Cuba

Cuban Medical Scholarship Program Stirs Debate

by Luke Reynolds, Staff Writer, WENR

In a late-night meeting in May 2000, Cuban President Fidel Castro extended an offer to U.S. Rep. Bennie G. Thompson, D-Miss., which promised to provide free medical education to 500 students from the impoverished regions of the American South. The congressman had been lamenting the poor health conditions in his state and the inadequate resources there for practical medical training. Thompson and other members of the Congressional Black Caucus responded positively to the offer, and four months later, Cuban lawmakers proposed a scholarship program for disadvantaged U.S. students. On April 6 of this year, eight U.S. students began their studies at the Latin American School of Medicine (ELACM).

Castro’s invitation to poor American students to join the ELACM program has generated anger and suspicion among Cuban émigrés, many of whom are in the medical field. They say the inclusion of Americans is an affront to the U.S. government and the national medical establishment. In addition, they claim that medical education in Cuba cannot and will not be divorced from communist indoctrination, despite the school’s insistence to the contrary. Although the United States allows for student-exchange programs with Cuba, the ELACM program is the most extensive — up to seven years — and the first to focus on professional training.

ELACM was founded in 1999 to train international students to become practicing doctors in their home countries. This year, approximately 4,000 students from South America and Africa are enrolled at the school, which is comprised of 28 buildings, 80 classrooms, 37 laboratories and newly renovated dormitories. ELACM, located 20 miles outside of Havana, offers its students — free of charge — a 2 ½-year undergraduate training program that prepares them for a five- to seven-year period of clinical studies administered at one of the 22 medical schools throughout the country.

To be eligible for the U.S. scholarship program, applicants must:

• Be a U.S. citizens from 18 to 25 years old
• Have a high school diploma or equivalent
• Be physically and mentally fit
• Have no criminal record or outstanding lawsuits
• Come from an economically disadvantaged community in the United States
• Be committed to practice medicine in poor U.S. communities after graduation

Although only eight are attending this year, 250 spots have been made available for U.S. students so far. The ELACM scholarships cover tuition, room-and-board and textbooks. Applicants were screened, interviewed and evaluated in the U.S. by representatives of the Cuban Ministry of Public Health and the ELACM faculty.

According to Joe Garcia, executive director of the Cuban American National Foundation, the largest Cuban-American organization in the U.S., the new program is “just one more propaganda game that the Cuban government is trying to play.”

Garcia insists he is not against the students traveling to Cuba, if only because first-hand exposure to the country’s economic and political environment will shatter some misconceptions. “They will return home after two hungry summers, join the Republican Party and vote against the Democrats who sent them there,” he said in an interview with WENR.

The Rev. Lucius Walker of the New York-based Pastors for Peace, however, does not view the program as a political ploy. “Any country has certain values that it teaches,” said Walker, who helped handle the students’ applications and escorted them to Cuba last spring. “The way that Cuba has opened its doors to these students who otherwise would not have the opportunity to become doctors is more Christ-like than Marxist.”

Political controversies aside, the program stirs other debates as well, including concerns over the legitimacy of Cuba’s public health record and the viability of ELACM training within the U.S. system.

For years, Castro has used his country’s medical record as proof of communism’s success, citing Cuba’s low infant mortality rate of 7.3 deaths per 1,000 births and the abundance of primary health-care providers. However, in a recent paper featured in The Medical Sentinel, a journal published by the Association of American Physicians and Surgeons, several Cuban doctors in Miami refuted these numbers and labeled them as propaganda. According to the authors, one needs only to examine the high mortality rates of mothers and of children 1 to 4 years old to see that these numbers are artificially inflated. In some cases, they report, a dying baby will be temporarily supported with expensive medical equipment just to bolster statistics in an ailing health sector.

“Just as the Soviet Union used to claim it had excellent standards of public health, no one is allowed to see behind the numbers,” Garcia said. “It is a false system.”

Credible estimations, however, do indicate that Cuba graduates around 2,000 doctors a year and that there are only 168 patients for each doctor in the country. In comparison, the world average is more than double that figure. World Health Organization (WHO) officials have praised Cuba’s outreach programs to Haiti as being the sole force preventing the complete implosion of that country’s national health system, and Cuban-trained personnel have played a significant role in rebuilding public health programs in the Caribbean and Central America, lands repeatedly ravaged by natural disasters. Life expectancy in Cuba hovers around 75 years, one year less than that in the United States.

“We see the program teaching students, to make them good doctors and teaching the importance of serving the people, rather than just making money,” the Rev. Walker told WENR.

Many public health experts in the United States and around the world have said that a medical degree from Cuba is as good as any, especially for practice in the developing world. Dr. Anthony Fitzpatrick, a professor at the University of South Florida College of Medicine who has worked in Cuba, fully endorsed the program in an interview with The Sun-Sentinel.

“I wouldn’t hesitate to work with a doctor educated there,” Fitzpatrick was quoted as saying in South Florida paper. “In fact, these students are going to learn something they can’t learn in the United States, and that’s how to get the best outcomes with the least amount of resources.”

