0:00:00.537,0:00:02.159
I want to tell you

0:00:02.159,0:00:06.850
how 20,000 remarkable young people

0:00:06.850,0:00:08.706
from over 100 countries

0:00:08.706,0:00:10.518
ended up in Cuba

0:00:10.518,0:00:14.321
and are transforming health in their communities.

0:00:14.321,0:00:16.401
Ninety percent of them would never

0:00:16.401,0:00:17.973
have left home at all

0:00:17.973,0:00:21.317
if it weren't for a scholarship[br]to study medicine in Cuba

0:00:21.317,0:00:23.128
and a commitment to go back

0:00:23.128,0:00:26.756
to places like the ones they'd come from —

0:00:26.756,0:00:30.203
remote farmlands, mountains, ghettos —

0:00:30.203,0:00:33.689
to become doctors for people like themselves,

0:00:33.689,0:00:35.781
to walk the walk.

0:00:35.781,0:00:38.447
Havana's Latin American Medical School:

0:00:38.447,0:00:41.372
It's the largest medical school in the world,

0:00:41.372,0:00:44.274
graduating 23,000 young doctors

0:00:44.274,0:00:47.002
since its first class of 2005,

0:00:47.002,0:00:50.611
with nearly 10,000 more in the pipeline.

0:00:50.611,0:00:54.432
Its mission, to train physicians for the people

0:00:54.432,0:00:56.483
who need them the most:

0:00:56.483,0:00:58.419
the over one billion

0:00:58.419,0:01:00.682
who have never seen a doctor,

0:01:00.682,0:01:04.515
the people who live and die

0:01:04.515,0:01:08.009
under every poverty line ever invented.

0:01:08.009,0:01:10.259
Its students defy all norms.

0:01:10.259,0:01:12.530
They're the school's biggest risk

0:01:12.530,0:01:14.990
and also its best bet.

0:01:14.990,0:01:17.505
They're recruited from the poorest,

0:01:17.505,0:01:20.076
most broken places on our planet

0:01:20.076,0:01:22.350
by a school that believes they can become

0:01:22.350,0:01:23.857
not just the good

0:01:23.857,0:01:25.792
but the excellent physicians

0:01:25.792,0:01:28.545
their communities desperately need,

0:01:28.545,0:01:32.197
that they will practice where most doctors don't,

0:01:32.197,0:01:34.623
in places not only poor

0:01:34.623,0:01:37.176
but oftentimes dangerous,

0:01:37.176,0:01:40.202
carrying venom antidotes in their backpacks

0:01:40.202,0:01:42.821
or navigating neighborhoods

0:01:42.821,0:01:46.142
riddled by drugs, gangs and bullets,

0:01:46.142,0:01:48.842
their home ground.

0:01:48.842,0:01:50.168
The hope is that they will help

0:01:50.168,0:01:52.768
transform access to care,

0:01:52.768,0:01:55.187
the health picture in impoverished areas,

0:01:55.187,0:01:57.346
and even the way medicine itself

0:01:57.346,0:01:59.889
is learned and practiced,

0:01:59.889,0:02:04.140
and that they will become pioneers in our global reach

0:02:04.140,0:02:06.660
for universal health coverage,

0:02:06.660,0:02:09.378
surely a tall order.

0:02:09.378,0:02:13.504
Two big storms and this notion of "walk the walk"

0:02:13.504,0:02:17.588
prompted creation of ELAM back in 1998.

0:02:17.588,0:02:20.591
The Hurricanes Georges and Mitch

0:02:20.591,0:02:22.143
had ripped through the Caribbean

0:02:22.143,0:02:24.348
and Central America,

0:02:24.348,0:02:26.727
leaving 30,000 dead

0:02:26.727,0:02:29.610
and two and a half million homeless.

0:02:29.610,0:02:33.303
Hundreds of Cuban doctors[br]volunteered for disaster response,

0:02:33.303,0:02:35.148
but when they got there,

0:02:35.148,0:02:37.231
they found a bigger disaster:

0:02:37.231,0:02:40.427
whole communities with no healthcare,

0:02:40.427,0:02:42.751
doors bolted shut on rural hospitals

0:02:42.751,0:02:44.630
for lack of staff,

0:02:44.630,0:02:47.301
and just too many babies dying

0:02:47.301,0:02:50.236
before their first birthday.

