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Cuba's medical internationalism is extraordinary, and in many ways the extent of its outreach programme puts the developed world to shame. It is impossible to fit Cuba's actions into any neat theoretical box—quite simply the revolutionary process follows no established paradigm. This exceptionalism is seen both in its approach to foreign relations and in its medical internationalism policy. Indeed, even during the days when it was economically dependent upon the Soviet Union, Cuban actions showed an exceptional degree of political independence. But because Cuba is so different, it is also difficult for developed nations to understand. This is a tremendous pity, for there is much to learn from Cuba's approach to developing sustainable public health systems in poor, Third World countries. There is also a great deal that, on a moral basis, wealthy nations can also learn about Cuba's policy of internationalist solidarity. [ABSTRACT FROM AUTHOR]

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 goat 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 pedasogy for the needs of vulnerable populations in the global South. [ABSTRACT FROM AUTHOR]