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The Cuban Solution

She and the others face another, longer-term challenge: winning admission to a U.S. residency program. Because the first class of Americans studying in Cuba won't graduate until next year, no one knows how their education will be viewed back home. And, of course, there is no guarantee that, if the aging Castro were to leave office or die, his successor would agree that the impoverished island should continue to pay for the education of students from one of the richest nations on earth.

Castro offered the medical scholarships six years ago, after hosting a dinner for visiting members of the Congressional Black Caucus. Rep. Bennie Thompson (D-Miss.) remembers sitting with Castro in the summer of 2000 and being impressed at Castro's command of U.S. statistics on such things as infant mortality and the number of medically uninsured. Castro talked about the thousands of Cuban doctors working in Africa and Latin America, and about training tens of thousands of foreign medical students.

Medicine has long been Castro's most effective foreign policy tool. According to Cuba's foreign ministry, this year alone Cuba is training 20,000 foreigners to be doctors, nurses and dentists, most free of charge. More than 2,500 Cuban doctors are treating earthquake victims in remote parts of Pakistan. In the past two years, the ministry says, Cuban specialists have performed eye surgery on 209,103 foreigners, including 157,000 from Venezuela, whose leftist president has forged close ties to Castro and sells Cuba cheap oil.

Thompson mentioned that some areas of his district in northwestern Mississippi were woefully underserved by doctors, and he remembers Castro saying: "We would love to help you address some of those inequities. If the Black Caucus can identify students who are willing to come and attend medical school, we make that offer free of charge." Soon afterward, Castro announced he was offering up to 500 scholarships for American students who were committed to serving impoverished U.S. communities but were unable to afford medical school.

From the beginning, the program has faced fierce opposition in the United States. "There were a lot of naysayers and critics," acknowledges the Rev. Lucius Walker Jr., head of the New York-based Pastors for Peace, which, along with the Interreligious Foundation for Community Organization, selects students and administers the program stateside.

While the Cuban foreign ministry praises the scholarships as an example of Castro's humanitarianism, his opponents contend that the offer was calculated to embarrass the United States. "This is pure propaganda, and the students are Castro's propaganda tools," says Ninoska Perez-Castello, a South Florida radio personality and a founder of the Cuba Liberty Council, an anti-Castro group. "I don't believe in the generosity of a dictator who crushes the skulls of his own people."

The Bush administration initially sided with the critics. But when it demanded that the students return home last year, the Black Caucus erupted. According to Walker, Colin Powell quietly persuaded the administration to back off, at least temporarily. "If our critics are willing to work with us to get more financial resources for medical care and training, I'm willing to listen," says Thompson. "Until then, I will fight to save this opportunity."

Such opportunities are scarce. Most U.S. medical students are both white and well-off. Only 6 percent of students entering medical school in 2000 were from families earning less than $50,000 a year; only 6 percent of doctors in the United States are black, Hispanic or Native American, according to a 2004 report by the Sullivan Commission on Diversity in the Healthcare Workforce.

The United States once had a successful program similar to the one being offered by Cuba: The National Health Service Corps Scholarship Program offered thousands of Americans free tuition and expenses in return for later practicing in areas that needed more doctors. Minorities relied heavily on the program: In 1980, one of every four black medical students had a corps scholarship.

But the Reagan administration began slashing the program each budget year. In 1981, the corps offered 6,159 scholarships. In 1982, the number was cut to 2,449. Last year, the corps awarded 90 new scholarships.

MELISSA WAS 7 WHEN SHE DECIDED TO BECOME A DOCTOR. At the time, she was watching a favorite aunt -- the one everyone said she resembled -- waste away from cancer. Melissa would sit with her for hours, bringing her water and food.

"Melissa thought that if she were a doctor she could have saved her aunt," remembers Melissa's grandmother Rosetta Hughes. "No one could talk her out of that notion."

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