25 November, 2020

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That SAITM Problem: What To Do And What Not To Do

By Uditha Devapriya

Uditha Devapriya

The Sri Lanka Medical Council (SLMC) is a regulatory body. The Government Medical Officers’ Association (GMOA) is a union. The former has to comply with the law, the latter can campaign against the law. The former is (supposedly) free of politicking, the latter (again, supposedly) is not. It is to be expected, then, that when the Court of Appeal rules in favour of a private medical school, the latter rises up, encourages the University student movement in the country to campaign against it, and goes to town distributing leaflets, pamphlets, and what-not to clarify its stance. Doesn’t make it perfect, but doesn’t trivialise its actions either.

Our students have always fought to protect our education system. They have protested against measures taken by successive government to turn it into a commodity and have, at an exorbitant cost to themselves and their families, succeeded. Nothing wrong there, particularly when considering the fact that most of those measures have tried by and by to transform education into a privilege for those who can afford it. Free education has become to us what the NHS has become in the United Kingdom, but that has not stopped our Ministers from setting up ad-hoc Colleges which have, thanks to the student movement, been absorbed into our University system (I am talking about the short-lived North Colombo Medical College).

That is why the student body, not just the Inter University Students’ Federation (IUSF, more popularly known as Anthare) should be heard: not because they remain stakeholders in our education system, but because they know how much at risk education is in a world where it’s being sold out to capital interests. This article, on SAITM and the crisis it compelled and continues to compel, delves into two broad issues. Before we get to the crux of the matter, we need to go through these issues and try to resolve them.

Two issues, two allegations

The first issue is the rationale for the opposition to the Malabe campus. The campaign against private medical Universities did not begin by condemning private education. It began by pointing out that the Malabe campus did not possess what’s needed to qualify the students who graduate from there. Put simply, the doctors who graduate aren’t qualified enough to practice here.

Two allegations are pertinent on this count. Allegation Number One is that the minimum entry requirements at the campus aren’t enough. It’s ridiculous to suggest that private Universities only attract those who obtained low A Level scores, because that assumes that those who fail the local A Levels are all dropouts who don’t deserve a second chance. This, however, doesn’t belie the fact that a great many of such entrants who enter the campus did obtain such low scores.

Dr Sameera Senaratne, the CEO of SAITM, observed in a media briefing last week that when the University was begun in 2009, the admissions policy was based on the criteria laid down by the University Grants Commission. Initially this meant it was open to students who obtained three S’s at their A Levels, but as time went by (according to Dr Senaratne) the minimum requirement was increased to entitle students with two C passes and one S. A fair enough counterargument.

Allegation Number Two is worse: that SAITM does not possess enough to be an accredited medical institution in the first place. In a speech delivered at a foundation session of the Sri Lanka Medical Association (SLMA), Professor A. H. Sheriff Deen lays out four prerequisites to a certified medical school: a teaching school, a proper curriculum, capital, and permission to start a degree awarding institution. On all these counts, Professor Deen contends, SAITM lacks what it takes to be accredited by the SLMC.

How much of a problem is this? Consider the allegation that the students at SAITM aren’t given adequate clinical training. What constitutes adequate clinical training? Experience at a teaching hospital, of course. Most of those opposed to SAITM, naturally, are opposed to it because its students are provided with PRIVATE clinical training, cut off from the State and therefore from its requirements for aspiring medical practitioners.

What is SAITM’s response to this? The fact that from its inception, attempts to link up with the Homagama, Talangama, and Avissawella hospitals were opposed by certain interests in the GMOA, and the fact that it was this which precipitated the establishment of a private training facility (supposedly the largest in Sri Lanka). A fair response, one can surmise, but then if the Sri Lanka Medical Council (SLMC) has objected to the private training facility, and given that the Council IS a governing body (unlike the GMOA), is it enough to counter those hell-bent against it?

The rationale of those opposed to the Malabe campus, therefore, has less to do with the idea of private education than the shortfalls of the institution. Moreover, they will point at the ERPM (Act 16) examination, which students returning from foreign Universities must sit through if they are to practice medicine, and at the fact that less than 20 percent pass it.

