Post Magazine: Med School Libre

Cindy Loose
Washington Post Staff Writer
Monday, July 24, 2006; 12:00 PM

American Melissa Mitchell wants to be a doctor to tend to the poor. But the Howard University undergraduate was unable to afford med school. That's when Cuba's maximum leader, Fidel Castro, offered a helping hand.

Cindy Loose , whose article about Mitchell and her fellow med students in Havana appeared in yesterday's Washington Post Magazine , will be online today to field questions and comments. As will Mitchell herself.

Submit your questions and comments before or during the discussion.

Cindy Loose is a reporter for The Post's Travel section.

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Medical School in Cuba: I have no problem having people study in any other country they want - it's not like other countries don't have sick people - however will people who do this be able to come back to the U.S. and practice medicine? The system is really set up for U.S. medical schools (in terms of residencies and internships) even though other countries have some very fine institutions and maybe even have better medical training the U.S. medical community looks down on their training.

Cindy Loose: Actually, a very large percentage of residents in U.S. hospitals are from foreign medical schools. I forget the exact percentage, but remember seeing it recently and being very surprised. Of course if you've ever been in a hospital, you'll no doubt have noticed how many of the residents and doctors are clearly from other countries.

And yes, Melissa and her colleagues are planning to come to the U.S. to practice. They will have to pass the same tough exams as anyone who studies in the U.S. and have to do a residency in a U.S. hospital. In fact, each has promised to return to the U.S. and practice in an underserved American community.

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Washington, D.C.: Who would be the best person to talk to about entering a program like this? I am a non-traditional applicant to medical school in the United States, but the program in Cuba sounds like an incredible opportunity, especially given that I am committed to serving the Latino community. I currently work in a DC latino clinic, La Clinica del Pueblo.

Cindy Loose: You should start by contacted Pastors for Peace at 418 W. 145 St. NY 10031, phone 212 926 5757.

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New York, New York: If there are any Washington Post readers who are inspired by your story and want to assist you how can we?(whether in currency or any other way)

Melissa Mitchell: Yes! There are many ways that you can assist us. Please email healthcare4humanity@yahoo.com, with any additional questions. I will dedicate time after the chat to respond more in depth, and to give more specific information about how you can help. Thanks so much!

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Madison, Wis.: I wanted to write in and encourage Melissa. I suspect roadblocks will continue to block her path. I don't think it matters how she gets through medical school, the world needs doctors like her. Please don't give up, Melissa.

Melissa Mitchell: Thank you so much for your encouragement! Encouragement is one of the many things that we are lacking, and we can use all we can get. Please email healthcare4humanity@yahoo.com with any additional questions for me.

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Washington, D.C.: I would like to know why your article is demonizing American medical schools and their students, and where you got your facts? Starting from the beginning, medical school in the U.S. is 4 years, not three, making medical school in Cuba 50 percent longer, not twice as long. In addition that only grants an M.D., in order to be licensed to practice you must go through at least a year of residency, making your medical education a minumum of 5 years. This idea that U.S. medical schools have "deamphazised" basic skills such a using a stethescope is nonsense.

I attend George Washington University Medical School and we are using our stethescope, learning physical exam and seeing patients from week one of medical school. While I agree with the fact that the system for entrance has flaws and favors those with wealthier parents or families with physicians already (neither of my parents finished college by the way), many prep courses offer scholarships and schools will work with you to arrange interviews to mitigate cost (such as local interviews (which I did), phone interviews or housing you while you are visiting).

Also, American mecical School's have high standards such as the Medical College Addmissions Test and exceptional GPA's because do you want your physician to have graduated with a 2.4 and 24 on their MCAT without any science classes? Check the AAMC website (www.aamc.org) to see the numbers behind what it takes to get into a medical school in the U.S.

Your article is a fine drama with potetntial for a happy ending, but if you intended it to be a serious, informative work I think you owe medical students and school across our nation an apology for portraying them as subpar and discriminatory as compared to the Cuban system.

