Cuba’s free med schools are the meritocratic institutions that America’s private system can’t match

The median parental income of the parents of new med school students in America is $100,000 — twice the national average. In Cuba, America’s brilliant, working class med students pay nothing — free tuition, lodging and meals — and they come home to America and provide front-line medical services to families who are frozen out of the US system, in which debt-saddled doctors opt for lucrative specialties instead of family medicine.

Even with wealthy parents, the average new doctor graduates with $180,000 in student debt. The proportion of new doctors who chose specialties that would help them avoid primary care doubled between 1990 to 2007.

But the American doctors who return from Cuba, having learned about the importance of community-oriented care, overwhelmingly go into primary medicine: family practice, internal medicine and pediatrics. They have been profoundly moved by seeing other brown people in teaching and mentorship roles during their time in Cuba, and have seen a system that keeps its population as healthy as Americans, despite a GDP that’s 10% of the USA’s; chronic, embargo-driven shortages of basic medicine and medical devices (and electricity). Cuban doctors work out of their homes, go door to door in their neighborhood seeking out stagnant water where mosquitoes might thrive, doing “the unglamorous work of public health.”

America’s “market driven” medical system is supposed to be a meritocracy, wherein the invisible hand plucks out the best and trains them to be even better, to the benefit of all. In reality, it lets the wealthy get richer by helping the rich. When equality of opportunity is at hand — as it is in the Cuban medical training system — the doctors look very different. It’s a hint of how much talent America’s wasteful system squanders, how much suffering it demands in the service of economic orthodoxy.

For American students unfazed by all that, Cuba offers a very different kind of medical school experience. For one, the student body is extremely diverse, with students from all over the world. They get a crash course in Spanish to prepare them for the all-Spanish curriculum.

“ELAM was this UN,” says Sefa-Boakye, whose parents are originally from Ghana. She grew up going to predominantly white schools, and seeing Afro-Cuban women leading school departments was a revelation. In the US, African-Americans and Hispanics or Latinos make up only 15 percent of students who enter medical school and only 7 percent of medical school faculty.

Cory Doctrow, boingboing

March 29, 2016

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