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0:11I want to tell you<\/span> how 20,000 remarkable young people<\/span> from over 100 countries<\/span> ended up in Cuba<\/span> and are transforming health in their communities.<\/span> Ninety percent of them would never<\/span> have left home at all<\/span> if it weren’t for a scholarship to study medicine in Cuba<\/span> and a commitment to go back<\/span> to places like the ones they’d come from \u2014<\/span> remote farmlands, mountains, ghettos \u2014<\/span> to become doctors for people like themselves,<\/span> to walk the walk.<\/span><\/span><\/p>\n 0:46Havana’s Latin American Medical School:<\/span> It’s the largest medical school in the world,<\/span> graduating 23,000 young doctors<\/span> since its first class of 2005,<\/span> with nearly 10,000 more in the pipeline.<\/span> Its mission, to train physicians for the people<\/span> who need them the most:<\/span> the over one billion<\/span> who have never seen a doctor,<\/span>the people who live and die<\/span> under every poverty line ever invented.<\/span> Its students defy all norms.<\/span> They’re the school’s biggest risk<\/span> and also its best bet.<\/span> They’re recruited from the poorest,<\/span> most broken places on our planet<\/span> by a school that believes they can become<\/span> not just the good<\/span> but the excellent physicians<\/span> their communities desperately need,<\/span> that they will practice where most doctors don’t,<\/span> in places not only poor<\/span>but oftentimes dangerous,<\/span> carrying venom antidotes in their backpacks<\/span> or navigating neighborhoods<\/span>riddled by drugs, gangs and bullets,<\/span> their home ground.<\/span> The hope is that they will help<\/span> transform access to care,<\/span> the health picture in impoverished areas,<\/span> and even the way medicine itself<\/span> is learned and practiced,<\/span> and that they will become pioneers in our global reach<\/span> for universal health coverage,<\/span> surely a tall order.<\/span> Two big storms and this notion of “walk the walk”<\/span> prompted creation of ELAM back in 1998.<\/span>The Hurricanes Georges and Mitch<\/span> had ripped through the Caribbean<\/span> and Central America,<\/span> leaving 30,000 dead<\/span> and two and a half million homeless.<\/span> Hundreds of Cuban doctors volunteered for disaster response,<\/span> but when they got there,<\/span> they found a bigger disaster:<\/span> whole communities with no healthcare,<\/span>doors bolted shut on rural hospitals<\/span> for lack of staff,<\/span> and just too many babies dying<\/span> before their first birthday.<\/span> What would happen when these Cuban doctors left?<\/span> New doctors were needed to make care sustainable,<\/span> but where would they come from?<\/span> Where would they train?<\/span><\/span><\/p>\n 3:11In Havana, the campus of a former naval academy<\/span> was turned over to the Cuban Health Ministry<\/span> to become the Latin American Medical School,<\/span> ELAM.<\/span> Tuition, room and board, and a small stipend<\/span> were offered to hundreds of students<\/span> from the countries hardest hit by the storms.<\/span> As a journalist in Havana,<\/span> I watched the first 97 Nicaraguans arrive<\/span> in March 1999,<\/span> settling into dorms barely refurbished<\/span> and helping their professors not only sweep out the classrooms<\/span> but move in the desks and the chairs and the microscopes.<\/span> Over the next few years,<\/span> governments throughout the Americas<\/span> requested scholarships for their own students,<\/span> and the Congressional Black Caucus<\/span> asked for and received hundreds of scholarships<\/span> for young people from the USA.<\/span> Today, among the 23,000<\/span> are graduates from 83 countries<\/span>in the Americas, Africa and Asia,<\/span> and enrollment has grown to 123 nations.<\/span> More than half the students are young women.<\/span> They come from 100 ethnic groups,<\/span> speak 50 different languages.<\/span> WHO Director Margaret Chan said,<\/span> “For once, if you are poor, female,<\/span> or from an indigenous population,<\/span> you have a distinct advantage,<\/span> an ethic that makes this medical school unique.”<\/span><\/span><\/p>\n 4:42Luther Castillo comes from San Pedro de Tocamacho<\/span> on the Atlantic coast of Honduras.<\/span> There’s no running water,<\/span> no electricity there,<\/span> and to reach the village, you have to walk for hours<\/span> or take your chances in a pickup truck like I did<\/span> skirting the waves of the Atlantic.<\/span> Luther was one of 40 Tocamacho children<\/span> who started grammar school,<\/span> the sons and daughters of a black indigenous people<\/span> known as the Gar\u00edfuna,<\/span> 20 percent of the Honduran population.<\/span> The nearest healthcare was fatal miles away.<\/span> Luther had to walk three hours every day<\/span> to middle school.<\/span> Only 17 made that trip.<\/span> Only five went on to high school,<\/span> and only one to university:<\/span> Luther, to ELAM,<\/span> among the first crop of Gar\u00edfuna graduates.