Where to train the world's doctors? Cuba.
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0:01 - 0:02I want to tell you
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0:02 - 0:07how 20,000 remarkable young people
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0:07 - 0:09from over 100 countries
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0:09 - 0:11ended up in Cuba
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0:11 - 0:14and are transforming health in their communities.
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0:14 - 0:16Ninety percent of them would never
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0:16 - 0:18have left home at all
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0:18 - 0:21if it weren't for a scholarship
to study medicine in Cuba -
0:21 - 0:23and a commitment to go back
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0:23 - 0:27to places like the ones they'd come from —
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0:27 - 0:30remote farmlands, mountains, ghettos —
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0:30 - 0:34to become doctors for people like themselves,
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0:34 - 0:36to walk the walk.
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0:36 - 0:38Havana's Latin American Medical School:
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0:38 - 0:41It's the largest medical school in the world,
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0:41 - 0:44graduating 23,000 young doctors
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0:44 - 0:47since its first class of 2005,
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0:47 - 0:51with nearly 10,000 more in the pipeline.
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0:51 - 0:54Its mission, to train physicians for the people
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0:54 - 0:56who need them the most:
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0:56 - 0:58the over one billion
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0:58 - 1:01who have never seen a doctor,
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1:01 - 1:05the people who live and die
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1:05 - 1:08under every poverty line ever invented.
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1:08 - 1:10Its students defy all norms.
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1:10 - 1:13They're the school's biggest risk
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1:13 - 1:15and also its best bet.
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1:15 - 1:18They're recruited from the poorest,
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1:18 - 1:20most broken places on our planet
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1:20 - 1:22by a school that believes they can become
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1:22 - 1:24not just the good
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1:24 - 1:26but the excellent physicians
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1:26 - 1:29their communities desperately need,
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1:29 - 1:32that they will practice where most doctors don't,
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1:32 - 1:35in places not only poor
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1:35 - 1:37but oftentimes dangerous,
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1:37 - 1:40carrying venom antidotes in their backpacks
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1:40 - 1:43or navigating neighborhoods
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1:43 - 1:46riddled by drugs, gangs and bullets,
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1:46 - 1:49their home ground.
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1:49 - 1:50The hope is that they will help
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1:50 - 1:53transform access to care,
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1:53 - 1:55the health picture in impoverished areas,
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1:55 - 1:57and even the way medicine itself
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1:57 - 2:00is learned and practiced,
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2:00 - 2:04and that they will become pioneers in our global reach
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2:04 - 2:07for universal health coverage,
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2:07 - 2:09surely a tall order.
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2:09 - 2:14Two big storms and this notion of "walk the walk"
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2:14 - 2:18prompted creation of ELAM back in 1998.
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2:18 - 2:21The Hurricanes Georges and Mitch
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2:21 - 2:22had ripped through the Caribbean
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2:22 - 2:24and Central America,
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2:24 - 2:27leaving 30,000 dead
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2:27 - 2:30and two and a half million homeless.
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2:30 - 2:33Hundreds of Cuban doctors
volunteered for disaster response, -
2:33 - 2:35but when they got there,
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2:35 - 2:37they found a bigger disaster:
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2:37 - 2:40whole communities with no healthcare,
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2:40 - 2:43doors bolted shut on rural hospitals
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2:43 - 2:45for lack of staff,
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2:45 - 2:47and just too many babies dying
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2:47 - 2:50before their first birthday.
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2:50 - 2:54What would happen when these Cuban doctors left?
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2:54 - 2:57New doctors were needed to make care sustainable,
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2:57 - 2:58but where would they come from?
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2:58 - 3:01Where would they train?
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3:01 - 3:05In Havana, the campus of a former naval academy
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3:05 - 3:08was turned over to the Cuban Health Ministry
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3:08 - 3:12to become the Latin American Medical School,
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3:12 - 3:14ELAM.
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3:14 - 3:16Tuition, room and board, and a small stipend
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3:16 - 3:18were offered to hundreds of students
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3:18 - 3:21from the countries hardest hit by the storms.
