‘The SAITM Issue’ and the politics of misnaming
Posted on May 11th, 2017


Whoever is against SAITM should also be opposed to fee-levying institutions such as private nurseries, tuition classes, outfits that offer all kinds of certification and practices such as channeling services.  This is an argument that is widely tossed around by those opposing opposition to SAITM.  The flak that Dr Anuruddha Padeniya of the GMOA has got over the past few days has been liberally padded with such logic.  His detractors have roundly castigated him for offering consultancy services in private hospitals even as he spearheads the agitation against SAITM.
The cause of the GMOA has not been helped by the fact that some of its fellow-travelers have waved the anti-privatization flag.  In other words, the ‘SAITM issue’ for them is but an expression of a process or even an economic policy preference they oppose, namely privatization.  
AITM: Means different things to different people on both sides of the divide
All causes have to deal with different stakeholders who have diverse outcome preferences.  The opponents have the option of picking out one or more of the claims or parties and target these.  That’s politics.  Misidentification, mislabeling, misrepresentation and such are part of the game.  
There are therefore people who are calling for the blood of the movers and shakers of GMOA, especially Dr Padeniya.  Naturally ‘the sick’ are used as grist.  The pro-SAITM or let’s say the anti-GMOA lobby would have us believe that no one cares more about the poor and the sickly of this country than them.  That again is politics.  It is useful, after all, to have the key issues shoved out of the debate.  Indeed, part of the story is to define ‘key issue’ in ways that make for easy engagement.  Everyone involved in this drama does this.
What all this helps displace is the important (let’s not say ‘THE key issue’) matter of a coherent policy with respect to education in general.   It is easy to say ‘we need more doctors’.  Of course we need more doctors, there’s no question there.  It’s easy to ask ‘if you are raising concerns about quality, can you give any guarantees about the quality of doctors produced by the state universities?’  It’s a valid question of course.  
It’s easy to take medical mishaps, inflate them, display them, throw them in the face of those who bring up the issue of standards (pertaining to SAITM) and scream ‘you don’t have a case, hoo-hoo’.  
It’s easy to say such things and raise such questions as long as you desist from talking about the realities in our hospitals — the congestion, the financial constraints, under-staffing across all categories, the consequent stress and say nothing about the incredible services rendered therein.  Easy and irresponsible. 
The SAITM issue” is a book that has not yet been written, or rather is a book whose pages are all over the media, including Facebook, Twitter, the blogsphere and elsewhere on the internet.  This is not an abridged version of that book and neither is it a review.  What’s written above is preface and what follows will be a short note on the seeming contradiction of GMOA members engaging in ‘private practice’ with a view to separate the issue of privatization or private income-earning practices from that of regulation and accreditation.  
One of the most sober comments on this element of the debate was offered on Facebook by Dr Waruna Jayasinghe.  It is worth translation.  He called it ‘From nurseries through SAITM to channeling….”
Montessori Schools: Whether or not a child has attended a Montessori is irrelevant when being enrolled in a school. The particular child is not required to have obtained instruction on any elements of the primary curriculum.
Tuition: Tuition gives students preparing for exams a boost.  However it is not the tutor who sets and conducts the exam, but the state.  Those who attend tuition classes and those who do not are assessed by a single institution and process.  (We can define the SAITM situation as one where the tuition master himself conducts an exam and produces doctors according to a Montessori system).  
Private degrees (e.g. IT) and private medical colleges: Since many don’t see a difference, let me use an example.  I obtain an IT degree of forgettable quality.  You give me a job.  I write software programmes at a rate.  You realize that they are useless.  You sack me.  In other words, the consumer, the quality controller and the boss are all one person and someone who knows the subject well.  Now assume I get a degree from SAITM.  Even if the quality controller, the Sri Lanka Medical Council, says ‘poor quality,’ the law forces recognition. Accordingly I am recruited and sent to serve in Wanathavilluva.  I prescribe medicines like crazy.  I also engage in private practice.  The patients’ conditions get worse courtesy my treatment and prescription, but they wouldn’t know I am the cause.  Since there are very few senior doctors in such facilities they too wouldn’t notice my idiocy.  So I will remain secure and happy.  Here the consumer, the quality-controller and the boss are independent of one another.  The quality controller has been crippled.  The consumer has no knowledge of quality and no authority either.  The boss doesn’t have the means nor the mechanisms to assess the work of junior physicians.  I continue to practice.  One day you come to me for treatment.  I prescribe. You die.  Your loved ones complain to the SLMC and my registration is cancelled.  This is of no use to you, since you are dead.  My friends will continue to treat and prescribe medicine to their patients.   
Channeling: I work in a government hospital.  After I clock-out, I have the freedom to make koththu or engage in channeling.  Since I am a doctor, I choose private practice.  I have knowledge and training to offer for a price.  You come to purchase these because you find it more convenient or of greater value to obtain these in this manner rather than getting it free at a government hospital.  You have the complete freedom to obtain treatment from a government hospital or from some other individual should you feel that I am expensive or that you would not get value for money from me. 
What this shows is that although people try to put everything in one heap, it is SAITM that disempowers people from choices and that if the quality of medical degrees is not strictly monitored the outcomes could be disastrous. 
Now some may argue that (say in the USA) universities offer their own degrees.  The issue there however is that there is assessment, there are ratings, there are minimum standards that have to be met for purposes of accreditation.
‘The SAITM issue’ is about accreditation.  It’s about quality control.  One can vilify the SLMC and argue about the quality of doctors produced by state universities, but one cannot shove under the carpet the issue of coherent and comprehensive assessment.  There has to be a single authority in the business of regulation or else a coherent and comprehensive process of evaluation.  
Someone can claim that the SLMC is not perfect.  That’s fine.  The solution would be to improve the institution and the processes therein.  The Government, as of now, appears to be ill-equipped intellectually and politically to sort out the mess to which it has contributed (as did the previous regime) by being frivolous and arrogant.  
What’s evident is a scandalous disregard for regulation and a bastardization of accreditation.   The Government should rise about the politics of  misidentification, mislabeling and misrepresentation because a) it is unhealthy, and b) as things stand it could maim or kill a lot of things, including the Government itself.
This cannot be healthy. 
Malinda Seneviratne is a freelance writer.  Email: malindasenevi@gmail.com.  Twitter: malindasene.  Blog:malindawords.blogspot.com