Cindy Loose: There most certainly was no intent to put demonize or even criticize American medical schools or students. As to the deemphasis of stethoscope skills, I suppose it depends on your definition---I can share with you articles about some American doctors who are concerned abot this, including one who has created a tape of breath sounds for students to download on their iPods.

I don't recall anyone in the article having a 2.4 and few science courses.

Best of luck to you in your medical studies--we certainly need you and wish you well.

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Greenbelt, Md.: If someone wants to send you some money to help with everyday expenses or to take those exams how can this be done?

Cindy Loose: Hi--I'll take this one for Melissa.

The program that administers the scholarships stateside, Pastors for Peace, can take tax deductible donations through their parent organization, the Interreligious Foundation for Community Organization. Checks can be made out to the Medical School Scholarship Fund, and I just spoke with the director, Rev. Lucius Walker, who said you can earmark the donation for Melissa is you wish. Although room and tuitoin is paid, students need books, supplies like stethoscopes (they are given one at the beginning of their studies, and when it wears out, too bad) hmoney to take tests, money for prep courses and plane rides home ot take the summer prep courses.

Checks may be sent to IFFCO, 418 W 145 St. NY, NY 10031, and their phone number is 212 926 5757. Mail to Cuba is extremely unreliable, but someone from the organization visits the students several times a year and takes care packages from parents, mail and supplies or cash that have been donated. Donatoins through IFCO are tax deductible.

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Burke, Va.: While Melissa's story is very moving, I can't help to think that Castro is manipulating public opinion. Why? I can't believe that he is so worried about the plight of poor American students and patients, when his own Cuban people don't have access to first-rate medical attention. While Cuban health care is free to Cubans, the quality of this care is pitiful. Emergency-care patients have to put up with blackouts at hospitals, and are told to bring their own bed sheets. In contrast, patients from foreign countries with dollars are given access to first-class medical facilities. Thus Castro's concern was genuine, he would ensure that Cubans would get the best medical attention before any foreigners.

Nevertheless, I agree that more scholarships and grants to needy medical students should be provided in the U.S. With the diversity reflected in the U.S. population, it is imperative that doctors and nurses from all groups are well represented.

Cindy Loose: Thanks for your thoughts.

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Edwardsville, Ill.: A friend kindly brought this article to my attention. How do you apply for this program?

Melissa Mitchell: To apply for the program, please contact www.ifconews.org. IFCO/ Pastors for Peace handles the application process. Thanks

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Baltimore, Md.: While admirable that Ms. Mitchell has gone to such lengths to pursue her medical ambitions, I take issue with the fact that she could not have pursued such goals at an American medical school. As a current third year medical student, I know firsthand the travails of the medical school application process. What your article seems to gloss over is the fact that Ms. Mitchell was perhaps under qualified for an American medical education. Unfortunately, I have a hard time believing Ms. Mitchell is a victim of racial prejudice and elitism. Competition for admission is fierce and the fact is it should be. Not everyone is cut out to be a doctor, regardless of their childhood dreams. Depicting Ms. Mitchell's failure to gain admission as a bold choice on her part to reject the American status quo undercuts efforts by minorities who overcome the same adversities that Ms. Mitchell ran from. There are many opportunities to support the underserved in America, being a medical doctor is certainly not the only one. In your rush to glorify Ms. Mitchell's quest to become a doctor, you fail to convince me that a Cuban medical education is in any way superior to the traditional American one.

Melissa Mitchell: Just wanted to respond to the comment about "under qualified". Actually I was very well qualified to apply to med school in the US. I decided not to because med school in the US did not meet my needs as a future doctor interested in working in underserved areas. The Cuban program did. So I made the decision based on my needs, not my qualifications. Thanks!

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Pawleys Island, S.C.: Does your free medical education come with any reciprocating obligations to service the medical needs in Cuba?

