October 2016, Vol. 8, No. 2  AJHPE         129

ResearchShort communication

Context and setting
Cuban medical internationalism[1] is a strategy aimed at providing medical 
personnel to under-resourced countries. To address the severe shortage 
of medical doctors in rural South Africa (SA), our government forged an 
intergovernmental agreement to train rural and disadvantaged students at 
tertiary Cuban medical facilities. The collaboration students spend a year 
studying Spanish, and then receive an additional 4 years of medical training 
before returning to SA to complete their 5th and final academic years. They 
graduate from a local medical school with a view to practise in rural and 
underserved areas of SA. This report summarises a study that explored the 
success of the collaboration strategy at a local medical school. 

Why the idea was necessary
Despite the implementation of a learner support programme, general 
observations indicate that approximately two-thirds of each returning class 
(averaging 10 - 13 students) are unable to complete their training within 
the dedicated 18 months after returning to SA. Generally, the students have 
difficulty integrating and applying their knowledge and skills on the SA 
clinical platform; they struggle to translate their knowledge into English; 
and they have had insufficient exposure to common SA diseases. 

What was done? 
To strengthen and support the collaboration students, this quantitative study 
used questionnaires and interviews to investigate the curricular experience 
and teaching exposures in clinical skills of the collaboration students before 
their return to SA. All the students were invited and participated (N=11). 
Institutional ethical approval was obtained. 

Results and impact
Findings revealed that the Cuban curriculum emphasises primary healthcare 
and training in clinical settings, which focus predominantly on preventive 
care. The healthcare philosophy also considers the disease profiles prevalent 
in the Cuban setting, thus leaving students inadequately prepared for 

clinical practice in SA. The majority of students displayed gaps in their 
knowledge and an inadequate performance of clinical skills.[2] The students 
found it difficult to translate the concepts learnt in Spanish into English 
medical terminology, and they reported inadequate knowledge of infectious 
diseases, specifically HIV/AIDS and tuberculosis. 

Knowledge and understanding of the context of healthcare delivery, 
including population characteristics and disease profiles, impact on curri-
cular decisions. Treating and managing infectious diseases that are prevalent 
in SA require consideration and communication between participating 
institutions to ensure adequate exposure and training for practice in SA 
conditions.

SA institutions are socially accountable to train doctors appropriately 
to respond to the needs of local communities. It is therefore important to 
support the academic needs and requirements of the collaboration students 
to ensure their successful education and training. This study identified areas 
where students lacked knowledge and skills, which informed the design and 
content of the support programme offered at our institution. 

Conclusion 
The study has highlighted the need to compare educational exposures and 
clinical experiences of students at our institution with those of the collaboration 
students to inform the details required in the support programme. Cuban 
medical internationalism may benefit countries with a similar language, 
patient profile and health contexts. This strategy, however, has limitations in 
SA, as it requires schools to allocate additional human and financial resources 
to support the collaboration students’ adaptation to the local context.

References
1. Huish R, Kirk JM. Cuban medical internationalism and the development of the Latin American School of 

Medicine. Latin Am Perspect 2007;34(6):77-92. DOI:10.1177/0094582X07308119
2. Motala M, van Wyk J. South African-Cuban medical collaboration: Students’ perceptions of training and 

perceived competence in clinical skills at a South African institution. S Afr Fam Pract 2016;1(1):1-6. 
DOI:10.1080/20786190.2015.1120936

Afr J Health Professions Educ 2016;8(2):129. DOI:10.7196/AJHPE.2016.v8i2.641

Cuban medical collaborations: Contextual and clinical challenges 
M Motala, MB ChB, MMedSci; J M van Wyk, BSc (Ed), BEd, MEd, PhD

Department of Clinical and Professional Practice, Nelson Mandela School of Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa 

Corresponding author: J M van Wyk (vanwykj2@ukzn.ac.za)

This open-access article is distributed under 
Creative Commons licence CC-BY-NC 4.0.

http://dx.doi.org/10.1177/0094582X07308119 
http://dx.doi.org/10.1080/20786190.2015.1120936