A Crackdown in the Caribbean

By Philip Elmer-DeWitt

Why medical schools are becoming outcasts of the islands

They are situated above grocery stores, in prefab buildings, near noisy bars and open sewers and on the grounds of abandoned convents. Goats and chickens come with the terrain, as do water shortages, blackouts and the occasional political coup. Many lack facilities normally considered standard: research libraries, X-ray machines, fresh cadavers. But for about 15,000 U.S. students desperate to become doctors, the makeshift medical schools that dot the Caribbean represent a last chance. Failure to get into graduate schools in the U.S. once meant flying off to universities in Mexico, Italy or the Philippines. Lately, students have been turning to the Caribbean, where in the past half-dozen years 16 profit-making educational enterprises have flourished on the islands of Montserrat, Antigua, St. Lucia, Dominica, Barbados, St. Vincent, Grenada and the Dominican Republic.

But there is trouble in paradise. Many of the island schools are coming under increasing criticism from U.S. medical authorities for providing inadequate training. Some are suspected of trafficking in phony transcripts. And a number of the medical examinations administered to Caribbean students have been tainted by widespread cheating. Last summer, 9,000 foreign-trained students had to retake tests that allow them to practice in the U.S. because nearly half had seen the questions beforehand. Then in December, U.S. investigators cracked a ring of American and Dominican officials selling bogus diplomas (up to $27,000 for an M.D.). The trail led to two of the Dominican Republic's most successful universities. Last month the schools were closed, their administrators jailed and all student transcripts seized. The action stranded about 900 U.S. students, some of whom were to graduate this year. Cried one American, less than a month from earning her degree: "My life is locked up in there!"

In addition, New York, California and, last week, Florida have imposed strict new requirements on hospitals that accept students from offshore schools. These actions have stirred an emotional debate over how many doctors the country needs and how they are to be trained. Defenders of the offshore schools argue that increasing the supply of physicians will lower medical costs and help deliver health care underserved: slums, rural areas and state psychiatric hospitals. Critics point out that there is already a doctor glut in many parts of the country and that too often the offshore schools provide second-rate training for third-rate candidates, half of whom fail the U.S. medical qualifying exams each year. "It's a disgrace," says Dr. Vincent Larkin at Brooklyn's Methodist Hospital. "A substantial number don't belong in medical school and will never be able to practice medicine."

A visit to several Caribbean schools offers little that would contradict the arguments of critics. Most operate on shoe string budgets and breakneck schedules, cramming a semester's work into four or five weeks. The aptly named Spartan Health Sciences University on St. Lucia has only two full-time professors. The physiology and biochemistry departments occupy one room, separated from the hallway by a beaded rope curtain. The microbiology laboratory consists of a few rough wooden tables. Students are advised to bring their own microscopes.

The Spartan school looks luxurious compared with the St. Lucia School of Medicine, opened with great fanfare last September by Edward Antar, owner of a New York discount electronics chain called Crazy Eddie's. "They had nothing," says Cornelius Lubin, an official in St. Lucia's Ministry of Health. "No labs, no cadavers." The school quietly closed in March. Closed less quietly was the Centre de Investigacion y Formacion Social. CIFAS was one of two Dominican medical schools shut down in May as part of the local government's effort to clear the rep utation of its university system. Only last April, Rector Quisqueya Rivas Jerez was still insisting that "this is no diploma factory." She has since been arrested and accused of falsifying documents.

Americans are willing to endure much in the hope of becoming physicians. Jeanne O'Connor of Staten Island, N.Y., remembers the day she landed at her school on Montserrat: "Mosquitoes were biting me from all sides. When I got to my dorm there was a tarantula in the closet and a lizard in the bathtub. I sat on my bed and cried." Overcoming these and even greater obstacles, many students attending the better Caribbean schools do manage to emerge with adequate medical educations. Nearly 80% of the students at St. George's University School of Medicine on Grenada passed their qualifying exams last year. The key to their success is the arrangement St. George's has maintained with hospitals across the U.S., by which students spend the last two years of medical school working in wards and gaining practical experience with patients.

Indeed, many hospitals welcome the Caribbean imports. "Our patients are very happy," says Dr. Larkin of Methodist, an inner-city hospital that has trouble attrac ing U.S. medical students and accepts about 20 offshore transfers every year. Says a nurse from nearby Coney Island Hospital: "The Caribbean students are more humble. The attitude of mainland students is to let others do the dirty work."

--By Philip Elmer-DeWitt. Reported by Marilyn Alva/ St. Lucia and Bernard Diederich/ Santo Domingo

With reporting by Marilyn Alva, Bernard Diederich