The Cuban Solution

By Cindy Loose
Sunday, July 23, 2006

A single candle casts a faint but warm light on the dark wood of a dining room table in Havana. The neighborhood has been hit with one of the rolling blackouts that occasionally plague the city, but Melissa Mitchell and Revery Barnes are determined to cram all night for their final exam in hematology and endocrinology anyway.

Revery straps a miner-style flashlight onto her head as Melissa sets up a battery-operated laptop filled with notes. They pile heavy medical textbooks on the floor, pull their chairs close together and prop open one textbook between them.

Back when Melissa was a premed student at Howard University, studying in the dark was never an issue. But this isn't Washington. This is Cuba, where Melissa, Revery and 95 other Americans are studying medicine in a country that's been an anathema to the United States for almost five decades. Thanks to Fidel Castro, their education is free. But that doesn't mean they aren't paying a price for turning to Cuba in their quest to become doctors. They've given up creature comforts most Americans take for granted, struggled to master hematology and other complicated subjects in a foreign language, and have no guarantees they will get a chance to practice medicine in the United States.

Right now, though, Melissa, 25, and Revery, 26, aren't thinking about any of that. Melissa, a third-year student, says she has to do well on this test because the professor is on her case. Cuban doctors place a premium on basic skills -- interpreting breath sounds from a stethoscope, for instance -- that have been deemphasized in the high-tech world of U.S. medicine. Not long ago during rounds, Melissa's professor exploded at her when he asked for a diagnosis of a patient, and she replied that the lab results weren't back yet.

"Are you planning to become a doctor or a lab analyst?" he growled. "Tell me what you heard and felt and saw."

To study for the exam, Melissa and Revery have already walked a couple of miles from the blackout-darkened dorms at Salvador Allende Hospital in central Havana to a Cuban friend's house. They were hoping that this neighborhood near the famous Malecon would still have electricity. No such luck.

"I reviewed anemia already," Melissa tells Revery. "I'll teach you anemia if you do diabetes" with me. Revery tilts her head low to illuminate a page, and they get to work.

Within a few hours, their last candle sputters out. The laptop is already dead. Soon the flashlight batteries lose strength, dimming the light from bright white to dingy yellow. Before being plunged into pitch blackness, the two begin packing up, filling backpacks with notes and books. The plan: walk back to the dorm because maybe lights have returned to that part of town. If not, Melissa's Cuban boyfriend has a flashlight. They'll walk to his house to borrow it.

"We can't complain," says Melissa, whose almond-shaped eyes make her look a little like a stylized portrait of Nefertiti. "We knew what it was going to be like when we signed up."

HOW BADLY DOES MELISSA MITCHELL WANT TO BE A DOCTOR? Badly enough to learn Spanish and commit to living in Havana for more than six years -- double the time it would take her to complete medical school in the United States. Badly enough to live as Cuban students do, in cramped dorms without air conditioning, eating rice and beans and little else. (The simplest things -- a phone call home, a soda or candy bar, checking e-mail -- are usually out of reach for students living on a monthly stipend of about $4.) Badly enough to defy a U.S. ban on travel to Cuba to be here.

Melissa knew when she accepted Castro's offer of room, board and tuition that relations between her own government and her benefactor were antagonistic at best. Last year she and her American classmates were ordered home by the Bush administration as part of a series of moves to tighten the 44-year-old embargo against Cuba. A few students abandoned their medical studies and returned to the United States, but most, including Melissa, stayed. Eventually, the administration relented and agreed to give the students temporary travel permits, which will be up for renewal next year.

The Americans are operating on faith that their Cuban education will prepare them to pass tough U.S. licensing exams. Even though their medical studies are in Spanish, they must pass the exams in English. Melissa has no idea how she will pay for the exams, which collectively cost more than $2,000, let alone the review courses that most students, U.S. and foreign, routinely take to prepare for them. Most of her classmates are in the same boat.

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