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3:21 - 3:23As a journalist in Havana,
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3:23 - 3:26I watched the first 97 Nicaraguans arrive
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3:26 - 3:29in March 1999,
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3:29 - 3:31settling into dorms barely refurbished
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3:31 - 3:35and helping their professors not
only sweep out the classrooms -
3:35 - 3:40but move in the desks and the
chairs and the microscopes. -
3:40 - 3:42Over the next few years,
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3:42 - 3:43governments throughout the Americas
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3:43 - 3:47requested scholarships for their own students,
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3:47 - 3:49and the Congressional Black Caucus
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3:49 - 3:52asked for and received hundreds of scholarships
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3:52 - 3:55for young people from the USA.
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3:55 - 3:59Today, among the 23,000
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3:59 - 4:02are graduates from 83 countries
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4:02 - 4:05in the Americas, Africa and Asia,
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4:05 - 4:10and enrollment has grown to 123 nations.
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4:10 - 4:13More than half the students are young women.
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4:13 - 4:14They come from 100 ethnic groups,
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4:14 - 4:16speak 50 different languages.
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4:16 - 4:19WHO Director Margaret Chan said,
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4:19 - 4:23"For once, if you are poor, female,
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4:23 - 4:26or from an indigenous population,
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4:26 - 4:27you have a distinct advantage,
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4:27 - 4:32an ethic that makes this medical school unique."
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4:32 - 4:36Luther Castillo comes from San Pedro de Tocamacho
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4:36 - 4:39on the Atlantic coast of Honduras.
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4:39 - 4:41There's no running water,
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4:41 - 4:43no electricity there,
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4:43 - 4:46and to reach the village, you have to walk for hours
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4:46 - 4:49or take your chances in a pickup truck like I did
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4:49 - 4:52skirting the waves of the Atlantic.
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4:52 - 4:57Luther was one of 40 Tocamacho children
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4:57 - 4:59who started grammar school,
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4:59 - 5:02the sons and daughters of a black indigenous people
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5:02 - 5:04known as the Garífuna,
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5:04 - 5:0720 percent of the Honduran population.
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5:07 - 5:12The nearest healthcare was fatal miles away.
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5:12 - 5:16Luther had to walk three hours every day
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5:16 - 5:18to middle school.
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5:18 - 5:20Only 17 made that trip.
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5:20 - 5:22Only five went on to high school,
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5:22 - 5:24and only one to university:
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5:24 - 5:26Luther, to ELAM,
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5:26 - 5:30among the first crop of Garífuna graduates.
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5:30 - 5:33Just two Garífuna doctors had preceded them
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5:33 - 5:36in all of Honduran history.
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5:36 - 5:42Now there are 69, thanks to ELAM.
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5:42 - 5:45Big problems need big solutions,
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5:45 - 5:49sparked by big ideas, imagination and audacity,
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5:49 - 5:52but also solutions that work.
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5:52 - 5:55ELAM's faculty had no handy evidence base
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5:55 - 5:59to guide them, so they learned the hard way,
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5:59 - 6:02by doing and correcting course as they went.
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6:02 - 6:05Even the brightest students
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6:05 - 6:07from these poor communities
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6:07 - 6:08weren't academically prepared
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6:08 - 6:11for six years of medical training,
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6:11 - 6:15so a bridging course was set up in sciences.
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6:15 - 6:16Then came language:
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6:16 - 6:19these were Mapuche, Quechuas, Guaraní, Garífuna,
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6:19 - 6:21indigenous peoples
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6:21 - 6:23who learned Spanish as a second language,
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6:23 - 6:26or Haitians who spoke Creole.
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6:26 - 6:28So Spanish became part
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6:28 - 6:32of the pre-pre-med curriculum.
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6:32 - 6:35Even so, in Cuba,
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6:35 - 6:38the music, the food, the smells,
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6:38 - 6:41just about everything was different,
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6:41 - 6:46so faculty became family, ELAM home.
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6:46 - 6:49Religions ranged from indigenous beliefs
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6:49 - 6:53to Yoruba, Muslim and Christian evangelical.
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6:53 - 6:57Embracing diversity became a way of life.
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6:57 - 6:59Why have so many countries
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6:59 - 7:02asked for these scholarships?
