The Private Medical College – A point of view

October 19, 2011, 7:43 pm

By Edward Gunawardena

Many people of this country are keenly following the controversy that has arisen after the establishment of a private medical college. Being myself interested, having been the Advisor to the UGC during the dispute that arose over the setting up of the Colombo North Medical College and also having been a Member of the Sri Jayawardenapura University Council, who in the early nineties strongly supported the establishment of a medical faculty with Dr. H. H. R. Samarasinghe as the first Dean, I have read at least a few of the arguments for and against the setting up of the MC Malabe.

The argument that a private medical school cuts across the concept of free education and as such should not be allowed to operate is ridiculous. In fact, free education does not exist anymore. Not only are fees being charged for every school activity, but even bribery is rampant.

In the early fifties of the last century, when the population of this country was less than 10 million and the economy was booming due to the Korean War ‘Free Education, the Pearl of Great Price’, as some journalists labeled it, was a huge welfare initiative of the first government of independent Ceylon. Politicians, short-sighted as they always are, never thought of its sustainability. But understandably, the beneficiaries of free education will keep on defending it, inasmuch as the Sinhala only policy of SWRD Bandaranaike is being defended by some idiots even today!

The plain truth is that today, the country is not in a position to provide free education to every child yearning to proceed beyond the Advance Level stage. Fifty years ago, even in medicine, the specializations were perhaps only medicine and surgery. Today the medical specializations range from the scalp of the head to the genitals, anus and the toes. Very soon the MBBS will be replaced by degrees such as Bachelor of Cardiology, Bachelor of Oncology, Bachelor of Nephrology, Bachelor of Urology etc.

What a village midwife did some years ago is today performed by a FRCOG (London) assisted by a MBBS (Col) and a team of nurses in an air-conditioned, sterilized theatre. And at what cost to the patient?

Why only medicine? What about Engineering, Architecture, IT, Computer Science, Finance, Food Technology and numerous other modern disciplines ? The state just cannot teach all these free. Nor is the state competent to teach these. The only modern profitable employment in this country that does not need even a Montessori education is politics.

The vacuum has to be filled by the private sector. Today, under the free and open economy, the private sector has been called upon to actively participate in the nation’s development effort. And development is not something that can be confined to factories, hotels, airlines, commercial farming etc. The patriotic private sector involvement, more than the purely mercenary foreign interests in the educating of our youth in all the modern disciplines required for a knowledge based economy, including medicine, has become a sine qua non for our progress - the path for which has been cleared and smoothened by the President himself.

No individual or an institution in its proper senses can say that allowing the establishment of teaching institutions by the private sector for medicine, engineering, IT, accounting, languages or even beauty culture will spell the doom of free education. Basic education, subsidised by the fruits of privatised education is bound to remain free. A thriving private sector in education, as is the practice the world over, will always be magnanimous enough to provide scholarships and bursaries to the deserving.

Unfortunately free education is a sensitive subject. As long as we have fools and opportunists in politics, the abolition of free education will not be considered. Arguably, even our universities have slumped to low levels in world ratings because of free education. With Mahapola grants, they are even paid to learn!

The most vociferous lobby against the MC Malabe is the GMOA, the trade union of government doctors, most of them being beneficiaries of free education. Going by the article that appeared in the Sunday Times of 25/09 on the Malabe Medical College dispute, there appears to be a serious lacuna in the definition of ‘Specialist Doctors’.

The Health Ministry, issuing a statement that media reports gave the wrong impression about the standard of specialist doctors serving in government hospitals has said, "all specialist doctors serving in the Health Ministry have obtained a post graduate qualification from the PGIM or gone for training abroad, assessed etc. and appointed as specialists."

The question that comes to my mind and I trust all right thinking people will agree with me is, ‘do these qualifications alone make one a specialist doctor’?

How many of these specialist doctors who engage in private practice whilst working for a state salary are concerned about the care and convenience of patients? How many of these consultants care for punctuality? How many care even to say sorry for the delay? Is there a limit to their case loads? Don’t they give preferential treatment to patients in government hospitals who channel them? After charging Rs. 1,000 or more and after subjecting to a long wait how many minutes do these specialists devote to a patient? How many gladly welcome questions from patients? How many even care to smile or use a few soothing words? Even common courtesy is alien to many of these men, with specialist qualifications.

