The current public discourse over the future of SAITM and its medical students’ future has been quite unfair in not taking all aspects into account. The state university students have portrayed the whole thing as a fight to defend Free Education from the throes of capitalism. On the other hand SAITM students have portrayed it as their right to study medicine at a Sri Lankan Private Medical College since they too have a desire to become doctors to protect the health of the nation. The aspect that is missing from the discourse is the status and future of medical students graduating and entering the Sri Lankan health sector from Foreign Universities. No one seems much interested in bringing them into the equation and making it a three party debate. A debate that involves every type of medical student of Sri Lankan origin.
Why the interest from me ? Because I was a medical student in a Chinese Medical University for a 8 month period, September 2013 to May 2014, as a paying foreign student for the MBBS in English medium. I quit the course and returned to Sri Lanka mainly to switch my career to International Relations, but it was also influenced by the concerns about the quality of education I was receiving. Thus I have a vested interest in making sure the current discourse involves the status and validity of foreign paid medical qualifications as well. Not just the SAITM qualification.
Minimum entry requirements have been a major concern with SAITM. Two Credit passes and a Simple pass for Local A/L qualified students and 2C and 1D passes for foreign A/L qualified students are the minimum requirements for entry into the MBBS programme at SAITM. That is the minimum requirement stipulated by Sri Lanka Medical Council (SLMC) for any student sitting the Examination for the Registration to Practice Medicine in Sri Lanka (ERPM).
Currently the SLMC maintains that even those who possess MBBS or equivalent qualifications cannot sit for the ERPM without proving those Advanced Level minimum requirements are met. The same restriction applies to Sri Lankans studying in foreign universities for medicine. But I have not come across a protester who has asked for foreign university students be prevented from sitting for ERPM or the validity of their qualifications to be revoked; a validity assured by the SLMCs List of Approved Foreign Medical Qualifications
Sri Lanka Medical Council
The quality of the medical education provided at SAITM is the next concern. I had a similar concern about the medical education in China. Qualifications of the lecturers was not the concern. The fact that their first language was Mandarin, meant that their English was not clear to us. Their intended lesson lacked clarity. Some failed to pronounce most of the Latin terms and would have us pronounce them instead. Only the rare gem of a Chinese lecturer was fluent in English and that too thanks to being educated abroad. Seniors weren’t reluctant to confess that they were getting through the exams thanks to self-studies and sheer willpower to become doctors. The Anatomy and BioChemistry labs had all the facilities one would expect of a medical faculty in the US, but again the limiting factor was the English communication of the lecturers.
I have no experience of lectures at SAITM to provide a comparison. But, what I can argue is that SLMC and University Grants Commission (UGC) are able to keep a constant eye of oversight over the quality of teaching at SAITM. However when it comes to foreign universities, SLMC and UGC have no resources or mechanisms in place for regular monitoring of standards. While the university I attended was at a relatively good standard, there are many which don’t even try to maintain standards. This is especially true of some privately owned medical colleges in India, Nepal and Bangladesh. There was a crisis last year when the Bangladeshi government cancelled the license of a private medical college in Bangladesh, leaving dozens of Sri Lankan students stranded in limbo. SLMC had not issued even a warning about the institute prior to that.
Sri Lanka has an advanced healthcare sector in relation to Nepal or Bangladesh. It is why doctors from Sri Lanka are in high demand for health sector jobs in developed countries. We breed good doctors. What is primitive in Sri Lanka is the ability to monitor and regulate the various medical qualifications that are apparently approved by the SLMC. The foreign universities that the SLMC has approved have not been visited by officials. There seems to be no criteria which governs the approval process. Only apparent criteria is a medical graduate from an unapproved foreign university being able to pass ERPM. No one asks whether they got clinical training at a hospital that is busier than Neville Fernando Teaching Hospital (NFTH). No one checks either. Then what is the logic of not treating SAITM graduates in the same manner. Given the precedent set in treating foreign medical graduates, this seems extremely unfair.
In conclusion I see two options to setting this fair. First, opposition to SAITM must also apply the same opposition to foreign medical graduates. Second, create a coherent monitoring mechanism to check the standards of all medical qualifications that qualify a Sri Lankan to sit for the ERPM. It should be jointly administered by the SLMC and UGC. The government needs to allocate special funds for such a mechanism to operate and even visit foreign universities to carryout stringent monitoring. Focus of it should not be merely on foreign universities and domestic private colleges, but also on the state medical faculties. It is a public secret that faculties in Rajarata and Ruhuna universities are not at the expected standards. Legislation should mandate all medical graduates (doctors) wishing to practice in Sri Lanka should sit for ERPM. No exception.
The result is not only a fair status quo, but also a competitive environment among even state faculties to provide quality medical education. The ultimate benefactors are the people of Sri Lanka, who will be assured of quality doctors treating them, regardless of the origin of their qualifications.
“For the purpose of getting all facts into play we carried out a small survey amongst Sri Lankan students studying medicine at foreign universities. 50 students were asked if they would have preferred to stay back to study medicine in Sri Lanka at a private medical college if they were able to practice as medical doctors in Sri Lanka without the conflict faced in the present. Off the 50, 44 stated that they certainly would have preferred to do so.
As mentioned before, a majority of SAITM students are ones who studied outside the National Advanced Level curriculum. Hence a significant point that needs to be taken into consideration is, should SAITM be nationalized or closed down, all these students would travel overseas to study medicine. The damage caused due to this would be two pronged. The first is that we as a country would lose valuable expertise. The second would be from an economic standpoint.”
~ Buddhi Ranasinghe
We have explored the entire problem through the eyes of every party involved in the incident. Does this situation affect the country as a whole? Can a middle path be found?What’s the economic aspects of the imbroglio?
Money has been a hot topic of discussion during this conflict between SAITM and the government medical students, therefore it is appropriate to analyse this situation from a purely economic standpoint. The true economic impact of private medical universities being set up is far deeper than what it may seem at the surface.