Health services everywhere are under pressure, so perhaps there are lessons to be learned from Cuba, where, to quote Cubans, “We are a poor people but we die of rich people’s diseases.” British medical students have an opportunity to see for themselves during their ‘elective period’ – a few weeks when they can study where and what they like.
Cuba Medical Link, a UK registered charity started six years ago by a London GP, has enabled 300 students to study in Cuba. Around two-thirds are British; the others come from 17 different countries. The charity provides personal advice and facilitates contact with the medical schools in Havana and Santiago.
No es fácil, as they say in Cuba. Foreign students are in Cuba on Cuba’s terms. They pay substantial fees for their tuition. They have to speak Spanish. They learn alongside Cuban medical students, they live with Cuban families.
Cuba is very different from home, yet many aspects of medical care are familiar, although British doctors no longer wear white coats. Students don a bata blanca and enter a world of shared knowledge of the human body and its infirmities. They may be working in buildings sadly in need of basic repairs, and doctors may have only a thin, shabby towel to dry their hands, but the commitment to patients is the same.
Elective students take their turn in examining patients and presenting their findings, and being questioned by the team. Blood tests and imaging are limited, so Cuban students learn to make a diagnosis without technology. As one British student said, “I felt like an amateur compared to their seemingly vast clinical skills!”
Some differences can be startling. To students educated in Britain, where confidentiality is a primary concern, it is a shock to find two doctors consulting in the same small room and all available space crammed with patients’ relatives and friends, nurses, medical students and even the next patient who has wandered in through the open door.
In many countries preventative health care is given only lip service, or is the responsibility of public health departments. Visiting students see how in Cuba it is everyone’s responsibility, and they make the connection with Cuba’s impressive health statistics. They may even take part: one student was proud to give a talk about reducing their risk of heart disease to a group of abuelos at their exercise class.
Health education in Cuba is partly political will, partly the directness of relationships in Cuba. A Cuban doctor can tell a patient he is ‘un poco gordo’ without offence. And in Britain GPs rarely peer into their patient’s fridge. As one student observed “The primary care doctor in Cuba is part shaman, part confessor and this demonstrates both their medical and social roles and how it is difficult, and probably inappropriate, to try to see one without the other.”
Students go to the beach, play football, go dancing with their fellow Cuban students. Cuban doctors teach them how to interpret X-rays and how to make a mojito, and they pick the students’ brains about how illnesses are currently managed in Britain.
Students find themselves a window on a different world. And not just Britain. The Indian parents of one British student came to visit. “We had a big dinner with the two families which was a mixture of Cuban, English and Indian food with a healthy amount of Cuban rum afterwards. It was a fabulously fun evening. Our hostess is fascinated by Indian culture but will probably never see the real India. I like to think in some way our visit allowed her and her family to understand a little more about other cultures as much as it helped us to do so.”
Students go home with fluent Spanish, albeit se comen las palabras, salsa skills, a taste for cuba libres, and lasting friendships. And a lot of food for thought. They see how the long term social and economical consequences of more than half a century of communist rule, el bloqueo and cultural isolation affect ordinary people’s lives. ‘No es fácil’.
As one student summed it up: “I’m very glad I took the leap, it was an incredible experience. I probably would have learnt more medicine somewhere else, but I feel strongly that the point of the elective experience is to broaden the student’s horizons, which it did with a vengeance!”