Pvt. Medical Colleges can make Lanka Asia’s education hub

The Nation
Dr Terrence de Silva, Former DDG Medical Services
By Carol Aloysius “The government’s goal to make Sri Lanka the hub of education in the Asian region, can only be realized by new investments in tertiary education, such as Private Medical Colleges. Setting up private medical colleges can not only play a major role in elevating the socio economic standards of the country, they will increase access to medical education which is limited at present, and by providing healthy competition to the existing state run medical universities and government teaching hospitals, thereby improving overall quality of medical education in the island.” Dr Terrence de Silva, a former Deputy Director General of Health Services and the current President of the Private Medical College Parents’ Association of the recently set up and only private medical college in the country, made this observation in an interview with The Nation, Thursday. Referring to the huge amount of expenditure on the part of the government to educate a single medical graduate at the government medical universities (over Rs 2 million) he asked, “If we as parents, are willing to spend our own money to educate our children at a private medical college in Sri Lanka, what’s wrong with that? We are not asking the government for any money or taking money from the tax payer for our children’s education. Our only wish is to give our children the opportunity of getting a medical degree in their motherland. To my knowledge, around 20% of doctors in the GMOA have also had their primary medical education in a private institution, (albeit in a foreign country) and paid for that education with their own monies. So why are they making such an issue about the private medical college at Malabe”? Commenting on the quality of education in SLMC approved private medical institutions abroad, he drew attention to a booklet giving names of foreign universities, medical schools and institutions recognised by the Sri Lanka Medical Council (SLMC) to practice medicine and surgery in Sri Lanka. He observed that at least 232 names of medical schools in over 44 countries including Ethiopia, Nigeria ,Papua New Guinea and even Afghanistan which is now embroiled in a civil war, had been included in the list. “All these medical schools are private fee levying institutions”. But their standards vary. While some are extremely good, there are others where information regarding their standards and education quality is inadequate. Some of our parents who have studied the country profiles and information available in the websites of these institutions are of the view that the authorities concerned do not have much first hand information about them as they are situated outside the country. So how can they evaluate their standards?” On the other hand, he noted, “The Private Medical College at Malabe is based in Sri Lanka itself. So should the SLMC or and anyone else wishes to ascertain its standards, they can visit the university and judge for themselves”. Referring to the large number of students who had spent a great deal of foreign exchange by obtaining their medical education abroad, he said that while some of these ‘foreign’ graduates had passed very well, a fair number of those passing out from the listed institutions of the SLMC had failed to satisfy the examination requirements conducted by the SLMC (Act 16 or the ERPM) in order to allow them to practice in Sri Lanka. “Nor has there been a proper survey as to how many of them have returned to Sri Lanka without completing their final exam”, he added. “About 300 students get enrolled in some 232 foreign medical schools spending over US 250,000 which would work out to 1,600 million rupees per year. It is my opinion that a handful of foreign qualified graduates who have studied in these foreign private fee levying medical schools, spending their own money, are among those pressuring the GMOA to oppose the establishment of a private medical school in Sri Lanka”, he observed. “The final outcome of all this is local private medical colleges suffer, with the result that we have to send our children abroad while the foreign medical schools continue to flourish, enjoying the registration of the SLMC.” Dr de Silva said that tertiary education had very minimal participation of the private sector until the setting up of the North Colombo Private Medical College in 1980. After its acquisition by the government there had been no move to set up a private medical college until the Private Medical College was set up recently at Malabe. As a result, tertiary education enrolment ratio for the age group 20-24 in Sri Lanka has remained at a low figure (4.7%). Commenting on the current trend of ‘Knowledge Economy’ which had been identified as a major area of development in the Vision 2020 programme of the government of Malaysia, he said that the GMOA too had advocated this concept and published a book titled,“Health Sector contributions to Knowledge Economy”. He said that compared to many Asian countries, Sri Lanka’s tertiary education was still largely public sector based, with minimal or no participation of the private sector, compared to 38% for Singapore, 30% for Japan, 25% for Malaysia and 6% for India. “These high levels of tertiary education enrolment rates have been achieved through the private sector participation. Although provision was available in Sri Lanka in the existing Universities Act No 16 of 1978 to recognise degree courses conducted by the private