The private medical college: A response to, ‘A different point of view’

October 30, 2011, 7:21 pm


by Edward Gunawardena

Dr. Sankalpa Marasinghe, certainly not ‘one’ Dr. Marasinghe writing to The Island of 24th October has made a spirited but fruitless effort to defend the GMOA and the SLMC. Unfortunately their cases as the legal fraternity would describe are ‘black’. Interestingly, he has strayed from the main issues and dwelt lengthily on the virtues of free education. In the process as most faithful state employees do today, he has not failed to draw inspiration from the Mahinda Chintana too.

Presumably, as a true beneficiary of free education who enjoyed a Mahapola grant too, he is one of the few who has dedicated himself to the care of his countrymen free of charge and for a modest state salary shunning the lucrative domain of private practice.

In this response I shall succinctly, in point form comment on the somewhat abrasive observations made by Dr. Marasinghe.

1. 1 was appointed to the specially created post of Advisor UGC in June 1987 primarily because of the student unrest situation that prevailed at the time. Having been a Fulbright Scholar with exposure to the student unrest in the United States universities in the sixties and having been a student leader at Peradeniya in the 50s, the President and the Secretary, Higher Education realizing the need for a student friendly negotiator at the UGC offered me the job on very attractive terms.

2. During the NCMC dispute which was aggravated with the JVP militant student wing too entering the fray I was totally opposed to the police using force on students. My recommendation to the Chairman of the UGC was as a conciliatory measure give in to the student demand of not giving the MBBS (Col) degree to the NCMC students. I held the view that the NCMC be given degree awarding status so that there could be a "BIBS (NCMC, Sri Lanka). This suggestion was pooh pooed by the NCMC Board of Management which comprised senior doctors like Ratnavele, Heen Nilame and Sivasooriyarn. What is significant is that all these doctors possessed the first degree MBBS (Colombo) !

I was not a sycophant like the present day advisors. It was for this reason that I decided to resign even before I had completed two years in the job. It needs to be appreciated that an advisor cannot compel his advice to be accepted.

3. On free education, the learned doctor says, " The government provided primary, secondary and Tertiary education free of charge to the public."

This Statement is only partially true. A large number of young men and women who after years of hard work qualify to pursue tertiary education cannot be accommodated in state universities. This is particularly so in the discipline of Medicine. Hence the urgent need for private teaching institutions to fill this vacuum. Interested entrepreneurs deserve to be encouraged by the state to set up teaching institutions. Laying of standards and monitoring the maintenance of such standards should be a responsibility of the state.

Society has a duty and obligation to provide any person keen to be a doctor and possessing the necessary academic qualifications and also the means, to become a doctor. Organizations of this elite profession have a duty to encourage the private sector to come to their rescue and not allow such young men and women deserving to be doctors to end up as hospital labourers.

As for the statement purported to have been made by His Excellency the President and quoted by Dr. M, "I will not curtail the free education of the country’s children", I would like to pose the question,. "Who is the politician who will promise to abolish free education? " That will be committing hara-kiri.

With the inability of state universities to absorb all those who qualify for university education, the free education of an important segment of the population, Adult students, has already been curtailed. Children comprise the only segment left. Even at this level parents are burdened with all manner of levies, not to mention the bribes at admission. What price free education ?

4. As for the nations affordability of free education I agree the tax payers are there to bear the cost. But after sponging on the taxpayer for free education what moral right has a doctor to charge exorbitant fees or treat parents shabbily or abandon the people who funded his free education and seek greener pastures abroad. To add insult to injury, as I have pointed out some doctors resort to shameless ways of collecting their fees to escape taxes and defraud insurers of patients.

Considering the above the concept of free education "which is a solid and deep economic strategy which has given Lanka a long term benefit," according to the learned doctor, remains a myth particularly in the healthcare sector.

5. I agree with Dr. M that opposition to free education is not a new development etc. However to use his own words I read with disbelief and dismay his statement, The arguments were the same as now, the only difference was that those voices were not paid back then" (emphasis mine). A nasty, unwarranted insinuation indeed unworthy of the noble profession be represents. Perhaps he thinks that dissenting voices in an intellectual controversy are "like the unscrupulous doctors who are swayed by money bags", that the Editor speaks about in his note. Dr. M should refrain from judging others by his own standards.

