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TwitterExcerpt from Where No Doctor Has Gone Before: Cuba’s Place in the Global Health Landscape by Robert Huish
From the section entitled A Bold Act of Diplomacy in chapter 4 The New Doctor Blooms: The Ethics of Medical Education, pages 107 to 108
A Bold Act of Diplomacy
In 2001, ELAM scholarships were extended to students from the
United
States as well. A year earlier, Fidel Castro had travelled to the
United States for
the Millennium Summit at the United Nations. While there, he had
travelled
to Harlem to give a public speech at the church where he had
stayed during
another United Nations meeting in the 1960s. At that time, the
United States
had imposed a hotel embargo on the Cuban delegation, and they
were forced
to hole up in a church basement in Harlem. Castro never forgot
the hospitality,
and in 2000 he returned to the church to give thanks. The public
speech
attracted a massive audience, including members of the US
Congressional
Black Caucus, who met Castro personally. Members commented to
Castro
that they had heard much about the strength of Cuba’s health-care
system.
They also mentioned that certain states, such as Mississippi and
Louisiana,
suffered an endemic physician shortage in rural areas. Others
told Castro
that health-care inequities in the United States
disproportionately target the
African-American population. Upon hearing the stories of massive
health
inequity within the United States, Castro offered five hundred
scholarships
for US students to come to ELAM (Castro, 2000). It was an offer
that came
from an economically hobbled country that had faced over
forty years of
aggression from the very country that was now seeking its
help. The symbolic
capital of a resource-poor country training physicians for
the largest
economy in the world was enormous.
The IFCO volunteered to handle the receipt of applications from US candidates before sending the portfolios on to ENSAP. The IFCO sought, but did not limit selection to, African-American and Hispanic students, women, and individuals coming from modest means. In addition to the application, candidates were invited to New York or California to participate in a three-day selection process involving an in-depth orientation on what to expect in Cuba. The first group was comprised of eighty-nine students from fifteen different locations. Enrolment to the programs has fl uctuated year-to-year; in 2006, only about twenty US students went to Cuba.
From the onset, the US students faced political challenges from their own government. Regrettably, the Bush administration, as part of a broader policy to restrict movement to and collaboration with Cuba, took harsh action against the ELAM students in 2002. The US Department of State and the US Treasury Department sent warnings to students stating that they could face jail sentences and fines upwards of $40,000 for pursuing a medical education that contravened the Trading with the Enemy Act. In response to this threat, ELAM fast tracked the US students through their first year and encouraged them to return home until the political hostility subsided.
The IFCO and individual members of the Congressional Black Caucus lobbied Secretary of State Colin Powell, who then convinced the Bush administration to permit the US students to complete their medical degrees. Powell agreed that it was unconscionable to threaten medical students, ones dedicated to serving the underserved, with prison terms and stiff fines. By 2003, travel licences were permitted for US citizens to enter and complete their degrees at ELAM. Twenty-four students from the original eighty-nine did not return to Cuba after the exemption was made. Today, enrolment continues on with 115 US students registered at the school. Nevertheless, the US embargo against Cuba persists, and the US students endure prolonged separation from their families, which is compounded by poor access to communication and few chances to return home during their studies.