0:02:50.236,0:02:54.070
What would happen when these Cuban doctors left?

0:02:54.070,0:02:56.784
New doctors were needed to make care sustainable,

0:02:56.784,0:02:58.096
but where would they come from?

0:02:58.096,0:03:00.901
Where would they train?

0:03:00.901,0:03:05.344
In Havana, the campus of a former naval academy

0:03:05.344,0:03:08.269
was turned over to the Cuban Health Ministry

0:03:08.269,0:03:11.620
to become the Latin American Medical School,

0:03:11.620,0:03:13.633
ELAM.

0:03:13.633,0:03:16.107
Tuition, room and board, and a small stipend

0:03:16.107,0:03:18.018
were offered to hundreds of students

0:03:18.018,0:03:21.051
from the countries hardest hit by the storms.

0:03:21.051,0:03:23.330
As a journalist in Havana,

0:03:23.330,0:03:26.047
I watched the first 97 Nicaraguans arrive

0:03:26.047,0:03:28.589
in March 1999,

0:03:28.589,0:03:31.305
settling into dorms barely refurbished

0:03:31.305,0:03:34.984
and helping their professors not[br]only sweep out the classrooms

0:03:34.984,0:03:39.663
but move in the desks and the[br]chairs and the microscopes.

0:03:39.663,0:03:41.542
Over the next few years,

0:03:41.542,0:03:43.454
governments throughout the Americas

0:03:43.454,0:03:46.627
requested scholarships for their own students,

0:03:46.627,0:03:48.505
and the Congressional Black Caucus

0:03:48.505,0:03:51.880
asked for and received hundreds of scholarships

0:03:51.880,0:03:55.120
for young people from the USA.

0:03:55.120,0:03:58.832
Today, among the 23,000

0:03:58.832,0:04:01.847
are graduates from 83 countries

0:04:01.847,0:04:04.851
in the Americas, Africa and Asia,

0:04:04.851,0:04:10.454
and enrollment has grown to 123 nations.

0:04:10.454,0:04:12.658
More than half the students are young women.

0:04:12.658,0:04:14.050
They come from 100 ethnic groups,

0:04:14.050,0:04:16.075
speak 50 different languages.

0:04:16.075,0:04:19.216
WHO Director Margaret Chan said,

0:04:19.216,0:04:23.254
"For once, if you are poor, female,

0:04:23.254,0:04:25.516
or from an indigenous population,

0:04:25.516,0:04:27.221
you have a distinct advantage,

0:04:27.221,0:04:31.950
an ethic that makes this medical school unique."

0:04:31.950,0:04:36.100
Luther Castillo comes from San Pedro de Tocamacho

0:04:36.100,0:04:38.970
on the Atlantic coast of Honduras.

0:04:38.970,0:04:40.882
There's no running water,

0:04:40.882,0:04:42.682
no electricity there,

0:04:42.682,0:04:46.282
and to reach the village, you have to walk for hours

0:04:46.282,0:04:49.195
or take your chances in a pickup truck like I did

0:04:49.195,0:04:52.490
skirting the waves of the Atlantic.

0:04:52.490,0:04:57.131
Luther was one of 40 Tocamacho children

0:04:57.131,0:04:59.134
who started grammar school,

0:04:59.134,0:05:01.878
the sons and daughters of a black indigenous people

0:05:01.878,0:05:03.734
known as the Garífuna,

0:05:03.734,0:05:07.210
20 percent of the Honduran population.

0:05:07.210,0:05:12.363
The nearest healthcare was fatal miles away.

0:05:12.363,0:05:15.850
Luther had to walk three hours every day

0:05:15.850,0:05:17.751
to middle school.

0:05:17.751,0:05:19.832
Only 17 made that trip.

0:05:19.832,0:05:21.936
Only five went on to high school,

0:05:21.936,0:05:24.100
and only one to university:

0:05:24.100,0:05:26.121
Luther, to ELAM,

0:05:26.121,0:05:30.130
among the first crop of Garífuna graduates.