They will also contend that even in 2015/2016, of the 1,260 well qualified local students who sat for it, 60 failed and had to be pruned out. Their argument is that in a context where even these bright students will not be given “consolation” MBBS degrees, how is it fair that capital be used to creep in and bypass the system? The answer, as always, depends on the way you perceive the issue. I have my caveat, though: Act 16 was designed specifically for students who sat for their medical exams outside the country. Strictly speaking, the students at SAITM are not from outside. Their degree and qualification is, but that’s another story. And another can of worms.

This belies a second, bigger issue: the inability of those opposed to structural deficits of a private establishment to distinguish between opposing those deficits and opposing what the establishment is based on: in this case, private education. Money doesn’t always coexist with merit, yes. The minute you let education be decided by capital, you artificially and immediately equate the top-scorer with the low-scorer. Does this mean that private education should be boycotted? By no means.

Elites and the original sin

If the State operates on the premise that education is a right for all, then the private sector should theoretically be allowed to go ahead with the principle of freedom for education: that is, freedom to enter a fee-levying institution if the student and his/her family are willing to pay their way through. The problem here, however, is to do not with the nature of private education, but with the nature of the sector in which SAITM operates: medicine. Pithily put, a field that involves the health and welfare of people should not be housed by people who have questionable credentials and money.

I know the argument of those who support private education: that medicine has become the monopoly of old, unwholesome, and bureaucratic elites. Elites, however, come in different shades, and as a friend of mine once told me, the one thing dividing the bureaucratic elite from the moneyed elite is that the latter are self-perpetuating. Nowhere is this truer than in the medical field.

And it’s not just about private medical campuses: it’s about the fact that even government doctors fudge it at their job, either joining lucrative careers in the private sector or opting for the channelling system and entering private practice. I fervently believe that an institution that wittingly or unwittingly qualifies a self-perpetuating social class must, of necessity, be vetted through the relevant governing body. I believe also, however, that inasmuch as moneyed interests must be cut off entirely, this does not shield the members of the GMOA and governing state institutions who politicise the issue beyond permissible limits and indulge in the same monetisation of their profession that they condemn in their press briefings.

In this regard, I believe Professor Carlo Fonseka put it best: that no less a figure than Karl Marx never underestimated the potential of free markets doesn’t in itself immunise private institutions from national vetting procedures. Profits matter, even in a government institution, but to make them the defining principle in education, particularly in a context where even the State suffers from intrusions by moneyed elites, is neither proper nor fair. We live in a society where equity is seen as more important than academic achievement. Given that profits (should) rank below academic achievement in the general order of things, isn’t it reasonable that for education to be properly maintained in the country, merit must be the overriding factor?

The SAITM side of the story

All this, of course, is what those opposed to SAITM would say. What of SAITM’s side of the story? An unbiased, sober reading of the issue reveals certain flaws with the GMOA, the union body of the SLMC. For instance, as Professor Deepthi Samarage said in an interview with “Ceylon Today” on January 30, the SLMC refused to grant even provisional registration to students graduating from the campus, on the pretext that the power of the 10-member Expert Committee tasked with ascertaining the credentials of the campus to make recommendations to SAITM was invalid.

Here’s what Professor Samarage said (I am quoting from the interview): “Nine members of that team made a comprehensive review over two and a half days. They produced an initial report to the Council, which stated (that) SAITM graduates can be registered after fulfilling a few SLMC recommendations. The SLMC recommendations included a one month clinical training for the students in a busy State hospital in major disciplines and to conduct a clinical examination for SAITM graduates. This is what was conveyed to SAITM at the wrap-up meeting by the review team.” In other words, the power to recommend, which wasn’t questioned before, was laid aside AFTER the meeting. By whom? The GMOA? The SLMC? Certain vested interests?

We can never really be sure. We can, however, infer. The fact is that SAITM has tried, from its inception, to work with the State. The fact is that the leading student body in our University system has opposed it, and not always for innocent reasons. As I mentioned before, that body has done a good job of confusing between opposing SAITM’s perceived deficiencies and opposing private education in general.

