José Jasán Nieves Cárdenas (Progreso Weekly)
About 250 US citizens have been studying in medical schools and practicing in medical institutions in Cuba since 2000, writing with their presence one of the most revealing pages of fruitful coexistence between the United States and Cuba.
The first doctors who graduated from a program created by the US Congress’ Black Caucus and former President Fidel Castro, and later channeled through the organization Pastors for Peace have already returned to their homeland, while the island’s schools continue to train dozens of new students. Every year, more arrive.
Deep-rooted prejudices and stereotypes have been broken by the interaction. The students’ greatest lesson is the realization that they’re both alike and different.
The asphyxiating air of Havana’s Monte Street disappears as we walk up the stairs. In the living room, the young Atuey Fénix plays with his grandmother while a computer plays back old chapters of the Sesame Street series.
It’s the home of Cassandra Cusack Curbelo, a Cuban-American who was given a free scholarship to become a doctor in her mother’s homeland.
“I’m Cuban enough so as not to be an extra-terrestrial here, but American enough to be seen as a crazy lady,” she says, smiling, while she prepares vegetarian hamburgers made with crushed grains for Atuey.
Born in Hialeah but raised in Chicago, Cassandra at age 30 decided to reconsider her job as a public relations specialist in an activist group.
“I wanted to do something sustainable. The knowledge of medicine will never go out of style or become obsolete,” she says. A friend of the family helped her to get on a list of scholarship recipients issued by the Cuban Foreign Ministry to solidarity groups.
Upon arrival in Cuba in 2008, she was placed — as all Americans were — in the Latin American School of Medicine (ELAM) on Baracoa Beach, west of Havana. She did her practice at the Salvador Allende Hospital in Havana’s Cerro municipality which is still known by the name of the Catalonian Virgin of La Covadonga.
“I don’t like elitist medicine, and in the United States almost all doctors are white, from wealthy families, who studied at an early age. They don’t usually do workups, generally don’t listen to you, don’t look at you, don’t touch you and they charge you $100 just to show up,” Cassandra says.
“I love the way doctors here talk. My teachers have been very natural and friendly.”
“The program doesn’t force anyone to do anything,” Cassandra replies when asked if political gestures were expected in exchange for her diploma. It would be neither extraordinary nor infrequent for the health authorities to ask doctors to practice in disadvantaged areas in exchange for the free training. But Cassandra insists that it isn’t so.
“Among us, there are people who are not interested in serving anyone. They say, ‘I’ll leave [Cuba], do my residency, and go on to make money.’ But most of us, we have dreams.
“I want to set up a clinic in New Orleans with my friends. Others have thought about Detroit. We have even thought about setting up a clinic in a poor Third World nation where we can spend our vacations and help the local population a little.”
Those who knew her in Havana remember her for her restless spirit and vocation for service. She was an active and renowned student during her years in Cuba. Therefore, her teachers and friends were not surprised to learn that, upon entering the difficult system of medical specialties in the U.S., Joanna Mae Sauers enlisted as a volunteer to fight Ebola in Africa.
Sauers arrived at the Cooper Hospital in Monrovia, Liberia, and tried to join the Cuban medical brigade that was working there.
“I was interested in working as a volunteer with the Cuban doctors, but they told me that they weren’t accepting any graduates from ELAM, given the circumstances of the epidemic. No doubt, it was their example and my experience in Cuba what inspired me to do that work,” Joanna says.
The idea of joining a Cuban brigade was not new to Joanna, a student of specialists who traveled to places like Pakistan, Angola, Venezuela or Haiti and in some cases accepted native doctors graduated in Cuba as members of their “mission.” Her closeness to Cuba was always there, through her solidarity with the people of the island.
“I heard about the program through a friend and applied for the scholarship through Pastors for Peace,” she says. “There are some basic requirements for admission, such as a payment for the application, an interview and an orientation session.
“First, you must be approved by the organization and then accepted into the program by the school. What they seek primarily are applicants who have a proven dedication to serve the needy.
“Most of the people I knew in the States were surprised when they heard that I was going to Cuba to study. They didn’t know that was possible and were amazed when they learned that the program is a totally free scholarship guaranteed by the Cuban government. They could hardly believe that such an opportunity existed.”
Sauers lived on the ELAM campus from her first to third year but later rented a room near the Covadonga Hospital. Learning the Cuban culture and the values of other friends from Africa, South America and the Caribbean was to her as important an education as the medical training.
“There was nothing better than visiting my friends in the provinces and sharing with them a good home-cooked meal, especially a dish of yucca with mojo, congri rice, fried plantains, salad and roasted pork. My mouth waters just thinking about it!” she says.
Hinges for normalization
Like their compatriots who have graduated or are about to graduate, Cassandra and Joanna are small examples of interaction between two countries with a longtime ideological confrontation. They have lived through coexistence without trauma and demonstrate that it is possible to maintain relations of mutual benefit.
The closed medical system in the U.S. — described by many as endogamous and elitist — has begun to accept graduates from Cuba, as reported by Joanna, one of the most recent 13 U.S. students at ELAM who passed the tests to practice medical specialties in the States.
“To me, it wasn’t particularly difficult to get my residency in the United States,” Joanna says. “I had to get through the USMLE [U.S. Medical License Examination] tests, which require rigorous knowledge. I did all I could to get as much clinical experience in the U.S. as I got in Cuba. That meant spending much of my summer vacations doing observations and clinical rotations in the U.S.
“Many programs of competitive specialties were interested in my application, because the ELAM is renowned through the graduates who returned before I did, and those who know about us and the Cuban medical system value our training quite a lot.”
That positive perception is noticed even in the state of Florida, says Cassandra, who says she has heard of hospitals interested in hiring doctors like her. “I know that Baptist Hospital and Jackson Hospital in Miami are,” she says.
Most of the Americans return home after their sixth year. Since the rapprochement of December 2014 they hope that the US will soon have an embassy in Havana but unsure of the possibility.
“As an American, I’m very cynical and say that as long as nothing is on paper nothing is happening. People can talk all they want but it may only be words,” says Cassandra. “[Cuba] is virgin land in the Caribbean and the wolves are drooling to come in.”
“I think the rapprochement is useful for both countries,” Joanna sums up. “Cuba is an example to the world in terms of top-level medical care and training. The US and much of the rest of the world have a desperate need for primary-care physicians. As graduates of this program, we can provide health services for the needy and share our experience with the rest of the world.”
From this experience a new type of doctor emerges — and a new source of interaction.