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US Doctors are leaving the United States to receive free medical training in Cuba

U.S. doctors are being trained in Cuba

Many aspiring doctors are leaving the United States to receive free medical training in Cuba.

HAVANA - Lillian Holloway picked her way through the darkened streets of Havana, skirting a pile of discarded pork bones, an unfinished construction trench, and fresh dog dung, on her long journey back to Philadelphia.

Past faded colonial facades looming out of the night like so many old ghosts, she crossed to a building with a worn sign: Hospital Pediátrico Docente del Cerro.

This children's hospital in a rundown section of Havana is Holloway's next step toward her own medical practice in Germantown or West Philadelphia. She is one of nearly 100 U.S. medical students enduring the hardships of life in communist-run Cuba for a free education and the hope of an eventual medical residency back home.

''This reminds me of North Philly. There's a lot going on,'' Holloway said, waving at bustling sidewalks illuminated by light spilling from once-grand buildings southeast of Old Havana, near the Latin American Baseball Stadium and the Plaza of the Revolution.

HER FOURTH YEAR

Holloway is in her fourth year as a medical student here. Six feet tall, with a model's looks and fluent in Spanish, she's a pioneer in a bata, the short white lab coat worn by medical students here. She's a long way from 50th and Westminster Streets in West Philadelphia, where she grew up, and from Upper Merion High School, where she graduated in 1997.

The United States ''is in dire need of family physicians,'' and will need 139,500 by 2020, up from 100,400 this year, according to the American Academy of Family Physicians.

In the children's hospital, several young patients sit in the allergy ward, inhaling directly from hoses attached to industrial-size oxygen tanks. Down a dimly lighted hall smelling faintly of sewage, an examining room is busy with parents bringing in their children.

One boy has a stomachache. He gets a vial of drops. Another boy has asthma. He is sent to the allergy ward.

Holloway confers often with the doctor and with the other medical students. This night is not as busy as Sunday, when she evaluated two children with kidney problems, one with chronic diarrhea and another with a respiratory ailment. She talked to the parents, gathered the family histories, and did the initial write-ups for the examining doctor.

Cuban medical training is long on patient exams, short on high-tech tests. The country has chronic shortages of almost everything, especially technical equipment. So students learn to do without.

Cuban medical training is very hands-on, compared to that of the United States. Students here deal with real patients in their very first weeks.

''We rely a lot on physical signs and symptoms,'' Holloway says. ``We don't want to run a whole range of tests for something they don't have -- we're not fishing . . . And unlike in the U.S., you may not have everything at every hospital.''

CASTRO'S CREATION

Fidel Castro created the Latin American School of Medical Sciences in 1999 to provide free medical training for Honduran, Nicaraguan, Haitian and Dominican Republic students after Hurricanes Mitch and George ravaged those countries.

Castro, who is widely believed to be terminally ill and who was too sick to attend his belated 80th birthday celebrations in Havana this month, made medical diplomacy a centerpiece of his regime. He dispatched Cuban doctors throughout the third world, and he soon expanded the free medical school offer to other Central American, South American, Caribbean and African countries. And in 2000, during a visit to Cuba by members of the U.S. Congressional Black Caucus, Castro offered free medical scholarships to U.S. students, too, if they agree to return to poor, underserved U.S. areas.

The first U.S. students arrived in the fall of 2001. They moved into the quarters of a former naval academy on the Cuban coast west of Havana, where there are 3,300 students from 29 countries.

They were expected to spend the next six years (compared to four in a U.S. medical school) enduring blackouts, water shortages, an endless diet of rice and beans, long lines for everything, little phone or Internet contact with the rest of the world, and long months between visits home. They had to know (or take a 12-week course to quickly learn) Spanish. For the first two years, they live in dormitories. They receive a monthly stipend of about $4.

Why would anyone do that?

Most of the more than 90 U.S. students here are African American or Hispanic. Many graduated from top-tier U.S. colleges but couldn't go to medical schools in the U.S. because of the high cost or because of low scores on admission exams or a lack of prerequisite courses. Others didn't apply to U.S. medical schools, put off by the cost or focus on lucrative specialties.

''To tell the truth, I got turned off by med students,'' said John Harris, who graduated as a biochemistry major from the University of California, Santa Barbara. ``A lot of them were in it to make a lot of money.''

SCHOOL'S HERO

Now in his fifth year in Cuba, Harris is something of a hero to his fellow students because he scored a 95 (out of a possible 99) on his first licensing exam in the United States (75 is the lowest passing score). He says a secret to success here is discipline.

``You need to be extremely independent. It's good to have experience with limited resources and comforts; it's better if you've lived in a third-world country before. Many people get here, and they're just shell-shocked. They're not used to the food or no hot showers. I've seen a lot of people drop out.''

On the plus side, Harris said, ``I don't have one-tenth of the distractions here. I don't have any bills to pay. I don't have to worry about rent. I have no desire to watch TV, because with just three government channels, there's nothing interesting to watch.''