The first time I saw an ELAM graduation, or more exactly ELAM graduates, I cried. This had something to do with the fact that I'd had just 2 or 3 hours of sleep the night before but much more because this was the medical education of my dreams and I had missed it. I'm not complaining about my medical education which was excellent and occurred back when University of California medical schools didn't cost much to attend. Medical school is a process more than a place and many who start are starry-eyed idealists who want to serve and help people. By graduation, and certainly by the end of internship, the bloom is off the grape. The eyes are set in strained hyper-alertness, trying to stay awake, feeling deeply fatigued, exploited, entitled... Payback time. The education has focused on fact, which is necessary and may not be sufficient. Idealism is not nourished although it would be tolerated if a student or house officer managed to maintain it. But everyone sounds enthusiastic at graduation, so how can one know that these ELAM students have really been trained to "serve the people?" (that phrase which still has meaning for me even after decades of Maoist use and abuse)
Because they do. ELAM is free: room board, books, lab, tuition. What is asked in return is that students return to their countries and practice medicine serving a poor and under-served group of patients. There is no enforcement mechanism; none is even possible. Yet over 90% of the students do this. They go to poor and rural areas and care for patients who would not otherwise have a doctor and who cannot pay much. They have learned to do this in medical school. They have given up a lot for the opportunity to serve - a six year program spent in a dorm situation far from friends and family and familiar surroundings and comfort. Certainly there is support, some of it institutional, much of it mutual and cooperative aid among students. For many students it is in a new language too, which doesn't make reading and comprehension any easier.
After graduation, when the new ELAM trained doctors return home, instead of joining the elite which is where most doctors are located in most societies they dedicate, not just a few years, but their careers to poor people's medicine. It doesn't just happen. This is exactly what they learned in school.
