Medical education courtesy of Castro

The Baltimore Sun

HAVANA -- As a little girl growing up, Erlyne Hyppolite wanted to be a doctor, but she always worried that an expensive medical degree was beyond her reach.

Now the 20-year-old from Lanham is living in Cuba and on track to become a pediatrician in six years.

And it isn't costing her a dime.

Hyppolite is studying in the Caribbean country, which has been at odds with the United States for decades, under a Cuban government program that trains students from 29 countries to become doctors. Though a relatively new initiative, it appeals to a growing number of students because of the free medical training.

Hyppolite is one of nearly 100 American students who have chosen to study at the Latin American School of Medicine, on a sprawling former naval academy base west of the capital, Havana.

The program graduated its first American student in 2006, with eight others expected to finish later this year. It's a college experience that would already be tough under normal circumstances, but it is made even more complex by the strained relationship between the United States and Communist Cuba.

An American embargo on Cuba means Hyppolite can't get care packages or other mail from home. She can't spend U.S. money in Cuba, and her parents can't visit her.

"I was scared at first," Hyppolite said. "But how could I pass it up?"

Hyppolite said the hardest days are when she yearns to talk to her family back in Maryland. It's too expensive to call regularly.

In 1999, Cuban President Fidel Castro began offering medical scholarships to students in Honduras, Haiti and the Dominican Republic after their countries had been hit by hurricanes. He has since expanded the program to more than two dozen other countries. The school has about 12,000 students - 3,000 at the main campus and the rest at training hospitals throughout the country.

Filling a need

In 2000, a group from the U.S. Congressional Black Caucus visited Castro and learned about the medical school. Democratic Rep. Bennie Thompson of Mississippi described poor areas in his district with no doctors. Castro offered to open his scholarship program to as many as 500 American students. The first group entered in 2001. Cuba's political leanings didn't concern him, Thompson said, but the lack of doctors back home did.

"I tend to make up my own mind as to who my friends and enemies are," Thompson said in a phone interview. "And in this instance we have a dire shortage of doctors in certain areas."

Cuban officials don't discuss how much the program costs. They describe it as a broader humanitarian mission to give back to poverty-stricken areas of the world.

Students from other countries who want to attend Cuba's medical school must have a high school diploma and must have taken science courses such as chemistry, biochemistry and biology. Once accepted, they study medicine for six years - two at the main campus and the remaining years at one of 21 medical schools throughout Cuba. They must agree to return home with their degrees and practice in underserved areas.

The experience is as much a cultural transition as it is educational, many of the students said. The curriculum is taught in Spanish. Those who don't know the language - and most don't - take an intense language immersion program before they begin their studies.

Students are housed in cramped dormitories with a dozen or more roommates. Showers are cold, and the meals are always the same - beans and rice. There is no cable television, just three stations that air educational or government-sponsored programming. Students wash their clothes by hand.

Though warned of the living conditions beforehand, most students said they couldn't afford a $200,000 medical education in the United States. Others had a hard time getting into American medical schools or scored poorly on the Medical College Admission Test, which the Cuban university does not require.

The students can struggle with Cuba's isolation.

"Everyone hits a wall at one time or another," said Ellen Bernstein, associate director of the Interreligious Foundation for Community Organization, the nonprofit that sponsors U.S. students in the program. "Either they're homesick, tired of living with a bunch of people with no privacy, tired of the food. Then they sit back for a minute and draw on whatever strength they have and the support of the other students."

Frugal existence

Hyppolite, who lived in Haiti as a child, was studying pre-medicine at Columbia Union College in Takoma Park when she heard about the program in Cuba. Although Hyppolite said she had good grades, she was having a hard time paying tuition, even with help from her parents.

She said that the transition has been tough but that she is adjusting.

She's had to learn to live frugally. The students are given just 100 pesos, or $4, to live on a month.

Like several students interviewed, Hyppolite said she wasn't intimidated by the political leanings of Cuba, and she hasn't felt pressure to adapt or promote Cuba's socialist agenda.

"I live my life like I want to," Hyppolite said.

Some students said they were attracted to the medical program partly because of Cuba's history.

"I think the whole revolution is awesome the way they took back their land," said Elicia De Los Reyes, a student from California who is in her first year of the program.

But longtime critics of Cuba and its leadership under Castro question the motives of the medical school.

"They try to use this as a nice propaganda tool to help their image a bit in the United States and internationally," said Camila Gallardo government relations director of the Cuban American National Foundation, an anti-Cuba group started by those who fled the country after the revolution a half-century ago claiming religious and political persecution.

While many students see opportunity through the program, others say they worry whether American hospitals will consider them for jobs with their Cuban training.

Bernstein said more American hospitals inquire about the students as the young program becomes better known. Prospective doctors who earn medical degrees outside the United States must get certification with the Educational Commission for Foreign Medical Graduates. The nonprofit group works to ensure that foreign medical students meet certain standards before practicing in the United States. The World Health Organization also recognizes Cuba's health system.

About 25 percent of U.S. doctors have degrees from international programs, according to the American Medical Association.

Some states, like California, don't recognize the Cuban school and will not provide a medical license to a student, but state officials said they would consider the program if a request were made by university officials. Maryland recognizes all foreign programs as long as their students earn certification through the foreign medical commission.

The first American graduated from the Cuban program last year. He passed his medical boards in the U.S. and is searching for a residency program.

Hyppolite said she won't worry about getting a job quite yet. She'll be 26 by the time she graduates. Every now and then, she looks around at her frugal living conditions and almost thinks twice about her decision.

"I gave my life up," Hyppolite said. "But it's worth it."

andrea.walker@baltsun.com

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