The plain truth is that many of these specialists are hell bent on seeing as many patients as possible, rushing from hospital to hospital till midnight, with even their clothes smelling of sweat.

If the private sector begins to produce doctors, this mad rush is bound to ease and the spoils will be distributed. This unquestionably is the primary motivating factor against the privatization of medical education.

It is against this background that one has to consider the PMC dispute. Even in secondary education, marked differences are observed in the behaviour, manners demeanor etc. of children attending different schools. A private medical college with links to an internationally recognised educational institution, will produce medical graduates, not only with raw medical qualifications, but also language and other useful skills and values. They are bound to be instilled with acumen primarily required of a doctor for the care and concern of patients.

Medicine has always been a profession looked up to in this country. I remember the days when our rustic village folks addressed them as Dostara Hamudurowo’. Doctors of the time were well mannered, gentle and kind hearted and always smartly dressed. Their concern for patients was such that they even visited them in their homes. Much attention was paid to after care, particularly post surgery.

I was indeed surprised one day when I saw a middle aged man dressed in trousers wearing rubber slippers walking along a corridor of the national hospital with a stethoscope dangling from his neck. I was saddened to know later that he was a doctor!

All these add up to the standard of the profession. The MBBS alone is insufficient. Many of the MBBS graduates passing out of state medical faculties are themselves doubtful of the quality and standard of their own degrees. I often wonder why they do not mention the name of the University behind the letters MBBS. Seldom do we see a MBBS (S.J.P.) OR MBBS (Ruhuna). A doctor with MBBS (Col.) proudly flaunts it. Some even have MBBS (Sri Lanka) when there is no such degree. Certainly, there is some apprehension booming that MBBS (Nizhny Novgorod) or MBBS (NNSMA) will sound more impressive and command greater respect, particularly abroad.

Another matter of concern is the grave danger that has arisen due to the increasing number of quacks in the country. With large advertising boards displaying bogus qualifications, these quacks practice with impunity. They even fraudulently earn millions, treating sports celebrities using banned substances. Finally, the manner in which, particularly the GMOA, has approached this issue does not reflect too well on the medical profession. The stated grievance of the GMOA is that no private institution can be allowed to function if it does not conform to standards.

This is certainly not an insurmountable criterion for the private sector. After all, even the ranks of Tuscany will agree that it is the private sector that has provided golden opportunities for private practice in hospitals with state of the art facilities that state hospitals cannot afford. It is also the private sector that provides the sponsorship for doctors to sharpen their skills and improve their knowledge, by attending world class seminars and workshops.

What the GMOA should do is to co-operate with the government and the private sector to achieve the desired standards and produce competent doctors as the country needs more doctors. Currently, the GMOA could suggest the upgrading of some of the peripheral hospitals to teaching hospitals. The promoters of private medical colleges will I am sure, gladly assist the government in this regard. The GMOA must appreciate the fact that the PMC Malabe is a courageous pioneering effort in medical education by a highly respected doctor and gentleman. And no pioneering effort is devoid of teething problems. Being a private enterprise, it will constantly strive for excellence.

The confrontational attitude of the GMOA is understandable. It has a national reputation for threats and strikes at the drop of a hat with callous disregard for the sick; and these are people who have received medical degrees at the taxpayers’ expense and who have taken the Hypocratic oath.

Deviating drastically from the ethical standards of debate the GMOA has sunk to abysmal depths of character assassination and defamation by referring to this sincere, laudable initiative as a ‘Sakviti’ type fraud; whereas, no student or parent has made such an allegation. Real ‘Medical Frauds’ take place today in the private hospitals with the unconscionable inflation of ‘Doctor’s fees’. Patients pay without protest. What greater exploitation of the helpless sick? Sometimes, doctor’s fees are not reflected in the official bill but collected by nurses. They also inflate their fees when the patient is insured. Thereby don’t the doctors defraud both the Inland Revenue Dept. and the Insurance provider?

The motive for this venomous approach of the GMOA, even dragging university students on to the streets has today become obvious. It knows that the PMC Malabe with its affiliation to the reputed Nizhny Novgorod Medical Academy (NNSMA) of Russia, under the entrepreneurial leadership of Dr. Neville Fernando, will spark the emergence of a vibrant private medical education culture in Sri Lanka that will spell doom to the mafia type domination that the GMOA has enjoyed for decades.