0:05:30.130,0:05:33.000
Just two Garífuna doctors had preceded them

0:05:33.000,0:05:36.044
in all of Honduran history.

0:05:36.044,0:05:41.945
Now there are 69, thanks to ELAM.

0:05:41.945,0:05:45.145
Big problems need big solutions,

0:05:45.145,0:05:48.937
sparked by big ideas, imagination and audacity,

0:05:48.937,0:05:51.940
but also solutions that work.

0:05:51.940,0:05:55.270
ELAM's faculty had no handy evidence base

0:05:55.270,0:05:58.790
to guide them, so they learned the hard way,

0:05:58.790,0:06:02.479
by doing and correcting course as they went.

0:06:02.479,0:06:04.741
Even the brightest students

0:06:04.741,0:06:06.654
from these poor communities

0:06:06.654,0:06:08.330
weren't academically prepared

0:06:08.330,0:06:11.023
for six years of medical training,

0:06:11.023,0:06:14.680
so a bridging course was set up in sciences.

0:06:14.680,0:06:16.255
Then came language:

0:06:16.255,0:06:19.416
these were Mapuche, Quechuas, Guaraní, Garífuna,

0:06:19.416,0:06:21.193
indigenous peoples

0:06:21.193,0:06:23.393
who learned Spanish as a second language,

0:06:23.393,0:06:26.190
or Haitians who spoke Creole.

0:06:26.190,0:06:28.127
So Spanish became part

0:06:28.127,0:06:32.285
of the pre-pre-med curriculum.

0:06:32.285,0:06:35.227
Even so, in Cuba,

0:06:35.227,0:06:38.461
the music, the food, the smells,

0:06:38.461,0:06:41.150
just about everything was different,

0:06:41.150,0:06:46.155
so faculty became family, ELAM home.

0:06:46.155,0:06:48.968
Religions ranged from indigenous beliefs

0:06:48.968,0:06:53.000
to Yoruba, Muslim and Christian evangelical.

0:06:53.000,0:06:57.484
Embracing diversity became a way of life.

0:06:57.484,0:06:59.474
Why have so many countries

0:06:59.474,0:07:01.949
asked for these scholarships?

0:07:01.949,0:07:05.201
First, they just don't have enough doctors,

0:07:05.201,0:07:06.967
and where they do, their distribution

0:07:06.967,0:07:09.409
is skewed against the poor,

0:07:09.409,0:07:11.871
because our global health crisis

0:07:11.871,0:07:14.836
is fed by a crisis in human resources.

0:07:14.836,0:07:18.688
We are short four to seven million health workers

0:07:18.688,0:07:21.152
just to meet basic needs,

0:07:21.152,0:07:23.010
and the problem is everywhere.

0:07:23.010,0:07:25.562
Doctors are concentrated in the cities,

0:07:25.562,0:07:28.172
where only half the world's people live,

0:07:28.172,0:07:29.960
and within cities,

0:07:29.960,0:07:34.139
not in the shantytowns or South L.A.

0:07:34.139,0:07:35.905
Here in the United States,

0:07:35.905,0:07:38.406
where we have healthcare reform,

0:07:38.406,0:07:40.954
we don't have the professionals we need.

0:07:40.954,0:07:43.469
By 2020, we will be short

0:07:43.469,0:07:47.608
45,000 primary care physicians.

0:07:47.608,0:07:49.765
And we're also part of the problem.

0:07:49.765,0:07:52.232
The United States is the number one importer

0:07:52.232,0:07:56.596
of doctors from developing countries.

0:07:56.596,0:07:59.465
The second reasons students flock to Cuba

0:07:59.465,0:08:01.692
is the island's own health report card,

0:08:01.692,0:08:04.662
relying on strong primary care.

0:08:04.662,0:08:06.484
A commission from The Lancet

0:08:06.484,0:08:08.990
rates Cuba among the best performing

0:08:08.990,0:08:11.839
middle-income countries in health.

0:08:11.839,0:08:13.785
Save the Children ranks Cuba

0:08:13.785,0:08:18.421
the best country in Latin[br]America to become a mother.

