There’s a crisis in world healthcare. There aren’t enough doctors, even for the developed countries to fill their own hospitals. And there are plenty of places with shortages of healthcare workers, where doctors don’t want to work because it’s not pleasant or comfortable. Inner cities, for example. Slums. Remote areas without access to running water and good schools. In the developing countries, it’s even worse. There are many people who have never even been near a doctor, and it’s usually them who most need medical care.
Squaring a circle
How can you square that circle? One medical school, the Latin American Medical School in Cuba, has taken hold of the problem by the scruff of its neck, and started to address it. Who better, the school has asked, to recruit as medical students than young people from those very areas that most need doctors? Those young people are committed to their communities and will return to them once trained, taking much-needed medical skills together with an understanding of what those communities need.
The Latin American Medical School was established in 2005 as part of the response to two hurricanes. Cuban doctors, volunteering to help, arrived in remote communities and found healthcare facilities unused, for lack of staff. They recognised that although they could provide treatment and care in the short term, a longer term strategy was needed. The Latin American School of Medicine, or ELAM, was born, on the campus of an old naval training school.
And since its establishment, it has trained around 23,000 young doctors from more than 100 countries across Latin America, Asia and Africa, and even from poor communities in the USA. They’ve come from shanty towns, remote communities miles from ‘civilisation’, and from the slum areas of large cities. And on graduation, they’ve gone back there, to provide healthcare for their communities. What’s more, they are more likely to be women than men, and more often than not, come from indigenous communities.
ELAM is tough on its students. There are no short cuts, and no easy ride: they have to go through ‘proper’ medical training. But the school also provides plenty of support for them. It understands that it’s drawing young people from indigenous communities, to whom even Spanish is a second language. There are pre-training courses in basic science, and in Spanish to ensure that everyone will understand the teaching. Diversity comes as standard.
The medical training is also designed to serve its students and provide the knowledge that they will need in future. Yes, of course there are lectures, and time spent in hospitals. But the core of the teaching is community-based, recognising that these students will spend most of their working lives in community clinics. They are also taught the importance of a good patient interview and clinical examination as the source of diagnosis. Expensive technology, not accessible to remote communities, is largely reserved for confirmation, not for initial diagnosis. Students also learn about public health, and the importance of looking at and treating the whole patient. And not just the patient, but the patient within their family and their community.
Success on the ground
It’s a fascinating experiment, but it is working? The answer is a resounding yes. Some of the earliest graduates, from the indigenous Garifuna community in Honduras, returned to their community and mobilised friends, family and neighbours to build a hospital. In the time since then, it has treated over one million patients. But perhaps the biggest and most obvious ‘success’ was the support that ELAM’s students and graduates were able to provide to Haiti after the earthquake in January 2010. ELAM’s students responded to the call for assistance by contacting 2000 of the school’s graduates, and hundreds arrived from 27 countries around the world to lend their aid. They were able to communicate easily with each other in Spanish, and with the Haitian community in Creole via Haitian graduates and ELAM students, flown in as translators. They stayed for months to provide help, then ELAM’s Haitian graduates picked up the burden to build a new health system.
Delivering sustainable healthcare for the future
ELAM’s graduates are well-trained to provide high quality healthcare with minimal technology and support. They want to deliver for their communities, wherever they are, and they know that they can. It’s a model of healthcare that developed countries cannot afford to ignore, and which offers the potential to solve the healthcare crisis for the world’s poorest communities.