The Latin American School of Medicine in Havana is renowned for its contribution to third world healthcare. John Moran reports
'One of our Cuban doctors working in Ethiopia performed 800 major operations, countless minor ones and, in some cases, even gave his own blood," says Victor Diaz Feran, offering one extreme example of his country's commitment to world medical aid to a group of young visiting physicians from Ireland led by Beaumont Hospital consultant renal transplant surgeon, Mr David Hickey, the former Dublin GAA football star.
The group is on a visit to the Latin American School of Medicine on the outskirts of Havana. At present, the school has 8,400 students from impoverished backgrounds in South and Central America, the Caribbean, Africa and even from disadvantaged areas of the United States.
Perhaps the most remarkable thing about the school is that there is absolutely no charge for the degree in basic medicine. Cubans take great pride in the work of the school, and many visiting heads of state and other dignitaries are brought here to see the school for themselves.
Standing in the reception area of the former naval cadet training academy under large paintings of two revolutionary leaders - one, South America's founding father Simon Bolivar and the other, Cuban poet and revolutionary Jose Marti - is Feran, director of international relations at the school.
Through an interpreter, Gladys, Feran welcomes the visitors and, after formalities, leads them to the conference centre where he outlines the school's origins. Lining the walls along the way are numerous cultural artefacts from the 24 countries represented among the school's 8,400 students.
It comes as something of a surprise to see the stars and stripes of the US standing proudly in the centre of the 23 other national flags. When jokingly asked by one of the Irish party about the US flag's prominence, Feran laughs, "They are in alphabetical order."
There are actually 80 students who have come from the US to study here. These are mainly black, Latino and native Americans from deprived backgrounds. Despite a scare earlier this year over new US travel restrictions, the students now have a special dispensation - secured in part by former US Secretary of State Colin Powell - which allows them to circumvent their government's embargo and other punitive measures to study in Cuba.
The attraction for US students is clear. While the cost of becoming a doctor here is free, in the US the average cost is more than $200,000. To qualify for entry, US students must be physically and mentally fit, have appropriate qualifications, have no criminal record and must promise to return to practise in poor neighbourhoods such as the ones they came from.
Apart from the absence of fees and full board, Feran says all course textbooks and ancillary materials are provided free. Furthermore, students receive pocket money of 200 Cuban pesos a month, and each year they are sent home for a 40-day holiday.
Outlining Cuba's commitment to world medical aid, Feran tells the Irish party that Cuba still has a standing offer that it made to the United Nations in 2001 to send 4,000 doctors to Africa, but it needs international assistance in providing resources to support them, which, as yet, has not been offered.
"It is our duty to help the sick in the neediest parts of the world," says Feran, "but particularly in Africa with the terrible problem of Aids. Of the 40 million affected worldwide, he says, "30 million are in Africa. We are offering the most costly and important element, the doctors."
Feran says the idea for the school came after Hurricane George and Mitch laid waste to great swaths of the Caribbean and South America in 1998. Haiti and the Dominican Republic, Nicaragua, Belize, Guatemala and, in particular, Honduras were devastated and 12,000 people lost their lives.
Cuba sent doctors to the worst affected areas, but when the initial crisis had passed they realised the extent of the difficulties facing the survivors, in particular, the lack of a basic medical infrastructure and information.
Hickey tells the group that Irish Army personnel volunteered for a special humanitarian mission to Honduras and were highly praised for their dedication and commitment by the government there. He says that when they returned to Ireland, soldiers commended the work of the Cuban doctors who stayed on to fight the diseases that followed and to help promote basic hygiene, water purification, vaccination and good medical practice.
"After six years," says Feran, "some Cuban doctors are still there, but they will have to return home some day. Yet, at the same time, people cannot be left without basic medical care and be vulnerable to disease and infections so we decided to set up a medical school specifically to train people from the poorer countries so that they can then return to their home and continue with the work started by the Cuban doctors."
In 1999 the first students arrived and 1,929 were registered.
"Because countries vary in their educational levels, we do a pre-med course so that everyone can begin the course on an equal level," Feran says.
"In the first two years, the basic sciences are covered. In year three and four, students are sent to medical facilities around the country.
"In the fifth, they go to hospital clinics where they link up with Cuban doctors and nurses.
"In their final year, students do internships in various hospitals where they cover internal medicine, surgery, gynaecology, obstetrics, paediatrics and general basic medicine. They then receive their medical degrees in primary medicine and will go back to their home countries," Feran says.
What they will have learned here is unique. Of all the world's healthcare systems, none is better placed than Cuba's to understand the needs of people in desperately poor countries as over the past 35 years some 25,000 Cuban doctors, nurses and paramedical specialists have worked voluntarily among the poor in places as far apart as Asia, Africa and Latin America. When each volunteer returns to Cuba, they are welcomed home as heroes and heroines in their towns and villages.
Feran says the Cuban people believe it is their duty to share their resources, however meagre, with those in their world who are less well off. Students are preferred from poorer communities in the countries of origin. Applications are processed through local Cuban diplomatic delegations.
Feran stresses that the teaching of medicine is not the only consideration. "We are not satisfied with just creating doctors, and we place heavy emphasis on moral values in the course. Respect for the human being is stressed, rather than any income gained from being a doctor.
"While working in our healthcare system, students see every day the practice of this value. Treating the person with great personal care is vitally important."
The cultural interchange is also important, he says. "We have lots of beautiful cultural artefacts and projects here where the students learn to enjoy and respect each other's culture. But of course it is not perfect, there are problems and people can behave in strange ways."
He says some students did not return to the school after their holidays. Others did not meet the standards required, though rather than sending them home they were placed on less demanding paramedical and ancillary courses of study.
Asked by The Irish Times whether after their return home next year there would be ongoing contact with the newly qualified doctors in order to evaluate progress and monitor the project's effectiveness, Feran says there would be a structured contact. It will be a challenge, he adds.
Later, as the group from Ireland walk around the school's grounds in brilliant sunshine not far from the bright blue sea, a group of young Peruvians gather playfully around Dr Feran, whose great dignity and warmth was remarked upon by many in the Irish group. And it is clear that his students feel the same.
Next year should be a time of great satisfaction for all at the Latin American School of Medicine when the first student cohort - the class of '99 - graduates and returns to put what they have learned here into practise.