0:08:18.421,0:08:21.410
Cuba has similar life expectancy

0:08:21.410,0:08:24.642
and lower infant mortality than the United States,

0:08:24.642,0:08:26.823
with fewer disparities,

0:08:26.823,0:08:28.623
while spending per person

0:08:28.623,0:08:31.638
one 20th of what we do on health

0:08:31.638,0:08:33.787
here in the USA.

0:08:33.787,0:08:36.779
Academically, ELAM is tough,

0:08:36.779,0:08:40.410
but 80 percent of its students graduate.

0:08:40.410,0:08:41.756
The subjects are familiar —

0:08:41.756,0:08:44.230
basic and clinical sciences —

0:08:44.230,0:08:46.656
but there are major differences.

0:08:46.656,0:08:50.267
First, training has moved out of the ivory tower

0:08:50.267,0:08:53.169
and into clinic classrooms and neighborhoods,

0:08:53.169,0:08:56.533
the kinds of places most of these grads will practice.

0:08:56.533,0:09:00.627
Sure, they have lectures and hospital rotations too,

0:09:00.627,0:09:05.657
but community-based learning starts on day one.

0:09:05.657,0:09:09.423
Second, students treat the whole patient,

0:09:09.423,0:09:11.337
mind and body,

0:09:11.337,0:09:13.843
in the context of their [br]families, their communities

0:09:13.843,0:09:15.990
and their culture.

0:09:15.990,0:09:18.890
Third, they learn public health:

0:09:18.890,0:09:21.990
to assess their patients' drinking water, housing,

0:09:21.990,0:09:25.286
social and economic conditions.

0:09:25.286,0:09:27.817
Fourth, they are taught

0:09:27.817,0:09:30.584
that a good patient interview

0:09:30.584,0:09:32.688
and a thorough clinical exam

0:09:32.688,0:09:35.523
provide most of the clues for diagnosis,

0:09:35.523,0:09:39.426
saving costly technology for confirmation.

0:09:39.426,0:09:42.976
And finally, they're taught over and over again

0:09:42.976,0:09:45.020
the importance of prevention,

0:09:45.020,0:09:47.420
especially as chronic diseases

0:09:47.420,0:09:51.580
cripple health systems worldwide.

0:09:51.580,0:09:54.770
Such an in-service learning

0:09:54.770,0:09:57.370
also comes with a team approach,

0:09:57.370,0:10:00.237
as much how to work in teams

0:10:00.237,0:10:02.183
as how to lead them,

0:10:02.183,0:10:04.310
with a dose of humility.

0:10:04.310,0:10:07.110
Upon graduation, these doctors share

0:10:07.110,0:10:09.820
their knowledge with nurse's aids, midwives,

0:10:09.820,0:10:11.790
community health workers,

0:10:11.790,0:10:14.176
to help them become better at what they do,

0:10:14.176,0:10:16.121
not to replace them,

0:10:16.121,0:10:19.250
to work with shamans and traditional healers.

0:10:21.311,0:10:23.870
ELAM's graduates:

0:10:23.870,0:10:28.527
Are they proving this audacious experiment right?

0:10:28.527,0:10:30.822
Dozens of projects give us an inkling

0:10:30.822,0:10:33.390
of what they're capable of doing.

0:10:33.390,0:10:35.153
Take the Garífuna grads.

0:10:35.153,0:10:37.343
They not only went to work back home,

0:10:37.343,0:10:39.750
but they organized their communities to build

0:10:39.750,0:10:43.151
Honduras' first indigenous hospital.

0:10:43.151,0:10:45.300
With an architect's help,

0:10:45.300,0:10:49.777
residents literally raised it from the ground up.

0:10:49.777,0:10:51.959
The first patients walked through the doors

0:10:51.959,0:10:54.299
in December 2007,

0:10:54.299,0:10:56.808
and since then, the hospital has received

0:10:56.808,0:10:59.958
nearly one million patient visits.

0:10:59.958,0:11:02.119
And government is paying attention,

0:11:02.119,0:11:04.640
upholding the hospital as a model

0:11:04.640,0:11:09.819
of rural public health for Honduras.

0:11:09.819,0:11:13.467
ELAM's graduates are smart,

0:11:13.467,0:11:16.920
strong and also dedicated.