6. My assertion, "What a village midwife did some years ago…………………… etc. remains unretracted Air Conditioned sterilized theatres, the availability of swift transport and communications, modern equipment such as incubators, baby rooms; efficacious drugs, well nourished mothers, improved pre and post natal care and nutrition, higher living standards, better trained medical staff etc. all have a bearing on maternal mortality rates.

But what I basically said was that what a midwife did then is today done by a FRCOG etc. I stand by this statement. What they normally perform is the identical task. They both assist in the natural biological function of childbirth. They both deliver.

But today again for monetary gain caesarian operations have become more the rule than the exception. I once came to know of a doctor who connived with parents to ‘cause a birth’ targeting the school admission date five years ahead! I wonder how ethical acts of this nature are ?

7. I am indeed happy to learn that our medical education has advanced to such a level that we are in a position to dump the Fellowship from the RCOG as our PGIM is comparable to any other such Institute in the world. This is no doubt a significant achievement. I hope the mandatory foreign training can be made reciprocal with doctors from the UK especially, receiving world recognized professional qualifications in Medicine , surgery, gynecology, Dentistry etc. from our own prestigious PGIM. We have beaten the ‘Suddas’ at cricket. It will certainly be great to teach them a bit of Medicine and surgery too.

8. When I referred to air – conditioned Theatres etc and asked ‘at what cost’? Dr. M discreetly side steps the question and says all labour rooms in state hospitals are being air-conditioned and patients not charged a cent. He pretends not to know the existence of the thriving private healthcare sector of which doctors from state hospitals are an integral part.

9. When I referred to the likelihood of the MBBS being replaced by degrees such as Bachelor of Cardiology I was only emphasizing the need to understand the world trend towards specialization in sub disciplines .

It cannot be denied that specialization is most marked in the medical profession. Are not there specialists or consultants for every imaginable ailment today ? As for the insult that my wisdom could not be any better than a village damsel’s, I am driven to surmise that ‘the working of the minds of village damsels’ is a guarded specialization of Dr. Marasinghe. A lucky man indeed !

Peradeniya will always be proud of me not for my wisdom but because as one who writes often to the newspapers I have never descended to personal levels, insults, insinuations or crude ridicule particularly in a public discussion or debate.

10. When I raised the question, ‘Do qualifications alone make a specialist doctor’ and went on to stress on the importance of ethics, I expected an intelligent and sensible response. With due respect to Prof. Lalitha Mendis permit me to say that her comment may satisfy a court of law. In reality no patient will complain against the doctor from whom treatment is sought ; not even a quak. Even law enforcement agencies eg. the Police or Inland Revenue are wary of going after errant doctors because of the historical regard and esteem the profession has enjoyed. These are the factors that are being ruthlessly exploited by some unscrupulous doctors.

If the SLMC is sincerely concerned it can certainly find ways and means of putting an end to the unconscionable exploitation of patients by doctors. The nation expects the SLMC to do its duty.

11. It is obvious that some medical graduates entertain doubts about the quality of their own degrees, received from state universities. What more evidence than their own name boards with qualifications displayed outside wayside clinics etc. One needs to only go round a little looking for these places. Seldom ‘is the qualification MBBS (SJP) MBBS (Ruhuna) MBBS (Kelaniya) to be seen. Such graduates prefer to write MBBS (Sri Lanka). The plain truth is that these graduates are not proud of the degrees they possess. The graduates with MBBS (Col) are proud of it because Colombo is reputed for better quality medical graduates.

12. Nowhere in my article have I referred to the Departments of Study in the PMC or the quality its staff. Dr. M has got his reading crossed somewhere. These hiccups do normally happen in uncoordinated joint efforts.

I must confess that I have the highest admiration for Dr. Neville Fernando. As a medical practitioner, as a politician and as a businessman his reputation for integrity is legendary. In all matters that affected his patients, his voters or his clients he has always acted with the highest sense of honour and dignity. It is shocking indeed for Dr. M in his eagerness to pay a tribute to Prof. Sheriffdeen to have referred to one of the seniormost living members of the medical profession as infamous, one of the most disparaging words in the English Language. I wonder what Prof. Sheriffdeen the much respected mentor of Dr. M. thinks of this most unethical outburst from one of his students.

