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)