Private Practice is ok, Practical Medical College is not!
Posted on September 19th, 2011
Shenali Waduge
The first fee levying medical school was opened in the 1980s. It was called the North Colombo Medical College. Not surprisingly, there were plenty of protests against its implementation. Now twenty years on protests have arisen against the gazette notification on 2nd September giving the right for South Asian Institute of Technology & Management (SAITM) to award medical degrees in Sri Lanka. We are used to protests by pro-JVP student unions but when GMOA & Sri Lanka Medical Council objects to the opening of private medical colleges when they themselves are involved in private practice, as citizens we need to find out on what grounds they are protesting & why?
Lets face facts. The State universities are unable to absorb all those who are eligible for university admission. When over 120,000 qualify to enter state universities only 20,000 are actually admitted. Most students with 3As cannot qualify because of the quota system. In 2006/7 only 1111 students were admitted to 1 of 7 state medical faculties (in Colombo, Peradeniya, Sri Jayawardenapura, Kelaniya, Jaffna, Ruhuna, Rajarata addition of Batticoloa makes 8 medical faculties).
Statistics are clear, 85% of students who qualify for university education are unable to gain admission because there are no seats. Only a handful of this number can afford to gain further education abroad. What about the fundamental rights to education of the others who qualify? Of those who obtained state sponsored medical education, how many are actually serving the nation? How many of this number are actually serving another nation?
So what are the reasons not to have a private medical college?
Those opposing are raising different issues as excuses to protest against forming private medical colleges in Sri Lanka. One such excuse is that the state faculties would loose lecturers who would be attracted by higher salaries. So what do the state university academic faculty actually enjoy they are given 3-4years paid leave to obtain post-graduate qualifications, they get vacation leave, conference leave, sabbatical leave with passage for spouses, they get research grants. Doctors in medical faculties are even engaged in private practice. So it is not that state academics are in want of privileges! Moreover, as a fee-levying entity academics are required to uphold the highest teaching skills & students & parents will not hesitate to point out inadequacies in teaching or facilities since they are paying for such! It is ok for doctors in state practice to run off to make money in private practice but it is not ok for teachers to teach in these private medical colleges?
For those who are unaware the former objections to the North Colombo Medical College (NCMC) in Ragama was primarily because the awarding degree was to be through the Colombo Medical Faculty. The protests eventually resulted in the NCMC being taken over by the state & being affiliated to Kelaniya University.
Today the alumni of NCMC are all specialists & university lecturers teaching the current state medical students!
What is the GMOA arguing against
As professionals & intellectuals it should have been the GMOA to pressurize the GOSL into ensuring that the country does not loose out foreign exchange as a result of close to 1000 students pursuing foreign MBBS programs.
Rs11,000million rupees is lost for students traveling overseas for studies.
Students going overseas for medical degrees must pay course fees that vary from Rs.2.5m to Rs.30m excluding costs of food, accommodation & other living costs. Recently, there was news of Sri Lankan students stranded in the UK as a result of their parents falling prey to bogus consultants arranging degree programs in foreign universities.
It is not a question revolving around the monetary status of the families who send these students. Any parent craves to give the best of education to their children & when a child desires to become a doctor any parent irrespective of their financial ability would somehow explore ways & means to provide that opening.
The 2nd September gazette notification recognizes the private medical college & allows it to award Bachelor of Medicine & Bachelor of Surgery degrees (MBBS).
The GMOA Government Medical Officers Association are opposing this move.
Their argument is that the Medical Council or the Ministry of Health were not consulted before giving the institute the right to award medical degrees.
Quality has been an aspect of the argument used by the GMOA against students of the Malabe private medical college. They seem to forget that from those that go overseas to follow foreign MBBS programs & return to sit the ACT exam hardly 10% pass while the majority have not even touched a patient during their studies abroad. GMOA has forgotten to raise this issue however, partly because their own children have pursued foreign MBBS programs.