To be sure, that doesn’t mar their concern. But it does mar their legitimacy. It also rebels against their vision for a freer education system, by which I am referring to the prerequisite that should exist in any education system, CHOICE. If choice is being denied to those who dropped out of the local University system, what better term do we have for their opponents than “hypocrites”? And if we are to take this campaign forward on the basis of its concern for standards, aren’t we doing everyone a disservice by marring the name of an institution when rational discussion would do? The answer, I believe, is self-evident and there for all to see.

Outside the courts

That is why, inasmuch as I personally have reservations about private education, I think the Court of Appeal did the correct thing by affirming the writ applications of Malshani Suraweeraarachchi and Dilum Sooriyarachchi, both of whom had their applications for registration as medical practitioners allegedly rejected by the SLMC. On the other hand, those who have a problem with the January 31 ruling contend that the law is not the final resort: that other methods of campaigning against the final verdict exist. They can appeal higher at the Supreme Court, but for now, the IUSF, the GMOA, and a section of the SLMC seem to have gone for the “outside the courts” strategy: stage protests, make noises, and compel our attention.

The way I see it, however, this will not work for them or for us. The public they are trying to reach at are diametrically opposed to the public they are reaching. Of the latter, the largely middle-class, urbanised, and affluent social class of the country figure in. They are not opposed to private education, even though they may be beneficiaries of free education (after all even students in State Universities are against the IUSF). Of the former, the not-so affluent, village schoolchild and teenager figure in. The IUSF is trying to campaign for them. They are not reaching them. Also, given their past record (in particular, their notorious demand for car permits and affirmation of private practice and channelling), their credibility seems to be waning. Tragically.

Charting a solution

So what’s the solution? First and foremost, the IUSF, the GMOA, and the SLMC must elevate the quality of their protests. They must understand that given our affirmation of private education, the people will not rally behind them for long. They must take their campaign from vilifying SAITM unconditionally to pointing out the flaws in both the private and public sectors. SAITM may or may not have committed a sin, we do not know. It did not commit the original sin, however. For that, the people behind the current protests must look elsewhere: at the crass monetisation of their profession and their own “flexibility” when it comes to opting for the private sector.

Secondly and more importantly, their campaign must be less concerned with virulently opposing private education than with trying to link up the state and private establishments in a way that is conducive to both parties. This has already been done. We mustn’t privatise education overtly, but for those who can afford and are willing to pay through, there must be avenues open. Whether or not they flunk their exams, whether or not they rank higher than products of the local system, are questions to be answered later. If they are the idiots we conveniently see them as, they will peter out. If not, the regulatory authorities will correct them.

When I wrote on higher education and private universities (“Plastering problems: Universities, private education, and the bigger picture”), I contended that there were two ways of looking at education: that it’s a right and that it’s a commodity. About a week later, R. M. B. Senanayake in a reply titled “A false distinction” countered what I wrote by saying, basically, that rights could also be commodities, to be marketed and sold at a theoretically equilibrium price.

Now Senanayake has always been a defender of the free market (which is at odds with his role as a defender of individual and collective rights, though that’s another issue), and I am not, but I wonder: have we been so enamoured of the dichotomy between rights and commodities that we tend to lose ground by slinging mud at the wrong places? The SAITM issue, and how it will eventually be resolved, may prove to be a litmus test on that count.

*Uditha Devapriya is a freelance writer who can be reached at udakdev1@gmail.com. His articles can be accessed at fragmenteyes.blogspot.com

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Latest comments

  • 5
    3

    Students admitted to the private MEdical College are definitely rich students whose parents have money. It is very difficult to think A Student from a rural area who never attended tuition classes and one who got just Two C’s and one pass would be admitted to the Private Medical college. AMPs are allowed to work in Hopital. but, they get training for many years before letting them work as full pledged doctors.

    the selection of minimum level of A/J requirement looks very fishy because, rich students never get passed without the help of the tuition class. Private Medical college probably on purpose allowed those very low requirement for admission which allows them to give admission simply to their friends and those who have good contacts and money.

    Private Medical college shoul elevate their standards better than the State universities.

    Secondly, These struggling students whould be allowed to work at the AMP – level ans get elevated to doctors.

