By Rohana R. Wasala

It goes without saying that the lives (meaning the future) of the students of the South Asian Institute of Technology and Medicine (SAITM) at Malabe and of the students agitating against the private institution are infinitely more important than the government’s policy decisions on education or its own survival. If necessary, policy decisions can be changed according to the will of the majority in the country; the same holds true for the government itself. The future of the young people involuntarily caught up in the current crisis centring on the private medical college problem is too precious to be left any longer vulnerable to jeopardy at the hands of opportunistic politicians. I am not a stakeholder in this matter in any way; I am only speaking up for what I believe to be right and just, and to stand by the young students on both sides, though their positions are contradictory at the moment. As a private individual, I support private medical education for reasons explained in an old article I wrote to The Island almost five years ago reproduced below.

However, after reading in the newspapers recently that the current chairman of the Sri Lanka Medical  Council, Professor Carlo Fonseka, has threatened to resign from his post if provisional registration is granted for the medical graduates of SAITM to practice as doctors, I have begun to feel that there must be some serious problem here, because I unreservedly respect him as an honest person, and I trust his stance to be the right one on this occasion. Later I saw an online video clip of Professor Fonseka declaring that an investigation conducted by the SLMC revealed that SAITM is not suitable (uchita nae) for training medical practitioners. Though that conclusion can be accepted without question since the correct procedure is sure to have been followed without it being unduly influenced by vested interests. Yet, the important thing is that it should not be held against the students who have successfully followed the medical course conducted by SAITM.  They have done no wrong. They studied medicine there under qualified tutors most or at least some of whom must have been from the state universities. If there had been any deficit in the required facilities for study and opportunities for clinical training, it must have been addressed in time in collaboration with the then government which first allowed SAITM to function in the face of objections from misguided champions of free education. At least now the present government must devise some way to rescue these young doctors, who have trained at no cost to the government. Taking over SAITM by the government, as suggested by minister Rajitha Senaratne some time ago, is worth considering for the time being. At least a proper method to improve the quality of those medical graduates, if found wanting after examination, should be implemented with the participation of the relevant government authority. Professor Fonseka, seemingly, has not expressed any objection to private medical education itself as far as I can understand.

The GMOA is also against the private medical college. Their opinion must be accepted as well informed and founded on principles. Perhaps the problem is entwined with the controversial ETCA issue. Anyway, I for one, hope that people who are competent to do so will take a sound decision regarding whether the private medical college should be closed down or allowed to continue. It must also be considered whether the engineering graduates of this institute are facing similar problems of quality. The government should not treat the SAITM medical students as if they have forfeited their human rights by opting to study medicine privately after qualifying at the GCE AL to do so.

(Not all students who pass with enough marks at the AL to enter university to follow a course can be admitted to state universities because there aren’t enough vacancies to accommodate them all. Simply, Sri Lanka isn’t rich enough to afford that. That’s why selections have to be made.) The government must act immediately to address the grievances of the protesting students and others in a meaningful and responsible manner, without waiting until things spiral out of control.

Following is the article mentioned in the opening paragraph. It was published in The Island newspaper nearly five years ago (Friday 16^th September, 2011):

Private medical colleges: a citizen’s point of view

By Rohana R. Wasala

When decisions about such nationally important matters as the setting up of private medical colleges are discussed, the issue should not be left entirely in the hands of politicians and trade unionists; for if it is, national interest usually runs the risk of being sacrificed for political advantage. The voice of the public whose welfare they struggle to serve must also be heard. I believe that many people tend to think the way I do about the proposed opening of private medical colleges in Colombo and other centres. Though I have no familiarity with medicine or medical education (and, in any case, this fact is irrelevant to my right as a concerned citizen to express an opinion, for what it’s worth, on the present problem), the controversy about establishing degree awarding medical institutions has intermittently engaged my attention over the past twenty-five years or so. In spite of the vagaries of the usually dithering official stand on the matter, like many others I have always been in support of the idea of having private medical colleges here in view of a number of obvious reasons, some of which I am setting forth below. Having said this, I acknowledge the right of others holding contrary views to dispute the proposed private medical colleges scheme, even though it looks as if the matter is already a fait accompli.

It’s a well known fact  that, in Sri Lanka, not all the students who successfully complete secondary school and thereby become eligible for higher education can find places in the state university system because of constraints due to scarcity of resources. Candidates for university are put through a rigorous selection process; a few are taken in while the majority are left in the lurch more or less. However, this statement must be qualified by the fact that things are somewhat  better now than before as a result of certain improvements introduced such as higher technical colleges under state initiative and private educational institutions affiliated to foreign universities, and also policy changes that allow students to study in a foreign university, which substantial numbers are now making use of. Admission to the more prestigious science and technology based faculties is even more competitive than admission to the humanities faculties. The district quota system initiated in the 1970’s enabled the better performing students of the underprivileged rural areas to have a share of the cake.Until the district quota concession came into operation entering the university to train as doctors and engineers remained an unrealisable dream for ambitious rural youth. However, when a certain proportion of the limited number of vacancies in the universities began to be reserved for them, a similar number of urban students performing equally well or often better (due to their ability to access better facilities) at the A/L  exam were deprived of their chances of getting into the university. Not all students who attend urban schools are from affluent families; neither are their rural counterparts all poor. The quota system is actually a rob Peter to pay Paul” strategy.

