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2 ELAM, a School for All Nations I know of no other medical school that offers students so much, at no charge. I know of no other medical school with an admissions policy that gives first priority to candidates who come from poor communities and know, firsthand, what it means to live without access to essential medical care. For once, if you are poor, female, or from an indigenous population, you have a distinct advantage . This is an institutional ethic that makes this medical school unique. Dr. Margaret Chan, director-general of the World Health Organization, Remarks at the Latin American Medical School of Medicine, October 27, 2009 The Escuela Latinoamericana de Medicina (ELAM) was opened in 1999 to provide a humanitarian response by Cuba in the wake of two natural disasters . From October 29 to November 3, 1998, Hurricane Mitch devastated several countries in Central America, and the previous month Hurricane Georges had laid waste to Haiti. The impact in Haiti was severe, with a death toll of 400 and 167,000 left homeless. The economic devastation was widespread, and 80 percent of banana plantations were destroyed. Even worse was the human toll throughout the Central American region, with thousands dead and disappeared. Infrastructure was destroyed, and the local economy was left in ruins. According to the Pan American Health Organization, by December 4, 6,600 people had died in Honduras, with a further 8,052 disappeared and presumed dead and 11,998 wounded. Nicaragua was also badly hit: 2,863 were confirmed dead, and there were 970 disappeared and 388 wounded. The total of dead and disappeared in El Salvador was 268 and 389 in Guatemala. The number of victims at that point was estimated to be 1,895,437.1 Fidel Castro responded to the calls for help from the Central American countries by sending large medical contingents. The immediate emergencies were resolved after several months of work. Afterwards, and with the agreement of the host governments, the Cuban medical staff remained, establishing Comprehensive Health Programs (or Programas Integrales de Salud). Cuba did so despite poor diplomatic relations with most of the ELAM, a School for All Nations · 43 Central American countries. Relations with Guatemala, for example, were only restored in 1998, with Honduras in 2002, Nicaragua in 2007, and both El Salvador and Costa Rica in 2009. More pressing than the resumption of diplomatic relations, however, was the need for a sustainable approach to healthcare in the affected regions. Cuba identified the long-term need to train doctors from the devastated communities, so that they could provide badly needed healthcare for their own people, ultimately replacing the medical support from Cuba. In order to carry out this ambitious program, the Cuban government established ELAM, turning a large, sprawling complex west of Havana that for years had trained cadets for the Cuban navy into the largest medical school in the world.2 In November 1998 Fidel Castro outlined his plans for ELAM, rejecting the interest of Spanish investors in establishing a tourist complex there, complete with golf course. Instead it would be a place where, in President Castro’s words, people would take “revenge” upon Mitch by training doctors to save more lives every year than had been lost in the hurricanes. The school was refurbished in record time, with the first students entering in February 1999, and since 2005 some 24,000 doctors from over 80 countries have emerged. Most have returned to their country of origin, especially to the countries of Central America, where they are gradually replacing Cuban physicians. The students at ELAM remain for the first two years on the Havana campus before being distributed throughout the island for a further four years of medical training at any of the almost two dozen training hospitals throughout the island. As of January 2014 there were over 11,000 students from 123 countries registered at ELAM. Included in this number were several dozen students from the United States, mainly from visible minority backgrounds. In his January 2014 visit to ELAM, UN secretarygeneral Ban Ki-moon congratulated Cuba on “the ingenious contributions of the school, for being leaders in South-South cooperation and in the forefront of international health” and referred to it as “the most advanced medical school in the world.”3 This chapter, based on a half-dozen research trips to ELAM and dozens of interviews with people associated with the school—current students, medical graduates from a number of countries, professors and administrators...


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