If a private medical college functions under guidelines given by the State authorities, if it is inspected & benchmarked for standards & its academic staff are monitored where lies the problem?
How many of these present doctors will volunteer to go & serve in rural hospitals? How many of these doctors presently protesting engage in private practice? Do they not run to attend to patients that channel them making Rs.1000minimum a patient & many often end up seeing over 40 patients a day making Rs.40,000 a day tax-free from private practice having studied free from public funds?
If the GMOA is objecting simply before it is aggrieved because it was not consulted that makes for a very shallow argument. While the GMOA has admitted that there are a shortage of doctors in Sri Lanka, as public citizens that look up to treatment by doctors I believe most of us are in agreement that we are very disappointed in the treatment given.
How many of us have nightmare experiences of lapses in treatment by the doctors serving in Sri Lanka, whether they are in private service or not?
So GMOA please donƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢t quote medical standards to us.
The Sri Lanka Medical Council recognizes 332 medical schools in 44 countries including universities in Afghanistan, Ethiopia, Nigeria & Papua New Guinea where standards are very low. Did the GMOA not think of the standards of these universities or their degrees?
Our education system
Lets look at our education in a snapshot. There are 9765 schools with
187,337 teachers for 4.2million students. Teachers obtain training in one of 17 national colleges of education, 9 teachers colleges for teacher training, 100 teacher centers for continuing teacher education & 4 faculties of education in universities. In 2009, 199,000 students sat for the advanced level examination &126,000 students qualified to enter university. Only 20,000 that is 17% of those who qualified were able to gain admission to State university. Most students sitting for the exam from main cities scoring 3As in science subjects are unable to enter due to the quota system.
It is the same for engineering & management subjects as well.
Quality of Sri LankaƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢s education
Lets be a little realistic. Despite students of the main cities including Colombo that score very high marks at the Advanced Level examination are unable to enter university because they do not meet the quota score. A student from a distant area with lower marks is more likely to get admission to universities in Sri Lanka which include the state medical faculty. While this quota system was derived mainly considering the fact that schools/teaching staff are not to the level of those in main city schools & infrastructure & facilities are also limited we know that in reality most of these students follow tuition classes in these main cities alongside the students of these main cities & tuition teachers go to these distant cities to teach them. Therefore, there is really no major difference in teaching or delivery or even infrastructure. Parents whether poor or rich ensure their children are somehow given the best of education. Thus, as a result of the quota system the undeniable fact is that it is not the highest mark holders that actually gain admission to university.
What are the students protesting against?
It is the right of every citizen to protest or object. We are well accustomed to JVP-led protests over the years. But some arguments being used need to be seriously looked at.
How can a fee-levying medical training program be a threat to free education?
How can such a fee-levying institute deprive the rights of the average student?
The quota given to the state medical college will remain the same? Private medical colleges are only targeting the qualified numbers who have not been able to gain admission to state universities & ironically these students have actually scored more marks than those who have been admitted.
Protests cannot stop privileges that the rich enjoy & it is wrong for the less affluent to despise children born rich. It is no oneƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢s fault that people are born into different incomes & it is upto individuals to change that status quo. That is not going to happen if they are going to be finding fault with those born privileged.
Similarly, It is the right of every child to obtain education. Sri Lanka belongs to a handful of countries that continue to provide ƒÆ’‚¢ƒ¢-¡‚¬ƒ…-free educationƒÆ’‚¢ƒ¢-¡‚¬ƒ”š‚ upto tertiary-level despite its colossal cost to the Government.
Free education means that whilst students study free it is the tax-paying public that enables this free education. It is prudent to note that while Sri LankaƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢s education system was looked up with respect decades ago that respect & appeal is now lost & the blame for that rests on the shoulders of the authorities, the lecturers, the students & mostly the unions.
We need to remember that the majority of students cannot obtain their medical degrees not because they are not qualified but because there is limited vacancies in the State medical college.
