BY CHRISTOPHER MARQUIS
 Herald Washington Bureau

 HAVANA -- After relying for decades on guerrillas and guns to export his Marxist
 model, Cuban President Fidel Castro has found another tool: ``doctor diplomacy.''

 The Castro regime, which claims high quality health care as a pillar of the
 41-year-old Cuban Revolution, has long sent its doctors abroad, welcomed health
 ``tourists'' to the island and developed drugs to attack some of the most stubborn
 blights of the developing world.

 Now, even though the country's medical system is so hard-pressed that patients
 must show up for surgery with their own sheets and soap, Castro has opened a
 medical school exclusively for students from across Latin America. Free of
 charge, Havana plans to train thousands of new doctors from neglected,
 impoverished populations of the region.

 In a white-washed former naval academy by the sea, the gleaming school has
 provided Castro with a needed burst of goodwill from his Latin and Caribbean
 neighbors. At the Ibero-American summit in Havana last November, Latin leaders
 who strongly criticized Castro's human rights record were dazzled by the school
 and clamored for more spaces for their students.

 Castro obliged, expanding plans to teach as many as 7,500 Latin American
 medical students over five years, 10 times the original number, school officials
 said. In so doing, the Cuban leader may hope to inoculate himself from further
 regional attacks and play the humanitarian in a part of the world where
 Washington has slashed economic aid in recent years.

 Officials deny that the school has a political purpose, even though it siphons off
 resources from a struggling health system that has long waiting lists for elective
 surgery, shortages of basic medicines, and outmoded and broken equipment.

 ``We don't teach politics, just medicine,'' said Nancy Nuñez, director of the
 school's foreign affairs department. But she added: ``We hope they come out of
 this course with the same human sensibility as the Cubans who spend time in
 other countries. We hope they don't see medicine as merchandise, but as
 humanitarian.''

 HIGH RATIO

 With one doctor for every 170 Cubans -- one of the highest ratios in the world --
 the country has exported its medical talent for decades, usually in the service of
 Socialist ``solidarity'' with nations such as Nicaragua under Sandinista rule during
 the 1980s.

 But after Hurricane Mitch in 1998 wiped out entire towns in Central America, Cuba
 deployed medical brigades across the region. Cuban doctors now work for free in
 some of the region's most remote hamlets, some of which have never had regular
 medical attention. Cuba has more than a thousand doctors in Guatemala,
 Nicaragua, Belize, Honduras and Haiti.

 The Latin American School of Medical Sciences opened last year, after 18 Latin
 American governments selected and sent 1,929 of their most promising students
 -- evenly divided between men and women -- from mostly rural, disadvantaged
 backgrounds.

 Most came from Central America, which has been tormented in recent decades
 by ideological proxy wars fueled by the United States on one side and the Soviet
 Union and Cuba on the other. Nicaragua sent 325 students, Honduras sent 279
 and Guatemala 252. Even El Salvador, a nation that doesn't have diplomatic
 relations with Cuba, sent students.

 FROM BOLIVIA

 Sandra Mercado, 25, with dimples and a white coat, came from Cochabamba,
 Bolivia. Books that would have been out of reach at $300 are given to her free.
 She gets up at 4 a.m. to study. She misses her family and her native food. But,
 sounding like the doctor she hopes to become, she adds: ``The organism adapts
 to everything.''

 Students live at the school, which has a theater, dormitories, 28 teaching
 laboratories and a post office. They get uniforms, food and a small stipend for
 expenses on weekends. They will remain there for 2 1/2 years, then be integrated
 into the Cuban system for the rest of their medical education.

 School officials say they don't know yet how much all this is costing the
 cash-strapped Cuban government. No one has even calculated teachers' salaries,
 materials and school upkeep, even though costs elsewhere are curbing basic
 medical services.

 The largest hospital in Cardenas, a city of 150,000 in the Matanzas province, for
 example, closed its operating room to all but emergency surgery for a year
 because it did not have the proper equipment to provide general anesthesia,
 doctors there said. It suffers shortages of everything from antibiotics to medication
 for ulcers and asthma, syringes, X-ray equipment, even sterile water. More than
 200 patients await operations, the doctors said.

 Cuban doctors, moreover, earn as little as a dollar a day, and many are forced to
 moonlight by selling trinkets or homemade rum to make ends meet.

 IMPRESSIVE RECORD

 Yet, on paper, Cuba's health record remains impressive, with infant mortality rates
 that rival those of the United States. It has eradicated diseases such as malaria
 that continue to plague the region.

 Indeed, Cuba's reputation for capable doctors, experimental treatments and
 personal therapy draws people from around the world. Dubbed ``health tourists,''
 these patients -- some of them desperate for cures -- shell out dollars to stay in
 clinics designed for foreigners or on designated floors of general hospitals.

 One of the most prominent health tourists in Cuba today is Diego Maradona, the
 legendary Argentine soccer player, who is being treated for cocaine addiction.
 Maradona, an idol of many Latin American children, checked himself in after
 expressing admiration for the Cuban Revolution.

 With so much medical talent, Cuba turned to its doctors and researchers for cash
 when its economy crashed after the Soviet Union withdrew its support a decade
 ago. Cuba pumped more than $1 billion into developing new medicines using
 biotechnology, and charted some successes. They include the use of interferon
 to combat hemorrhagic dengue and a therapeutic vaccine for certain cancers. Its
 meningitis B vaccine is so promising that SmithKline Beecham, which is partly
 based in the United States, obtained approval from the Clinton administration to
 test the drug, despite a U.S. ban on trade with Cuba.
 

                     Copyright 2000 Miami Herald