Promoting the health of marginalized populations in Ecuador through international collaboration and educational innovations.

This paper examines two innovative educational initiatives for the Ecuadorian public health workforce: a Canadian-funded Masters programme in ecosystem approaches to health that focuses on building capacity to manage environmental health risks sustainably; and the training of Ecuadorians at the Latin American School of Medicine in Cuba (known as Escuela Latinoamericana de Medicina in Spanish). We apply a typology for analysing how training programmes address the needs of marginalized populations and build capacity for addressing health determinants. We highlight some ways we can learn from such training programmes with particular regard to lessons, barriers and opportunities for their sustainability at the local, national and international levels and for pursuing similar initiatives in other countries and contexts. We conclude that educational efforts focused on the challenges of marginalization and the determinants of health require explicit attention not only to the knowledge, attitudes and skills of graduates but also on effectively engaging the health settings and systems that will reinforce the establishment and retention of capacity in low- and middle-income settings where this is most needed.

Transsexuals' Right to Health? A Cuban Case Study.

In 2008, Cuba's minister of public health signed Resolution 126, an act that assured complete coverage for Cubans seeking sexual reassignment surgeries (also known as gender confirmation surgeries), the first of any country in Latin America to do so. Ten years later, Cuba is celebrated as having one of the most open and inclusive LGBTQ public health and education programs in the Americas. As illustrated throughout this article, the Cuban state approaches sexuality and sexual identity not as rights-based issues but rather as health-based challenges. Through the case study of Cuba's understanding of transsexuals' right to health, we argue that Cuba has provided an example of how the right to health for all moves toward breaking down the barriers of stigma by improving health outcomes for those with transsexual health needs.

How Cuba's Latin American School of Medicine challenges the ethics of physician migration.

This paper demonstrates a working alternative to the accepted ethics of physician migration. A dominant cosmopolitan ethics encourages upward mobility of physicians in a globalized labour force, and this ultimately advances the position of individuals rather than improving public health-care service for vulnerable communities in the global South. Cuba's Escuela Latinoamericana de Medicina (ELAM) challenges this trend as its institutional ethics furnishes graduates with appropriate skills, knowledge and service ethics to deliver quality care in marginalized areas. This paper provides an analysis of how ELAM trains physicians in community-oriented service for marginalized areas in the global South. The principle finding of this analysis is that ELAM exhibits a working alternative to the accepted ethics of physician migration, as it encourages graduates to practice in marginalized communities rather than feed the migration pipeline into the North. Arguably, ELAM serves as an important case study in how a medical school's ethics can work to bring graduates closer to the communities that are in desperate need of their skills and of their compassion.

Going where no doctor has gone before: the role of Cuba's Latin American School of Medicine in meeting the needs of some of the world's most vulnerable populations.

OBJECTIVES: To explore the institutional ethics of Cuba's Latin American School of Medicine (ELAM). As a response to the aftermath of Hurricane Mitch in 1998, Cuba recruited over 11,000 students from marginalized communities in 29 countries to study medicine free of charge. ELAM's stated goal is for students to return to their home communities to apply their skills after a 6-year programme. The aim of this research was to determine if ELAM builds capacity for students to serve vulnerable communities in the global South. STUDY DESIGN: This paper focuses on ELAM's selection process and curriculum in order to build understanding of its institutional ethics. Much has been written about how medical schools, in the North and South alike, do a great deal to build institutional ethics where graduates seek employment in urban and wealthy centres. By exploring ELAM's training programme, this study aimed to determine if the school is capable of forming an alternative ethic where graduates seek service to vulnerable populations. METHODS: First-person interviews with students, instructors, administrators and government officials were undertaken to build a sense of ELAM's institutional ethics. In addition, a literature review of ELAM's curriculum was conducted through documents obtained via Cuba's online web-portal 'INFOMED'. RESULTS: Document analysis and first person interviews revealed themes of community oriented primary care (COPC), within ELAM's core curriculum and an institutional ethics of serving vulnerable populations in the global South. Students are taught the importance of practising prevention and health promotion at the community level, and alongside rigorous training in core clinical competency, students are to embrace COPC practices as part of their daily routines. CONCLUSIONS: ELAM is an important human resource for health capacity building projects. While the quantity of ELAM graduates is remarkable, the importance of this project is the development of an institutional ethic that values success as a graduate's ability to serve the indigent. ELAM's ability to recruit students from vulnerable communities is impressive, and the emphasis of prevention and promotion frameworks at the community level is a badly needed pedagogy for the needs of vulnerable populations in the global South.