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7:02 - 7:05First, they just don't have enough doctors,
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7:05 - 7:07and where they do, their distribution
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7:07 - 7:09is skewed against the poor,
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7:09 - 7:12because our global health crisis
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7:12 - 7:15is fed by a crisis in human resources.
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7:15 - 7:19We are short four to seven million health workers
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7:19 - 7:21just to meet basic needs,
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7:21 - 7:23and the problem is everywhere.
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7:23 - 7:26Doctors are concentrated in the cities,
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7:26 - 7:28where only half the world's people live,
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7:28 - 7:30and within cities,
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7:30 - 7:34not in the shantytowns or South L.A.
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7:34 - 7:36Here in the United States,
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7:36 - 7:38where we have healthcare reform,
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7:38 - 7:41we don't have the professionals we need.
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7:41 - 7:43By 2020, we will be short
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7:43 - 7:4845,000 primary care physicians.
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7:48 - 7:50And we're also part of the problem.
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7:50 - 7:52The United States is the number one importer
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7:52 - 7:57of doctors from developing countries.
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7:57 - 7:59The second reasons students flock to Cuba
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7:59 - 8:02is the island's own health report card,
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8:02 - 8:05relying on strong primary care.
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8:05 - 8:06A commission from The Lancet
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8:06 - 8:09rates Cuba among the best performing
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8:09 - 8:12middle-income countries in health.
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8:12 - 8:14Save the Children ranks Cuba
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8:14 - 8:18the best country in Latin
America to become a mother. -
8:18 - 8:21Cuba has similar life expectancy
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8:21 - 8:25and lower infant mortality than the United States,
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8:25 - 8:27with fewer disparities,
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8:27 - 8:29while spending per person
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8:29 - 8:32one 20th of what we do on health
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8:32 - 8:34here in the USA.
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8:34 - 8:37Academically, ELAM is tough,
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8:37 - 8:40but 80 percent of its students graduate.
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8:40 - 8:42The subjects are familiar —
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8:42 - 8:44basic and clinical sciences —
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8:44 - 8:47but there are major differences.
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8:47 - 8:50First, training has moved out of the ivory tower
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8:50 - 8:53and into clinic classrooms and neighborhoods,
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8:53 - 8:57the kinds of places most of these grads will practice.
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8:57 - 9:01Sure, they have lectures and hospital rotations too,
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9:01 - 9:06but community-based learning starts on day one.
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9:06 - 9:09Second, students treat the whole patient,
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9:09 - 9:11mind and body,
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9:11 - 9:14in the context of their
families, their communities -
9:14 - 9:16and their culture.
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9:16 - 9:19Third, they learn public health:
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9:19 - 9:22to assess their patients' drinking water, housing,
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9:22 - 9:25social and economic conditions.
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9:25 - 9:28Fourth, they are taught
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9:28 - 9:31that a good patient interview
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9:31 - 9:33and a thorough clinical exam
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9:33 - 9:36provide most of the clues for diagnosis,
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9:36 - 9:39saving costly technology for confirmation.
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9:39 - 9:43And finally, they're taught over and over again
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9:43 - 9:45the importance of prevention,
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9:45 - 9:47especially as chronic diseases
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9:47 - 9:52cripple health systems worldwide.
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9:52 - 9:55Such an in-service learning
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9:55 - 9:57also comes with a team approach,
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9:57 - 10:00as much how to work in teams
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10:00 - 10:02as how to lead them,
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10:02 - 10:04with a dose of humility.
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10:04 - 10:07Upon graduation, these doctors share
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10:07 - 10:10their knowledge with nurse's aids, midwives,
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10:10 - 10:12community health workers,
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10:12 - 10:14to help them become better at what they do,
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10:14 - 10:16not to replace them,
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10:16 - 10:19to work with shamans and traditional healers.
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10:21 - 10:24ELAM's graduates:
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10:24 - 10:29Are they proving this audacious experiment right?
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10:29 - 10:31Dozens of projects give us an inkling
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10:31 - 10:33of what they're capable of doing.
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10:33 - 10:35Take the Garífuna grads.