The ELACM application requires its students to pledge their commitment to return to their home countries and serve “in a poor and medically underserved community.” In Rep. Thompson’s rural Mississippi and in regions throughout the United States plagued by a lack of hospitals and doctors, such resourcefulness could prove useful.

According to the program’s brochure, the first six months of study are devoted to a traditional pre-med track comprised of classes in chemistry, biology, math, physics and health sciences. In addition, all students are required to take a class entitled “History of the Americas; all non-Spanish-speaking students are required to complete an intensive 12-week Spanish program.

Yet whether or not graduates from ELACM can be accredited to practice medicine in the U.S. is another issue altogether. Cuban doctors have had success working in other countries, but the question remains as to how their training meshes with accepted U.S. practice.

The Educational Commission for Foreign Medical Graduates (ECFMG), the institutional tool for evaluating medical training outside the United States, requires foreign medical graduates to pass a medical science examination, an English proficiency examination and, finally, a clinical skills assessment. Upon passing, the applicant may begin to practice medicine or continue with his or her postgraduate medical education. Candidates are subject to state-specific accreditation processes as well.

However, according to Garcia, “There are already thousands of Cuban-trained doctors in the United States who are unable to work. They simply can’t get qualified,” he said.

Citing a study in a 1980 issue of the Journal of Public Health, The Medical Sentinel article points to the 25 percent Cuban pass rate on the ECFMG exams to indicate the inferiority of Cuba’s educational system. In addition, Cuba’s medical supplies and textbooks are reported to be outdated and inadequate. ELACM officials have said they will bring in ECFMG test experts to prepare the American students and ensure that the program is a success.

Walker has received only positive feedback from the students thus far. Instructors have accommodated the students’ varied backgrounds in medical sciences and Spanish. “[The students] really appreciate the attention and the care that the Cuban system has given them,” he said. “They modify their classes to fit their needs.

“The bottom line is that this program is training kids from this country who wanted to be doctors and couldn’t under our system,” Walker said.

Khalil Marshall, who was raised in the Bronx and served in the Navy before accepting the scholarship, said to the Los Angeles Times, “I’m here to become a doctor and then go back to the United States and practice free health care. I don’t care about making money. I’ve never had it, so I won’t miss it.

Argentina

Minister of Education Andres Delich announced the formation of a think tank of higher-education experts to discuss curbing the increased enrollments in national universities. Some of the proposed solutions include the introduction of an entrance exam, the establishment of university colleges and the administration of a final evaluation exam to measure institutional quality.

Delich expressed his concern with the drastic increase in enrollments at the University of Buenos Aires (UBA) over the past four years. Since 1997, the student population has increased 38 percent, reaching a total of 253,000. Some career tracks within the school, most notably the Faculty of Economic Sciences, are extremely overcrowded, which has prevented proper quality control and diluted university standards.

Argentinean schools enjoy autonomy by constitutional law, but Delich hopes to draw up a proposal for reform that universities will embrace to cut back enrollments and streamline particular degree programs. In early talks, the suggestion of an entrance exam was met with strong resistance from university officials.

— La Nacion
April 5, 2001

Bolivia

The Ministry of Education has commenced its first official review of private universities under the newly devised General Regulations on Private Universities in Bolivia. Officials adamantly assert that the process is not intended to accredit private institutions, which should be done specifically to each degree offered, but instead evaluates the institution as a whole. Private universities had to submit the required documents to the ministry by April 16 in order to be considered for the status of “complete” universities.

According to Vice Minister of Higher Education Renzo Abruzzese, the assessment will be based on three criteria:

• Achievement of minimal requirements set forth in the external evaluation bill of December 1997
• Fulfillment of the recently introduced General Regulations
• Evidence of the institution’s capacity for self-evaluation

If any institution fails to meet these criteria, it will be allowed a second attempt in two years. If it fails at that time, the government will grant the institution three more years to meet the minimum criteria. Failure at this juncture would result in the closing of the institution.

Public universities are not subject to the new General Regulations or governmental assessment, as the Bolivian Constitution protects their right to self-regulation as autonomous institutions.

— El Diario
April 16, 2001

Canada

University students and teachers are outspokenly denouncing the government’s involvement in recent World Trade Organization talks regarding the General Agreement on Trade in Services (GATS). Many worry that the agreement could open the nation’s public education sector to unbridled private for-profit ventures, jeopardizing current quality standards.

The GATS would allow free trade in service industries across national boundaries. Although the Canadian trade minister has said the agreement will not affect the domains of public health or education, since GATS only applies to private businesses, opponents insist that the definition of “public services” will not include post-secondary education. They believe that since higher education has opened up to privatization, citing the government’s recent decision to allow the DeVry Institute to grant degrees, the Canadian legal system will, by necessity, open up education to enterprising private investors.

The correlative fear is that these private institutions could bypass national regulations, such as entrance standards and tuition caps, labeling them trade barriers. Both the Canadian Federation of Students and the Canadian Association of University Teachers have condemned the talks, which will continue for at least three more years before decisive action is taken.

