Colombo Telegraph

Medical Mafia, Ethics & Education

By Hilmy Ahamed

Hilmy Ahamed

Sri Lanka has exemplary health indicators and is often referred to as a model for other developing nations. This is due to the yeomen service provided by a number of dedicated health professionals. Yet, Sri Lanka is one of the few countries that a large number of mercenary medical professions and industry are allowed to hold the sick to ransom, despite the Hippocratic oath taken by its doctors.

One would hardly find a doctor who would give evidence against his or her own during times of medical neglect. Today, the medical industry has been commercialized to the extent that they hold the patient and their family’s hostage even after the death of a patient.

Medical conditions become emotionally desperate situations where the immediate family is obliged to provide the best to their sick, and in most cases way beyond what is affordable. This leads to situations where they just cannot afford to settle the final medical bills even to discharge the body after a death. The hospitals do not warn the patient’s family of the estimated costs. Even when they do, it probably is too late as the patient’s condition is far too vulnerable to move them out to an affordable facility. Recently, we received the welcome news of a Colombo court ordering the management of a private hospital to release the body of a deceased immediately to his close relatives, which was reportedly detained for several days until the hospital’s exorbitant bill was settled.

Further, the sky rocketing cost of the doctor’s fees is settled through a “chit” plundering the patient and defrauding the state of its taxes. This has been an accepted practice and the authorities are fully aware of this scam, yet no action has been taken against this unscrupulous practice, fearing incarceration by the industry and the wrath of the medical profession. There are no safeguards through the consumer protection authority or any other state institutions on the health industry due to the fear of trade union action by these shylocks, who want their pound of flesh. Their trade union action or holding patients to ransom is totally against the Hippocratic oath they take and are as hypocritical as their practice. The state should intervene firmly and ensure that the citizens are provided quality private medical facilities at an affordable cost because the majority of them have studied for “FREE” in our state universities and schools.

The health industry has become lucrative global ventures and there is high demand for medical education, which our state universities are unable to cope with. We now see a large number of students who pass the GCE A’ Level examination with above average results and are unable to enter local medical universities. They are leaving to study abroad at exorbitant costs and several other negative outcome. Parents who dream of a medical education for their children use their meager saving and sometimes sell or mortgage their valuable assets to provide this education abroad, eventually to lose them to some foreign nation. Very few countries offer full or partial scholarships for medical education. Sri Lanka Medical Council that has thwarted private medical education locally has no qualms about allowing these foreign graduates to work in Sri Lanka if they pass the Examination for Registration to Practice Medicine (ERPM) formerly know as act 16 examinations.

The students, who now attend foreign medical collages, are also eating in to the country’s scarce foreign exchange resources. This, and the negative cultural and social consequences of displacement could be easily avoided if private medical education is encouraged in Sri Lanka with state hospitals providing the necessary clinical facilities and other support for a fee if required. After all, this education is for our own children and they have the right to use the taxes paid by their parents. Yet, the Sri Lanka Medical Council and some student unions oppose this, citing various reasons. They have no reservations about the same students graduating from foreign universities and practicing alongside them locally. The often-claimed reason for opposing is their eligibility is due to their poor advanced level results. This is not true as they have passed the GCE A’ level with the requirements set as per the university grants commission. Further, if their grades are sufficient to follow medical education abroad that has been approved by the Sri Lanka Medical Council and are eligible to practice locally, they should have the option of studying locally in their own home environment. The investment Sri Lanka made on these smart kids on their primary education too is increasingly harnessed by foreign nations. Further, they are compelled to move away from their families, friends and culture, which in itself is a traumatic experience.

The Government provides free education up to the degree and even postgraduate levels. There are also private or international schools that have filled a vacuum for quality education by those who could afford it, but the opportunities for private school candidates who follow the international curriculum to enter local universities is restricted. There is also considerable social prejudice against these students. This is an infringement on their basic human rights. Their parents probably are all taxpayers. Many students therefore are forced to turn to private institutions in Sri Lanka or go abroad to obtain their degrees. While some foreign graduate and postgraduate programmes are offered and accepted, medical students continue to face many obstacles due to the medical mafia not allowing accreditation to any local private medical degree awarding programmes.

The basic education requirement to follow a medical degree course is 3 passes at A’ Level In the Science stream (Biology, Chemistry, Physics or Mathematics). Today, even students who have all A grades in their advanced level are not guaranteed admission to a local university of their choice. As per a study undertaken by NR de Silva , A Pathmeswaran and HJ de Silva, “approximately 850–900 enter the six state medical schools in Sri Lanka. The university grants commission, with a policy that has remained basically unchanged for several decades, centrally administers this. “At present, 40% of seats are awarded on the sole basis of the GCE A level aggregate score (‘merit quota’), and 55% is divided among the 25 districts of Sri Lanka. The balance 5% is reserved for 13 ‘educationally underprivileged’ districts”

The district quota system was introduced to facilitate students from backward areas to enter universities with a lesser grade. This is seen by urban students as a breach of their fundamental right to seek university education on their merit, yet this is seen by the majority as an incentive for students from rural areas to have access to university education. While admitting it as an elitist notion to object to this concession, this quota system has been accused of being the destroyer of quality higher education in Sri Lanka. It is the responsibility of the state to provide quality education without discrimination to all its citizens.

