BY GARY MARX
  Chicago Tribune

  HAVANA - KRT NEWSFEATURES

  (KRT) - Two years ago, Cuban President Fidel Castro electrified a New York City audience when he announced that Cuba would provide free medical training to hundreds of low-income Americans.

  Today, nearly 60 Americans are studying medicine along with several thousand other foreign students at the Latin American School of Medical Sciences, a sprawling former naval academy on the outskirts of Havana.

  The American students are from New York, New Jersey, Minnesota and a dozen other states. Most are black and Latino. Some are poor, others middle class.

  There are graduates from elite universities who said they were drawn by Cuba's culture and politics. There are others who didn't finish college. Some students said they couldn't resist the idea of becoming a doctor without spending a dime.

  "I can't say that I came here only to make a political statement," said Rachel Hardeman, 23, a Minneapolis resident and graduate of Xavier University of Louisiana. "My main goal is to become a doctor, an excellent doctor."

  A chemistry major and Spanish language minor in college, Hardeman said she was preparing to apply to U.S. medical schools when her mother sent her an article about Castro's scholarship offer. Hardeman said she made the decision to study medicine in Cuba in early August. Three weeks later she was in Cuba.

  "I never dreamed I'd end up here," she said. "But I was sympathetic to Cuba and always wanted to study in a Spanish-speaking country."

  Training doctors for free - even in Cuba - seems like an idea above reproach, an offer so generous that any criticism appears petty and unwarranted. The students have all pledged to return to the United States upon graduation to work in needy communities.

  But the scholarship program has become more fodder for dispute in the tangled relationship between Cuba and United States, with critics seeing it as just another attempt by Castro to thumb his nose at the giant to the north. It also has been sucked into the broader debate about whether capitalism or socialism produces better doctors and which country has a more humane society.

  Several American students said they were attracted to the program because they believe Cuba's health-care system - widely regarded as among the best in the
  developing world - creates compassionate doctors who, unlike their U.S. counterparts, view medicine as a service rather than as a commodity. Cuban physicians generally earn less than $20 a month.

  The Rev. Lucius Walker, head of the Interreligious Foundation for Community Organization, a New York-based group that recruits students for the program, said that Castro's scholarship offer wouldn't be necessary if American medical schools opened their doors wider to disadvantaged minorities.

  "Cuba didn't create the discrimination against black people (by) U.S. medical schools," Walker said. "That's a U.S. phenomenon."

  Jordan Cohen, president of the Association of American Medical Colleges, acknowledged that blacks and other minorities are under-represented in U.S. medical schools, despite programs to recruit them. Minorities comprise only 12 percent of the medical school population, according to official statistics. But Cohen worries the Cuban medical education may not be rigorous enough to prepare students for the tough examinations that all foreign med-school grads must pass before they can enter training programs and practice medicine in the United States.

  "We are very deeply concerned that these students that are recruited to Cuba may not have adequate education and background and, hence, they will be wasting their time and not fulfilling their dream," he said.

  The early numbers are not encouraging, although more recent arrivals say they are better prepared. Only two of the first eight Americans who started the program last year are still in medical school. Reflecting the discipline and rigor of all Cuban schools, the Americans live in spartan dorm rooms without hot water or toilet seats. They share a telephone and eat food - mostly bread, milk, rice, beans and pork - that while adequate is hardly sumptuous.

  Without access to junk food, one first-year student said he lost 26 pounds since arriving in August.

  The students are required to make their beds daily and their dorm rooms are inspected once a week. They wear uniforms to class and are prohibited from leaving campus during the week. They receive a monthly stipend of $4.

  "In college I lived on my own and had my own apartment. I had my own car," said Hardeman. "So to be told that I couldn't leave, that was a shocker."

  Adding to the adjustment is the U.S. economic embargo, which makes it difficult for students to keep in touch with their families. Receiving letters and packages via U.S. mail is impossible. Telephone calls, at more than $2.50 a minute, are out of reach for many students.

  Narcisco Ortiz, 27, a former resident of Newark and graduate of Drew University in New Jersey, said he has spoken to his family only six times since he arrived in August. Ortiz said he needs sweaters - Cuba in winter is colder than he expected - but has yet to figure out a way to have them shipped to Cuba.

  "It's tough," said Ortiz, a former community organizer and city government employee. "Even something as simple as sending a letter we can't do. That has a serious
  psychological effect."

  Offering scholarships to disadvantaged students is nothing new for the Castro government. Almost from the beginning of the revolution, Castro has given tens of thousands of students from Africa, Latin America and other parts of the developing world free room and board.

  The effort, along with sending thousands of Cuban doctors overseas, fits neatly into the revolution's goal of projecting a youthful image and reflects the value Cuban
  leaders place on sacrifice, education and Third World solidarity. It also scores moral points for Cuba in its ideological battle against the United States.

  "Training doctors from less developed countries creates some prestige and good will for Cuba," said Julie Feinsilver, an author who has studied the politics of the Cuban health care system.

  But Castro foes say training American medical students is a completely different matter. Why, they ask, would a poor country such as Cuba spend scarce resources on training Americans if public relations weren't the primary motive?

  "It's a lot of smoke and no fire," said Joe Garcia, executive director of the anti-Castro Cuban-American National Foundation.

  Walker, the recruiter, said between 150 and 175 individuals have applied to the program. Among the most important requirements, he said, is demonstrating a deep commitment to helping the poor, along with "drive, motivation, and desire."

  The students are to spend the first two years at the campus learning basic sciences, then finish their studies at a regional medical facility. The program, taught in Spanish, lasts six years.

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  © 2003, Chicago Tribune.