Private Medical Education in SriLanka and double standard of SLMC/GMOA.
Posted on October 12th, 2016

ARSATH CAREEM

It is our time to change way of thinking towards Private Medical Education in SriLanka and double standard of SLMC/GMOA.

First of all I would like to introduce myself. It will help the readers able to understand my background and my point of view. I am Arsath Careem, currently working as a Contract Engineer in Government Organisation Qatar. I have completed MSc in Construction Project Management with Sheffield Hallam University UK and BSc in Quantity Surveying with University of Wolverhampton, UK. Also, I am a member Association for the Advancement of Cost Engineering (AACE), USA and APC Practitioner of RICS, UK. I am proud to say that I am a product of Private Education. I am in the beginning of thirties of my life. But, I have travelled this far and achieved a lot in my career due to private education. It gave me freedom of choice where I want to be. I believe am a right person to discuss about this topics even though am from a non-medical background. Recently, I have witnessed many comments and arguments in social Media’s regards to private education especially private medical education (PMC) and it is motivated to do my own research towards this topic. Finally, it’s time to express my findings on current heated issues in our country.

Education is the most powerful weapon, which you can use to change the world. Its benefits are everlasting. It is right of all humans irrespective of any difference. Whether it’s given free or one pays for it.  Generally, we Srilankan always misunderstood the word free”. There is nothing free in this world. We are living a world it is completely money oriented. Therefore, besides nothing comes free. Someone is paying for our ‘free education’ via taxes and contributing to our Education. Every country Government taking major role to educate their citizens using limited fund and resources. As a developing country, Sri Lanka has failed to provide higher education opportunities for all the students who qualified for university entrance due to financial issues.

As per the UGC statement regards to the Last year 2015 exam results, there are 302,434 students are appeared for Advanced Level Examination. Out of these students 155,550 students has passed the examination. However, only 27,306 number of students are selected for various courses for higher education. Which is merely 9.03% of total students and 17.55% of successfully passed students. From the last year examination, there are 128,244 qualified students are eliminated from the system.  Is this above statistics healthy for a developing country? Definitely not. Overall every year there are 90% of the students are eliminated from higher studies. Majority being denied of university education. Most of these A/L only qualified students ultimately join the work force without a formal undergraduate education or skills developed. That’s why we are far from developed countries and still eternally poor. We are eliminating qualified students from higher education through our own system. What mechanism we have for the students who are succeeded and Advanced Level Examination and not able to study higher Education? This is the reason we are far behind from developing world. We have to create opportunities for the students who are eager to learn and achieve their ambition.

Another debatable matter in our education is advanced level examination which is used to measure our intelligence students. It is yet another examination and it measures ones knowledge over a limited period of time. We are selecting intelligence students through AL exams in respective disciplines and giving admissions to continue higher studies in government universities. However, it is unfair to judge a student’s capability from a competition examination of a few hours, not forgetting the luck involved. Therefore, I concur advanced level examination should not prevent any students to achieve his/her dream. There should be an alternative options available in order to achieve student’s desire dreams. The education system in Sri Lanka is not the best. We do not select the top due to the district quota. It is time to give everyone the freedom to study who have basic qualifications to study higher education.

The world is progressing using open economy in order to meet their challenges in modern era. We are lacking far behind to them holding on to the outdated principals in the communist world.  In the open economy Education is a major commodity. Western Countries are making a major contribution to their economy using open Education System. We are the people exporting our students to those countries. Recently some of our regional countries which are used education and technologies to overcome poverty which are Malaysia, South Korea and Singapore. There have used open education as a tool for development. Why we won’t learn a lesson from those countries? Therefore, Private education is essential because the government cannot afford to provide higher education to all the students that succeed in their A/Ls.

No one has the rights to deny for Education as per student interest once he or she have a basic qualification to continue higher education. But, in our country only educated peoples are the enemies of education and denying other students fundamental rights of Education. This is disgusting. Most of the students’ parents are tax payers. As per the Aristotle educating the mind without educating heart is no education at all. Therefore, we should include a subject in all university courses about basic human rights’ in order to behave as a human and respect each other’s.

Recently, we are experienced many protest from medical students and doctors’ on streets and hospitals. This is very rare to the modern world and also not a healthy situation for developing country as well. The protestors always stating that they are doing these ugliest in order to safeguard poor patients. But, the universal truth is these professional doctors are fighting on streets & protesting for their own benefits while risking poor patient’s life. What are these demands?

  • Better Medical standard for their patients?
  • Provide better medicine for the critical patients by removing sub-standard medicine from the stores?
  • Take strict action against the private hospital mafia?
  • Introduce better standard to the mushrooming private hospitals?
  • Divulge and take tough action by the bribery commission against corrupt practices of the doctors in order to safe guard the good name of profession?

