HONDURAS REJECTS CUBAN MEDICAL TRAINING; THE UNDERSERVED ARE UNCONVINCED.

Despite a chronic inability to provide and deliver health and medical services to its impoverished population, Honduras has announced that it will reject more than half the medical-school scholarships Cuba has offered for the coming year. In accepting only 20 of the 45 scholarships offered,

Honduran Health Minister Merlin Fernandez told reporters, "There are no pressures of any kind in this case." The real reason, he said, was that "we are trying to reorient the cooperation program signed with the island. We just want to prepare laboratory technicians, anesthetists, and other specialties that the national health service requires."

It is the 5000-member Colegio Medico, however, that controls the practice of medicine in the country. The colegio has come under criticism in the past for its reluctance to serve the rural poor or respond in times of crisis, most notably after the devastation of Hurricane Mitch in 1998 (see NotiCen, 1998-11-12).

Cuba's contribution to ameliorating the Honduran shortfall of medical coverage has been of unquestionable value to underserved patients. Since 1998, 400 Cuban doctors and nurses have worked in the regions where Honduran doctors are loath to go. More than 650 medical students, many from these poor populations, have studied medicine in Cuba, and some have already returned to serve their communities.

The island has maintained this assistance in the face of the Honduran government's general hostility to Cuba, not faltering when Honduras joined El Salvador, Nicaragua, Peru, Australia, and the Czech Republic in 2004 to condemn the Cuban government before the UN Commission on Human Rights (UNCHR) in Geneva or when it voted against Cuba again in April 2005.

Soon after the vote, Cuba's ambassador in Honduras said that his country would not suspend its aid programs. "We will continue to maintain the cooperation with Honduras because our mission is humanitarian, it is to cooperate with the people and with the communities," said Ambassador Alberto Gonzalez Polanco.

Blasted in Geneva, lauded in Honduras

The vote in Geneva in April went against Cuba 21-17, with 15 abstentions. In the region, Honduras was joined by Guatemala, Mexico, and Costa Rica in the annual event. The initiative was watered down this year, largely because of diminished US authority on questions of human rights, according to most analysts.

"But none of this, like the change of a vote, will affect the solidarity among peoples, which is unalterable," said Gonzalez. The ambassador readily acknowledges that cultural and social initiatives of this kind are fundamental to his government's foreign policy. "We will continue working in training Honduran youth who study in Cuba. We want to tell this community that the more than 720 young people who study different professions in Cuba, plus those who will be added this year, will continue to be children of Cuba."

Whatever the government's behavior, of greatest importance to his country, said Gonzalez, is that "we have received a demonstration of solidarity and friendship from this community, and solidarity and friendship cannot be exchanged for other things."

The Cuban medical brigade in Honduras has, according to the Cuban Ministry of Public Health (MINSAP), performed more than 6 million medical consults in the past seven years, treating almost 87.5% of the population. MINSAP records show that during this period their doctors treated 2.6 million children, performed 119,493 surgical procedures, and attended 17,000 births. They gave 68,000 trainings in various disciplines and techniques for Honduran doctors and nurses and made 436,486 house calls, all as part of a preventive-medicine program that did not previously exist in Honduras. The 400 Cuban professionals in Honduras are a rotating cadre. This program, which includes the medical students, is provided without charge.

The Cuban health initiative stands in contrast to the performance of the local professionals. As these figures were being disseminated, Honduran health professionals were striking for better pay (see NotiCen, 2003-10-30), leaving hospitals and clinics uncovered, procedures and appointments cancelled. Only emergency services were available as the Confederacion Unitaria de Trabajadores de Honduras, the Sindicato de Trabajadores de la Medicina y Hospitales, and the Asociacion de Empleados Publicos marched demanding the firing of Health Minister Fernandez.

A different class of doctor

The Cuban strategy circumvents issues of labor solidarity by training people who come from the classes most in need, who would, at least theoretically, be motivated more by class affiliation than by upward mobility.

Juan Carrizo Estevez, rector of Cuba's Escuela Latinoamericana de Medicina (ELAM), speaking of the new doctors about to return home, said, "They come ready to serve the poor, the humble, with a sense of national and international solidarity." The rector was in Honduras supervising the work of 215 students who will graduate in July. He said they were trained under the same philosophy as are Cuban doctors, "with the concept of humanism, solidarity, so that they can offer their service with scientific and technical preparation to the population."

The Hondurans represent the largest national group of the more than 10,000 medical students from 27 countries currently enrolled in the Escuela Latinoamericana. Carrizo said this was because the school opened just after Mitch devastated the country, placing Honduras in greatest need along with Guatemalans, Salvadorans, and Nicaraguans, whose countries also sustained damage. The school has, in its few years of operation, gained a reputation for excellence, has served 93 countries, and has trained 3,000 foreign doctors. The school operates with 500 professors and has 46 hospitals in Havana alone.

Gonzalez said the Hondurans have been excellent students; 80% of those who started have graduated at an extraordinarily high academic level. Many came from families so poor that they could only afford to come home once or twice during their six years of school. These Hondurans also have the distinction of being in the first ELAM class to graduate.

How these new doctors will integrate into the Honduran medical establishment is quite another matter. They have been trained to a different standard. ELAM's mission statement spells that standard out: "The opening, in Havana, of the Escuela Latinoamericana de Medicina forms part of the solidarity tradition of the Cuban people with other peoples of the world. This school is a university that has the mission of training basic general physicians, oriented toward primary health care as a fundamental focus of their professional concern, with a high scientific, humanistic, ethical, solidary preparation, capable of acting in their environment in accordance with the needs of the region for sustainable human development."

The school was conceived as a direct response to the devastation of the hurricane, and the school's Web site credits President Fidel Castro with its conception. It is free of charge to the students and to their governments. The school serves students who "come fundamentally from the most humble strata of their societies and present ethnic, educational, and cultural diversities, but all pursue their studies in a fraternal and friendly atmosphere."

The school accepts 1,500 students each year. Its campus is the former Academia Naval Granma, ceded by the armed forces. The students are not limited to this campus, however, and work and study throughout Cuba's 21 centers for medical studies. Students who do not speak Spanish first take a semester-long language course. Before beginning medical studies, they take a pre-medical basic sciences curriculum. They graduate with the degree of Medical Doctor in six years, after passing the state examinations in theory and practice. The state exams take four weeks to complete.

In addition to access to the full Cuban health system, ELAM has its own 60-bed teaching hospital. The curriculum also includes courses in English for the first 10 semesters.

With all this available, for many in Honduras it is inconceivable that the country would refuse to take full advantage. Families of prospective students have charged that the Health Ministry has fought them every step of the way in trying to get their students signed up, and they are now outraged by the snub. Family members told reporters they are asking the government for a better explanation than the "reorientation" offered by the minister. They said they want to know how the Honduran government can "permit itself the luxury" of scorning scholarships for which the government will invest not one cent. They point out that the country has only one doctor for each 1,166 inhabitants, few of whom would practice in rural areas or areas where private services are financially out of reach. [Sources: Juventud Rebelde (Cuba), 11/16/04; Notimex, 03/10/05, 03/16/05, 04/11/05; Spanish news service EFE, 04/14/05; Associated Press, Europa Press (Spain), La Prensa (Honduras), 04/18/05; ELAM (Cuba) elacm.sld.cu, no date]