— Campus News
April 6, 2001

Chile

The Education Ministry recently approved a budget allocating an additional $390,000 this year to the 25 universities of the national Council of Rectors. According to officials, the budget of each university for the coming year will increase by no less than 4 percent. Although no details were released as to how the money would be distributed, it is believed that the bulk of it will go toward providing scholarships. Click here to see a list of the universities in the Council of Rectors.

— Diario Publico
April 26, 2001

Dominican Republic

The National Council on Higher Education has uncovered at least 15 cases of falsified diplomas and degrees and expects to discover more. The investigation thus far has revealed that medical degrees and licenses from the Universities of Santo Domingo and Central del Este were fetching up to nearly US$2,000 on the black market.

— Hola Hoy
May 8, 2001

Mexico

The teaching staff at the Universidad Autonoma de Zacatecas recently rejected a proposed 10.5 percent hike in salaries, holding out for the 30 percent initially demanded. The university lecturers, numbering over 1,700, have stopped classes, affecting the studies of 18,000 enrolled students.

— Time Higher Education Supplement
February 23, 2001

United States

Beaver College in Philadelphia, Pa., announced it would change its name to Arcadia University, effective July 16. The change comes in wake of the college’s successful application for “university” status, but officials also considered the benefits of dropping its infamous name. Beaver College has been the butt of jokes on late-night TV shows such as “The Late Show with David Letterman” and “Saturday Night Live.” After distributing surveys about the new name to alumni and forming student focus groups, the school’s trustees decided on the Arcadia title, in reference to a region of ancient Greece.

— CNN.com
Nov. 20, 2000

Regents College, one of the country’s oldest and most recognized providers of distance education, has changed its name to Excelsior College. The transition is meant to emphasize the school’s independence from the New York State Board of Regents, which founded and ran the school until 1998. Regents has administered distance education programs for more than 30 years, and has attracted particular attention for its work with the U.S. military. The name change took effect Jan. 1.

— College Bound
April 2001

Michigan State University, Purdue University and the University of Wisconsin have canceled agricultural exchange programs in Ireland and the United Kingdom. Officials at the schools say the recent outbreak of foot-and-mouth disease in the region has made study there unfeasible, since most agricultural sites are off-limits and are struggling to contain the outbreak. The risk of transporting the disease into the United States also deterred the continuance of the programs.

— The Times Higher Education Supplement
March 23, 2001

Uruguay

The Ministry of Education and Culture announced its intention to improve the quality of teaching in universities by promoting competition among institutions on the basis of their curriculums. Officials hope an emphasis on self-evaluation will, in turn, transfer public attention from mere diplomas to the quality of the institutions.

The basis for legitimate educational standards will be the University of the Republic, the country’s largest public university. Pushing for self-evaluation and broadcasting institutional quality will avoid the pitfalls of forcing schemes upon constitutionally autonomous public universities, while at the same time encompass both private and public institutions in a uniform, competitive framework

The announcement comes on the heels of some surprising new data regarding the division of public and private education. Recent studies show that private schools of higher learning enroll only 10 percent of the number enrolled at the University of the Republic, but that those same private institutions account for more than 30 percent of the country’s annual graduates.

Private universities were first recognized in 1984, at the establishment of the Catholic University of Uruguay. In 1995, new private institutions were permitted under law, and the government drafted and adopted certain institutional regulations. Since then, public university staffs have suffered from the competition of private institutions with less stringent curriculums. The proposed plan for self-evaluation, along with the greater allocation of funds for public schools, mirrors a successful initiative in Argentina.

— El Pais
February 20, 2001

Venezuela

A group of approximately 600 rebel students seized the administrative building of the University of Central Venezuela on March 28, touching off a suspension of classes that lasted into May. The students have called for extensive reforms of university governance, ranging from simple decision-making procedures to the “re-legitimizing” of school officials. They have also unequivocally demanded the resignation of university rector Giuseppe Gianetto.

According to a report by the New York Times, the rebel group is sympathetic to President Hugo Chavez’s proposed “National Education Project,” which calls for the complete overhaul of textbooks and the reintroduction of a pre-military training program. Chavez recently appealed to Cuban President Fidel Castro to provide advisers to oversee teacher training, and already many Venezuelan teachers have been sent to seminars and educational programs in Cuba. Teachers and parents, however, have accused the President of using public education to advance nationalism and indoctrinate students with Marxist ideology.

The 600 rebels form a small minority out of the school’s 64,000 students, and other student groups have responded forcefully to the disruption of classes. Violence on campus between these groups has left many university facilities damaged and several students and university employees severely injured. Gianetto has maintained a firm stance of noncompliance, and local government has refused to intervene in the conflict on the grounds that such a move would violate university autonomy.

The effects of the monthlong paralysis of university operations have been far-reaching. Thousands of professors and school staff have been left temporarily jobless. Graduation has been postponed, preventing a whole class of students from earning their degrees and entering the work force. In addition, many worry the extended conflict will leave lasting scars on the school’s image.

The rebel group had drawn up a plan for reform with the aid of professor and worker groups, and had suggested it would relinquish the administrative building in early May, but Gianetto has so far been unwilling to compromise. Many school officials are leaning toward an appeal to an international organization, such as UNESCO or Amnesty International, to help resolve the stalemate.

— El Mundo
April 28, 2001