<\/span> Just two Gar\u00edfuna doctors had preceded them<\/span> in all of Honduran history.<\/span> Now there are 69, thanks to ELAM.<\/span><\/span><\/p>\n 5:52Big problems need big solutions,<\/span> sparked by big ideas, imagination and audacity,<\/span> but also solutions that work.<\/span> ELAM’s faculty had no handy evidence base<\/span> to guide them, so they learned the hard way,<\/span> by doing and correcting course as they went.<\/span> Even the brightest students<\/span> from these poor communities<\/span> weren’t academically prepared<\/span> for six years of medical training,<\/span> so a bridging course was set up in sciences.<\/span>Then came language:<\/span> these were Mapuche, Quechuas, Guaran\u00ed, Gar\u00edfuna,<\/span> indigenous peoples<\/span> who learned Spanish as a second language,<\/span> or Haitians who spoke Creole.<\/span> So Spanish became part<\/span> of the pre-pre-med curriculum.<\/span> Even so, in Cuba,<\/span> the music, the food, the smells,<\/span> just about everything was different,<\/span> so faculty became family, ELAM home.<\/span> Religions ranged from indigenous beliefs<\/span> to Yoruba, Muslim and Christian evangelical.<\/span> Embracing diversity became a way of life.<\/span><\/span><\/p>\n 7:08Why have so many countries<\/span> asked for these scholarships?<\/span> First, they just don’t have enough doctors,<\/span>and where they do, their distribution<\/span> is skewed against the poor,<\/span> because our global health crisis<\/span> is fed by a crisis in human resources.<\/span> We are short four to seven million health workers<\/span> just to meet basic needs,<\/span> and the problem is everywhere.<\/span> Doctors are concentrated in the cities,<\/span> where only half the world’s people live,<\/span> and within cities,<\/span> not in the shantytowns or South L.A.<\/span> Here in the United States,<\/span> where we have healthcare reform,<\/span> we don’t have the professionals we need.<\/span> By 2020, we will be short<\/span> 45,000 primary care physicians.<\/span> And we’re also part of the problem.<\/span> The United States is the number one importer<\/span> of doctors from developing countries.<\/span><\/span><\/p>\n 8:07The second reasons students flock to Cuba<\/span> is the island’s own health report card,<\/span> relying on strong primary care.<\/span> A commission from The Lancet<\/span> rates Cuba among the best performing<\/span> middle-income countries in health.<\/span> Save the Children ranks Cuba<\/span> the best country in Latin America to become a mother.<\/span>Cuba has similar life expectancy<\/span> and lower infant mortality than the United States,<\/span> with fewer disparities,<\/span>while spending per person<\/span> one 20th of what we do on health<\/span> here in the USA.<\/span><\/span><\/p>\n 8:44Academically, ELAM is tough,<\/span> but 80 percent of its students graduate.<\/span> The subjects are familiar \u2014<\/span> basic and clinical sciences \u2014<\/span> but there are major differences.<\/span> First, training has moved out of the ivory tower<\/span>and into clinic classrooms and neighborhoods,<\/span> the kinds of places most of these grads will practice.<\/span>Sure, they have lectures and hospital rotations too,<\/span> but community-based learning starts on day one.<\/span>Second, students treat the whole patient,<\/span> mind and body,<\/span> in the context of their families, their communities<\/span> and their culture.<\/span> Third, they learn public health:<\/span> to assess their patients’ drinking water, housing,<\/span> social and economic conditions.<\/span> Fourth, they are taught<\/span> that a good patient interview<\/span> and a thorough clinical exam<\/span> provide most of the clues for diagnosis,<\/span> saving costly technology for confirmation.<\/span>And finally, they’re taught over and over again<\/span> the importance of prevention,<\/span> especially as chronic diseases<\/span> cripple health systems worldwide.<\/span><\/span><\/p>\n 10:02Such an in-service learning<\/span> also comes with a team approach,<\/span> as much how to work in teams<\/span> as how to lead them,<\/span> with a dose of humility.<\/span> Upon graduation, these doctors share<\/span> their knowledge with nurse’s aids, midwives,<\/span> community health workers,<\/span> to help them become better at what they do,<\/span> not to replace them,<\/span> to work with shamans and traditional healers.<\/span><\/span><\/p>\n 10:32ELAM’s graduates:<\/span> Are they proving this audacious experiment right?<\/span> Dozens of projects give us an inkling<\/span> of what they’re capable of doing.<\/span> Take the Gar\u00edfuna grads.<\/span> They not only went to work back home,<\/span>but they organized their communities to build<\/span> Honduras’ first indigenous hospital.<\/span> With an architect’s help,<\/span> residents literally raised it from the ground up.<\/span> The first patients walked through the doors<\/span> in December 2007,<\/span> and since then, the hospital has received<\/span> nearly one million patient visits.<\/span> And government is paying attention,<\/span>