Sorry their demands are none of above all.  It’s only against other students Freedom of Education & their own monetary issues. We have one physician per 2000 patients 0.49per 1000 and ranked 123 in the planet and these people still go on protests putting their duties aside. This would happen when the most responsible government professional organization got involved with dirty politics.

Currently, our country experiencing very much shortage of doctor’s in government hospitals especially rural areas. However, our so called genius SLMC doctors are so busy in upgrading private hospitals and some are very busy to serve other country peoples. How you can justify you can work private clinics and abroad while you have studied using own country free education system and still people required your services? It is very funny that some doctors are still answering ‘they are contributing economy by earing foreign currencies’ while we have shortage of doctors. Are they for economy or health? If these professionals are really worrying to develop country economy definitely they will accept private medical education. We are continuously exporting our students to other country for higher education. The most worrying things is we are exporting our students to the countries which are less in health standards when comparing to us. Why we can’t use our medical professionals to educate our children rather sending to abroad. It has been estimated that approximately 300-400 students go abroad annually to study medicine which rounds up to approximately 700 million rupees spent overseas for education per year. Why we can’t use those monies in to contribute our economy? The students who went abroad always required to re-study our syllabus. Which is approximately took 6-10 years to become a doctor. Even those studies are not relevant to our disease environment. These are just waste of resources to national economy. To create new jobs, wealth and prosperity for the srilankan people we have to open to talent, its very foundation to our economic success.

These protestors are owe to answer lot of questions in terms of basic human rights, freedom of education, country economy and ethical behaviour of professional organisation to general public who are contributed to their education. Also it is against the Oath they have taken before commence their job. These SLMC/GMOA members are should be set an example to other juniors rather leading to behave in appropriate way. These GMOA should learn from world leading professional organisation like RICS, CIOB who are guiding construction professional to behave ethically in order to build trust among the people and societies. Nowadays, we are ashamed while these leading GMOA/SLMC professionals are talking to media. Actually, they don’t know how to behave in front of media and general public. Some of the Doctors always think they are superior to other professionals. These type of mentality people never grow up. One of leading Consultant from Srilanka who is currently working in UK simply generously commented in social media about these behaviour. ‘’Come out frogs from that deep well and see the rest of the world progressing, It is attitude nothing else’’. They don’t see how rest of the world progressing. They are only considering how to create opportunities to earn money themselves rather poor patients. There are setting bad example for our children who want to become a good professionals like Doctor in near future.

Dr. Lalith Perera who is passed out from Colombo medical faculty and expressed his view regards to the current heated PMC issues, All these years we were living like frogs in a deep well without seeing the outer world. We thought that we were the best, we disregarded other graduates and but finally I realized that we were wrong” and further he stated that we fought with these people and chased them from our health system. Now they are doing extremely well in other countries giving their knowledge and skills to other people”.

Srilanka has better health standard than other South Asian countries like India, Pakistan, and Bangladesh. According to WHO, the Sri Lankan health system ranks at 76 out of 190 and has beaten India which ranked at 112. However, it does not mean we have achieved the desire standards and can be relax. Don’t forgot that there are 75 countries which are progressing better than us. It is time to think positively regards to PMC and re-structure our health policies in order to improve our health standards. I have come cross some of doctors Facebook un-justified status saying that ‘the reasons for other south Asian countries are behind our health standard due to private medical education’. This is how these doctors are defending themselves against PMC. In my opinion it is foolish things comparing Srilanka health standard with India. My question here is how private education will contribute to lower health standards. I would argue that it is due to the fact India large populations. Those countries governments are not able to provide free medical to their own citizen as we receiving today. Also, it is notable that  It is estimated that 1.2 billion people spread across 28 self-governing states and seven territories within the federal re public of India does not have access to quality health care and have to pay for medical treatment out of their own pockets. As per World Bank data GDP percentage of India public health expenditure is low compare to Srilanka. Also Srilanka more developed than India in terms of life happiness, literacy, education and standard of living. We are ranked 73 in human development while India ranked 135. Literacy rate of Srilanka is 92.6% which is near to developed countries. It is only 72.1 % in India. Srilanka per capital is nearly double of India. SL$ = 10,566, India = $6162. Also poverty is very high in India than Srilanka. It is 10 times less than India. These are the real factors contributing better health standard rather private medical education. The universal truth is it is hard to manage better health standard when you containing 18% of the world’s population. I concur here that private medical education are not the reasons for lower health standard, but, above mentioned all. Globally, there are many countries have Private Medical Education. India top of the list with 137, USA 62, Japan 29, Malaysia 11, Thailand 3, Philippines 3, Spain 2, Australia 2, Caribbean region 56, Chile 35, Nigeria 2, Middle East Region 32, UK & Germany 1.