The ‘professorship’ of Dr. Neville Fernando may seem to be challengeable. As Dr. M points out, traditionally a Professor was also a Head of Department in a university. Indeed this was the form at Peradeniya of my time. Much water has flowed under the bridges since then. Today there are many professors even outside universities. In many countries all university teachers are referred to as Professors, Associate Professors or Assistant Professors. Heads of affiliated Colleges of Universities are generally designated as professors. Before the formation of the University of Ceylon in 1942, the University College which existed, affiliated to the London University had a principal designated Professor. He was the famous Professor Robert Marrs. The Malabe PMC is affiliated to the Nizhny Novgorod State Medical Academy a recognized university and Dr. Neville Fernando is the head or Rector. His case is not different from that of Prof. Marrs of the now defunct Ceylon University College.

Nizhny Novgorod State Medical Academy has gone a step further. After a complete assessment of the credentials of Dr. Fernando and his contribution to the improvement of the quality of Higher professional education, the Scientific Council of the NNSMA has thought it fit to award Dr. Neville Fernando an honorary professorship.

It needs to be understood that the academic world has come a long way since the days when there was only one professor for a particular discipline and he/she was the Head of he Department. Having for nearly a century got accustomed to the British model we sometimes fail to comprehend the diversification that has taken place. The duration of courses, types of degrees, manner of recognition of contributions to academic progress etc. vary from country to country today.

I have been the most vociferous opponent of dubious Doctorates and Professorships in this country. However in this instance I have no reason to doubt the merit worthiness and legitimacy of the professorship of Dr. Fernando. It is indeed difficult to understand the venomous invective of "Dr. Marasinghe. The reference to Dr. Neville Fernando as an infamous ‘professor’ is unquestionably libelous and disparaging.

The laboured attempt by Dr. M to character assassinate Dr. Neville Fernando will certainly not dilute or absolve the culpability of the GMOA for the unethical practices that I have referred to. Even if the ‘Professorship’ of Dr. Fernando is considered to be ‘unethical’ it can in no way have an adverse impact on patients. But it cannot be denied that the public suffer innumerable inconveniences due to the unethical practices of some doctors. This argument of Dr. Marasinghe reminds me of the pithy Sinhala saying, ` Koheda Yanne, Malle Pol’ !

13. Prof. Sheriffdeen is a much respected Surgeon and teacher. He is indeed a man of eminence who has reached the zenith of his profession. The balanced views expressed by him needs to be respected. Unlike his pupil, Prof. Sheriffdeen has not berated the private sector. The crux of his letter to the Island is the emphasis on the absolute need to maintain the required standards in the teaching of Medicine. However, I have emphatically stated that the highest standards are not beyond the reach of the private sector. To reject the private sector participation in medical education on the unfounded presumption that private sector institutions are incapable of achieving the desired standards amounts to the throwing away of the baby with the bathwater,

14 Dr. H.H.R. Samarasinghe is another highly respected physician and gentleman. Contrary to what has been stated by Dr. Marasinghe I have not worked with him nor have I claimed in my article that I have worked with him. I have merely stated that in the early nineties, as a member of the Council of the Sri Jayawardenapura University I strongly supported the establishment of the Medical Faculty with Dr. H.H.R. Samarasinghe as the first Dean.

15. In his lengthy response to my article of 18th Oct. in abrasive ‘playing to the gallery’ type of language, Dr. M has been only able to get a few pot shots at less important peripheral outposts. The fortress remains intact strong as ever. Briefly the gravamen of my paper asserts that:

a) State universities are not in a position to accommodate all the students who qualify for medical education and the assistance of the private sector is vital.

b) Free education in its originally envisaged from does not exist. When it comes to the Tertiary level the greater number of the deserving students are shut out from the free streams. Even at primary and secondary levels the state has failed to provide free education to all deserving children. Hence the proliferation of international schools even in rural areas.

c) There is an acute shortage of doctors and the need to encourage the private sector to open teaching institutions.

d) Medical ethics are not being observed and patients continue to be inconvenienced and fleeced. Even open quackery continues to thrive unabated.

and

e) The GMOA drops its confrontational attitude and co-operate to establish and maintain the desired standards at the PMC.

All the above have been ignored or only scantily dealt with .

In conclusion, let me remind the learned doctor that the canards concocted by him that dissenting voices are paid voices and the Island has benefited from the media budget of the PMC for publishing my article have been more than adequately dealt with by the Editor. The unscrupulous doctors must be hanging their heads in shame !

To this I would like to add that ethics do matter very much in public correspondence too.