sector institutions, until the present government took over the office, this provision has been under utilized”, he noted. He pointed out that as a result, with limited number of state universities, university admissions had to be restricted. When the District quota basis came into operation for admitting students to universities, he said there were instances where students with 3 A’s o r 2 A’s and 1 B in some districts were unable to secure a place in the medical or engineering faculties, whereas students with much lower grades were selected to such courses. “I personally know of cases where students from one district sat the exam in another district just to get admission. However in the students at the Malabe medical college, most of them sat the exam from their own home district. Since they were unable to gain admission to a state university, we had the option of sending them abroad. But we parents chose to keep them under our supervision and guidance. The Private Medical College at Malabe was our only option”. Spelling out the advantages of letting students study in their own country under parental supervision and guidance, he said that it helped to discipline them and give them good moral values. “For example, I was Director of the Rajagiriya Hospital when the North Colombo Medical College was started. I personally know that there was a huge demand for the newly passed out students of the former NCMC by Consultant doctors on the grounds that they found them to be very disciplined, humane, prepared to work long hours, and were very conscientious about their work. I’m certain the products of this new medical college will be the same as they will be studying under their parental supervision and guidance”. Asked to comment on the non availability of a teaching hospital for the students to do their clinical training, he said, it was due to a misunderstanding. ”At the start we were made to understand that the students could work in a government hospital. We had a verbal agreement that they could use government hospitals with the SLMA. But after the election of new SLMA officers in June, the committee changed. The GMOA was very co-operative at the beginning and even sent out a circular asking doctors for their views when we were wanting to set up this college. But now they are refusing to let our students go to government hospitals. We never imagined the GMOA would do this to us.” He said that in order to train doctors qualified abroad in a local setting the Health Ministry allowed them the opportunity of working in a government hospital. “If they can, why not these students. After all, they are all Lankans. And in actual fact, priority should be given to those who are studying here instead of wasting foreign exchange studying abroad. Besides, if our students at Malabe are allowed to use the government hospitals for training, I’m certain it will lead to benefits for both parties”. As an example he noted that that the students of the former private medical college at Ragama had been allowed to do their clinical attachments at the North Colombo General Hospital Ragama, which later became a Teaching Hospital. The result was an overall upsurge in the quality of the hospital. “As the Director of that newly upgraded Teaching Hospital , I was able to witness a massive development that took place in this hospital within a short period of establishing the private medical school. Not only the hospital but the whole of the Ragama town became modernized with the upgrading of the hospital – thanks to the healthy competition given from the private medical school which got down the latest technology and equipment. This will happen to all our teaching hospitals if they were given healthy competition from the private sector,” he said. The medical school at Malabe was established in 2009. Dr de Silva said that work on a new hospital for the students was now underway and should be ready for use for 3rd year students. A doctor from a government medical institution in Colombo however voiced concerns over private medical colleges being set up in the country. She said, “If the government is going to give priority to setting up private medical colleges, then the government medical universities will be sidelined. If priority is given to putting up Private Medical Colleges in keeping with the current trend of ‘Knowledge Economy’ in order to attract more foreign students and bring in more revenue to the country, then it is likely that most of the latest equipment and technology will be invested in those private colleges. It would also lead to a brain drain with the best professors joining the private medical colleges. Furthermore, there will be a lowering of standards as the cut off marks would be lowered in order to increase intake to these new universities. So the ordinary coconut plucker’s child who gets 220 marks when the cut off marks are 221 will have no chance of becoming a doctor.” So what does she suggest instead? “I say upgrade the present facilities in our universities. Increase the cadre of lecturers. And increase the intake of students. There is now an urgent need for more doctors and specialists in especially the peripheral hospitals. We must do something to increase the number of doctors able to serve in these hospitals. But it should not be at the cost of lowering standards”, she emphasized. is . What do our readers have to say on this issue? Do send in your views to carol@nation.lk

PMC: Doc in the dock

"Thaaththa," Bindu Udagedera asked, "what is all this fuss about a medical college?"
