Medical Education in Cuba
http://www.100md.com
《新英格兰医药杂志》
To the Editor: Most Americans, like Mullan, in the Perspective article on the Latin American School of Medicine (Dec. 23 issue),1 do not see the whole picture of Cuban medicine. President Fidel Castro may be generous to international students, but he bans Cubans from universities if their politics differ from the government's. Admissions standards in Cuban medical schools are nonexistent, so that Cuba can fill the schools and export doctors to other countries. In many cases, the Cuban government gets paid and the doctors receive only a small portion of the payment.
Moreover, the Cuban health care system lacks essential medications for its own citizens, although it offers excellent health care to foreigners in exchange for dollars. Recently, a Miami resident had to send pain medication to her brother in Cuba, who had been warned that there would be no analgesic agents available after his coronary-artery bypass surgery.
Castro's gestures of apparent generosity are made only for political gain. The solution to the lack of racial and ethnic parity in U.S. medicine is not to lower the standards in medical schools but to improve education in poor areas, starting in elementary schools.
Barbara R. Cowley, M.D.
1561 Bella Vista Ave.
Coral Gables, FL 33156-6464
bcowleymd@comcast.net
References
Mullan F. Affirmative action, Cuban style. N Engl J Med 2004;351:2680-2682.
To the Editor: Mullan leaves misleading impressions of Castro, Cuba, and its medical system. Four years ago, I visited Cuban facilities, from Havana to the countryside. The practice level everywhere was anachronistic at best. True, the system was highly organized, but in rural areas, we saw malnourished children and adults. The exportation of Cuban physicians to Third World countries has benefits both for developing countries and for Cuba, since it siphons off doctors who might otherwise be unemployed. Providing medical services abroad does not negate totalitarian depredation. Totalitarian regimes can have some redeeming features, but their political context cannot be overlooked. As a Cuban friend remarked, other countries have excellent, free health care and educational systems without sacrificing individual liberty. Mullan's viewpoint belies the reality of Cuban life — a reality dominated by repression and deprivation.
Daniel Ein, M.D.
Washington Allergy Associates
Washington, DC 20037
To the Editor: The article by Mullan highlights the superb job that Cuba does of supplying physicians to the developing world. I have had experience with a newly created medical school in the Gambia, in West Africa, that is sponsored by the Cuban government as well. The facility is spartan, but it does an excellent job of providing a comprehensive, appropriate education for practice in an area of limited resources. The good will it engenders locally makes it a valuable model for the United States to consider as an alternative or adjunct to support of military endeavors.
As a member of a medical-school admissions committee, I think Mullan misrepresents how important a given grade or result on the Medical College Admission Test might be. At our institution, efforts are made to avoid rigid formulas as we evaluate candidates, including those whose qualities — whether racial, ethnic, or otherwise — can enrich a class. I hope Mullan's comments do not discourage candidates from applying to U.S. schools before considering alternatives such as the Latin American School of Medicine.
John P. Lawrence, M.D.
University of Iowa Carver College of Medicine
Iowa City, IA 52242
john-lawrence@uiowa.edu
Dr. Mullan replies: There is no doubt that life in Cuba is hard, as Dr. Ein notes. I did not see the malnutrition he reports, but I also observed absolutely no obesity — anywhere. However, as an American whose government enforces a trade embargo that sharply curtails Cuba's economic capabilities, I find it hard to escape a sense of responsibility for Cuba's spare diets and "anachronistic" medical equipment. I agree with Dr. Ein that the dispatching of Cuban doctors to developing countries has benefits for Cuba as well as for the host countries. There is no question that the regimented nature of Cuba's system facilitates sending doctors overseas, but that does not obviate the benefit or the message of their humanitarian work. Numerous Cuban physicians described to me both the pride and the excitement that they derived from their time abroad.
Dr. Cowley's allegation that medical-school admissions standards are "nonexistent" is at variance with both the competitive nature of medical-school entrance in Cuba and the excellent performance of the Cuban medical system that its graduates staff.1 Cuban physicians work in some of the world's poorest countries, supported by the Cuban government. The South African government does pay Cuba for the doctors deployed there — funds Cuba uses to help cover the costs of its doctors working elsewhere.2
I appreciate Dr. Lawrence's comments on the thoroughness of his admissions committee in examining the credentials of candidates with less-than-perfect academic credentials. One can hope that such diligence at the University of Iowa and elsewhere will bring more members of minority groups into the profession.
