Gail Reed: Where to train the world's doctors? Cuba.

82,286 views ・ 2014-10-01

TED


Please double-click on the English subtitles below to play the video.

00:12
I want to tell you
0
12537
1622
00:14
how 20,000 remarkable young people
1
14159
4691
00:18
from over 100 countries
2
18850
1856
00:20
ended up in Cuba
3
20706
1812
00:22
and are transforming health in their communities.
4
22518
3803
00:26
Ninety percent of them would never
5
26321
2080
00:28
have left home at all
6
28401
1572
00:29
if it weren't for a scholarship to study medicine in Cuba
7
29973
3344
00:33
and a commitment to go back
8
33317
1811
00:35
to places like the ones they'd come from —
9
35128
3628
00:38
remote farmlands, mountains, ghettos —
10
38756
3447
00:42
to become doctors for people like themselves,
11
42203
3486
00:45
to walk the walk.
12
45689
2092
00:47
Havana's Latin American Medical School:
13
47781
2666
00:50
It's the largest medical school in the world,
14
50447
2925
00:53
graduating 23,000 young doctors
15
53372
2902
00:56
since its first class of 2005,
16
56274
2728
00:59
with nearly 10,000 more in the pipeline.
17
59002
3609
01:02
Its mission, to train physicians for the people
18
62611
3821
01:06
who need them the most:
19
66432
2051
01:08
the over one billion
20
68483
1936
01:10
who have never seen a doctor,
21
70419
2263
01:12
the people who live and die
22
72682
3833
01:16
under every poverty line ever invented.
23
76515
3494
01:20
Its students defy all norms.
24
80009
2250
01:22
They're the school's biggest risk
25
82259
2271
01:24
and also its best bet.
26
84530
2460
01:26
They're recruited from the poorest,
27
86990
2515
01:29
most broken places on our planet
28
89505
2571
01:32
by a school that believes they can become
29
92076
2274
01:34
not just the good
30
94350
1507
01:35
but the excellent physicians
31
95857
1935
01:37
their communities desperately need,
32
97792
2753
01:40
that they will practice where most doctors don't,
33
100545
3652
01:44
in places not only poor
34
104197
2426
01:46
but oftentimes dangerous,
35
106623
2553
01:49
carrying venom antidotes in their backpacks
36
109176
3026
01:52
or navigating neighborhoods
37
112202
2619
01:54
riddled by drugs, gangs and bullets,
38
114821
3321
01:58
their home ground.
39
118142
2700
02:00
The hope is that they will help
40
120842
1326
02:02
transform access to care,
41
122168
2600
02:04
the health picture in impoverished areas,
42
124768
2419
02:07
and even the way medicine itself
43
127187
2159
02:09
is learned and practiced,
44
129346
2543
02:11
and that they will become pioneers in our global reach
45
131889
4251
02:16
for universal health coverage,
46
136140
2520
02:18
surely a tall order.
47
138660
2718
02:21
Two big storms and this notion of "walk the walk"
48
141378
4126
02:25
prompted creation of ELAM back in 1998.
49
145504
4084
02:29
The Hurricanes Georges and Mitch
50
149588
3003
02:32
had ripped through the Caribbean
51
152591
1552
02:34
and Central America,
52
154143
2205
02:36
leaving 30,000 dead
53
156348
2379
02:38
and two and a half million homeless.
54
158727
2883
02:41
Hundreds of Cuban doctors volunteered for disaster response,
55
161610
3693
02:45
but when they got there,
56
165303
1845
02:47
they found a bigger disaster:
57
167148
2083
02:49
whole communities with no healthcare,
58
169231
3196
02:52
doors bolted shut on rural hospitals
59
172427
2324
02:54
for lack of staff,
60
174751
1879
02:56
and just too many babies dying
61
176630
2671
02:59
before their first birthday.
62
179301
2935
03:02
What would happen when these Cuban doctors left?
63
182236
3834
03:06
New doctors were needed to make care sustainable,
64
186070
2714
03:08
but where would they come from?
65
188784
1312
03:10
Where would they train?
66
190096
2805
03:12
In Havana, the campus of a former naval academy
67
192901
4443
03:17
was turned over to the Cuban Health Ministry
68
197344
2925
03:20
to become the Latin American Medical School,
69
200269
3351
03:23
ELAM.
