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I want to tell you

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how 20,000 remarkable young people

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from over 100 countries

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ended up in Cuba

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and are transforming health in their communities.

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Ninety percent of them would never

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have left home at all

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if it weren't for a scholarship
to study medicine in Cuba

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and a commitment to go back

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to places like the ones they'd come from —

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remote farmlands, mountains, ghettos —

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to become doctors for people like themselves,

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to walk the walk.

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Havana's Latin American Medical School:

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It's the largest medical school in the world,

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graduating 23,000 young doctors

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since its first class of 2005,

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with nearly 10,000 more in the pipeline.

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Its mission, to train physicians for the people

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who need them the most:

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the over one billion

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who have never seen a doctor,

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the people who live and die

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under every poverty line ever invented.

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Its students defy all norms.

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They're the school's biggest risk

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and also its best bet.

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They're recruited from the poorest,

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most broken places on our planet

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by a school that believes they can become

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not just the good

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but the excellent physicians

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their communities desperately need,

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that they will practice where most doctors don't,

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in places not only poor

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but oftentimes dangerous,

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carrying venom antidotes in their backpacks

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or navigating neighborhoods

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riddled by drugs, gangs and bullets,

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their home ground.

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The hope is that they will help

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transform access to care,

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the health picture in impoverished areas,

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and even the way medicine itself

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is learned and practiced,

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and that they will become pioneers in our global reach

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for universal health coverage,

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surely a tall order.

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Two big storms and this notion of "walk the walk"

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prompted creation of ELAM back in 1998.

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The Hurricanes Georges and Mitch

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had ripped through the Caribbean

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and Central America,

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leaving 30,000 dead

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and two and a half million homeless.

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Hundreds of Cuban doctors
volunteered for disaster response,

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but when they got there,

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they found a bigger disaster:

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whole communities with no healthcare,

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doors bolted shut on rural hospitals

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for lack of staff,

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and just too many babies dying

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before their first birthday.

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What would happen when these Cuban doctors left?

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New doctors were needed to make care sustainable,

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but where would they come from?

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Where would they train?

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In Havana, the campus of a former naval academy

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was turned over to the Cuban Health Ministry

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to become the Latin American Medical School,

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ELAM.

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Tuition, room and board, and a small stipend

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were offered to hundreds of students

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from the countries hardest hit by the storms.

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As a journalist in Havana,

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I watched the first 97 Nicaraguans arrive

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in March 1999,

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settling into dorms barely refurbished

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and helping their professors not
only sweep out the classrooms

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but move in the desks and the
chairs and the microscopes.

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Over the next few years,

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governments throughout the Americas

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requested scholarships for their own students,

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and the Congressional Black Caucus

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asked for and received hundreds of scholarships

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for young people from the USA.

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Today, among the 23,000

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are graduates from 83 countries

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in the Americas, Africa and Asia,

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and enrollment has grown to 123 nations.

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More than half the students are young women.

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They come from 100 ethnic groups,

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speak 50 different languages.

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WHO Director Margaret Chan said,

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"For once, if you are poor, female,

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or from an indigenous population,

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you have a distinct advantage,

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an ethic that makes this medical school unique."

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Luther Castillo comes from San Pedro de Tocamacho

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on the Atlantic coast of Honduras.

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There's no running water,

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no electricity there,

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and to reach the village, you have to walk for hours

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or take your chances in a pickup truck like I did

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skirting the waves of the Atlantic.

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Luther was one of 40 Tocamacho children

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who started grammar school,

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the sons and daughters of a black indigenous people

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known as the Garífuna,

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20 percent of the Honduran population.

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The nearest healthcare was fatal miles away.

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Luther had to walk three hours every day

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to middle school.

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Only 17 made that trip.

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Only five went on to high school,

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and only one to university:

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Luther, to ELAM,

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among the first crop of Garífuna graduates.

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Just two Garífuna doctors had preceded them

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in all of Honduran history.

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Now there are 69, thanks to ELAM.

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Big problems need big solutions,

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sparked by big ideas, imagination and audacity,

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but also solutions that work.

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ELAM's faculty had no handy evidence base

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to guide them, so they learned the hard way,

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by doing and correcting course as they went.

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Even the brightest students

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from these poor communities

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weren't academically prepared

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for six years of medical training,

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so a bridging course was set up in sciences.

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Then came language:

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these were Mapuche, Quechuas, Guaraní, Garífuna,

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indigenous peoples

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who learned Spanish as a second language,

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or Haitians who spoke Creole.

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So Spanish became part

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of the pre-pre-med curriculum.

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Even so, in Cuba,

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the music, the food, the smells,

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just about everything was different,

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so faculty became family, ELAM home.

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Religions ranged from indigenous beliefs

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to Yoruba, Muslim and Christian evangelical.

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Embracing diversity became a way of life.

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Why have so many countries

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asked for these scholarships?

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First, they just don't have enough doctors,

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and where they do, their distribution

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is skewed against the poor,

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because our global health crisis

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is fed by a crisis in human resources.

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We are short four to seven million health workers

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just to meet basic needs,

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and the problem is everywhere.

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Doctors are concentrated in the cities,

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where only half the world's people live,

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and within cities,

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not in the shantytowns or South L.A.

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Here in the United States,

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where we have healthcare reform,

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we don't have the professionals we need.

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By 2020, we will be short

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45,000 primary care physicians.

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And we're also part of the problem.

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The United States is the number one importer

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of doctors from developing countries.

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The second reasons students flock to Cuba

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is the island's own health report card,

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relying on strong primary care.

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A commission from The Lancet

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rates Cuba among the best performing

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middle-income countries in health.

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Save the Children ranks Cuba

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the best country in Latin
America to become a mother.

