By Ariaratnam Gobikrishna –

When you grow up in a country like Sri Lanka, where opportunities can be limited, your aspirations are often shaped by the small world around you—your village, your school, and the community in which you were raised. The examples you see and the expectations placed upon you come primarily from your immediate family. Dreams are rarely limitless; they are constrained by what seems possible within your surroundings.

I never grew up imagining that I would one day become a doctor. There was no defining childhood ambition, no mentor who inspired that path, and no carefully laid plan. Yet, in retrospect, life’s unseen forces seemed to conspire in unexpected ways, propelling me along a zigzagging path toward a profession that ultimately became my vocation.

These thoughts resurfaced today because, completely out of the blue, I received an invitation to a reunion of the first ever private medical school in Sri Lanka that I had attended briefly. I had left for India as a refugee after two years in Ragama, when the 1983 ethnic riots abruptly changed the course of my life. This unexpected invitation from the private medical college alumni brought back memories—not only of a place and a time, but also of how unpredictable life can be. Looking back, I realize that the paths we ultimately travel are often shaped as much by unforeseen events as by our own intentions.

After I left Sri Lanka, the private medical school I had attended became the target of fierce opposition from the state medical establishment. Amid sustained protests and political pressure, it eventually lost its accreditation, was abolished, and its remaining assets were later absorbed into the University of Kelaniya.

Thirty years later, while I was on vacation in Colombo, history seemed to repeat itself. A new private medical school in Malabe had become the focus of equally intense demonstrations, and I later learned that it too ultimately met a similar fate. A friend who had followed the controversy shared an anecdote that has stayed with me ever since. One of the most vocal leaders of the campaign was a young member of a government medical faculty who publicly declared that he was spearheading the movement to safeguard the standards of medical education in Sri Lanka. During one interview, a reporter asked him a simple question: what had been his Advanced Level examination results when he gained admission to medical school? According to my friend, he replied that he could not remember. Whether or not the exchange unfolded exactly as recounted, the irony was difficult to ignore. Here was someone passionately invoking academic standards while seemingly unable—or unwilling—to recall the very credentials that had earned him a place in the system he was defending.

That brings me to the enduring question of what it truly means to uphold the standards of medical education in Sri Lanka. Allow me to place my own story into that broader conversation.

I may be more than twice the age of that young academic, but I remember my Advanced Level results as clearly today as I did then. On my first attempt, I obtained one A, two Bs, and one S—an A in Zoology, Bs in Chemistry and Botany, and an S in Physics. I had every hope of securing admission to medical school. Instead, I was offered a place in the Faculty of Agriculture at the University of Peradeniya.

After I enrolled at Peradeniya, I soon discovered that many students admitted to medical school had entered with academic results that, on paper, were less competitive than mine. This was largely a consequence of the district-based admissions policy then in effect. There were also persistent allegations that some applicants had misrepresented their permanent residence to qualify under more favorable district quotas.

When the opportunity arose to enroll in the newly established private medical school in Ragama, I could not resist. I accepted the opportunity with immense gratitude. At a time when my father, who had been largely absent from my life, unexpectedly stepped forward to support my education. That decision ultimately set in motion a journey that later took me from India to the United States, made possible by the extraordinary generosity and support of my stepmother.

Having said that, was I angry about being denied a place in the state-funded medical school? Absolutely. Yet, with the benefit of time and a more measured perspective, I can also appreciate the rationale behind the district-based admissions policy. I had grown up in Jaffna, where I had access to some of the best schools and tuition classes in the country. Another Tamil student from a remote village in the North or East, a Muslim student from an underserved community, or a Sinhalese student from a rural village in the South may not have enjoyed the same educational opportunities. If the objective was to create a more level playing field, then the principle behind the policy was understandable—and perhaps even necessary.

What was regrettable, however, was that the system could have been made far fairer with a simple safeguard: eligibility should have been based on the school a student attended during the final year of the Advanced Level examination. Such a rule would have made it far more difficult to manipulate claims of permanent residence and would have greatly reduced opportunities for abuse while preserving the spirit of the policy.

That, however, leaves another important question. What should become of students who achieved good grades—sometimes even better than those who ultimately entered medical school—but were denied admission because of the quota system? Should they simply be penalized for making way for students from disadvantaged backgrounds? Surely a fair society owes them a meaningful alternative.

Sri Lanka had very few such alternatives at the time. Even today, despite greater access to foreign universities, opportunities within the country remain limited. This is particularly unfortunate in professions such as medicine, where there has long been a shortage of trained personnel. Instead of forcing talented students to seek expensive education abroad—resulting in a substantial outflow of foreign exchange—why not expand high-quality medical education within Sri Lanka? Doing so would create opportunities for deserving students, retain valuable resources within the country, and produce doctors who are more likely to build their careers at home, especially now that the decades of civil conflict are behind us.