The Malabe private medical college
It is undeniable that Sri LankaƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢s 7 state medical colleges are insufficient to cater to our populace when less than 1200 students are admitted to learn medicine. There is no argument that we cannot rely on state medical faculties to increase to meet the countryƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢s requirement.
The effort by former MP Dr. Neville Fernando is a laudable one. The venture began from the sale of the Central at the request of the previous Sri Lanka Medical Council President Dr. H. H. R. Samarasinghe & former Higher Education minister Prof. Visva Warnapala in 2009 with BOI approval, having met criteria of the University Grants Commission. The proposed site (covering 17, 000 square feet in extent) is located in Malabe as the GMOA & SLMC were against clinicals being conducted in private hospitals and even went further to object to clinicals being conducted in Homagama & Avissawella hospitals though an MOU was signed with the former Health Minister. Thus the 7acre land set up to be the new teaching hospital alongside the main campus. The 1000 bed teaching hospital is to be opened by March 2012 & will be the largest private hospital. Presently the 1st batches are continuing their clinicals at Lanka Hospitals & Hemas Hospital Wattala.
The Malabe campus will be a Green campus by 2012.
The gazette notification recognizing the SAITM specifically says that clinical training is required to be conducted by the faculty in its own hospital or in agreement with other teaching hospitals with the setting up of professional units & adequate human resources. Moreover, the gazette also stipulates that loans have to be obtained by a state bank for both infrastructure facilities & hospital.
The proposed faculties would include in addition to medicine, languages, IT, business management, graphics & engineering. The present staff number 100.
The Vice Chancellor Prof. Malkanthi Chandrasekera has taken 2 years sabbatical leave from the Peradeniya Medical Faculty continues to teach anatomy & genetics at the Peradeniya faculty during the weekends.
The SAITM (Malabe medical college) is affiliated to Nizhny Novgorod State Medical Academy (founded in 1920) of the Russian Federation which has Russian parliament approval. The English medium education was introduced in
1998 and at present the university accommodates over 4500 students of which over 600 students are from 31 countries. 22% of student fees will be paid as royalty to Nizny medical university. 20% lecturers will be from the Nizny medical university. Students will be required to complete the course in both English & Russian as the final 2 years of study will be in Russia. The Malabe campus will take two batches each year in February & September for medical degrees (4 batches in totally annually). The private medical college also proposes to give 20% free scholarship to financially weak students with high Z scores.
The South Asian Institute of Technology & Medicine University (SAITM) only admits students who have passed Advanced Level science stream. The minimum qualification is 2 credits & 2 simple pass. The 5 year course fee is around Rs.6.4m.
302 medical students including 48 foreign students are currently studying medicine at the Malabe private medical college taught by a medical faculty of 60 inclusive of 13 Russian professors. There is also an Engineering faculty with 220 students & an IT faculty with nearly 100 students all offering foreign degrees.
Way forward
These protests are totally irrelevant. GMOA protests cannot stop or block students obtaining private medical education. Instead they should be thinking of ways & means to provide better service delivery to the public.
Hundreds of Sri Lankan students are presently overseas paying to obtain medical degrees & are they not doctors! Is GMOA comfortable with the standards of these foreign medical institutes & how are the GMOA able to remotely ascertain the standard of these degrees? Isnt it easier to maintain the standards in SAITM from Sri Lanka?
GMOA has a significant representation in the Sri Lanka Medical Council the body tasked with maintaining the standards of medical education in Sri Lanka so the GMOA is perfectly placed to ensure that all private medical colleges must keep to their standards.
Education must never become a business. It is a service for which fleecing cannot be part & parcel of the profits.
The public is behind the Minister on the current stand being taken to include private medical colleges as it is likely to fill the void. What the GMOA & SLMC should be concentrating on in ensuring that any shortcomings in these private medical institutes meet the state standards & criteria.