Fitzhugh Mullan, M.D.
Health Affairs
Bethesda, MD 20814
Moreover, the Cuban health care system lacks essential medications for its own citizens, although it offers excellent health care to foreigners in exchange for dollars. Recently, a Miami resident had to send pain medication to her brother in Cuba, who had been warned that there would be no analgesic agents available after his coronary-artery bypass surgery.
Castro's gestures of apparent generosity are made only for political gain. The solution to the lack of racial and ethnic parity in U.S. medicine is not to lower the standards in medical schools but to improve education in poor areas, starting in elementary schools.
Barbara R. Cowley, M.D.
1561 Bella Vista Ave.
Coral Gables, FL 33156-6464
bcowleymd@comcast.net
References
Mullan F. Affirmative action, Cuban style. N Engl J Med 2004;351:2680-2682.
To the Editor: Mullan leaves misleading impressions of Castro, Cuba, and its medical system. Four years ago, I visited Cuban facilities, from Havana to the countryside. The practice level everywhere was anachronistic at best. True, the system was highly organized, but in rural areas, we saw malnourished children and adults. The exportation of Cuban physicians to Third World countries has benefits both for developing countries and for Cuba, since it siphons off doctors who might otherwise be unemployed. Providing medical services abroad does not negate totalitarian depredation. Totalitarian regimes can have some redeeming features, but their political context cannot be overlooked. As a Cuban friend remarked, other countries have excellent, free health care and educational systems without sacrificing individual liberty. Mullan's viewpoint belies the reality of Cuban life — a reality dominated by repression and deprivation.
Daniel Ein, M.D.
Washington Allergy Associates
Washington, DC 20037
To the Editor: The article by Mullan highlights the superb job that Cuba does of supplying physicians to the developing world. I have had experience with a newly created medical school in the Gambia, in West Africa, that is sponsored by the Cuban government as well. The facility is spartan, but it does an excellent job of providing a comprehensive, appropriate education for practice in an area of limited resources. The good will it engenders locally makes it a valuable model for the United States to consider as an alternative or adjunct to support of military endeavors.
As a member of a medical-school admissions committee, I think Mullan misrepresents how important a given grade or result on the Medical College Admission Test might be. At our institution, efforts are made to avoid rigid formulas as we evaluate candidates, including those whose qualities — whether racial, ethnic, or otherwise — can enrich a class. I hope Mullan's comments do not discourage candidates from applying to U.S. schools before considering alternatives such as the Latin American School of Medicine.
John P. Lawrence, M.D.
University of Iowa Carver College of Medicine
Iowa City, IA 52242
john-lawrence@uiowa.edu
Dr. Mullan replies: There is no doubt that life in Cuba is hard, as Dr. Ein notes. I did not see the malnutrition he reports, but I also observed absolutely no obesity — anywhere. However, as an American whose government enforces a trade embargo that sharply curtails Cuba's economic capabilities, I find it hard to escape a sense of responsibility for Cuba's spare diets and "anachronistic" medical equipment. I agree with Dr. Ein that the dispatching of Cuban doctors to developing countries has benefits for Cuba as well as for the host countries. There is no question that the regimented nature of Cuba's system facilitates sending doctors overseas, but that does not obviate the benefit or the message of their humanitarian work. Numerous Cuban physicians described to me both the pride and the excitement that they derived from their time abroad.
Dr. Cowley's allegation that medical-school admissions standards are "nonexistent" is at variance with both the competitive nature of medical-school entrance in Cuba and the excellent performance of the Cuban medical system that its graduates staff.1 Cuban physicians work in some of the world's poorest countries, supported by the Cuban government. The South African government does pay Cuba for the doctors deployed there — funds Cuba uses to help cover the costs of its doctors working elsewhere.2
I appreciate Dr. Lawrence's comments on the thoroughness of his admissions committee in examining the credentials of candidates with less-than-perfect academic credentials. One can hope that such diligence at the University of Iowa and elsewhere will bring more members of minority groups into the profession.
Fitzhugh Mullan, M.D.
Health Affairs
Bethesda, MD 20814