70
203620
2013
03:25
Tuition, room and board, and a small stipend
71
205633
2474
03:28
were offered to hundreds of students
72
208107
1911
03:30
from the countries hardest hit by the storms.
73
210018
3033
03:33
As a journalist in Havana,
74
213051
2279
03:35
I watched the first 97 Nicaraguans arrive
75
215330
2717
03:38
in March 1999,
76
218047
2542
03:40
settling into dorms barely refurbished
77
220589
2716
03:43
and helping their professors not only sweep out the classrooms
78
223305
3679
03:46
but move in the desks and the chairs and the microscopes.
79
226984
4679
03:51
Over the next few years,
80
231663
1879
03:53
governments throughout the Americas
81
233542
1912
03:55
requested scholarships for their own students,
82
235454
3173
03:58
and the Congressional Black Caucus
83
238627
1878
04:00
asked for and received hundreds of scholarships
84
240505
3375
04:03
for young people from the USA.
85
243880
3240
04:07
Today, among the 23,000
86
247120
3712
04:10
are graduates from 83 countries
87
250832
3015
04:13
in the Americas, Africa and Asia,
88
253847
3004
04:16
and enrollment has grown to 123 nations.
89
256851
5603
04:22
More than half the students are young women.
90
262454
2204
04:24
They come from 100 ethnic groups,
91
264658
1392
04:26
speak 50 different languages.
92
266050
2025
04:28
WHO Director Margaret Chan said,
93
268075
3141
04:31
"For once, if you are poor, female,
94
271216
4038
04:35
or from an indigenous population,
95
275254
2262
04:37
you have a distinct advantage,
96
277516
1705
04:39
an ethic that makes this medical school unique."
97
279221
4729
04:43
Luther Castillo comes from San Pedro de Tocamacho
98
283950
4150
04:48
on the Atlantic coast of Honduras.
99
288100
2870
04:50
There's no running water,
100
290970
1912
04:52
no electricity there,
101
292882
1800
04:54
and to reach the village, you have to walk for hours
102
294682
3600
04:58
or take your chances in a pickup truck like I did
103
298282
2913
05:01
skirting the waves of the Atlantic.
104
301195
3295
05:04
Luther was one of 40 Tocamacho children
105
304490
4641
05:09
who started grammar school,
106
309131
2003
05:11
the sons and daughters of a black indigenous people
107
311134
2744
05:13
known as the Garífuna,
108
313878
1856
05:15
20 percent of the Honduran population.
109
315734
3476
05:19
The nearest healthcare was fatal miles away.
110
319210
5153
05:24
Luther had to walk three hours every day
111
324363
3487
05:27
to middle school.
112
327850
1901
05:29
Only 17 made that trip.
113
329751
2081
05:31
Only five went on to high school,
114
331832
2104
05:33
and only one to university:
115
333936
2164
05:36
Luther, to ELAM,
116
336100
2021
05:38
among the first crop of Garífuna graduates.
117
338121
4009
05:42
Just two Garífuna doctors had preceded them
118
342130
2870
05:45
in all of Honduran history.
119
345000
3044
05:48
Now there are 69, thanks to ELAM.
120
348044
5901
05:53
Big problems need big solutions,
121
353945
3200
05:57
sparked by big ideas, imagination and audacity,
122
357145
3792
06:00
but also solutions that work.
123
360937
3003
06:03
ELAM's faculty had no handy evidence base
124
363940
3330
06:07
to guide them, so they learned the hard way,
125
367270
3520
06:10
by doing and correcting course as they went.
126
370790
3689
06:14
Even the brightest students
127
374479
2262
06:16
from these poor communities
128
376741
1913
06:18
weren't academically prepared
129
378654
1676
06:20
for six years of medical training,
130
380330
2693
06:23
so a bridging course was set up in sciences.
131
383023
3657
06:26
Then came language:
132
386680
1575
06:28
these were Mapuche, Quechuas, Guaraní, Garífuna,
133
388255
3161
06:31
indigenous peoples
134
391416
1777
06:33
who learned Spanish as a second language,
135
393193
2200
06:35
or Haitians who spoke Creole.
136
395393
2797
06:38
So Spanish became part
137
398190
1937
06:40
of the pre-pre-med curriculum.
138
400127
4158
06:44
Even so, in Cuba,
139
404285
2942
06:47
the music, the food, the smells,
140
407227
3234
06:50
just about everything was different,
141
410461
2689
06:53
so faculty became family, ELAM home.
