Sunday Times 2
Should we abolish private medical education in Sri Lanka?
View(s):By Dr. Miran Salgado
Private medical college and private medical education have once again become bitter words generating an awful taste, as it was merely 35 years ago when I was a medical student at the Colombo Medical Faculty. Answers to the questions raised today as to private medical education can be found if the events that unfolded 35 years ago are analysed.
Regardless of the long delay in the replay, the main actors of this drama remain almost the same. History is repeating its self and ironically we have failed to learn from history!
A protest against the South Asian Institute of Technology and Medicine (SAITM).
The North Colombo Medical College (NCMC) aka Private Medical College (original PMC) which was subsequently nationalised and renamed the Faculty of Medicine, Kelaniya University was started by a group of wealthy, influential private practitioners who controlled the College of General Practitioners in the 80’s. They were disillusioned by the district-based admission criteria introduced by the Bandaranaike Government which effectively excluded their children and the children of the Colombo’s wealthy from the state run medical schools. Admissions to the PMC was based on the minimum criteria for university entry as well as “other” criteria including extracurricular activities, proficiency in English, and if I were to guess, one’s family back ground and connections.
They clearly had the backing of politicians then in power during the J.R Jayewardene era and a sizable proportion of doctors including members of the Colombo Medical Faculty and its Dean, Professor Daphne Atygalle. Many of the Colombo medical faculty staff were involved both in teaching and curriculum development at the NCMC.
Many professed that admitting students to the medical schools on a formula based on merit and district basis not only eliminated better qualified urban candidates but it also admitted non-English speaking less refined “out station” ( village) students who not only had poor scores but clearly did not suit the medical profession: they did not have the “finesse” to be physicians – at least by their standards. This was similar to the attitude of the Colombo’s elite when swabasha education was first introduced in 1957 opening the gates of opportunity to the uneducated masses.
We were drawn into campus politics irked by the control of the Medical Student Union by the Janatha Vimukthi Peramuna (JVP) and its proxies who pretty much made puppets out of the rest of the student body. Lunch time picketing and strikes “at the drop of a hat” disrupting class work led some of us to form the United Independent Medical students Federation in order to counter-balance the unchecked and uncontested authority of the JVP and its proxies.
As the first ever group to challenge the JVP in the medical faculty in the student assembly elections, we managed to split the medical faculty votes almost in half (less fourteen votes) and for the 1st time shift power to the independent group in Colombo University (controlled by the Nava Sama Samaja Party) from the JVP. Regardless of this dynamics of power both factions of the medical faculty at the time passionately opposed the NCMC/PMC for different ideological reasons.
We were more concerned with the Colombo degree being granted to the NCMC and already stretched resources being shared by the NCMC. We were not so convinced with the concept of undermining the free education system as a whole, as many private higher education institutions were already in operation in non-medical fields and no one opposed them. The JVP was more concerned with whipping up emotions of the masses and hence undermining free education was a better theme. The JVP also demanded the nationalisation of the NCMC which was almost impossible for the then-UNP government which had given numerous assurances to the NCMC and helped its creation. In fact the JVP wanted to create an impossible demand that would continue to fester till such time the Government was in imminent collapse.
We who belonged to the non JVP fraction took great pains to explain to the powers at the time including the current Prime Minister who was the minister of Education and Youth Affairs in the J. R. Jayewardene cabinet that the PMC issue was close to the hearts and minds of the medical students and granting a separate degree to the NCMC would clearly diminish the magnitude of the problem and erode their support base. We were able to see that the PMC issue was a catalyst for greater unrest of the entire university student population based on the premise of undermining free education which was a catchy theme for a broader struggle between the haves and the have-nots.
Unfortunately this was realised far too late and giving into this simple demand later, could not stop the JVP momentum which nearly toppled the Premadasa presidency ultimately leading to the nationalisation of the NCMC. The suffering endured by students of both institutions could have been averted by giving into some simple and justified demands early and taken the steam off a broader political movement.
Fast forward 35 years, and students of the Colombo Medical Faculty with the help of their brethren in other universities instigated once more by the JVP are rising against a private medical college (South Asian Institute of Technology and Medicine – SAITM) started by physician turned businessman Dr. Neville Fernando. He had constructed his own private 500 bed hospital as a medical school training ground for the newly formed private medical school. The Sri Lanka Medical Council chaired by non-other than our beloved Carlo Fonseka (I still think he is one of the best teachers I have had) and the GMOA have once again weighed in.