Cindy Loose: I'll help Melissa with this one, even though my info is second hand----all America students pledge they will return to the U.S. and practice in underserved communities---after of course passing U.S. licensing exams and doing a U.S. residency.

There is no other obligation. Of course while they are studying in Cuba, they are treating Cuban patients under the supervision of Cuban doctors.

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Washington, D.C.: Although I don't support Fidel Castro's politics, I applaud him for what he's done. Why is it that many American institutions would rather employ many racist immigrant doctors from places such as Africa rather than funding the education of African-American students to become doctors? It sounds to me that Fidel Castro is combatting the racism, that many other institutions and other individuals are perpetuating by insinuating that only Foreignors are qualified to do medicine as compared to the Locals.

Charity begins at home. This is a lesson that many still have yet to learn. Despite what others like to state, there are many brilliant African-Americans who are competent enough to become doctors and who would probably deliver better healthcare to populations in need more so than racist immigrant doctors who look down on populations such as the African-American population.

Cindy Loose: Thanks for your comments.

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Washington, D.C.: I work at one of the high-end medical schools in D.C., and I think it is shameful that a promising future doctor must kiss her dreams goodbye thanks to a lack of a few hundred dollars for application fees.

Cindy Loose: Thanks for tuning in and participating. Application fees alone are actually thousands, and that doesn't count prep course and tests. But, same idea. Thanks again.

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Vancouver, BC : Cindy, what were living conditions like for you while researching this article? As a Canadian citizen, I have no restrictions on my travel to Cuba and have been there twice in 2000 and 2002. Once I went on an organized tour and once with family and friends, making our own arrangements. We had a lovely time both times, with none of the inconveniences the medical students experience. Does Cuba make a special effort to keep tourist areas functioning even when other parts of the country are not? I must say I now feel a bit guilty, having read your article.

Cindy Loose: Living conditions for tourists are marvelous----their are really terrific, classy hotels for tourists both in Havana and at least in the other place I've visited, Veradero Beach.

There are really beautiful Cuban restaurants for those who have foreign currency to spend, although the ambiance tends to be better than the food, except in the little restaurants, no more than 12 tables, that are operated by individuals.

If Americans are ever again allowed by the U.S. gov. to visit Cuba, I think much of the rest of the Caribbean would be begging for visitors---it's a really beautiful country.

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Gaithersburg, Md.: Fascinating article!

Do students in the program feel they are being adequately prepared to pass U.S. licensing tests and practice medicine in the states?

I think it's wonderful to see encouragement of the basic skills, with less of a focus on technology. Good luck Melissa!

Cindy Loose: This really should be Melissa's question, but she has so many I'll try to help---The students I spoke with anticipate the tests with great trepidation, but believe they are being prepared to take them. Their biggest worry, I think, is not having the money to sign up for the tests and for the prep courses that even U.S. students studying in the U.S. take.

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Springfield, Md.: Great article! And how sad that promising med students have to go to Cuba because no such opportunities are available in this country.

It sounds from the article, though, that Revery has only a few community college courses. Is a college degree required for admission to the program? As a doctor myself, I'm not going to defend all the bells and whistles you have to jump through to become licensed in this country, but a basic grounding in chemistry. biology, and similar courses seems like a good idea.

Melissa Mitchell: No, a college degree is not required to apply for the program, which is actually one of the benefits of the program. Those who have access to a college education will generally also have access to a medical education.

The program offers a semester of premed courses to ensure that every student begins 1st year on the same level.

Also, keep in mind that the US is one of the ONLY countries in the world that requires an undergraduate degree the apply to med school. You don't even need one in Europe!

Thanks

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Gahanna, Ohio: I hear that Cubans have to wait longer to see a doctor because many of the hospitals have been designated foreigner-only (read Venezuelan). Is that true?