142
413150
5005
06:58
Religions ranged from indigenous beliefs
143
418155
2813
07:00
to Yoruba, Muslim and Christian evangelical.
144
420968
4032
07:05
Embracing diversity became a way of life.
145
425000
4484
07:09
Why have so many countries
146
429484
1990
07:11
asked for these scholarships?
147
431474
2475
07:13
First, they just don't have enough doctors,
148
433949
3252
07:17
and where they do, their distribution
149
437201
1766
07:18
is skewed against the poor,
150
438967
2442
07:21
because our global health crisis
151
441409
2462
07:23
is fed by a crisis in human resources.
152
443871
2965
07:26
We are short four to seven million health workers
153
446836
3852
07:30
just to meet basic needs,
154
450688
2464
07:33
and the problem is everywhere.
155
453152
1858
07:35
Doctors are concentrated in the cities,
156
455010
2552
07:37
where only half the world's people live,
157
457562
2610
07:40
and within cities,
158
460172
1788
07:41
not in the shantytowns or South L.A.
159
461960
4179
07:46
Here in the United States,
160
466139
1766
07:47
where we have healthcare reform,
161
467905
2501
07:50
we don't have the professionals we need.
162
470406
2548
07:52
By 2020, we will be short
163
472954
2515
07:55
45,000 primary care physicians.
164
475469
4139
07:59
And we're also part of the problem.
165
479608
2157
08:01
The United States is the number one importer
166
481765
2467
08:04
of doctors from developing countries.
167
484232
4364
08:08
The second reasons students flock to Cuba
168
488596
2869
08:11
is the island's own health report card,
169
491465
2227
08:13
relying on strong primary care.
170
493692
2970
08:16
A commission from The Lancet
171
496662
1822
08:18
rates Cuba among the best performing
172
498484
2506
08:20
middle-income countries in health.
173
500990
2849
08:23
Save the Children ranks Cuba
174
503839
1946
08:25
the best country in Latin America to become a mother.
175
505785
4636
08:30
Cuba has similar life expectancy
176
510421
2989
08:33
and lower infant mortality than the United States,
177
513410
3232
08:36
with fewer disparities,
178
516642
2181
08:38
while spending per person
179
518823
1800
08:40
one 20th of what we do on health
180
520623
3015
08:43
here in the USA.
181
523638
2149
08:45
Academically, ELAM is tough,
182
525787
2992
08:48
but 80 percent of its students graduate.
183
528779
3631
08:52
The subjects are familiar —
184
532410
1346
08:53
basic and clinical sciences —
185
533756
2474
08:56
but there are major differences.
186
536230
2426
08:58
First, training has moved out of the ivory tower
187
538656
3611
09:02
and into clinic classrooms and neighborhoods,
188
542267
2902
09:05
the kinds of places most of these grads will practice.
189
545169
3364
09:08
Sure, they have lectures and hospital rotations too,
190
548533
4094
09:12
but community-based learning starts on day one.
191
552627
5030
09:17
Second, students treat the whole patient,
192
557657
3766
09:21
mind and body,
193
561423
1914
09:23
in the context of their families, their communities
194
563337
2506
09:25
and their culture.
195
565843
2147
09:27
Third, they learn public health:
196
567990
2900
09:30
to assess their patients' drinking water, housing,
197
570890
3100
09:33
social and economic conditions.
198
573990
3296
09:37
Fourth, they are taught
199
577286
2531
09:39
that a good patient interview
200
579817
2767
09:42
and a thorough clinical exam
201
582584
2104
09:44
provide most of the clues for diagnosis,
202
584688
2835
09:47
saving costly technology for confirmation.
203
587523
3903
09:51
And finally, they're taught over and over again
204
591426
3550
09:54
the importance of prevention,
205
594976
2044
09:57
especially as chronic diseases
206
597020
2400
09:59
cripple health systems worldwide.
207
599420
4160
10:03
Such an in-service learning
208
603580
3190
10:06
also comes with a team approach,
209
606770
2600
10:09
as much how to work in teams
210
609370
2867
10:12
as how to lead them,
211
612237
1946
10:14
with a dose of humility.
212
614183
2127
10:16
Upon graduation, these doctors share
213
616310
2800
10:19
their knowledge with nurse's aids, midwives,
214
619110
2710
10:21
community health workers,
215
621820
1970
10:23
to help them become better at what they do,
216
623790
2386
10:26
not to replace them,
217
626176
1945
10:28
to work with shamans and traditional healers.