    • 5
      1

      Jimmy,
      “It is very difficult to think A Student from a rural area who never attended tuition classes and one who got just Two C’s and one pass would be admitted to the Private Medical college”
      If you watched Sirasa News yesterday, you would have seen Mahinda himself handing out SAITM scholarships to poor students in 2013.

      • 7
        1

        GMOA is holding poor patients to ransom and should not be allowed.

        They enjoy the opportunity to do private work at private hospitals but does not allow private medical schools. What a load of crap !!

        Easiest way to crush GMOA is to pay the govt doctors well and prevent them from doing private practice. Let them decide whether they want to be in govt or out of it. Cannot eat the cake and have it as well..

    • 1
      0

      There is one solution,if they strike, withdraw all the duty paid cars and force them to pay the subsidy stat. Stop all duty paid leave to study abroad,withdraw all housing facilities and handover the hospitals to Chinese Doctors

  • 5
    2

    The decision of the Court of Appeal would be appealed and the decision of the Supreme Court is judicially final. If we accept a thing called the rule of law then the decision of the SC has to be respected by all parties. The idea of the Trade Unions to use its muscle power, however justifiable it may be, can be against this principle of rule of law should the final judicial decision is against their wishes. As it is, their is an indirect influence on the Bench that if the final decision is against the wishes of the Trade Unions then the entire health services would criple and innocent people would suffer, only to bring discontent against those in power. The TUs are not worried about judicial decisions if they have the necessary muscle power to bend the government. They imply that the business of compliance to law, make the law, bend the law brake the law is that of the Executive and the Executive must adhere to the TU demand. So where is the rule of law?

    • 3
      0

      Law is made by Legislature which is Parliament.(govt) Law is used to bring illegal things into alignment through a judgment verdict releasing justice into a situation and is done by the Judiciary. The Executive branch of govt. is the President and Cabinet of Ministers who head the various depts. like health and education as well as the UGC and other statutory bodies like SL Medical Council. Tragedy strikes when these bodies of govt. join hands with Trade Unions like GMOA and IUSF etc whose attitudes are to topple govt. for their own ideologies joining the disgruntled and powerless political opposition parties, who are waiting for any issue through which they could fill their empty longings. Ragged, mind controlled poor students are victims. Justice was released to SAITM doctors legally identifying SLMC violation of Medical Ordinance, by not registering them to complete their internship. SLMC was directed to register them. Simple.

  • 5
    2

    A practical and fine analysis.I

  • 4
    7

    A theoretical and ideological discussion, but with no practical reality of how to outwork. SLMC has a court order to register SAITM doctors who are lawfully qualified in every aspect from entry to MBBS. SLMC violated Medical Ordinance when they depended on trade union GMOA power, instead of being the above board unbiased honest body with integrity as in the rest of the world. They should have passed on the ‘team report to higher authority and stopped at that boundary. All locals with even more deficits in faculties, overcome and qualify and are registered. So why not SAITM. SLMC has no power to govern but only to monitor and help upgrade for the benefit of nation. Their attitude is wrong to destroy and not build up. Now must take consequences and obey law of the land which issue is not necessarily personal politics.

  • 11
    1

    Private medical faculty is a national issue facing younger generation in this nation. This has nothing to do with the GMOA. GMOA is not doing any thing for the doctors. GMOA leadership does not know thier role, they have other agendas.GMOA is doing politics.Now GMOA has ganged up with Mahinda,JO,and JVP,Peratugami scoundrels
    Role of the GMOA is to look in to the issues of GMOA members. problems of the government medical officers.
    Unfortunately, current GMOA has failed to achieve any thing for the medical profession. Now it has become a renewed form of newly appointed beggars inertia. GMOA is there to address burning issues facing medical personnel as a whole, professionals should be able to achieve broader and relevant issues like Saturday issue affecting all doctors without resorting to any form of trade union action though discussion and negotiation as a mature, respectable and an esteemed profession.
    GMOA please attend to doctors burning issues and do not put the innocent pateiets in difficulty by resorting to unruly strikes and destabilize the current yahapalanaya government.