Therefore instead partnering with pro-JVP protests the GMOA/SLMC members are dutybound to ensure that any private medical units set up deliver as promised. The energy that the GMOA/SLMC are using for these unnecessary & totally uncalled for agitations & protests could well have been used to advise the Ministry authorities of any shortcomings or inadequacies. Strikes that leave poor patients to suffer does not help the situation at all. It is immoral & unethical to use strikes as a bargaining tool & for doctors who have become what they are because of free education it is totally callous on their part. In the eyes of the public it makes the citizens realize the true nature of most doctors in service despite obtaining free education.
In summary what needs to be reiterated for readers to understand the hypocrisies & the inconsistencies behind these protests is that the Nizhny Novgorod State Medical Academy is approved by the Sri Lanka Medical Council which translates to mean that anyone qualifying with an MBBS from Nizny is entitled to do the ERPM (Examination for Registration to Practice Medicine) in Sri Lanka which is conducted by the SLMC. Passing the ERPM means a person is granted licence to practice medicine in Sri Lanka. Despite the Ministry of Education granting approval for the degree, students need to obtain the licence to practice with the EPRM. What appears at stake is the interests of the students while this tug of war is taking place for their interests are at stake.
As professionals the GMOA/SLMC should have not adapted the present tactics that have only undermined their professionalism amongst the public to showcase them as jealous opponents to ventures that would certainly help Sri Lanka. Statistics reveal the need & the stand by professional bodies like the GMOA/SLMC has not gained any supporters other than those antharaya mobs!
Shenali Waduge
September 19th, 2011 at 4:20 pm
Those who obtain free education at universities must understand that they are paid for by the people. They have no right to go against the people.
When the leadership training program was introduced some damn fools (including some fools at this forum) screamed for nothing. What happened? The leadership program went ahead and it was a remarkable success. Losers lost again.
JVP GMOA and JVP student union nonsense should be disregarded. They are trying to further take away the fundamental rights of students to get an education. We need private medical, engineering, IT, accounting, hotel, etc. colleges; fullstop.
If anyone is against these or against the leadership program, go fly a kite.
September 19th, 2011 at 4:40 pm
Well said Shenali! I would like to point out a few things
1. Has the GMOA ever (I mean ever) stood up for something connected to the welfare or betterment of patients?
2. How many medical practitioners (after receiving education courtesy of the taxpayer) are ever willing to go to rural areas where doctors are in real need?
3. How many doctors stay in the hospital during duty hours without going to the “Pola” (private practice)? Has the GMOA ever spoken up against this?
The private medical college is the best thing. Those pompous people think that they are “beyond this world” when they get into medical faculty. At least now people with a genuine desire to help people (with money of course) can become doctors.
No offense to the divine people (doctors, nurses and other professionals) who help people who are sick and in need. However, most doctors are doctors just because they got good marks in the A/Ls not because they want to help sick people in need. They are social parasites do nothing more than take the helpless patient hostage for their own privileges.
September 20th, 2011 at 1:33 am
It is a good thing to provide more opportunities for learning in the higher education field. Poorer students need to be given scholerships as happens in UK private schools and Colleges.
September 20th, 2011 at 9:38 am
The opertunities in SL for students qualified to enter universities are very low. This is a very bad situation. The country can’t afford to give more oppertunities free. There should be an alternative for students than going abroad which takes too much of forieghn exchgange. There should be exams to employee the graduates to standerdise and to make sure they are upto standard. Blocking students opertunities is not the correct thing to do. It is very selfish and foolish.
September 20th, 2011 at 10:19 am
Shenali, once again has exposed the highly corrupt practices of those who are in a highly noble profession but degrading to the lowest level of SAKKILIYAS(I beg pardon from S’s as they are much above that of some medical professionals.
Only in Sri Lanka that these so called Doctors in Govt service who staged work stoppages against the very oath they have professed.What a shame???