218
628121
3129
10:33
ELAM's graduates:
219
633311
2559
10:35
Are they proving this audacious experiment right?
220
635870
4657
10:40
Dozens of projects give us an inkling
221
640527
2295
10:42
of what they're capable of doing.
222
642822
2568
10:45
Take the Garífuna grads.
223
645390
1763
10:47
They not only went to work back home,
224
647153
2190
10:49
but they organized their communities to build
225
649343
2407
10:51
Honduras' first indigenous hospital.
226
651750
3401
10:55
With an architect's help,
227
655151
2149
10:57
residents literally raised it from the ground up.
228
657300
4477
11:01
The first patients walked through the doors
229
661777
2182
11:03
in December 2007,
230
663959
2340
11:06
and since then, the hospital has received
231
666299
2509
11:08
nearly one million patient visits.
232
668808
3150
11:11
And government is paying attention,
233
671958
2161
11:14
upholding the hospital as a model
234
674119
2521
11:16
of rural public health for Honduras.
235
676640
5179
11:21
ELAM's graduates are smart,
236
681819
3648
11:25
strong and also dedicated.
237
685467
3453
11:28
Haiti, January 2010.
238
688920
4354
11:33
The pain.
239
693274
1835
11:35
People buried under 30 million tons of rubble.
240
695109
4003
11:39
Overwhelming.
241
699112
2149
11:41
Three hundred forty Cuban doctors
242
701261
1878
11:43
were already on the ground long term.
243
703139
2441
11:45
More were on their way. Many more were needed.
244
705580
2403
11:47
At ELAM, students worked round the clock
245
707983
3244
11:51
to contact 2,000 graduates.
246
711227
3218
11:54
As a result, hundreds arrived in Haiti,
247
714445
3184
11:57
27 countries' worth, from Mali in the Sahara
248
717629
4297
12:01
to St. Lucia, Bolivia, Chile and the USA.
249
721926
4488
12:06
They spoke easily to each other in Spanish
250
726414
3296
12:09
and listened to their patients in Creole
251
729710
2689
12:12
thanks to Haitian medical students
252
732399
2126
12:14
flown in from ELAM in Cuba.
253
734525
2227
12:16
Many stayed for months,
254
736752
1688
12:18
even through the cholera epidemic.
255
738440
2778
12:21
Hundreds of Haitian graduates
256
741218
2340
12:23
had to pick up the pieces,
257
743558
2722
12:26
overcome their own heartbreak,
258
746280
2014
12:28
and then pick up the burden
259
748294
1866
12:30
of building a new public health system for Haiti.
260
750160
3568
12:33
Today, with aid of organizations and governments
261
753728
2497
12:36
from Norway to Cuba to Brazil,
262
756225
2553
12:38
dozens of new health centers have been built,
263
758778
2226
12:41
staffed, and in 35 cases, headed
264
761004
3571
12:44
by ELAM graduates.
265
764575
3922
12:48
Yet the Haitian story
266
768497
1868
12:50
also illustrates some of the bigger problems
267
770365
2059
12:52
faced in many countries.
268
772424
2216
12:54
Take a look:
269
774640
1744
12:56
748 Haitian graduates by 2012, when cholera struck,
270
776384
5782
13:02
nearly half working in the public health sector
271
782166
3746
13:05
but one quarter unemployed,
272
785912
2071
13:07
and 110 had left Haiti altogether.
273
787983
6110
13:14
So in the best case scenarios,
274
794093
2768
13:16
these graduates are staffing
275
796861
1870
13:18
and thus strengthening public health systems,
276
798731
3249
13:21
where often they're the only doctors around.
277
801980
3179
13:25
In the worst cases, there are simply not enough jobs
278
805159
2791
13:27
in the public health sector,
279
807950
1642
13:29
where most poor people are treated,
280
809592
2566
13:32
not enough political will, not enough resources,
281
812158
2799
13:34
not enough anything —
282
814957
2206
13:37
just too many patients with no care.
283
817163
3453
13:40
The grads face pressure from their families too,
284
820616
2984
13:43
desperate to make ends meet,
285
823600
2303
13:45
so when there are no public sector jobs,
286
825903
2576
13:48
these new MDs decamp into private practice,
287
828479
2621
13:51
or go abroad to send money home.