Although I am not a graduate of the former private medical school, I remain deeply indebted to the institution. Its generosity at a critical moment in my life helped open the door for me to continue my medical education in India when circumstances forced me to leave Sri Lanka. Perhaps that connection has never entirely disappeared, because I was recently invited to join its alumni discussion group. Through that group, I have come to know many of the approximately forty graduates who successfully navigated the extraordinary obstacles placed in their path. Their subsequent careers speak for themselves. Many have become highly accomplished physicians and specialists. Some chose to remain in Sri Lanka and serve their communities, while others have distinguished themselves in healthcare systems around the world.

Their achievements challenge the long-held assumption that the private medical school experiment, launched in 1981, was destined to undermine the standards and integrity of medical education in Sri Lanka. On the contrary, their professional success suggests that the quality of a medical graduate depends less on the ownership of the institution and more on the rigor of its training and, above all, the standards by which competence is assessed.

Many countries, particularly the United States, rely on a system of standardized national examinations throughout medical training and before independent practice. Every medical student, regardless of whether they attend a public or private institution, is required to meet the same objective benchmarks. Those who fail to demonstrate the necessary knowledge and clinical competence do not progress. Such a system ensures that students who are unprepared are identified and filtered out long before they are licensed to practice.

If we look closely at the history of these protests, their consequences extend far beyond the immediate disruption they caused. Families who invested their hard-earned savings in their children’s education were left facing enormous uncertainty, while the repeated interruptions simply prolonged medical training and created avoidable delays in producing much-needed doctors for the country. What makes this particularly troubling is that many of those who instigate or encourage such protests can quickly return to the security of their government positions, salaries, benefits, and private practices. The students, meanwhile are the ones whose lives and careers are placed on hold.

Another anomaly I have noticed time and again during my visits to Colombo is the persistent perception among many locally trained doctors that there is a wide gap in standards between themselves and Sri Lankan students who obtain their medical degrees abroad—whether in Bangladesh, India, China, Belarus, or any number of other countries.

Those returning graduates are often subjected to a prolonged and demanding sequence of qualifying examinations before they are permitted to enter the profession, and many struggle through that process. Yet local medical graduates are not required to pass the same qualifying examination before beginning their internships. The locals who fail their own final examinations are generally given another opportunity after a relatively short interval. Somehow, within that system, the assumption persists that the locally trained graduate is inherently better prepared, while the foreign-trained graduate must first prove that he or she is worthy of joining the profession.

It is this presumption of superiority that I find difficult to understand. If the concern is genuinely about competence and patient safety, why not subject everyone—whether educated in Colombo, Jaffna, Batticaloa, India, Bangladesh, China, Belarus, or anywhere else—to the same national standard before entering internship? A common examination would settle the question far more fairly than assuming that every foreign medical graduate is inferior to every local graduate, including the 30–40% who failed the final MBBS examination on their first attempt. It is understandable to give local graduates first preference in internship placements, but everything else, for the sake of the patients, should be based on merit.

Perhaps the final irony is also the most amusing. While foreign-trained medical graduates are sometimes viewed with suspicion or spoken of as though their education were inherently inferior, many established consultants in Sri Lanka proudly display their own foreign qualifications, fellowships, training and affiliations at every opportunity—not only because these credentials confer prestige in the eyes of the general public, but also because overseas postgraduate training has traditionally been an integral, and ordinarily required, component of the pathway to Board Certification as a specialist in Sri Lanka. At the same time, local postgraduate trainees fiercely compete for opportunities to travel abroad, acquire advanced skills, obtain additional diplomas and fellowships, and return with credentials that visibly distinguish them from colleagues who have not had the same opportunity—though, ironically, many of them never return at all. There is, of course, nothing wrong with seeking the best training the world has to offer. Medicine has always benefited from the exchange of knowledge across borders. The irony lies elsewhere: foreign medical education can often be regarded with suspicion when it belongs to a young graduate seeking entry into the profession, yet become a badge of honor when attached to the résumé of an established specialist. Welcome to the land of irony!

Nearly half a century later, perhaps it is time to ask what these repeated battles against private medical education actually achieved for Sri Lanka. Did closing medical schools improve the quality of our doctors? Did years of protests strengthen medical education? Did placing hardships on foreign medical graduates improve our overall health care in our country? Or did we simply disrupt the lives of hundreds of young people, exhaust their families, drive some of our talent and money overseas, and delay the production of doctors a country desperately needed?

If our real purpose was to protect the standard of Sri Lankan medicine, why did we spend so much energy pitting one group of medical students against another, instead of testing, mentoring, training and nurturing them?

Standards are protected by standards—not by shutting doors, condescension, or grandiose delusions.