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Cuba has similar life expectancy

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and lower infant mortality than the United States,

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with fewer disparities,

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while spending per person

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one 20th of what we do on health

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here in the USA.

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Academically, ELAM is tough,

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but 80 percent of its students graduate.

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The subjects are familiar —

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basic and clinical sciences —

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but there are major differences.

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First, training has moved out of the ivory tower

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and into clinic classrooms and neighborhoods,

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the kinds of places most of these grads will practice.

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Sure, they have lectures and hospital rotations too,

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but community-based learning starts on day one.

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Second, students treat the whole patient,

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mind and body,

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in the context of their 
families, their communities

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and their culture.

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Third, they learn public health:

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to assess their patients' drinking water, housing,

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social and economic conditions.

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Fourth, they are taught

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that a good patient interview

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and a thorough clinical exam

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provide most of the clues for diagnosis,

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saving costly technology for confirmation.

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And finally, they're taught over and over again

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the importance of prevention,

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especially as chronic diseases

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cripple health systems worldwide.

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Such an in-service learning

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also comes with a team approach,

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as much how to work in teams

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as how to lead them,

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with a dose of humility.

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Upon graduation, these doctors share

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their knowledge with nurse's aids, midwives,

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community health workers,

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to help them become better at what they do,

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not to replace them,

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to work with shamans and traditional healers.

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ELAM's graduates:

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Are they proving this audacious experiment right?

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Dozens of projects give us an inkling

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of what they're capable of doing.

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Take the Garífuna grads.

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They not only went to work back home,

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but they organized their communities to build

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Honduras' first indigenous hospital.

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With an architect's help,

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residents literally raised it from the ground up.

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The first patients walked through the doors

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in December 2007,

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and since then, the hospital has received

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nearly one million patient visits.

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And government is paying attention,

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upholding the hospital as a model

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of rural public health for Honduras.

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ELAM's graduates are smart,

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strong and also dedicated.

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Haiti, January 2010.

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The pain.

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People buried under 30 million tons of rubble.

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Overwhelming.

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Three hundred forty Cuban doctors

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were already on the ground long term.

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More were on their way. Many more were needed.

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At ELAM, students worked round the clock

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to contact 2,000 graduates.

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As a result, hundreds arrived in Haiti,

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27 countries' worth, from Mali in the Sahara

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to St. Lucia, Bolivia, Chile and the USA.

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They spoke easily to each other in Spanish

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and listened to their patients in Creole

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thanks to Haitian medical students

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flown in from ELAM in Cuba.

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Many stayed for months,

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even through the cholera epidemic.

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Hundreds of Haitian graduates

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had to pick up the pieces,

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overcome their own heartbreak,

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and then pick up the burden

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of building a new public health system for Haiti.

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Today, with aid of organizations and governments

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from Norway to Cuba to Brazil,

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dozens of new health centers have been built,

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staffed, and in 35 cases, headed

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by ELAM graduates.

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Yet the Haitian story

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also illustrates some of the bigger problems

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faced in many countries.

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Take a look:

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748 Haitian graduates by 
2012, when cholera struck,

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nearly half working in the public health sector

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but one quarter unemployed,

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and 110 had left Haiti altogether.

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So in the best case scenarios,

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these graduates are staffing

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and thus strengthening public health systems,

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where often they're the only doctors around.

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In the worst cases, there are simply not enough jobs

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in the public health sector,

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where most poor people are treated,

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not enough political will, not enough resources,

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not enough anything —

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just too many patients with no care.

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The grads face pressure from their families too,

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desperate to make ends meet,

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so when there are no public sector jobs,

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these new MDs decamp into private practice,

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or go abroad to send money home.

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Worst of all, in some countries,

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medical societies influence accreditation bodies

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not to honor the ELAM degree,

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fearful these grads will take their jobs

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or reduce their patient loads and income.

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It's not a question of competencies.

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Here in the USA, the California Medical Board

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accredited the school after rigorous inspection,

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and the new physicians are making good

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on Cuba's big bet,

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passing their boards and accepted

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into highly respected residencies

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from New York to Chicago to New Mexico.

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Two hundred strong, they're coming

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back to the United States energized,

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and also dissatisfied.

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As one grad put it,

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in Cuba, "We are trained to provide quality care

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with minimal resources,

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so when I see all the resources we have here,

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and you tell me that's not possible,

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I know it's not true.

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Not only have I seen it work, I've done the work."

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ELAM's graduates,

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some from right here in D.C. and Baltimore,

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have come from the poorest of the poor

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to offer health, education

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and a voice to their communities.

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They've done the heavy lifting.

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Now we need to do our part

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to support the 23,000 and counting,

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All of us —

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foundations, residency directors, press,

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entrepreneurs, policymakers, people —

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need to step up.

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We need to do much more globally

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to give these new doctors the opportunity

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to prove their mettle.

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They need to be able

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to take their countries' licensing exams.

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They need jobs in the public health sector

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or in nonprofit health centers

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to put their training and commitment to work.

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They need the chance to be

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the doctors their patients need.

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To move forward,

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we may have to find our way back

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to that pediatrician who would

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knock on my family's door

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on the South Side of Chicago when I was a kid,

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who made house calls,

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who was a public servant.

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These aren't such new ideas

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of what medicine should be.

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What's new is the scaling up

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and the faces of the doctors themselves:

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an ELAM graduate is more likely to be a she

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than a he;

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In the Amazon, Peru or Guatemala,

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an indigenous doctor;

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in the USA, a doctor of color

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who speaks fluent Spanish.

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She is well trained, can be counted on,

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and shares the face and culture of her patients,

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and she deserves our support surely,

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because whether by subway, mule, or canoe,

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she is teaching us to walk the walk.

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Thank you. (Applause)