Cindy Loose: I don't think the students would be privy to those figures, but I can tell that a big, modern hospital in downtown Havana does seem to have a lot of foreigners wearing eye patches. Cuba seems to have some very good doctors and equipment for eye surgery and tout their groundbreaking techniques. No question it is something Castro can offer to places like Venezuela, which has the oil. Whether that means Cubans have to wait for eye surgery, I have no way of knowing and I'm sure Melissa wouldn't either. (The Havana hospital where she works is not the one to which I refer that has lots of eye patients.)

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Manassas, Va.: Do you have a sense that Cuban doctors can't find work in Cuba; hence, they are sent (with fanfare, might I add) to "friendly" countries such as Bolivia, Venezuela, and Angola?

Cindy Loose: Cuban doctors are assigned work; I think the issue is that Cuba trains more doctors than it needs. There is no doubt that medicine is Cuba's primary way of reaching out the world---what the motives are are of course open to interpretation, but every country's foreign aid usually comes with hopes of making a good impression at the very least.

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Washington, D.C.: Cindy,

Thank you for profiling these wonderful people;

and

Melissa,

I can't even begin to verbalize how much I respect your strength, your courage, and your determination to pursue that which is important to you. I have no doubt that God will bless you abundantly as you journey through life serving those who have great need. Perhaps the best thing that could have happened to you is that you were unable to attend school in the United States because you will have learned lessons that many U.S. trained physicians will never learn. Good for you!!!

Melissa Mitchell: Thank you so much!!!

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Springfield, Va.: Who wrote the headline for this article? Perhaps the temptation to spoof off of Cuba Libre (a rum and Coke) was too great, but Libre means free as in Freedom, which many Cubans do not have. Gratis would seem to be the word the headline editor was looking for. This is unfortunate, as to me it just seems to underline the fact that these students are actually studying under a dictatorship, and not some benevolent millionaire.

Cindy Loose: I don't write the headlines, but you are write about the word nuances.

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New London, Conn.: I read your article with particular interest. After all, we're facing a shortage of physicians in the near future as baby boomers are retiring and growing older. For a while I pondered medical or nursing school. One thing not mentioned in your article was that there are "fee assistance programs" available that sharply discount application fees as well as standardized test fees. In addition, your article touched on the fact that many of the students in this program desire to work in traditionally/historically underserved areas. There are numerous "loan forgiveness" and "repayment" programs avialable, where a substantial portion or all of loans are forgivem/repayed in exchange for working in underserved areas (think of the old Northern Exposure tv series.) These are viable options. Did you meet anyone who discussed these options?

Melissa Mitchell: Greetings

Receiving these "fee assistance programs" assumes that you have already been accepted to medical school, which is the roadblock for most. A college degree, preparing for the entrance exams, and paying for applications is a challenge that many qualified students never reach based on financial or social difficulties. These difficulties do not imply that these students are underqualified, just unable.

Thanks!

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Tallahassee, Fla.: The quality of medical care in Cuba has been brought into question. According to the CIA fact book, medical care in Cuba is supurb. In fact, infant mortality in Cuba is lower than in the U.S. It is less than 7.0 per thousand live births.

Melissa Mitchell: Thank you for your support!

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New York City , N. Y. : While she's reluctant to talk much about Castro or communism, she does admire Cuba's stated goal of providing medical care to all of its citizens. Health care, she says, should be a right, not a privilege. "If you're not going to give a break to someone when they're sick, when are you ever going to give them a break?"

Do you think this is a brave or fair or intellectually honest way of addressing the kind of oppression Castro has overseen for over 40 years?

Why, editorially, is this a better profile to do than for a scholarship [for] Afghan, Iranian, Saudi Arabian or Venezuelan students studing in an American medical school?

Cindy Loose: There probably is a good story to do about foreigners studying medicine in the U.S. I came across this story while visiting Cuba to do a story about traveling there--a story that sort of lost its purpose after a Bush Administration crackdown shut most of the legal categories allowing Americans to travel to Cuba.

To do one story isn't to stay that there aren't other stories to do, thank goodness, or we journalists would be out of jobs quickly.

