By Tom Fawthrop in Cienfuegos, Cuba
(photo from me ... the ELAM - Latin American School of Medicine - graduating ceremony of 2009. Cuba accepts applicants from poor neighbourhoods all over the world, including the USA.)
In universities across Cuba, the next generation of African doctors is being trained on scholarships that may prove more valuable than any foreign aid package to their continent.
When they graduate, the doctors will return home to treat patients in some of Africa's poorest countries, equipped with some of the best medical training in the world.
Their education and training will not have cost them anything, and many say they plan to use their skills to help those too poor to pay for treatment.
"I am from a very poor family in Eastern Cape," says Sydney Mankale Moroasale, a South African medical student currently studying at Cienfuegos University in Cuba.
"People all around me were suffering. I said to myself 'Why couldn't I be the one to help them?' It was my dream to be a doctor."
A further 125 South African medical students study alongside Moroasale at Cienfuegos, while another 224 are enrolled in other Cuban universities. None of them would have been able to study medicine at all had it not been for the scholarship programmes.
A total of 286 African doctors have graduated from Cuba since the first batch in 2005.
After the 1959 revolution, Fidel Castro, the former Cuban president, pioneered the creation of a dynamic and comprehensive public health system which has been praised by the World Health Organization for providing free healthcare to all its citizens.
Even doctors working in countries ideologically opposed to communist Cuba admit that the system works.
"It is internationally known that medical standards are very high in Cuba, and medical training is very good," says Dr Arachu Castro, a Spanish specialist in social medicine at the Harvard Medical School.
*Community-based approach*
Some South African doctors, mostly those working in the private sector, have questioned medical standards in Cuba, but in the main, public health experts have defended the island's medical achievements - particularly its focus on primary healthcare.
Dr Julio Padron Gonzalez, who runs the foreign student medical programme at Cienfugos University, explains why this is so important.
"The medical curriculum is patient-centred and orientated toward the family doctor and community health," he says. "Ninety per cent of health problems can be dealt with at the level of primary healthcare."
This approach has impressed many of the students studying on the programme.
Johanne Mkhabele is a South African student specialising in HIV/Aids prevention and treatment.
"We have to learn from Cuba how to involve the whole community in preventing HIV/Aids, and not just leave it to the health workers," he says. "Everybody has to be involved."
Reversing the brain drain
Dr Julio Padron says primary healthcare is a key part of the students' education*In recent years, South Africa has watched thousands of doctors leave the country in search of higher salaries in the West. The problem is not unique to South Africa - many African countries face a similar brain drain.
Cuba has bucked the trend of poaching doctors from Africa, and its efforts to give, rather than take, doctors from the continent has impressed the African countries who benefit.
"I don't know of any other country in the world that has 30,000 foreign students. Cuba has demonstrated you don't have to be wealthy to help other nations," says Segun Bamigbetan Baju, the Nigerian ambassador to Havana.
"Cuba is a developing country making great sacrifices and denying itself so many things to help Africans," he adds.
Since the 1970s, Cuba's programme to reverse the brain drain has seen 17,000 professionals, including doctors, return to African countries. More than 50 per cent returned to practise medicine and nursing.
In addition, Cuba has pioneered co-operation in establishing new medical schools in Ethiopia, Uganda, Ghana, Gambia, Equatorial Guinea and Guinea Bissau.
The students say it is not only the intense focus on primary healthcare that they would not pick up in a South African medical school.
One of the first year subjects is medical philosophy and ethics, a course which stresses a commitment to patients, health as a human right and the moral obligation of doctors to provide services to the rural poor.
So what lies behind Cuba's commitment to training African doctors?
"We are showing an example that it is possible to do things in a different way, even though we don't have many resources," says Clara Esther Gomez, a lecturer at the medical school at Cienfugos.
Globalising healthcare
Cuban doctors and medical professors refer to their international mission as 'Globalising Healthcare'. But in a globalised world, what is to stop some of the new doctors following their home-grown counterparts to the West to search for lucrative careers?
"I assure you with my life that no doctor trained in Cuba, once he starts practising back home, will ever leave the country," South African student Moroasale says emphatically when asked.
Of far greater concern is how far Cuban graduates can apply the community-based approach once they are integrated into a very different kind of health system back home.
Moroasale is determined to make a difference. "I am going to offer every patient what they need without checking first what they have in their pocket," he says.
But Gomez admits it may be tough for some of their graduates to deal with the medical establishment at home.
"The entrenched doctors in South Africa will not readily accept the Cuban-trained doctors and treating patients without payment," she says.
"It will be a battle of ideas, but in this battle, humanity and health will win over money."
