“Medicine is an area we should be organizing around in our communities,” according to David Lavender, a former Olympia resident, who recently completed medical school in Cuba. He’s now back in the states and looking for residency opportunities to continue his training. I was fortunate to hear about his experience through a mutual friend, and wanted to find out how it came about, and how it has shaped his views.
Lavender never really considered medical school as a career path when he lived in Olympia; at that time he was focused on food/agriculture issues, sustainability, and farming, and was working at a local CSA. Around 2001, an Olympia friend, Rick Fellows, working with Pastors for Peace on caravans to Cuba, initially told him about the program and planted a seed that would later come to fruition.
While studying at SPSCC, Lavender had an opportunity to travel to Brazil where he learned more about the Escuela Latino Americana de Medicina (ELAM) program in Cuba, attended by students from around the world. The goal of the school is to train 15,000 to 18,000 physicians in 108 countries worldwide. He learned that there were many American students enrolled, with a program goal of 50% African–American, 25% Latino, and 25% from the remaining population. This got Lavender thinking about his career choices, and the rare opportunity to participate in such a progressive effort. His curiosity about the program took root, and he ultimately made a decision that would change the course of his life.
In the U.S., medical school is primarily for the more privileged, and for those exceptional students from the lower/middle classes who have honed their skills in the sciences, and/or been mentored, a chosen few; scholarships are available, though somewhat limited. Thus many take on student loans, creating an untenable debt load that follows them into life for years after school. This also results in an elite class of medical professionals whose privileged social status separates them from the every day lives of their patients.
Contrast this with ELAM, where students from around the globe come together to study medicine, and take on no debt as a result. Tuition, at zero dollars, is a non–issue, a modest room and board allowance is covered, and all books and other necessary supplies are provided. For most students, the only expense incurred is for travel to/from Cuba to/from their home country during the course of their five–year enrollment. Lavender, admitted to the school in 2011, finished in 2017; his expenses averaged around $800 to $1,000 annually.
The concept of accessible community health is key to the success of Cuba’s medical system. Cuba boasts more doctors per capita than any other country in the world. Clinics are located within each neighborhood based on population, so each clinic serves around 600 to 1000 people. Very often the doctor lives right upstairs from the clinic, or in close proximity. House calls are also utilized as necessary, and dedicated ‘poly–clinics’ have been developed for new treatments and specialty areas such as pre–natal care. All care is free, and according to Lavender, Cubans trust their doctors.
Contrast this model with the chaos inherent in the US health care system, where access is limited depending on the particular plan chosen by/available to the consumer/patient; where long waits for appointments are often the norm; where huge premiums, co–pays and/or medical bills may often bankrupt patients and result in devastating consequences. As a result, many thousands of Americans go without care or necessary medication, especially young adults. Certainly, the myriad nature of political realities in the US further complicates access to health care.
Due to the US imposed trade embargo against Cuba, certain medications that are available to Cubans are not available to patients in the US; one example is Herberprot–P, a pharmaceutical developed in Cuba, for effectively treating diabetic foot ulcers. Another is CIMAVAX, a lung cancer vaccine invented in Cuba, but not permitted in the states. A 2015 report on the Cuban health system by the World Health Organization noted, “In Cuba, products were developed to solve pressing health problems, unlike in other countries, where commercial interests prevailed.»
Taking into account the opioid epidemic that is rampant in many American communities, including here in Washington State, how does Cuba compare? According to Lavender it is a non–issue, as only ‘a negligible amount of illegal drugs exists on the streets’ there. As for the mental health crisis that is manifested across the US, with access to treatment very limited, in Cuba access to treatment is readily available and is not stigmatized; thus, homelessness is not an issue.
Women in Cuba have access to all aspects of family planning and have the right to choose if and when to start or add to their family. There is no shame attached to the right to choose, nor is there any consequence for such a personal choice. On the surface, these may appear to be unfair comparisons, given that the differences in political systems are so stark between the U.S. and Cuba. However, the social impacts must be accounted for.
Cuba continues to recruit and host students from around the world to study medicine at ELAM. To find out more check out the Pastors for Peace website or the website for the school itself.
Joanne McCaughan is an Olympia resident and was a member of the second Venceremos Brigade to Cuba.