with a dose of humility.

  • Upon graduation, these doctors share

  • their knowledge with nurse's aids, midwives,

  • community health workers,

  • to help them become better at what they do,

  • not to replace them,

  • to work with shamans and traditional healers.

  • ELAM's graduates:

  • Are they proving this audacious experiment right?

  • Dozens of projects give us an inkling

  • of what they're capable of doing.

  • Take the Garífuna grads.

  • They not only went to work back home,

  • but they organized their communities to build

  • Honduras' first indigenous hospital.

  • With an architect's help,

  • residents literally raised it from the ground up.

  • The first patients walked through the doors

  • in December 2007,

  • and since then, the hospital has received

  • nearly one million patient visits.

  • And government is paying attention,

  • upholding the hospital as a model

  • of rural public health for Honduras.

  • ELAM's graduates are smart,

  • strong and also dedicated.

  • Haiti, January 2010.

  • The pain.

  • People buried under 30 million tons of rubble.

  • Overwhelming.

  • Three hundred forty Cuban doctors

  • were already on the ground long term.

  • More were on their way. Many more were needed.

  • At ELAM, students worked round the clock

  • to contact 2,000 graduates.

  • As a result, hundreds arrived in Haiti,

  • 27 countries' worth, from Mali in the Sahara

  • to St. Lucia, Bolivia, Chile and the USA.

  • They spoke easily to each other in Spanish

  • and listened to their patients in Creole

  • thanks to Haitian medical students

  • flown in from ELAM in Cuba.

  • Many stayed for months,

  • even through the cholera epidemic.

  • Hundreds of Haitian graduates

  • had to pick up the pieces,

  • overcome their own heartbreak,

  • and then pick up the burden

  • of building a new public health system for Haiti.

  • Today, with aid of organizations and governments

  • from Norway to Cuba to Brazil,

  • dozens of new health centers have been built,

  • staffed, and in 35 cases, headed

  • by ELAM graduates.