Going where no doctor has gone before: The place of Cuba's Latin American School of Medicine in building health care capacity for Ecuador.

Martin Luther King said that “of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Today, despite the overwhelming quantity of attention and resources given towards global health, social inequity has never been worse as many in the global South remain perilously marginalized from the receipt of sustainable primary-care services. Amidst this backdrop Cuba developed the Latin American School of Medicine (ELAM) as a response to the global South’s lagging supply of human resources for health. The school has received 11,500 students from 29 different countries, including the United States. Every student receives a free, six-year medical education as part of a moral commitment to practice their skills in areas where they are most needed. This dissertation explores how ELAM is building capacity to meet the needs of communities in Ecuador, a country that has endured structural adjustments to its public health sectors. It is about sharing the lived experience of certain ELAM graduates to understand if they are able to reduce health-care inequity in their communities despite personal and structural challenges. This is best understood in how graduates practice community-oriented primary care (COPC) within their communities. This study finds that ELAM’s institutional ethics are counter hegemonic to dominant neoliberal tendencies in health-care service provision, but that only with appropriate social and political support will the ethics and skills of these graduates scale up into positive changes in community health. The study conceptualizes ELAM as an alternative-development project grounded in a tradition of Cuban medical internationalism. It offers insight into the program of study, discusses the nature of public health care in Ecuador, and then explores the professional experiences of several Ecuadorian ELAM graduates. This dissertation serves as a preliminary step in understanding how ELAM impacts the accessibility of vulnerable populations to health-care services in Ecuador. It demonstrates the strengths and challenges of ELAM graduates in seeking to strengthen human resources for health. The ELAM story shows how investing in people can work towards overcoming neoliberal health-care hegemony, which has done a great deal to promote health-care inequality rather than ensure social equity.