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10:35 - 10:37They not only went to work back home,
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10:37 - 10:40but they organized their communities to build
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10:40 - 10:43Honduras' first indigenous hospital.
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10:43 - 10:45With an architect's help,
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10:45 - 10:50residents literally raised it from the ground up.
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10:50 - 10:52The first patients walked through the doors
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10:52 - 10:54in December 2007,
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10:54 - 10:57and since then, the hospital has received
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10:57 - 11:00nearly one million patient visits.
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11:00 - 11:02And government is paying attention,
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11:02 - 11:05upholding the hospital as a model
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11:05 - 11:10of rural public health for Honduras.
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11:10 - 11:13ELAM's graduates are smart,
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11:13 - 11:17strong and also dedicated.
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11:17 - 11:21Haiti, January 2010.
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11:21 - 11:23The pain.
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11:23 - 11:27People buried under 30 million tons of rubble.
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11:27 - 11:29Overwhelming.
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11:29 - 11:31Three hundred forty Cuban doctors
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11:31 - 11:34were already on the ground long term.
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11:34 - 11:36More were on their way. Many more were needed.
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11:36 - 11:39At ELAM, students worked round the clock
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11:39 - 11:42to contact 2,000 graduates.
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11:42 - 11:46As a result, hundreds arrived in Haiti,
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11:46 - 11:5027 countries' worth, from Mali in the Sahara
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11:50 - 11:54to St. Lucia, Bolivia, Chile and the USA.
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11:54 - 11:58They spoke easily to each other in Spanish
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11:58 - 12:00and listened to their patients in Creole
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12:00 - 12:03thanks to Haitian medical students
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12:03 - 12:05flown in from ELAM in Cuba.
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12:05 - 12:06Many stayed for months,
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12:06 - 12:09even through the cholera epidemic.
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12:09 - 12:12Hundreds of Haitian graduates
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12:12 - 12:14had to pick up the pieces,
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12:14 - 12:16overcome their own heartbreak,
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12:16 - 12:18and then pick up the burden
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12:18 - 12:22of building a new public health system for Haiti.
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12:22 - 12:24Today, with aid of organizations and governments
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12:24 - 12:27from Norway to Cuba to Brazil,
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12:27 - 12:29dozens of new health centers have been built,
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12:29 - 12:33staffed, and in 35 cases, headed
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12:33 - 12:36by ELAM graduates.
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12:36 - 12:38Yet the Haitian story
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12:38 - 12:40also illustrates some of the bigger problems
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12:40 - 12:43faced in many countries.
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12:43 - 12:44Take a look:
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12:44 - 12:50748 Haitian graduates by
2012, when cholera struck, -
12:50 - 12:54nearly half working in the public health sector
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12:54 - 12:56but one quarter unemployed,
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12:56 - 13:02and 110 had left Haiti altogether.
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13:02 - 13:05So in the best case scenarios,
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13:05 - 13:07these graduates are staffing
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13:07 - 13:10and thus strengthening public health systems,
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13:10 - 13:13where often they're the only doctors around.
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13:13 - 13:16In the worst cases, there are simply not enough jobs
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13:16 - 13:18in the public health sector,
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13:18 - 13:20where most poor people are treated,
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13:20 - 13:23not enough political will, not enough resources,
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13:23 - 13:25not enough anything —
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13:25 - 13:29just too many patients with no care.
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13:29 - 13:32The grads face pressure from their families too,
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13:32 - 13:34desperate to make ends meet,
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13:34 - 13:36so when there are no public sector jobs,
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13:36 - 13:39these new MDs decamp into private practice,
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13:39 - 13:43or go abroad to send money home.
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13:43 - 13:46Worst of all, in some countries,
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13:46 - 13:49medical societies influence accreditation bodies
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13:49 - 13:52not to honor the ELAM degree,
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13:52 - 13:55fearful these grads will take their jobs
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13:55 - 13:58or reduce their patient loads and income.
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13:58 - 14:01It's not a question of competencies.
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14:01 - 14:04Here in the USA, the California Medical Board
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14:04 - 14:07accredited the school after rigorous inspection,
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14:07 - 14:09and the new physicians are making good
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14:09 - 14:11on Cuba's big bet,
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14:11 - 14:13passing their boards and accepted
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14:13 - 14:16into highly respected residencies
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14:16 - 14:20from New York to Chicago to New Mexico.
