The Cuban Solution

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The Cuban Solution
Melissa Mitchell wants to be a doctor to tend to the poor. But the Howard University undergrad was too poor herself to attend medical school. That's when Cuba's maximum leader offered a helping hand.

During summers with her grandmother in Alabama, she's volunteered at a free medical clinic, where she says there's been real appreciation for the skills she's learned in Cuba. "I've gotten to know a doctor in Birmingham who has worked all over the world. He worked in West Africa on disaster relief, and American doctors were, like, 'I don't have this, I don't have that,' but the Cuban doctors just went to work," she says.

The doctor, Tom Ellison, a Birmingham cardiologist and epidemiologist, says Melissa has the makings of a great doctor. "On rides on our mobile clinic to an impoverished rural area outside Birmingham, I saw her dedication, her work ethic, her rapport with patients," Ellison says.

One night he took her to an emergency room where he has privileges, and an ambulance brought in a man whose eye was hanging from its socket. "Some of the hospital's students had to leave the room, but she was right in there, eager to learn and see," says Ellison. He's hoping that the hospital officials who've seen Melissa working from the mobile clinic will offer her a residency in Alabama. Once she clears that hurdle, he says, "I'd hire her in a minute."

Melissa, who is scheduled to graduate in the spring of 2009, says it should help that she and her classmates are "not looking for the prestigious residencies; we want to do work no one else wants to do.

"Besides," she says, "I believe I was born to do this, so it will happen."

A SERIES OF GRACEFUL, SPANISH-STYLE BUILDINGS WITH TILED ROOFS, each circled by wide porches, cluster around a leafy square on the campus of Salvador Allende Hospital. It's reminiscent of the European hospitals shown in old World War II movies, where wounded American soldiers would convalesce -- and usually fall in love with a nurse -- before heading home.

Melissa, who has just finished her hematology and endocrinology exam, emerges from one building looking shellshocked.

She and Revery never did find a flashlight last night: They went to Melissa's boyfriend's house, but he was out and had taken the flashlight with him. And she thinks she blew the test. Part of it required matching diseases to symptoms, and, although some of the choices made no sense, she tried to match everything. Only after class did she realize that not all of the diseases had a match. The professor had talked so fast that only the Cubans understood the directions. If she's failed, she'll get a second chance to retake it. After that, failure would mean the cancellation of her summer break -- and repetition of the course in the fall.

Narciso Ortiz, a student from New Jersey who is the elected head of the American student body, fears he blew the test as well. But Ortiz is the fixer, the leader, and he focuses on trying to comfort Melissa. They also discuss whether she can switch from working in one ward at Salavador Allende to one headed by a doctor she particularly likes. Narciso promises to set up a meeting for her with the hospital administrator.

With eyes bloodshot from lack of sleep, Melissa heads off to take a shower and then a nap.

THE OLD MAN'S EYES LIGHT UP WHEN MELISSA ENTERS HIS ROOM. He lies in a white metal, hand-cranked hospital bed but struggles to sit when she arrives. She helps him get upright. He jerks when she puts the cold metal of her stethoscope against his bare chest. They both giggle for a minute, then chat as she warms the stethoscope by rubbing it against her palm before trying again.

As a third-year student, Melissa is assigned two beds in this ward, where she works six mornings a week before attending lectures in the afternoon. Once a week, she also works an overnight shift at the emergency room. Sundays are free, except when her emergency room duties fall on that day. Sometimes, especially on Saturday mornings, she doesn't feel like getting up. But always, there are the patients to inspire her to roll out of bed. "I don't want them getting bounced around among different people," she says.

The opportunity to work with patients very early in her training has been the biggest advantage of studying medicine in Cuba, Melissa says. Often the equipment available is basic, but, in some ways, that's an advantage, too, she says. Sometimes, the only needles available are the big old-fashioned, reusable kind, and if you can give a painless injection with those, you can certainly do it with the thin needles used in the United States. She's looking forward to "playing with the high-tech toys" available in the States, but figures she's better off learning to work without them for now.

She sweats as she makes her way around the ward, 20 rooms that hold 40 beds in a one-story building. There is no air conditioning, but it's a graceful old building with high ceilings and white walls with decorative tiles stretching waist high. Each room has two doors, one leading to the central hallway, the other to the porch that wraps around the building. Beside each bed is a folding beach chair for visitors.

Melissa has a new patient in the bed next to the old man. Melissa looks at an X-ray of the patient's lungs. She notes their elongation. It's a sign, she tells me later, of emphysema.

Once she finishes examining her patients, she joins the other medical students for rounds, visiting each room with a supervising doctor. Melissa presents her new patient, offering her opinion of what's wrong. The X-rays are passed around and discussed. It's pretty much like rounds on every TV hospital drama ever broadcast.

Before she leaves the ward, Melissa fills out her patients' charts, then heads outside into the sultry air. After lunch, there will be hours of lectures, then hours of study. But it's a Monday. So today, she notes happily, the cafeteria will be serving chicken.

Cindy Loose is a reporter for The Post's Travel section. She and Melissa Mitchell will be fielding questions and comments about this article Monday at noon at washingtonpost.com/liveonline.