In Srilanka we are just born and being crawl stage in PMC. Before, we start to walk up a group of people are trying to break our legs. Privatisation an act of reducing workload of government to satisfy people needs and demands. It can be generate profit. It does not matter. The main thing is country and society are progressing using privatisation. We are in a post war period. It is time for develop rapidly where we lack of development due to three decades of war. Due to globalisation there are demands for doctors throughout the world especially western countries and Middle East region. This has encouraged to start private medical in above listed countries. It allows to meet the expanding population demands, increase the physician density, increase health standards, increase job opportunities for everyone, healthy competition will improve health standards, reduce monopoly of the doctors it is ultimately benefits to poor patient who can receive quality services within low cost, technology can reach faster than state universities, etc. In South Asia region India is leading to promote medical tourism. Similarly Malaysia and Thailand are performing same way and providing cheaper medical care to foreign patients. This lucrative demand for exported” medical services may be instrumental in the mushrooming of private medical colleges in India and Malaysia. Why can’t we promote our medical education on this way and significantly contribute to our economy.

Currently, we have some of UGC approved world class private education providing institutions in Srilanka such as SAITM, SLIIT, NIIBM, BCAS, and ICBT etc. however, SAITM is the only private college who provide medical education in our country. Maintaining Quality is vital for producing qualified doctors. What is most important is the quality of education which should not be sacrificed under any circumstances. The quality should be monitored throughout the all stages of MBBS degree programme. There is no doubt that PMC has to concern seriously about monitoring quality of education and availability of patients for clinical teaching which are two major challenges face by private medical colleagues. However, it can be overcome using accreditation process by relevant authorities. Accreditation is a quality control measures which is maintain high standards of medical education and health care process. For the additional clinical training government hospitals can be used to receive required clinical exposure. Not all the hospitals are used by the government universities, and there are ample number of patients in other hospitals.

The multimillion dollar question is Are SAITM producing qualified doctors to treat sick? The answer is definitely ‘yes’. There is no doubt. I am going to explain here from my own research and introduction with SAITM students how SAITM is producing qualified doctors to serve Srilanka.

First of all, the quality of medical education begin with selecting a right students for the course who can able to bear the workload and complete it successfully. The current SAITM minimum requirements for MBBS degree is 2C, S in bio stream and minimum of 30% in common general test. Which is well par above to the minimum UGC requirements of 3S to apply for higher education. Further, they are selecting 75 students per each batch from 500 applicants. There is no way to select any of students who don’t have minimum requirements since they have enough candidates are competing to secure the place. Some bias Medias are circulating false information to the public that SAITM is not fulfil the minimum requirements for student’s entry. Recently, SAITM registrar Mrs. Husni Hussain emphasized to public media that who have failed their AL exam have not been enrolled to medicine course’’. She further went to say the process of student entry that they call applicants and screen the results. Then, applicants undergo preliminary interview. Subsequently they submit the list of applicants along with their certificates to the secretary of the ministry of higher education. And the final list is made after the final interview with UGC representative and chosen entrance are registered with SAITM. Therefore, in her capacity she reiterated that there is no students in SAITM who failed in advanced level examination in medicine degree. It is noted that many of SAITM students has 3A’s in London advanced level examination and even they don’t have any choice to study in any of government universities. According to Dr Anusha Tissera Withanachchi MBBS-NCMC (Hon), DCH, MD (Hon), MRCPCH, FRCPCH “At the end of the day a good doctor is much more than someone, who just makes the cut off according to district basis, which is solely based on A/L results.”

SAITM did students entry as per followings.

  1. UGC – approval
  2. Ministry of Higher Education approval
  3. Degree awarding status
  4. Gazette notifications No. 1721/19 dated August 30 2011
  5. Gazette No. 1829/36 dated September 26 2013

Recently, SAITM students revealed the truth of falsehood which created by some Medias that they are all from super rich families. The student’s say that majority of them are from middle class families and their parents work hard to pay the cost of education. It is worth to point out SAITM also provided Rs.500 million worth of scholarship for deserving students.

The next thing are curriculum, teaching methods and qualified academic staff. The curriculum made by the same professors and lectures who did in state universities. SAITM comprises well experienced leading professors and top consultants who have been given comprehensive theory, clinical knowledge and providing tremendous job for these students to become a qualified doctors. Therefore, it won’t be an entertainment for these pressure groups.