0:11:16.920,0:11:21.274
Haiti, January 2010.

0:11:21.274,0:11:23.109
The pain.

0:11:23.109,0:11:27.112
People buried under 30 million tons of rubble.

0:11:27.112,0:11:29.261
Overwhelming.

0:11:29.261,0:11:31.139
Three hundred forty Cuban doctors

0:11:31.139,0:11:33.580
were already on the ground long term.

0:11:33.580,0:11:35.983
More were on their way. Many more were needed.

0:11:35.983,0:11:39.227
At ELAM, students worked round the clock

0:11:39.227,0:11:42.445
to contact 2,000 graduates.

0:11:42.445,0:11:45.629
As a result, hundreds arrived in Haiti,

0:11:45.629,0:11:49.926
27 countries' worth, from Mali in the Sahara

0:11:49.926,0:11:54.414
to St. Lucia, Bolivia, Chile and the USA.

0:11:54.414,0:11:57.710
They spoke easily to each other in Spanish

0:11:57.710,0:12:00.399
and listened to their patients in Creole

0:12:00.399,0:12:02.525
thanks to Haitian medical students

0:12:02.525,0:12:04.752
flown in from ELAM in Cuba.

0:12:04.752,0:12:06.440
Many stayed for months,

0:12:06.440,0:12:09.218
even through the cholera epidemic.

0:12:09.218,0:12:11.558
Hundreds of Haitian graduates

0:12:11.558,0:12:14.280
had to pick up the pieces,

0:12:14.280,0:12:16.294
overcome their own heartbreak,

0:12:16.294,0:12:18.160
and then pick up the burden

0:12:18.160,0:12:21.728
of building a new public health system for Haiti.

0:12:21.728,0:12:24.225
Today, with aid of organizations and governments

0:12:24.225,0:12:26.778
from Norway to Cuba to Brazil,

0:12:26.778,0:12:29.004
dozens of new health centers have been built,

0:12:29.004,0:12:32.575
staffed, and in 35 cases, headed

0:12:32.575,0:12:36.497
by ELAM graduates.

0:12:36.497,0:12:38.365
Yet the Haitian story

0:12:38.365,0:12:40.424
also illustrates some of the bigger problems

0:12:40.424,0:12:42.640
faced in many countries.

0:12:42.640,0:12:44.384
Take a look:

0:12:44.384,0:12:50.166
748 Haitian graduates by [br]2012, when cholera struck,

0:12:50.166,0:12:53.912
nearly half working in the public health sector

0:12:53.912,0:12:55.983
but one quarter unemployed,

0:12:55.983,0:13:02.093
and 110 had left Haiti altogether.

0:13:02.093,0:13:04.861
So in the best case scenarios,

0:13:04.861,0:13:06.731
these graduates are staffing

0:13:06.731,0:13:09.980
and thus strengthening public health systems,

0:13:09.980,0:13:13.159
where often they're the only doctors around.

0:13:13.159,0:13:15.950
In the worst cases, there are simply not enough jobs

0:13:15.950,0:13:17.592
in the public health sector,

0:13:17.592,0:13:20.158
where most poor people are treated,

0:13:20.158,0:13:22.957
not enough political will, not enough resources,

0:13:22.957,0:13:25.163
not enough anything —

0:13:25.163,0:13:28.616
just too many patients with no care.

0:13:28.616,0:13:31.600
The grads face pressure from their families too,

0:13:31.600,0:13:33.903
desperate to make ends meet,

0:13:33.903,0:13:36.479
so when there are no public sector jobs,

0:13:36.479,0:13:39.100
these new MDs decamp into private practice,

0:13:39.100,0:13:43.115
or go abroad to send money home.

0:13:43.115,0:13:46.300
Worst of all, in some countries,

0:13:46.300,0:13:49.236
medical societies influence accreditation bodies

0:13:49.236,0:13:52.251
not to honor the ELAM degree,

0:13:52.251,0:13:54.568
fearful these grads will take their jobs

0:13:54.568,0:13:58.123
or reduce their patient loads and income.

0:13:58.123,0:14:01.104
It's not a question of competencies.

