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  1. In the countryside of western Havana, during the fall, rickety yellow buses carry first-year medical students from the Latin American School of Medicine. Wearing short-sleeved white smocks and stethoscopes, they go door to door, doing rounds, often speaking to their patients in broken Spanish. “Even people whose houses I wasn’t visiting sometimes would ask me to take their blood pressure, because they just saw me in the street,” Nimeka Phillip, an American who graduated from the school in 2015, told me. The Latin American School of Medicine, or E.L.A.M., was established by the Cuban government, in 1999, after a series of natural disasters, including Hurricane Mitch, left vulnerable populations in Central America and the Caribbean in dire need of health care. This year, in the aftermath of hurricane season, hundreds of Cuban health workers, many of them E.L.A.M. graduates, will travel to some of the hardest-hit areas of the Atlantic to treat the injured and sick. All of the students who attend E.L.A.M. are international. Many come from Asia, Africa, and the United States. The school’s mission is to recruit students from low-income and marginalized communities, where they are encouraged to return, after they graduate, to practice medicine. In the U.S., black and Latino students represent approximately six per cent of medical-school graduates each year. By contrast, nearly half of E.L.A.M.’s American graduates are black, and a third are Latino. “You would never see those numbers” in the U.S., Melissa Barber, another American E.L.A.M. graduate, told me. “You would never see those numbers” in the U.S., Melissa Barber, another American E.L.A.M. graduate, told me. Barber is a program coördinator at the Interreligious Foundation for Community Organization, in Harlem, which recruits American students for E.L.A.M. Applicants with college-level science backgrounds and the requisite G.P.A. go through an interview process with the organization. Those who make the cut are then recommended to E.L.A.M. The school accepted its first American applicants in 2001, a year after a delegation from the Congressional Black Caucus, whose leadership included Representatives Bennie Thompson and Barbara Lee, travelled to Cuba and held talks with the Ministry of Education about the need for doctors in rural black communities, and the financial obstacles that make it difficult for low-income and minority students to enroll in American medical schools. While some nations pay for their students to attend E.L.A.M., Fidel Castro decided that Americans, like Haitians and students from poor African countries, should attend for free.