The next important thing is clinical training. The SAITM has its own modern teaching hospital which is largest in the country includes well equipped theatres, intensive care units and laboratories. The Neville Fernando Teaching Hospital (NFTH) functioning from last 02 years and there has been a rapid increase in the numbers of patients. There is always a speculation from SLMC that NFTH does not meet the number of patient when compare state hospitals. However, SAITM administration has been continuously using some of the leading private hospital in the Colombo region such as Nawaloka, Asiri Surgical Hospital PLC as an alternative options for clinical training in the absent of state hospitals in order to reach the required standards. In additional to that SAITM has requested to obtain a non-teaching government hospital with the promise of upgrading it and making a payment per student. However, this request was objected by pressure groups. Finally, the same group went to prepare a report and saying that SAITM doesn’t meet the clinical requirements. This is clearly expressed the double standards of SLMC.

Recently, Professor and Head of the department of Paediatrics, Professor Deepthi Samarage speaks regards to “SLMC Report on SAITM: what you know and what you don’t know” say that SLMC mainly criticized that SAITM students are lack in field of Community medicine and Forensic medicine since it is only provided in the state hospitals. However, Later on SAITM received Supreme Court decision to practice in Avisawella, kaduwela base hospital and fulfilled required standards. Therefore, that claim was no longer valid. She further replied to another criticism of SLMC which is inadequate of practical exposure in all areas in terms of number of cases. She agreed that when compare to the state hospital private hospital has less number of patient. However, SAITM has adopted different methods of teaching and several other reasons they met desired standards. It has proven in the final exam by external examiners.  Further, it is unfair to compare the private sector teaching hospital with state hospitals’. There are standards to be followed in private hospitals when students to examine patients. Therefore, to provide adequate training different teaching techniques are being used in developed countries such as mannequins which is internationally accepted and providing students effective way to learn. The same method has been used by SAITM and achieved the required standards.  It is worth to point out that in SAITM all students supervised by Consultants. But, in state faculties mostly from juniors.

At the end, students having final exam to become graduates. SAITM having final examination for the students who have completed all the subjects and required clinical trainings by compromising the required exam standards such as MCQ, SEQ and clinical examination. The exams are held under UGC supervision and are held according to the standards of government universities and students are assessed by visiting professors from state universities. In the last exam they have used volunteer’s professors from Peradeniya, Colombo and Karapitiya universities. Therefore, the quality of exam has been monitored throughout whole process.

In the past century medical education has progressed rapidly. On the other hand, we are still living with sheer hatred and jealousy towards other students that cannot be cured. This illness is spreading quickly like a cancer among a conservative doctors, students causing symptoms of continuous protest unethically in the past couple of years and disturbing general public. These PMC students are not demanding any special freedom or rights. They are feeling some pressure groups deadlock their career and doing injustice to them. They want equal right to showcase their capability as doctors. SAITM is confident that they have produced graduates who are pare with those from the state medical universities. If you are really doubt on their ability practice as a doctor on these PMC students, SLMC should be given a fair opportunity to write a license exam to proof themselves as they are ready to serve humanity. Recently, these passed out students made a press conference and expressed that they are ready to face any unbiased examination”. Yet, I am really don’t understand why SLMC not considering this request. In my opinion, these SAITM students will do better than state faculty students which is similar to what NCMC Doctors are doing at present.

GMOA is only a trade union. It’s should not be allowed to make decision regards to private medical college. Already, these SLMC/GMOA professionals are downgraded themselves among general public. They are shown their double standards in many ways regards to private medical education. These professionals never worried about private clinics. But, only worried private education. If the government hospitals are doing such a good job why are so many people queuing at private practices? Recently, SAITM Professor and Head of the department of Paediatrics, Professor Deepthi Samarage asks in front of the media that SLMC has no concerns over the quality of training of foreign medical graduates, they have no qualms over state hospitals being used to train them. What have they got against SAITM?” It is worth to question how they can approve Kothalawala medical faculty. Are these professionals’ not aware whether private clinics available every corner of srilanka similar to grocery shops? Are they afraid to give an opportunity due to the fact they have to compete with these students in the job market and losing their private practices? If yes then it should be. It is a healthy situation for a country to progress rather maintain demand on their services. We don’t grow when things are easy, we grow when we face challenges. The whole world opens to good qualification. Therefore, don’t worry about the competition and believe on your ability and make progress. This is how rest of the world are progressing. Why we are exempted from that?

I urge these medical professionals and students should stop these meaningless protest to avoid causing inconveniences to general public. It’s time to general public start to think positive towards private medical education rather promoting these false allegations created by SLMC & GMOA and should ready to act against the pressure groups who are carrying shameful behaviour to destroy other student’s freedom of education to fulfil their private agendas. In conclusion, private medical education is healthy for a country which is look to improve its economy and health standards of the citizen. It is your time to change your mind and express your support towards PMC rather keep silent to allow injustice.

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