But when I heard about Americans studying medicine in Cuba, with scholarships from the Cuban government, and promising to return home to served underserved communities, it sure seemed like an interesting story to me. Still does, I might add.

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Retinne, Belgium: Hi, Melissa. Although I live in Belgium, I grew up in the Mississippi Delta. I applaude your bravery and efforts to become a physician to the poor. I read about your experience and think of a conversation with a Bulgarian friend, whose mama is also a doctor. She said most doctors in the rich West no longer know how to practice the "art" of medicine. You will probably end up a much better practitioner than others in your residency, as you are being taught to diagnose from subtle cues, not test results. Good luck.

Melissa Mitchell: Thank you for your support!!

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Alexandria, Va.: Melissa, como aprendiste espanol? Can you tell us a bit more about the linguistic challenges you are facing? A recent news item talked about the challenges American doctors are facing in treating persons who don't speak English and the lack of interpreters for this. You will have a leg up on those doctors after conducting your training in Spanish.

Melissa Mitchell: Apprendi todo alla! Ya me puedo communicar bastante bien. Really, it just depends on determination. Learning a new language is always a challenge, but we are immersed. And sometimes, embarassment can be a STRONG motivation! I learned, and am still learning, but I can now communicate fairly well.

Thanks!

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San Juan, PR: Are the students allowed to visit the rest of Cuba?

Cindy Loose: Yes, if they have money to do so. I know a few have gone abot a little when their parents visited and were able to pay for the trips. But between heavy study and work schedules and lack of money, they don't get out much. One student said that in three years, she'd been to one jazz concert and one movie, and that had been the extent of her excursion/entertainment budget.

Americans have a hard time traveling in Cuba because they U.S. government bans most travel. If you can jump that hurdle, you can travel anywhere in Cuba, except of course Guantanamo.

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Columbia, Md.: Did you try to get into any medical school in places like Granada, or other outposts that Americans often go instead of an American school?

Did the lack of protein in your diet affect the ability to study and retain knowledge?

Cindy Loose: Melissa is getting bogged down with questions, so I'll take a stab at this one----the biggest problem of the students in Cuba was money, and that same problem would have applied to Granada or elsewhere.

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Clarksburg: I am curious to whether you had to take any sort of political indoctrination courses while medical school there?

Melissa Mitchell: No, we didn't have to take any political course. They make strong effort to stay away from politics. This program is about producing doctors, not politicians.

Thanks

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Champaign Ill. Please explain why in both the article and the photo gallery, you claim that it takes six years - "twice as long as it does in the US" -to graduate from medical school, which implies that in the U.S. it takes three year. It actually takes four.

Cindy Loose: Most of the students spend an extra year studying Spanish.

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Flint Hill, Va.: Sincere thanks to these women for their commitment, courage and perseverance. Our world desperately craves people who answer this call to serve the poor. Isn't it incredible that Cuba and Castro whom we vilify are the world leaders as far as training medicos for the 3rd world! And isn't it striking that Reagan, whose memory Republicans revere, set off the budget cuts for training doctors who would serve the poor that reverberates to this day. I hope you are able to find the funds and residencies to complete the process here in the U.S.

Melissa Mitchell: Thank you for your support!!

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Boston, Mass.: Melissa,

Did you pass your exam? The article had me rooting for you.

Melissa Mitchell: Thank you for support. No, I have to take the exam again this summer, but am a little behind because of lack of funding! But, God willing, everything will work out!

Thanks!

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Fort Worth, Tex.: Melissa--

While your goal to become a doctor is admirable, I question you taking this extreme step to accomplish it. Are you the least bit concerned that Castro is giving you this scholarship to use you as a propaganda tool?

Melissa Mitchell: That's a good question. But I'm not really concerned about the whys and hows. I'll be a doctor soon, empowered to serve my people. And if the price for that is being used as propaganda...so be it!

Thanks!