"Well," Bindu's father Percy said, "I think the government wants to set up a private medical college…"
"So, what is wrong about that?" Bindu wondered.
"I think the doctors' trade union is protesting against that…" Percy said.
"But thaaththa," Bindu remembered, "didn't they have a private medical college some years ago as well?"
"Yes, they did," Percy remembered, "but then the rathu sahodarayas protested against it…"
"And what happened then?" Bindu was curious.
"The government at that time had it affiliated to a state university as its medical school…" Percy explained.
"So," Bindu asked, "what is the problem with this new medical school?"
"The doctors' trade union seems to be against it…" Percy said.
"And why is that, thaaththa?" Bindu inquired, "after all, there are many other private institutions which are granting degrees of their own…"
"Yes," Percy agreed, "that is true indeed…"
"And, aren't there many students who leave the country every year to study medicine in other countries, thaaththa?" Bindu asked.
"Yes, of course there are…" Percy said.
"So," Bindu said, "won't we be saving an awful lot of money for our country if we set up our own private medical school?"
"I suppose you could say that," Percy said, "and we could even earn money for our country by asking foreign students to study in our private medical colleges…"
"Then thaaththa," why are the doctors opposing this private medical college?" Bindu was puzzled, "surely, they must be having some reason…"
"I think what the doctors are saying is that the new medical school should be up to standard…" Percy said.
"So, why do the doctors think that it will not be up to standard?" Bindu wanted to know.
"Well," Percy explained, "the doctors say that there is no proper hospital to train students at this new medical college and this is why they are protesting…"
"So, thaaththa," Bindu suggested, "the simple solution is to build a hospital for them, isn't it?"
"No, Bindu," Percy said, "I'm afraid it is not that simple…"
"Why do you say that, thaaththa?" Bindu asked.
"Well, "Percy said, "because this is a private medical college and because doctors are a group of professionals who deal with human lives, the doctors trade union are saying that the private medical school must be closely monitored to ensure that standards must be maintained…"
"Well, that is not a bad idea at all…" Bindu conceded, "but thaaththa, how do they manage to maintain the standards of all those doctors who return after qualifying in other countries?"
"I think they do that by holding an exam for them…" Percy recalled.
"Then," Bindu said, "there is nothing wrong with the doctor's trade union demanding that everything possible should be done to maintain standards in the new medical school as well…"
"I suppose so," Percy agreed, "so maybe the government should listen to them, after all…"
"Yes, they should," Bindu proposed, " but the government should also ensure that not only medical colleges but doctors also maintain their standards…"
"What do you mean by that, Bindu?" Percy was puzzled.
"Why, thaaththa, if the doctors' trade union insists that private medical colleges should maintain standards for the doctors they train, it is only fair that the government also should make a similar demand from the doctors' trade union…" Bindu argued.
"And what demand is that?" Percy wanted to know.
"Why thaaththa, then the government should insist that doctors also maintain minimum standards in their private practice…" Bindu said.
"And how would they do that?" Percy wondered.
"Why, thaaththa, the government should say that doctors can see only a limited number of patients per day in their private practice to ensure that all their patients are seen properly…" Bindu said.
"I suppose there is no harm in that," Percy declared.
"Then, thaaththa," Bindu suggested, "the government could also say that a doctor doing private practice should spend a minimum period of time with each patient…"
"There is no harm in that too…" Percy agreed.
"And maybe the government could go one step further and say what the doctors could charge for their services instead of charging what they feel like…"
"I suppose that is not a bad idea either…" Percy said.
"Then, everyone would be happy, wouldn't they?" Bindu asked.
"I am not so sure about that, Bindu…" Percy said.
"Why do you say that, thaaththa?" Bindu wanted to know.
"Well, I am sure the doctors' trade union will be happy if the government maintains standards in the new medical school but I am not so sure whether they will be so happy about the government imposing all those conditions on their private practice…" Percy observed.
"But thaaththa," Bindu pointed out, "if the doctors' trade union really has the interests of patients at heart and they are talking about putting patients' lives at risk surely, they can't object to maintaining standards in their private practice as well…"
Percy was not so sure about that.

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