  • 2
    0

    It is time that people should think about the country rather than concentrate to achieve or sustain their personal agendas.Establishing private medical colleges definitely will prevent our foreign currency going out to the foreign medical colleges. Giving certain percentage of admissions to foreign student will reduce the course fee of our local students so that middle class can as well have an access to local private medical colleges. It will promote tourism as well. But we need to ensure the standards being maintained. I don’t see any harm to use state sector resources to complement the facilities of the private medical colleges for a reasonable fee provided this money to be spent back to the benefit of the poor patients.

  • 3
    1

    There are few batches of students who passed out without proper clinical training. It is ridiculous to accredit or accept “pass” qualifications when it is obvious that they did not have proper training. Medicine is not a degree in fine arts where one can learn to treat patients by reading.
    Look at the Dean’s recommendations. They do not request to abolish private medical education. But without proper regulation, this will be equal to O/L tuition and the recognition we enjoy as a country will be destroyed in no time.
    The SLMC due process was curtailed by the minister not escalating the relevant amendments via the Cabinet. This has nothing to do with anything mentioned in this article.

    How did the BoI story disappear and where did the Russian university go?
    SAITM can only be recognised if and if only the deficits are corrected. The recognising body is the SLMC. without that provision the medical education in this country will be ruined. There will be six more private medical colleges in no time.

  • 4
    0

    Education has fast changed. Medical Technology is also the same. therefore, govt alone cannot handle it. Besides, there is hugh surplus of A/L passed students who can not get into the University. Sri lanka also has a severe brain drain of educated people. Becasue of that, not only the flowing out of Foreign currency, but also for other reasons, there should be private Universities.

    Therefore, Private Medical college should have thought of preparing students better than the state universities do. Instead, it looks, the private medical college has ulterior motives to prepare rich students with minimal A/L qualifications for doctors. that allows, politicians children, daughter-in-las, doctors children who do not have very good qualifications to become doctors. I here, even the University has some graduate students who parents are in the supervisory board offering the post geraduate degree.

    Private medical collage should have started with very high standards in order to have good acceptance with the govt as well as with the foreign countries. Instead, they made a very foolish decision most probably intentionally.

    IF they are rolling out the same graduate that the state university is rolling out, then it becomes automatically competition and comparision.

  • 1
    0

    The private universities are needed for Sri Lannka,but they should be set up through following a proper procedures. The deans medical faculties of all state universities have presented proposals how to set up such universities. First thing is such universities should not be profit making institutes. Second thing is Sri Lanka should request world famous higher standard universities to open their branches in Sri Lanka to undertake the universities. Third thing is the enrollment qualifications for the universities should be properly standardized so as to accept for everyone.Fourth thing is the universities must follow a acceptable method to recruit fair amount of in-affluent student to mitigate the possible social injustice visible for the general public.Above all, it is paramount to appoint a highly qualified professional to study and formulate proposals to set up such universities considering all above cafeterias.

  • 1
    0

    I have few queries that have not been answered. Who sets standards? Is it one or the other of ministers, the institution or the university itself, GMOA, Medical council or courts? Should these standards (if we insist on any) apply to raw materials, the processing and quality assurance of the final products equally? (I have been told that in state universities there are more external examiners than the university staff assessing the candidates. we also have SAITM’s assurance that their products are of the same quality – but only their word. The foreign graduates who commenced their training at a recognized medical school, having obtained SLMC’s eligibility certificate have to sit for an exam on their return). Just as much as we recognize the rights of the ‘doctors’ to practice their craft (upon us) do we have a right to know that they actually are duly qualified? Is that ‘due qualification’ only a legal document? Please note that my worries are only on the quality. this is not a harangue against private education.

  • 0
    0

    EIGHT DEANS HAVE SAID THAT ADMISSION TO SAITM SHOULD BE SUSPENDED FOR 6 MONTHS. NOW LETS VISIT THE CREDENTIALS OF THESE WISE GUYS. THEY REPRESENT UNIVERSITIES WHICH RANK WORLDWIDE AT BELOW 2000 LEVEL. EVEN IN ASIA THEY CANNOT MAKE THE FIRST 200. IS THE KETTLE CALLING THE PT BLACK? PLEASE GET AT LEAST ABOVE 1000 BEFORE YOU CAN SPEAK.

    HOW COME THAT SAITM HAS ENGINEERING AND OTHER FACULTIES YET THERE IS NO PROTEST ?

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