Affirmative Action, Cuban Style  by Fitzhugh Mullin, M.D.

          The following is excerpted from a 3 page Perspective in the New England Journal of Medicine for December 23, 2004.  ELAM is the Spanish acronym for the Latin American School of Medicine in Havana.  A colleague’s reaction to this: “Even bad people can have an occasional good idea.”

…….The…..opportunity dates to June 2000, when a group from the congressional Black Caucus visited Cuban President Fidel Castro.  Representative Bernie Thompson (D-Miss.) described huge areas in his district where there were no doctors, and Castro responded with an offer of full scholarships for U.S. citizens to study at ELAM……committing  500 slots to U.S. students who would pledge to practice in poor U.S. communities…….

           There are 88 U.S. students at ELAM, 85% of them members of minority groups and 73% of them women…….Applicants are required to…… be from poor communities, and make a commitment to return to those communities.  Students who don’t speak Spanish start early with intensive language instruction…..They report that living conditions are spare….., but they are well taken care of and the education is rigorous……

             The health care system in which these students are working is exceptional for a poor country and represents an important political accomplishment of the Castro government…..Cuba… has….health indicators on a par with those of the most developed nations---despite the U.S. embargo that severely reduces the availability of medications and medical technology. This success clearly plays well at home and has enabled Cuba to send physicians abroad to Cold War hot spots such as Nicaragua and Angola.  Yet Cuba has sent thousands of physicians to work in some of the world’s poorest countries.  Since 1998, 7150 Cuban doctors have worked in 27 countries---on a proportional basis this is the equivalent of the United States sending 175,000 physicians abroad.  In the same spirit, ELAM trains young people from these countries and sends them home to practice medicine.  Although these programs make political points for Cuba, they also represent an extraordinary humanitarian contribution to the world’s poor populations…….

                Which brings us back to Castro’s gambit.  Why is he reaching out to U.S. students?  What an irony that poor Cuba is training doctors for rich America, engaging in affirmative action in our behalf, and—while blockaded by U.S. ships and sanctions---spending its meager treasure to improve the health of U.S. citizens.  Whether one considers this a cunning move by one of history’s great chess players or an extraordinary gesture of civic generosity—or a bit of both---it should encourage us to reexamine our stalled efforts to achieve greater racial and ethnic parity in American medicine.  If Castro can find diamonds in our rough, we can too.

Excerpted by John A. Frantz, M.D. January 9, 2005

A colleague’s reaction to this was, “Even very bad people can have good ideas.”