Becoming a doctor at the latin American school of medicine in havana, Cuba

While Cuba is island nation of merely 11 million inhabitants ranking 110 among 226 according to GDP, its health achievements often outperform those of far wealthier countries, a phenomenon known as the ‘Cuban miracle'. At least partly, this ‘miracle' results from Cuba's treatment of health as a constitutional, social and human right, revealed in a healthcare system premised on primary care and virtually free at the point of use, and in a unique approach to medical diplomacy. This includes sending healthcare workers to assist the underserved worldwide and offering free medical education to youth from disenfranchised backgrounds, including US nationals, at the Latin American School of Medicine (ELAM) in Havana. However, as ELAM graduates return to their countries they face multiple challenges incorporating themselves into environments premised on radically different values than those underlying Cuban society. Such is the case of US ELAM graduates, who upon their return face a healthcare system that even after the major 2010 federal reform poses substantial barriers to equitable care. Our study examined the experience of a convenience sample of twenty US ELAM graduates through semi-structured, in depth interviews that were qualitatively analyzed to identify key themes. Our aims were to identify the challenges and facilitators to these graduates' reinsertion into the US healthcare system and society more generally, and to understand how the Cuban medical curriculum contributes to the development of graduates' professional identity, ethic of service, and good ‘fit' with an egalitarian system of care. We present preliminary findings of our investigation.