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Anonymous: I thought there was a program where students could attend for free in return they would serve poor, rural, or underrepresented areas in the U.S. This was the backround of "Northern Exposure". There was a lot of reports of people who went through this program but then didn't serve their time after med school. This program would work if there is proper enforcement of service. One negative was that students did not have any cotrol of where they were assigned.

Cindy Loose: I think you're probably thinking of the National Health Service Corps scholarships. Until Reagan began cutting the funds, there were many thousands of these scholarships each year, as the story mentions, more than 6,000 in 1981, even after the cuts began. Last year, 90 such scholarships were awarded by the Corps.

Ninety doesn't go too far in a country with other 300 million people, of course. Plus, I noted in there literature that it states money is given at such and such a date, and if your school requires it earlier you have to pay and then get reimbursed. That doesn't address the costs of taking tests and applying to schools, but the big thing, I think, is the low number of such scholarships now available.

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Sykesville, Md.: Cindy, this was a really great article. I had no idea Cuba was helping to train U.S. physicians and bet the White House is pretty embarrassed that you have given so much publicity to this program!

My question is whether you have any thoughts as to how this will all play out? I have to say, while I admire her efforts greatly, I am dubious about how Melissa and her classmates will fare on U.S. accreditation tests, even with 6 years of study.

Melissa Mitchell: Greeetings

The licensing exams ARE a big issue, as they are for any international graduate trying to practice in the US. We have a different order of curriculum, for which we're seeing now that it's better to take the exam after our 3rd year, instead of 2nd. Since we have a 6 year program, our curriculum is much more spread out.

A huge issue that we have is funding for these exams, which cost between $700 and $1600 EACH. Since we don't have loans to assist us, and we're not working, it becomes very difficult.

Thanks

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Alexandria, Va.: Given that these students are being trained under a dictatorship which represses dissent, are the American and other foreign students permitted latitude that Cubans do not have in expressing criticim of the status quo in Cuba? Also, I feel that many posters' questions regarding American medical school options have not been addressed. For Melissa, did you investigate any other options for staying in the US? (such as grant programs or other funding options for the application process - I know of at least one program where a student's medical education is paid for provided the student committs to several years practicing in underserved areas or treating underserved populations - at first glance, this would seem like a perfect program for your interests.)

Cindy Loose: This should be Melissa's question, but she's getting so many let me try to help:

I don't know what latitude students have in criticizing the government, but am guessing it wouldn't be all that welcome.

As to other scholarships--you are right, the scholarship that gets repaid by working in underserved areas does sound perfect for Melissa, but that program has been strippped to almost nothing---90 scholarshipos last year, as the story notes. There are thousands of people fighting for those few chances. I don't know if Melissa or the other 90 someting student in Cuba actually applied for those or not, but as you may imagine, getting one is really tough, and the odds very long.

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Washington, D.C.: I attended Howard w/Melissa. We had a couple classes together but were not close. I had no idea she was off to medical school, in Cuba, no less! I admire her greatly and certainly wish her well.

My question is how she managed to learn sufficient Spanish to keep up with med school classes in that language. It's a skill that will serve her well in later life! I'm a teacher in a D.C. elementary school school where many of the students speak Spanish, and I'm still nowhere near fluent despite trying hard. I will use Melissa as my role model to try even harder!

Melissa Mitchell: Thanks for your support, HU!!!!!!

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Arlington, Texas: Melissa, I admire you so much! I can't imagine trying to live on $4 a month. Is there any way I can send you a care package?

Melissa Mitchell: Greetings

Yes!! For more information about providing support, please email healthcare4humanity@yahoo.com. I will dedicate time after the chat to give more detailed information.

Thanks so much

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Arlington, Va.: How's the internet access in Cuba? Any problems with censorship? Do you have more access than the average Cuban citizen?

Cindy Loose: Again, helping Melissa catch up.