4 Responses to “‘The SAITM Issue’ and the politics of misnaming”

  1. Ananda-USA Says:

    I whole heatedly agree with Malinda Seneviratne, that the issue is not government education/private education but accreditation, maintanence if standards in medical practice and oversight.

    In the USA, as in many other countries, the vast majority of thd doctors are orifice by private universities and colleges, but standards are msintained by both by private professional bodies and government certification boards.

    That is the way it should be in Sri Lanka too, because tge alternatives are lack of competent doctors and the proliferation of medical quacks. Both of these results in the denial of quality health care to patients in need. Politics should not play a part in resolving this issue.

  2. Ananda-USA Says:

    Oops! I meant to say “I whole heartedly agree ….”

  3. Ananda-USA Says:

    Oops! I meant to say ” the vast majority of doctors are produced by private ……”

  4. Dilrook Says:

    In all tertiary education institutions it is the same institution that imparts knowledge that examines students. Sri Lankan universities that produce doctors rank worse than Zimbabwe universities. Trying to impose quality on SAITM by these graduates serves little. The maximum they can assess is the level of education they received.

    The supreme court has given the verdict which cannot be disregarded. SLMC must accept all SAITM graduates and specify clearly the areas they lack. SAITM in turn should enhance training on those specifics. There is no blanket rejection of SAITM which amounts to contempt of court.

    If SLMC is not co-operating, the government must create by an act of parliament another medical council to regulate the profession and discount the SLMC. It should draw professionals from other countries too, preferably from top medical colleges of the world.

    The scary example Malinda provides can be applied to patients when state university produced doctors go on strike. These strikes can potentially kill more patients than a SAITM graduate due to alleged lower standard. Didn’t we hear amputating the arm of a young woman for no reason and amputating the wrong leg of another by the so-called high quality doctors. Not to forget the lady doctor who allegedly abused Sinhala pregnant women awaiting delivery! Another two doctors have forcibly performed operations on Sinhala women to deny them further pregnancies. And the male doctors that abused female patients.

    Another point of interest is the disruption local doctors staged in 1996 against Russian graduates. Surely, they were of much higher education quality! Therefore, I refuse to buy the argument that the real issue is any concern for the patient. From what has been happening in the country, the patient always comes last (if at all he makes it into the list).

    It is also good for the government to consult patients if they want SAITM graduated doctors to serve them. Patients will be 47 million rupees better off getting their diagnosis from a SAITM graduate than from a state medical college graduate they funded to the tune of 7 million rupees each. (If 7 million was invested at 15% the perpetuity is valued at 47 million in today’s terms).

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