Going where no doctor has gone before: the role of Cuba's Latin American School of Medicine in meeting the needs of some of the world's most vulnerable populations.

OBJECTIVES: To explore the institutional ethics of Cuba's Latin American School of Medicine (ELAM). As a response to the aftermath of Hurricane Mitch in 1998, Cuba recruited over 11,000 students from marginalized communities in 29 countries to study medicine free of charge. ELAM's stated goal is for students to return to their home communities to apply their skills after a 6-year programme. The aim of this research was to determine if ELAM builds capacity for students to serve vulnerable communities in the global South. STUDY
DESIGN: This paper focuses on ELAM's selection process and curriculum in order to build understanding of its institutional ethics. Much has been written about how medical schools, in the North and South alike, do a great deal to build institutional ethics where graduates seek employment in urban and wealthy centres. By exploring ELAM's training programme, this study aimed to determine if the school is capable of forming an alternative ethic where graduates seek service to vulnerable populations.
METHODS: First-person interviews with students, instructors, administrators and government officials were undertaken to build a sense of ELAM's institutional ethics. In addition, a literature review of ELAM's curriculum was conducted through documents obtained via Cuba's online web-portal 'INFOMED'.
RESULTS: Document analysis and first person interviews revealed themes of community oriented primary care (COPC), within ELAM's core curriculum and an institutional ethics of serving vulnerable populations in the global South. Students are taught the importance of practising prevention and health promotion at the community level, and alongside rigorous training in core clinical competency, students are to embrace COPC practices as part of their daily routines.
CONCLUSIONS: ELAM is an important human resource for health capacity building projects. While the quantity of ELAM graduates is remarkable, the importance of this project is the development of an institutional ethic that values success as a graduate's ability to serve the indigent. ELAM's ability to recruit students from vulnerable communities is impressive, and the emphasis of prevention and promotion frameworks at the community level is a badly needed pedagogy for the needs of vulnerable populations in the global South.