Eight Americans have graduated from a Cuban medical school after six years of studies fully funded by Fidel Castro's government.
They plan to return home, take board exams for licenses to practice and provide cheap health care in poor neighbourhoods.
"Cuba offered us full scholarships to study medicine here. In exchange, we commit ourselves to go back to our communities to provide health care to underserved people," says Carmen Landau, 30, of Oakland, California.
The programme is part of Castro's pet project to send thousands of Cuban doctors abroad to tend to the poor in developing countries, such as Venezuela and Bolivia, and train tens of thousand of medical students from developing countries in Cuba.
Officials in Cuba's communist government relish the idea of training doctors for the United States, its arch-enemy since Castro took power in a leftist revolution in 1959.
The ailing Cuban leader, 80, did not attend the graduation for 850 students from 25 countries at Havana's Karl Marx theatre.
He has not appeared in public since intestinal surgery forced him to hand over power to his brother Raul Castro a year ago.
There are 88 Americans studying medicine in Cuba. The first to graduate two years ago was Cedric Edwards, who is now working at Montefiore Hospital in New York City's Bronx borough.
The US students praised Cuba's universal, free health-care system, which is community based and focuses on preventing illness before it becomes more serious and costly, in contrast to the US health industry indicted for being profit-based in Michael Moore's recent film Sicko.
"We have studied medicine with a humanitarian approach," said Kenya Bingham, 29, of Alameda, California.
"Health care is not seen as a business in Cuba. When you are sick, they are not going to try to charge you or turn you away if you don't have insurance," she said.
The main difference in studying in Cuba was that there was no charge and the graduates can begin their practice debt-free, said Jose De Leon, 27, from Oakland.
"When medical doctors graduate in the United States they are usually in debt, between $US250,000 to $US500,000, ($NZ310,000 to $NZ620,000) and spend the first 10 years of their careers paying it off," he said.