This is not to argue that the quota system should be scrapped. It must stay so long as the urban-rural disparity in the distribution of educational opportunity persists. At the same time it behoves the government to devise some way, within its policy framework, to help out not only those who are subject to the glaring anomaly just mentioned, but all secondary school graduates (successful AL students) who must perforce be left out of the state universities for lack of space.

We must appreciate the fact that over the years all governments from time to time have adopted compensatory measures such as establishing junior universities, polytechnics, advanced technical colleges, the Open University, etc on their own (i.e. on state initiative); and since the late 1970’s the changed economic policies have enabled private enterprise to invest in higher education in order to open avenues for students intent on following further studies, especially employment focused courses, and have helped them even to travel abroad for the same purpose if their parents can afford it.

For want of something better, ordinary people show their tacit acceptance of this setup, where education remains basically the responsibility of the state with private entrepreneurs being allowed to contribute to the process by supplementing its efforts; it is almost the case that no alternative is conceivable in the existing circumstances. Today along with free state education we have a parallel, but informal and unregulated private instruction system beginning at the pre-school level and continuing up to and including the tertiary in some subject areas. For all students, with rare exceptions, it is seemingly impossible to prepare for public exams, be they Grade Five Scholarship, or GCE O/L or A/L examinations, without the support of private tuition providers, which, needless to say, comes at a price for their poor parents.

The same sort of description would fit the health domain. Like education, health is a responsibility that the government cannot relinquish, and delegate entirely to the private sector. But we know that a flourishing private medical service exists catering to a fairly large clientele. It must also be admitted that in both areas state institutions still remain the sheet anchor for the common people. Private involvement in education and health is likely to increase rather than decrease. It will actually save the government a lot of money, which it can use not only to improve the free education and the free health services that it now provides, but also to channel them to those who most deserve them.

So, the argument that private medical colleges will pose a threat to free education is a myth. In addition to tuition centres mentioned above, there’s already a fast spreading ‘international’ school system which doesn’t come under the purview of the Ministry of Education. These schools cost the country dear in terms of foreign exchange, because they generally prepare students for foreign examinations, who will eventually enter foreign universities. Then, there are private schools, which nevertheless are subject to ministry supervision. If all this is not seen as  undermining free education, why should medical colleges be objected to on the grounds of such a threat?

Already thousands of our students go abroad every year to study in foreign universities. It is not only the children of the very rich who do this. Parents of modest  means sometimes mortgage or sell their property to find enough money to send their children for a decent education in a foreign university. There are many others who would like to do the same if only they could manage it. And it is not only for medical studies that students go abroad at great expense to the country; they prefer a foreign degree even in subject areas where there’s no dearth of study resources within the country. The truth is that many more would go overseas to qualify in such domains (as computer, business administration, hospitality, law, chemistry etc) if there aren’t so many recognized foreign universities affiliated private institutions in the country already.

What encourages students and parents to readily accept opportunities for private education, particularly at the higher levels either here or abroad at considerable expense, is the negative image of our universities that the prevalent  perceptions have created in the public mind with or without reason: these include the chronic inadequacy of student facilities and essential resources such as libraries, qualified tutorial staff, ancillary academic services, apparent indiscipline among students incited by opportunistic politicians, lack of a link between university courses and industry needs for human resources, and opportunity costs incurred due to disruptions, closures, postponed exams, student and staff boycotts while younger job seekers qualified in alternative ways grab whatever jobs are available, and so on and so forth. The upshot of all this is that people have by and large lost their trust in the local university system.

In this context private medical colleges will be seen as a boon in many ways. Among students who pass the AL but do not get selected to follow a course in medicine in the state universities there are those who would like to do so privately either here or abroad. Naturally, the establishment of private medical colleges locally will benefit them, by making medical education cheaper. It will also be accessible to more students. The vast amounts of foreign exchange currently spent on Sri Lankan students who travel to a foreign country to study medicine can be saved; the scramble for places in the state universities can be eased. Students who can afford it will join these colleges, thus leaving extra space for the more needy among the medical aspirants.

The charge that private medical education will cause a decline in standards is as spurious as the familiar claim that it is meant to privilege the dull children of rich parents. Standards do not depend on whether an institution is privately run or state run. In the case of medical education and practice (both public and private) quality assurance can be maintained through a statutory body set up for the purpose if the government is serious about it. The General Medical Council of the UK, for example, protects the public by ensuring proper professional standards. It sets and regulates standards in the undergraduate and postgraduate medical education and training as well as in the practice of medicine.

The country needs more of qualified professionals in the medical service. It is not only the rich who go to private practitioners. Even samurdi beneficiaries do. But how often do we hear about quacks fleecing the helpless public? Do all medical specialists think twice about their exorbitant charges when they see their not so rich clients stand for hours on end in queues cramped in their dingy underequipped ‘channel’ centres? Do the authorities care? Why don’t those who object to private medical colleges being set up talk about such problems? Is it not good if we have as many general physicians and specialist doctors as we need in order that patients can obtain required treatment at an affordable price? Why waste time talking about nonexistent threats to free education and professional standards, which are themselves as good as nonexistent, as far as we can see?