September 20th, 2011 at 12:47 pm
Bravo, Shenali! Once again you have written a well researched article on an important topic … with the correct conclusions.
Indeed, Sri Lanka should allow Private Universities, in general, and Private Medical Colleges, in particular, to educate the sons and daughters of Sri Lankan tax paying citizens who cannot enter Government Universities … for whatever reason. Creating artificial shortages by throttling the supply of qualified professionals is not in the interest of the nation.
In this connection I would add ….
1. The GMOA and the SLMC should continue to be standards setting accreditation bodies for the medical profession. Let them specify the criteria that Private Medical Schools must meet. The Boards of these institutions should have a minority of Govt appointed members and respected non-medical profession members, to preserve the public’s interest, and some members from respected foreign universities (US, UK, Russia, China, India etc) to ensure that international standards are being met as well. The latter will ease the path to foreign accreditation for our medical graduates. In this way, we can provide for the inherent right of medical professionals to police their profession, while preventing their self-serving agenda geared to erecting barriers to entry to the profession.
2. Similar Boards should be set up by other professional bodies (Institution of Engineers, Association of Charted Accountants) perhaps under the aegis of the Organization of Professional Associations (OPA) of Sri Lanka to ensure standards in other professional fields, always making sure that both the professional interests and the public’s interests are protected.
3. The right of a doctor, or any other professional, to decide whether to serve in Sri Lanka, or to emigrate to a foreign country cannot and should not be denied … for that is a fundamental human right. By increasing the supply of these professionals through Private Colleges, Sri Lanka would be in a better position to meet the shortfall in created through emigration, normal attirition, and shortage of graduates, while defusing the frustrations created among well qualified students who want to become professionals.
4. As Shenali points out, the creation of Private professional teaching institutions in Sri Lanka would save the country several hundred million dollars of foreign exchange paid for tuition in foreign universities every year. Moreover, if high, internationally accredited, standards are maintained, it would become a foreign exchange earner for the country, while providing employment to many Sri Lankans who need good, well paying jobs. If foreign accreditation is maintained, Sri Lanka could, in time, become a recognized place not only to acquire a professional education at lower cost than in Western countries, but also as a place where quality medical services that are prohibitively costly in the West can be affordably obtained by foreign citizens. India is already well known in the USA as the preferred place for such “medical tours”. When such centers of excellence spring up, funds flow in for research and high-technology medical equipment leading to a resurgence of scientific and technological research, development, innovation, and growth of the entire economy. Meanwhile, Sri Lanka earns money, people get jobs, and get better educated in the high tech skills necessary to compete effectively in the global marketplace of the future. ALL of this translates into propelling Sri Lanka faster on the path to achieving our shared dream of the New Wonder of Asia.
5. Finally, a word about politically motivated student protests orchestrated by the JVP and other political parties. ALL political demonstrations and protests in educational establishments should be banned and declared illegal. The few professional agitators who disrupt teaching deny a valued opportunity to the vast majority of other students who are there to gain the skills for their livelihood … as I did many decades ago at E-Fac in Peradeniya. No politics should be allowed on campus, and violation of those laws should end up getting you a semi-permanent job breaking rocks in prison. Education is serious business … let us keep it that way. Defence Secretary Gotabhaya Rajapaksa may be the ideal person to enforce student discipline on campus … the same way he is bringing respect for the Rule of Law in the rest of the country.
Good job, Shenali!
September 21st, 2011 at 11:06 am
We could do with more Technical Colleges, Polytechnics (teaching different languages), Teacher Training Institutes, and a host of other training institutes too which would be Job oriented, of course. On line courses in most studies, (other than courses where attending a University is a must such as Medical, Engineering etc. ), would provide jobs. There certainly needs to be more entrepreneurship from within Lanka itself to fill these present vacuums. Quality a must in all these ventures.
Thank you, Shenali, for bringing out important facts we have to face.