In 2014, the former government of Mahinda Rajapaksa laid down plans to set up ten foreign universities in Sri Lanka by 2020, under its ambitious target of making Sri Lanka an international hub of excellence in higher education.

The University of Central Lancashire in Britain started their project of setting up a branch campus in Mirigama, Sri Lanka, with an investment of US $ 120 million. They have received tax holidays, along with duty waivers for items that are to be imported for the execution and implementation of the project. Regretfully, this has not taken off as yet and the much expected “laying of the foundation stone” during the visit of Prince Charles during his visit to CHOGM 2014 did not take place.

The first private medical collage was established in 1980 as the North Colombo Medical College. However, due to heavy opposition from the Marxist unions, some medical professionals, state university students and other professionals, the college was nationalized and renamed the Kelaniya Medical Faculty. The North Colombo Medical College as a private medical university was fully supported by a large number of medical professionals.

The next attempt at setting up a private medical college was the South Asian Institute of Technology and Medicine (SAITM). A brilliant concept and the brainchild of Dr Neville Fernando. This was undertaken in collaboration with the Nizhny Novgorod State Medical Academy, Russian Federation. Here, the final year students were offered entrance to the Nizhny Novgorod State Medical Academy in Russia, which has been recognized by the Sri Lanka Medical Council, thereby allowing its graduates to practice medicine in Sri Lanka after passing the licensing examination.

SAITM also started a local MBBS programme 5 years ago. To provide clinical support, Dr Neville Fernando invested heavily in setting up the Dr Neville Fernando Teaching Hospital (NFTH), a 1002 bed facility ( a bed more than the Japanese grant of the Sri Jayawardenepura hospital to JR Jayawardene in recognition of his support at the Treaty of San Francisco or San Francisco Peace Treaty ). The hospital’s website claims “NFTH is not, yet another private hospital in the country, which charges exorbitant prices from their patients for the services provided. The hospital services are presented in such a way that it is very much affordable to the greater majority of the local population who are average or lower middle income earners, but never compromising on the service standards or the quality of medical care. As a socially responsible corporate citizen, Dr Neville Fernando Teaching Hospital (NFTH) reserves 20% of the operational bed capacity for the benefit of the less privileged patients offering free beds and medical care at a concessionary rate. It also charges heavily discounted and subsidized rates for the medicine, lab and radiologic investigations”.  A noble concept indeed.

The were recent media reports that Sri Lanka Medical Council has concluded that the clinical facilities for medical education at SAITM is inadequate and that it cannot be recognized as a medical degree awarding institution. There is an intake of students who are completing their degree programme this year, and now these students have complained to the human rights commission on the breach of their fundamental right by the Sri Lanka Medical Council. They also staged a peaceful demonstration outside the Sri Lanka Medical Council against their discrimination. Prof. Carlo Fonseka as President of the Sri Lankan Medical Council has accused the Neville Fernanda Teaching hospital of neglect and responsibility for the bacterial infection of the late Ven. Sobitha Thero while receiving treatment at the hospital.

This is seen as a ploy by the mafia to stir up a revolt against the noble initiative of Dr Neville Fernando and his social venture. Dr Fernando has taken steps to sue Prof. Fonseka for a staggering Rs. 500 Million for falsely accusing the hospital. It is indeed regrettable that Prof. Fonseka, an octogenarian has made such statement. Questions have been raised as to his medical capability at 83 to take rational decisions involving the health of the nation.

If the reasons for the Sri Lanka Medical Council rejecting the SAITM medical degree are valid, it is incumbent on the government to investigate and make necessary arrangements to support and ensure that the clinical facilities are upgraded to the required standards or provide access to clinical training for private medical education in state hospitals. If the well-equipped Dr Neville Fernando Teaching Hospital (NFTH) is below the required standard, It is incumbent on the government to support this socially conscious private entrepreneur to elevate the quality of patient care and clinical facilities to the required standards. After all, Dr Niville Fernando is also providing a yeomen service by providing subsidized medical facilities to the needy, which is the responsibility of the government. This will ensure that the degree offered by this private university is as good and recognized as any other in the country. The government should also assist in improving this hospital as there are no hospital facilities for the people of Battaramulla, Kaduwela, Malabe and beyond that is equipped with modern facilities.

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