Money is the biggest barrier to internet access in Cuba. Hotel lobbies usually have internet access, but you pay like the equivilent of $5 to use them. I believe there are also internet cafes that are somewhat cheaper, but still out of range of the budgets of most American students, and most Cubans too I'll dare say. I left Melissa enough money to contact me and get messages from me because I knew I would need her to answer questions I didn't think of before leaving Cuba. I know she made htat little bit of money go as long a way as possible by prewriting messages before going online so that she could get her thoughts out as quickly as possible, not wasting any time thinking aboutwhat she wanted to write, but pasting and getting on to the next message quickly.

I have corresponded by email with people I've met in Cuba, and my messages arrived and were answered. There may however be censorship, I just don't know, and I don't think Melissa would know either.

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Boca Raton, Fla.: Congratulations Melissa for having the courage to something that many would not.

Frankly, as a child raised abroad and used to the medicine that I suspect you will practice, I am shocked how mercenary medical care has become where I live now. And talking about waiting for appointments and then waiting in the doctors' offices and then waiting for the lab results!

Your professor who doesn't want you to become a lab analyst is right on cue!

Many best wishes for what I know will be a happy and giving career.

Melissa Mitchell: Thanks for your support!!

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Washington, D.C.: What gave you the inspiration and drive to apply for medical schools and to never quit? What advice would you give someone who is interested in going to dental school, but is facing difficulties in trying to play for school?

Melissa Mitchell: Greetings...I like your question and would like to respond more in depth. Please email me at healthcare4humanity@yahoo.com after the chat. I'll be dedicating time to give more detailed responses

Thanks

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Washington, D.C.: Ms. Loose continues to point out that there are very few scholarships from the Public Health Service to support medical students, but there are many, many others not mentioned. One that comes immediately to mind is the military, who will pay for all your schooling, exams, room and board, and give you a monthly stipend. Did Melissa consider this option?

Cindy Loose: Again, trying to help Melissa keep up. You are certainly correct that you can get a free education in the military. I didn't think to ask Melissa about that, but I'm doubting she considered that option.

As to other scholarships--given the huge debt that most students incur during medical school, I'm thinking scholarships outside the military aren't so easy to come by.

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Waterford, Mich.: Have Melissa and Revery passed Step 1 yet? Or have they moved on to the the next year without passing?

Melissa Mitchell: Greetings

I'll be taking the exam again this summer, but I'm having difficulties finding the funding, since there are no loans for us, and we're not able to work. But we did move on to (and finish) our third year. Since this is a US exam it does not affect our studies in Cuba.

Thanks

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Arlington, Va.: Fascinating article, I was glued to it on the train and had to stop and sit on the platform to finish and digest. I guess when you really know what your path is the obstacles that one must endure to follow it are less of a hindrance. But my question is more practical. How much Spanish did you have when you began the program and how can you even function in such a demanding field of study without starting at a pretty proficient level? I'm guessing that language is less of an issue with hard sciences than in social sciences or humanities.

Cindy Loose: This too is Melissa's question, but I'm trying to help:

Melissa didn't know any Spanish when she arrived. She spent six months of intensive Spanish training, and then of course continued studying Spanish as she began her classes. She said learning the language was her greatest challenge, but she is now fluent. I think knowing the language is just as important in her science classes as any other kinds, but being in a place 24-7 is a help in mastering a new language. She and the others, of course, are learning all the technical and scientific terms in Spanish in class, and their class books are in Spanish, but they all try to learn the English terms simultaneously. They share whatever English books they can afford to buy while they are stateside and try to learn the terms in both languages, since they'll be tested in class in Spanish, but their exams in the U.S. will be in English.

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Alexandria, Va.: Melissa, your story is a great inspiration. My wife is a doctor here in DC and I am a professor who has done a great deal of human rights work. How can we send you money to support you in your studies?

Melissa Mitchell: Greetings. Thank you so much for your interest. Please email me at healthcare4humanity@yahoo.com for more information about how to help. I will dedicate time after the chat to give more detailed information. Thanks!

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Luby, Md.: I just want to congratulate you on excellent journalism that may help those of us inside the beast see it from the outside.