288
831100
4015
13:55
Worst of all, in some countries,
289
835115
3185
13:58
medical societies influence accreditation bodies
290
838300
2936
14:01
not to honor the ELAM degree,
291
841236
3015
14:04
fearful these grads will take their jobs
292
844251
2317
14:06
or reduce their patient loads and income.
293
846568
3555
14:10
It's not a question of competencies.
294
850123
2981
14:13
Here in the USA, the California Medical Board
295
853104
2508
14:15
accredited the school after rigorous inspection,
296
855612
3600
14:19
and the new physicians are making good
297
859212
2048
14:21
on Cuba's big bet,
298
861260
2191
14:23
passing their boards and accepted
299
863451
1811
14:25
into highly respected residencies
300
865262
2385
14:27
from New York to Chicago to New Mexico.
301
867647
4091
14:31
Two hundred strong, they're coming
302
871738
2625
14:34
back to the United States energized,
303
874363
2385
14:36
and also dissatisfied.
304
876748
2587
14:39
As one grad put it,
305
879335
1631
14:40
in Cuba, "We are trained to provide quality care
306
880966
3454
14:44
with minimal resources,
307
884420
2002
14:46
so when I see all the resources we have here,
308
886422
2576
14:48
and you tell me that's not possible,
309
888998
2162
14:51
I know it's not true.
310
891160
2170
14:53
Not only have I seen it work, I've done the work."
311
893330
5619
14:58
ELAM's graduates,
312
898949
1961
15:00
some from right here in D.C. and Baltimore,
313
900910
3517
15:04
have come from the poorest of the poor
314
904427
3168
15:07
to offer health, education
315
907595
2333
15:09
and a voice to their communities.
316
909928
2916
15:12
They've done the heavy lifting.
317
912844
2652
15:15
Now we need to do our part
318
915496
2014
15:17
to support the 23,000 and counting,
319
917510
3617
15:21
All of us —
320
921127
1354
15:22
foundations, residency directors, press,
321
922481
3634
15:26
entrepreneurs, policymakers, people —
322
926115
3184
15:29
need to step up.
323
929299
2153
15:31
We need to do much more globally
324
931452
1991
15:33
to give these new doctors the opportunity
325
933443
2939
15:36
to prove their mettle.
326
936382
2393
15:38
They need to be able
327
938775
1003
15:39
to take their countries' licensing exams.
328
939778
3204
15:42
They need jobs in the public health sector
329
942982
2948
15:45
or in nonprofit health centers
330
945930
1755
15:47
to put their training and commitment to work.
331
947685
3847
15:51
They need the chance to be
332
951532
2283
15:53
the doctors their patients need.
333
953815
4859
15:58
To move forward,
334
958674
1857
16:00
we may have to find our way back
335
960531
2992
16:03
to that pediatrician who would
336
963523
2183
16:05
knock on my family's door
337
965706
1687
16:07
on the South Side of Chicago when I was a kid,
338
967393
3186
16:10
who made house calls,
339
970579
1910
16:12
who was a public servant.
340
972489
2891
16:15
These aren't such new ideas
341
975380
1823
16:17
of what medicine should be.
342
977203
2362
16:19
What's new is the scaling up
343
979565
2725
16:22
and the faces of the doctors themselves:
344
982290
3383
16:25
an ELAM graduate is more likely to be a she
345
985673
3457
16:29
than a he;
346
989130
1930
16:31
In the Amazon, Peru or Guatemala,
347
991060
2927
16:33
an indigenous doctor;
348
993987
2351
16:36
in the USA, a doctor of color
349
996338
3014
16:39
who speaks fluent Spanish.
350
999352
2396
16:41
She is well trained, can be counted on,
351
1001748
3679
16:45
and shares the face and culture of her patients,
352
1005427
3644
16:49
and she deserves our support surely,
353
1009071
3409
16:52
because whether by subway, mule, or canoe,
354
1012480
4466
16:56
she is teaching us to walk the walk.
355
1016946
2998
16:59
Thank you. (Applause)
356
1019944
5570
About this website

This site will introduce you to YouTube videos that are useful for learning English. You will see English lessons taught by top-notch teachers from around the world. Double-click on the English subtitles displayed on each video page to play the video from there. The subtitles scroll in sync with the video playback. If you have any comments or requests, please contact us using this contact form.

https://forms.gle/WvT1wiN1qDtmnspy7