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14:20 - 14:22Two hundred strong, they're coming
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14:22 - 14:25back to the United States energized,
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14:25 - 14:27and also dissatisfied.
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14:27 - 14:29As one grad put it,
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14:29 - 14:32in Cuba, "We are trained to provide quality care
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14:32 - 14:34with minimal resources,
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14:34 - 14:37so when I see all the resources we have here,
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14:37 - 14:39and you tell me that's not possible,
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14:39 - 14:41I know it's not true.
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14:41 - 14:47Not only have I seen it work, I've done the work."
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14:47 - 14:49ELAM's graduates,
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14:49 - 14:52some from right here in D.C. and Baltimore,
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14:52 - 14:56have come from the poorest of the poor
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14:56 - 14:58to offer health, education
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14:58 - 15:01and a voice to their communities.
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15:01 - 15:03They've done the heavy lifting.
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15:03 - 15:06Now we need to do our part
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15:06 - 15:09to support the 23,000 and counting,
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15:09 - 15:10All of us —
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15:10 - 15:14foundations, residency directors, press,
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15:14 - 15:17entrepreneurs, policymakers, people —
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15:17 - 15:19need to step up.
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15:19 - 15:21We need to do much more globally
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15:21 - 15:24to give these new doctors the opportunity
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15:24 - 15:27to prove their mettle.
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15:27 - 15:28They need to be able
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15:28 - 15:31to take their countries' licensing exams.
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15:31 - 15:34They need jobs in the public health sector
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15:34 - 15:36or in nonprofit health centers
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15:36 - 15:40to put their training and commitment to work.
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15:40 - 15:42They need the chance to be
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15:42 - 15:47the doctors their patients need.
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15:47 - 15:49To move forward,
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15:49 - 15:52we may have to find our way back
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15:52 - 15:54to that pediatrician who would
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15:54 - 15:55knock on my family's door
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15:55 - 15:59on the South Side of Chicago when I was a kid,
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15:59 - 16:00who made house calls,
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16:00 - 16:03who was a public servant.
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16:03 - 16:05These aren't such new ideas
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16:05 - 16:08of what medicine should be.
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16:08 - 16:10What's new is the scaling up
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16:10 - 16:14and the faces of the doctors themselves:
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16:14 - 16:17an ELAM graduate is more likely to be a she
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16:17 - 16:19than a he;
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16:19 - 16:22In the Amazon, Peru or Guatemala,
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16:22 - 16:24an indigenous doctor;
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16:24 - 16:27in the USA, a doctor of color
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16:27 - 16:30who speaks fluent Spanish.
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16:30 - 16:33She is well trained, can be counted on,
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16:33 - 16:37and shares the face and culture of her patients,
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16:37 - 16:40and she deserves our support surely,
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16:40 - 16:45because whether by subway, mule, or canoe,
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16:45 - 16:48she is teaching us to walk the walk.
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16:48 - 16:54Thank you. (Applause)
- Title:
- Where to train the world's doctors? Cuba.
- Speaker:
- Gail Reed
- Description:
-
Big problems need big solutions, sparked by big ideas, imagination and audacity. In this talk, journalist Gail Reed profiles one big solution worth noting: Havana’s Latin American Medical School, which trains global physicians to serve the local communities that need them most.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 17:08
Morton Bast edited English subtitles for Where to train the world's doctors? Cuba. | ||
Morton Bast approved English subtitles for Where to train the world's doctors? Cuba. | ||
Morton Bast edited English subtitles for Where to train the world's doctors? Cuba. | ||
Morton Bast edited English subtitles for Where to train the world's doctors? Cuba. | ||
Morton Bast edited English subtitles for Where to train the world's doctors? Cuba. | ||
Madeleine Aronson accepted English subtitles for Where to train the world's doctors? Cuba. | ||
Madeleine Aronson edited English subtitles for Where to train the world's doctors? Cuba. | ||
Madeleine Aronson edited English subtitles for Where to train the world's doctors? Cuba. |