Health for export

Cuba, though cash-strapped, provides medical training even for students from the US

In John Lennon Park in Havana, Cubans eagerly study the inscription from the song "Imagine" at the foot of his statue: "You may say I'm a dreamer,/ But I'm not the only one." Lennon has become a cultural icon in this city of dreams. But for some Cubans, the socialist dream has turned sour over four decades of a US-imposed trade embargo and Fidel Castro's grip on power. Nobody had ever imagined a "socialist heaven" based on the hell of an economic blockade.

Such contradictions are rife in Cuban society. A housing crisis, erratic transport and queues for nearly everything echo those of many threadbare third world economies. And yet Cuba is in a class apart. It may not have gold reserves and dollars, but it is wealthy in medical and educational achievements. The island has the best health system in Latin America - the envy of less-developed nations - and despite the daily struggle of many to put food on the table, life expectancy is similar to that in the UK. Cuba is one of the few developing countries to manufacture and supply its Aids patients with antiretroviral drugs, although the shortage of more basic medicines can be so acute that patients quip: "It is easier to get a kidney transplant in Cuba than a simple aspirin."

Despite being cash-strapped, Cuba is a major aid donor to other developing countries, sending more medical missions abroad than any other country. There are currently about 4,610 Cuban health workers providing humanitarian aid in 65 countries, surpassing even the efforts of Medecins Sans Frontieres.

When Hurricane Mitch devastated Central America in October 1998, western governments responded with a short-term Band-Aid approach. But Castro declared that Cuba would provide assistance for the longer term. He argued that the countries that had been hit - Gua-temala, Honduras, Haiti and Nicaragua - must have their own doctors. A former naval college in Havana was renovated and converted into the new Latin American Medical School. The school's 7,000 foreign students take special courses in coping with epidemics, emergencies and natural disasters.

The offer of six years' free medical training has even been extended to would-be doctors from the richest nation on earth. More than 50 US students are now studying medicine in a country that figures in Bush's "axis of evil" - a great embarrassment for the world's superpower. As long as these students are hosted by Cuba and don't spend any money in the country, the US Treasury is unable to prosecute them under the Trading With the Enemy Act, the legislation still used to punish American tourists who defy Washington's blockade.

Most US students are African Americans, such as 26-year-old Cordy Brown from Mississippi, who would have had very little chance of ever gaining admission to a medical school back home. Wing Wu, a Chinese-American from Minnesota now in her third year, explained: "US minorities are getting smaller and smaller representation in US medical schools; there's no way I could afford medical school in the US." Mississippi is one of the many poor parts of the US where few doctors want to work, and these students have come to Cuba with the intention of going back and serving in their local communities.

Can Cuba really afford to provide such generous aid, especially to the US? Dr Luis Cordoba Vargas, a former deputy health minister, explained: "I don't think Cuba can afford to do it; it is a political gesture based on altruism. Many western countries take medical graduates from the third world to prop up their own health systems; we have taken the lead in Latin America to provide these countries with more doctors."

Leonardo Mauricio, a Cuban teacher, stoutly defended the policy: "Solidarity does not mean much from a rich country; real solidarity comes from sharing the little you have with those who have even less." This solidarity is certainly reflected in the school's campus. Home to 24 different nationalities, it is a remarkable experiment, not just in medical education, but also in international living.

US doctors and medical students accept that there are major differences between a Cuban medical education and their curriculum at home. Dr Michael Garvey, on a US delegation visiting Havana, characterised the Cuban approach as "a no-thrills education living in dormitories, but with excellent teachers focused on the holistic needs of the patient and a strong orientation to preventive medicine. American medical schools are too focused on high-tech diagnostics at the expense of the doctor-patient relationship."

The distinction between Cuban and American training is clear to Wing Wu: "Here we learn that healthcare is a human right and that patients have to be treated as human beings." In the US, access to healthcare is not a human right: 43 million citizens have no health insurance and deprived communities have few doctors.

While Cuba's prestige in Latin America has never been higher, thanks to its general generosity and specific initiatives such as the medical school, the country's relations with the EU have plummeted since it cracked down on 75 dissidents and executed three hijackers earlier this year. The EU jumped into line with the US and imposed its own brand of discriminatory sanctions against Cuba, including downgrading ministerial relations and cutting off funding for cultural links.

But as it grows ever clearer that globalisation and free markets cause declining public health in the developing world, the EU should consider backing Cuba's dream to "globalise free healthcare and solidarity", and put people's lives before pleasing the US.