0:14:01.104,0:14:03.612
Here in the USA, the California Medical Board

0:14:03.612,0:14:07.212
accredited the school after rigorous inspection,

0:14:07.212,0:14:09.260
and the new physicians are making good

0:14:09.260,0:14:11.451
on Cuba's big bet,

0:14:11.451,0:14:13.262
passing their boards and accepted

0:14:13.262,0:14:15.647
into highly respected residencies

0:14:15.647,0:14:19.738
from New York to Chicago to New Mexico.

0:14:19.738,0:14:22.363
Two hundred strong, they're coming

0:14:22.363,0:14:24.748
back to the United States energized,

0:14:24.748,0:14:27.335
and also dissatisfied.

0:14:27.335,0:14:28.966
As one grad put it,

0:14:28.966,0:14:32.420
in Cuba, "We are trained to provide quality care

0:14:32.420,0:14:34.422
with minimal resources,

0:14:34.422,0:14:36.998
so when I see all the resources we have here,

0:14:36.998,0:14:39.160
and you tell me that's not possible,

0:14:39.160,0:14:41.330
I know it's not true.

0:14:41.330,0:14:46.949
Not only have I seen it work, I've done the work."

0:14:46.949,0:14:48.910
ELAM's graduates,

0:14:48.910,0:14:52.427
some from right here in D.C. and Baltimore,

0:14:52.427,0:14:55.595
have come from the poorest of the poor

0:14:55.595,0:14:57.928
to offer health, education

0:14:57.928,0:15:00.844
and a voice to their communities.

0:15:00.844,0:15:03.496
They've done the heavy lifting.

0:15:03.496,0:15:05.510
Now we need to do our part

0:15:05.510,0:15:09.127
to support the 23,000 and counting,

0:15:09.127,0:15:10.481
All of us —

0:15:10.481,0:15:14.115
foundations, residency directors, press,

0:15:14.115,0:15:17.299
entrepreneurs, policymakers, people —

0:15:17.299,0:15:19.452
need to step up.

0:15:19.452,0:15:21.443
We need to do much more globally

0:15:21.443,0:15:24.382
to give these new doctors the opportunity

0:15:24.382,0:15:26.775
to prove their mettle.

0:15:26.775,0:15:27.778
They need to be able

0:15:27.778,0:15:30.982
to take their countries' licensing exams.

0:15:30.982,0:15:33.930
They need jobs in the public health sector

0:15:33.930,0:15:35.685
or in nonprofit health centers

0:15:35.685,0:15:39.532
to put their training and commitment to work.

0:15:39.532,0:15:41.815
They need the chance to be

0:15:41.815,0:15:46.674
the doctors their patients need.

0:15:46.674,0:15:48.531
To move forward,

0:15:48.531,0:15:51.523
we may have to find our way back

0:15:51.523,0:15:53.706
to that pediatrician who would

0:15:53.706,0:15:55.393
knock on my family's door

0:15:55.393,0:15:58.579
on the South Side of Chicago when I was a kid,

0:15:58.579,0:16:00.489
who made house calls,

0:16:00.489,0:16:03.380
who was a public servant.

0:16:03.380,0:16:05.203
These aren't such new ideas

0:16:05.203,0:16:07.565
of what medicine should be.

0:16:07.565,0:16:10.290
What's new is the scaling up

0:16:10.290,0:16:13.673
and the faces of the doctors themselves:

0:16:13.673,0:16:17.130
an ELAM graduate is more likely to be a she

0:16:17.130,0:16:19.060
than a he;

0:16:19.060,0:16:21.987
In the Amazon, Peru or Guatemala,

0:16:21.987,0:16:24.338
an indigenous doctor;

0:16:24.338,0:16:27.352
in the USA, a doctor of color

0:16:27.352,0:16:29.748
who speaks fluent Spanish.

0:16:29.748,0:16:33.427
She is well trained, can be counted on,

0:16:33.427,0:16:37.071
and shares the face and culture of her patients,

0:16:37.071,0:16:40.480
and she deserves our support surely,

0:16:40.480,0:16:44.946
because whether by subway, mule, or canoe,

0:16:44.946,0:16:47.944
she is teaching us to walk the walk.

0:16:47.944,0:16:53.514
Thank you. (Applause)