Dr. Graham Sowa knows some people might see him as a communist or even a spy.
After all, he chose to attend medical school in Cuba, worked for a time in the island’s health-care system, and now tells anyone who will listen about the quality of his education there.
But Sowa — now a resident in internal medicine at Brandon Regional Hospital — sees his moves as nothing more than fiscal responsibility.
Like other international students, he paid no tuition while attending Havana’s Latin American School of Medicine. So while colleagues face debts reaching into the hundreds of thousands of dollars, Sowa doesn’t owe a cent.
Cuban doctors made headlines in recent weeks when the Trump administration’s foreign aid agency offered to pay organizations for investigating whether Cuba commits human rights violations by sending doctors overseas and pocketing their pay.
As an American, Sowa did not participate in the program. But he has friends who did.
And he dismisses the premise behind the offer from the U.S. Agency for International Development.
“That’s total bull," said Sowa, 33.
More than 38,000 Cuban health workers, nearly half of them doctors, are working in 66 countries that pay the Cuban government for the service, said Cuba Archive director Maria Werlau, whose Washington, D.C., nonprofit works to promote human rights for Cubans.
“These expert services generate Cuba $7.7 billion,” Werlau said.
The Cuban government says the doctors it sends overseas serve people in poor areas where medical professionals are in short supply.
“Cuba says they want to provide humanity with medical care,” Sowa said. “It is their commitment toward international solidarity.”
To boost that claim, the Latin American School of Medicine was founded in 1999 to provide tuition-free medical training to citizens from around the world, its website says.
Graduates from other countries can forge careers independent of the socialist nation and its health-care system.
In exchange for free tuition, they must promise to provide medical care to their own nation’s underserved communities. But the promise is made on the honor system; there are no enforcement mechanisms.
The United States is not among the 66 countries that pay Cuba for doctors. But in 2000, the United States and Cuba did agree to allow low-income Americans to attend the Latin American School of Medicine.
Since then, almost 200 U.S. citizens have graduated from the school and around 90 are attending the school now, according to Oakland-based MEDDIC, a nonprofit that promotes cooperation in health care between Cuba and the United States.
Sowa, a native of Grapevine, Texas, who received a bachelor’s in anthropology from the University of North Texas, came across the Cuba option while applying to medical schools during the recession and wondering how he would pay for his education.
Sowa said that the way he sees it, he is fulfilling his pledge to assist the underserved by working at Brandon Regional Hospital, where patients include people without insurance and where many go for their primary health care.
Sowa spent two years taking classes on a Havana campus that was once a Cold War-era military base. Students there come from some 100 different countries.
Cubans attend separate medical schools.
Afterward, Sowa served a four-year general medicine rotation at a Cuban hospital, working alongside the island’s medical professionals.
What he missed most living in Cuba was air conditioning and the variety of foods he had become used to.
“But you learn there is no need for 12 different types of ketchup,” he said.
Stories about deprivation in Cuban heath care, like patients having to provide their own sheets, can be true, he said.
"It depends on the level of care. At the one I worked in, you had to bring bed sheets to the general medicine ward. If you moved up to intensive care, you had air-conditioned rooms.”
Bathrooms can be “third world,” he said. Fifty patients might share three toilets.
Still, he said, doctors have fewer patients and spend more time with each of them than in the United States.
“Cubans told me, ‘At least there are doctors to tend to us, and that is what matters.’"
Cuban colleagues spoke to him honestly about their government, Sowa said, openly criticizing some of the ways it works.
“Everyone I knew had no reason to lie to me."
Many told him they wanted to serve overseas, he said.
Sowa knew Cuban doctors working in Havana who were paid around $50 a month. Some who worked as doctors in overseas missions made thousands of dollars per month.
“Everyone I knew would come back, spend six months at home and then go do another,” Sowa said.
Still, calling the missions a form of human trafficking, the United States has placed sanctions on those Cuban officials in charge of the system.
Werlau with Cuba Archives refers to the medical missions as a “form of modern slavery." She said doctors’ get just 20 to 25 percent of their salaries and the Cuban government pockets the rest.
For this reason, Brazil’s conservative president Jair Bolsonaro ended his country’s medical partnership with Cuba in 2018. Doctors who defect from the socialist nation have called the system repressive.
What’s more, doctors are paid only a portion of their take-home salary until they return home. If a doctor defects, Cuba keeps the money.
“It is to prevent capital flight,” Sowa said. “Could it be a better relationship? Yeah, it probably could be. But at the end of the day they signed a contract."
What angers critics about the system, Sowa said, is that the earnings support socialism.
That’s why the U.S. Agency for International Development is offering $3 million to organizations willing to “investigate, collect, and analyze information related to human rights violations – including forced labor – of Cuban medical personnel exported overseas.”
In a recent announcement, the agency says the Cuban program is designed to prop up a failing economy with foreign dollars “while Cubans on the island struggle to find adequate healthcare.”
Sowa met his wife Maylin Zaldívar in Havana.
They chose to make Tampa their home because its Cuban culture made her transition easier. They might one day return to Cuba or move to a country in need of doctors.
The Latin American School of Medicine, Sowa said, provided “an environment where I was around people not just from U.S. social backgrounds but a lot of other countries.
"That was important because the notion of practicing medicine outside the United States is important to me.”