There are clear differences and similarities between what gave rise to the student unrest then and what is happening now. Thirty five years ago the opposition to the PMC consisted of the vast majority of the medical students, some of the left-leaning, popular medical school professors including Carlo Fonseka and Colvin Gunaratne. Carlo and Colvin both belonged to the Physiology Department and were actively involved in leftist politics. They were excellent teachers not only of Physiology but also of their leftist ideology. The arguments against the then private medical college (i.e. NCMC) were as follows:
1) Colombo Medical Faculty degree should not be awarded to the NCMC students.
Almost all Colombo medical college students as well as other university students were against the Colombo degree being awarded to a private institution. This was difficult to contest. It seemed that money and power became eligibility criteria for obtaining the Colombo Medical degree through a back channel. This is clearly not an issue today with the Malabe PMC as they will be granting their own medical degree.
2) At the time, Carlo Fonseka and Colvin Gunaratne passionately argued that the PMC undermined the free education system. This was supported by most left leaning students including the JVP which supported anything which was antigovernment. Free education equalised the playing field in education which was the only avenue for the poor and less fortunate to come up and be placed above the wealthy. This was now being short changed. The concept is not difficult to understand except there were private education and degree awarding institutions present in most other lucrative fields such as engineering, marketing, accountancy and business. So why single out medicine? What about the students who spend a fortune outside the country obtaining foreign medical degrees and returning to Sri Lanka?
Regardless, surprisingly the argument of undermining free education appears to draw the attention of the youth even today and their fears should be alleviated. In fact this appears to be more of a struggle between the rich and the poor in a country where income disparity has widened exponentially.
Thirty years after graduating from the Colombo medical school and having trained both in Sri Lanka and the United States I continue to support district basis admissions having seen many bright colleagues who have done extremely well and become excellent physicians later in life who would have been left behind had it not been for the district basis admission policy. District basis by itself appears unfair as it does not correlate directly with economic hardship but it is extremely difficult to weigh in multiple factors especially in the Sri Lankan context.
On the other hand I strongly believe that a well-rounded student makes a better physician and marks alone should not be the only criteria for admission. This clearly applies to the many excellent well rounded candidates with better marks left out of the public universities due to the district quota. We have seen many outstanding physicians who have come through the NCMC. It is probably worthwhile studying the trajectory of the first few batches of students who were admitted the NCMC and comparing them to the graduates of the other faculties.
Selecting candidates via an interview process is difficult to implement at the state universities, particularly in Sri Lanka, where political interference permeates every aspect of existence and corruption is out of control.
3) Government resources and hospitals should not used to support private medical schools.
It is rather obvious that teaching hospitals maintain better standards throughout the world. These provide better and more sophisticated medical care to patients. If there is a need for more physicians in the country, encouraging the private sector is a logical solution. The government could always levy a fee from the schools for the use of their facilities but should not compromise the limited resources available for teaching at the government institutions used by the state run schools. Hospitals which are currently not used by the students of the government institutions could be assigned to private schools. The teaching faculty at state run medical schools should not be actively engaged in teaching at private institutions.
As far as SAITM is concerned none of the above appears to be an issue. Thirty five years after I first opposed the then PMC (NCMC) mainly on the grounds of awarding the Colombo University degree to the NCMC and upon a partial conviction that the free education system is being compromised by setting up a private medical school I strongly believe that Sri Lanka could gain by encouraging private higher education institutions to operate side by side with state funded institutions:
1) If there is a continued need/ shortage of professionals in a given area encourage setting up of private higher education institutions. The quality of all such professional degree awarding institutions private or public should be monitored by an independent body such as Liaison committee on Medical Education (LCME) existent in the United States which would grant them accreditation on a three to five year cycle.
2) Encouraging and rewarding private universities to diversify their student body based on geography, ethnicity, and socio economic back grounds as well as extracurricular activities while the government institutions follow a strictly score based admission policy.
3) Make low interest student loans available for all candidates admitted to private universities through the State. Enforce need blind admission policies to the private universities to safe guard the less affluent.
The main argument leveled against SAITM appears to be the quality of training although even from 10,000 miles away one could guess that the training in the Eastern campus cannot be superior to that of SAITM. The GMOA which has progressively become unpopular amongst the masses has joined hands with the JVP and the joint opposition to fish in troubled waters with complete disregard of a court ruling which enumerated the double standards used to asses SAITM as opposed to other medical schools.
Sri Lanka appears to be making strides in ethnic reconciliation and media freedom but has conveniently forgotten the vast number of youth it buried in 1971 and 1988-89. It is time we address the issues of our youth early and without further delay before they become fodder for bankrupt political parties.
(The writer is the Chairman of the Department Of Neurosciences and Chief Division of Neurology New York Presbyterian, Brooklyn Methodist Hospital, New York, USA.)