Melissa Mitchell: Thanks for your support!!

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Washington, D.C.: I've read that by some measures, infant mortality and life span, the Cuban medical system is comparable or even slightly better than the U.S. At the same time, the Cuban system lacks much of the high tech equipment and perhaps many of the latest blockbuster drugs. That poses the following questions:

Does the Cuban system compare unfavorably in other regards?

Do other factors (obesity, violent crime) explain the relatively poor U.S. performance relative to dollars spent?

Does the technological superiority of the U.S. system not produce better outcomes?

Thanks

Cindy Loose: This is a huge question I don't think Melissa or I are totally competent to answer, but here's the little insight I have:

There are areas of medicine where the Cubans do really well, and areas where an infusion of technology and training would not doubt be helpful. They put a lot of emphasis on preventative medicine. Sometimes the drugs people need aren't available, at least not right away, even in Havana. I spoke with a doctor who has been volunteering each year in Cuba to help train a specialist, and he says that sometimes surgeons aren't as efficient as they oculd be because there isn't enough equipment--like here a doctor would do back to back surgeries all day, while in Cuba and surgeon might have only one or two trays of surgical supplies and would have to wait until the set he has has been sterilized.

The Cubans have made some advances on tropical diseases we don't see here.

Again, a complicated question, but I'm sure for most things, you'd rather be treated here, assuming of course you had insurance.

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Washington, D.C.: I'm joining Melissa & her classmates next year. I'm a believer in all people recieving healthcare regardless of thier income. I would like to know how i should prepare for Cuba next year and re-adjusting to Medical School?

Cindy Loose: Wow, big question----if you send your email addres to loosec@washpost.com I'll pass it on to melissa and I'm betting she'll tell you all you need to know.

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New Albany, Ohio: Cindy-How long were you in Cuba? Where did you visit? Trinidad? Santa Clara? Pinar Del Rio? Santiago? Or, were you only in Havana and Varadero?

Cindy Loose: I've been twice, the second time only to the medical schools in and outside Havana. First time didn't get further than Veradero. The trip to do this story was only four days----not nearly enough time. I would however some day love to see all those other places you mentioned.

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Louisville, Ky.: Why stop at Fidel? Why not apply to Al Queada for a stipend? After all, if you are willing to take 30 peices of silver from one enemy, why not hit up on the others in the world!

Melissa Mitchell: What???

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Annapolis, Md.: Just a quick comment to the writer who believes that the Cuba medical school program is an attempt by Castro to manipulate public opinion. Perhaps it is, but his intent can't be to draw attention away from the poor medical care his own people are receiving. Cuban health statitics far surpass our own, and they manage to do it on a tiny health care budget.

Cindy Loose: No time to respond in full, and also lacking qualifications to really answer, but thanks for the input.

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Cindy Loose: Hey--We've actually gone over our time. Sorry we could not reply to all those who sent in questions or comments---we really did type as fast as our little fingers would go.

Thanks for tuning in. It was fun.

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Washington, D.C.: I'm a student that's applying for the program from Medical school in Cuba as well. I leave next year what should i be preparing to re-adjust to concerning Cuba, what comforts should I be ready to do without?

Cindy Loose: Hey, one last reply---email me, loosec@washpost.com, and I'll try to get you a fuller answer.

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Arlington, Va.: When I read the article title "The Cuban Solution" this morning the first thing it came to mind was a political solution. Obviously the article is not about this topic, but in the greater context it is related. Do you think the US embargo against Cuba is justified? And do you think the embargo is accomplishing it goals?

Cindy Loose: If the goal is overthrowing Castro, that certainly hasn't happened during the 40 whatever years its been in effect.

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Melissa Mitchell: Thanks so much to everyone who participated today. For more questions or detailed information please contact me, Melissa Mitchell at healthcare4humanity@yahoo.com. I'll be dedicting plenty of time to respond to more questions! Thanks again, it's been a great pleasure.

Melissa Rose Mitchell

Medical Student

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