Since its inception the South Asian Institute of Technology and Medicine (SAITM) has had detractors who held varied opinions on the institution as well as local private medical education. However among them the Government Medical Officers Association (GMOA) has been one of the most vocal opponents, which has moved them to launch serious union strike actions in the recent past while also engaging in protests and discussions to prevent any private medical college from being established in Sri Lanka. Nevertheless it is interesting to note that other health sector professionals appear to hold a somewhat different opinion in this regard. Many appear to be open for private education, not only for the doctors but their own professions as well while claiming that the government has in fact provided the best possible solution for the SAITM issue.
The tussle over the South Asian Institute of Technology and Medicine (SAITM) and private medical education in Sri Lanka as a whole appears to have no acceptable solution to all parties involved. With a satisfactory resolution far off it is perhaps the students of the local universities and their parents as well as that of SAITM who have suffered the most during the time elapsed.
While responsible parties continue to squabble over possible solutions, the education of all students involved has been disrupted leaving parents to start Satyagraha campaigns while others are left to agonize over the future of their children, finances and the sacrifices made.
To 56 year old Sandhya Jayaweera, the mother of a first year student at the Medical Faculty of the University of Colombo the satyagraha campaign was the last resort.
Worried about her child along with others who have been continuously boycotting lectures over the issue, Sandhya says the parents have decided to do whatever necessary to ensure the students are successful in their fight to ensure free education. “That is why we have resorted to commencing a satyagraha campaign and are determined to help our children to achieve what they believe in,” she says.
Sandhya along with other parents have been continuing a Satyagraha amidst opposition for four consecutive days. However while supporting her child’s cause Sandhya is also sensitive to the problems faced by the students of SAITM. “We have no grudge against the children studying at the private university,” she says adding that she would like to see justice being done to those students as well.
According to her the only solution to ensure fairness for all involved is the nationalization of SAITM as no good has come out of allowing the privatization of certain services. “Look at the SLTB today and what has become of it by allowing private owned busses,” she points out adding that nationalization is the only solution acceptable to them, a sentiment echoed by other local university students and parents alike. However the stance continues to be vehemently opposed by pro SAITM parties who point out the need for private education in the Sri Lankan education system.
For Nihal Gajasinghe the President of the Colombo District Medical Faculty Parents Union the nationalization of SAITM along with the Dr. Neville Fernando Teaching Hospital is the only solution acceptable to the current issue.
“We are absolutely against privatizing medical education in Sri Lanka” he says vehemently. According to him no civilized country has privatized medical education.
“The quality of the education provided as well as the standards of doctors will drop if this is allowed” he says adding that private students also will need not attend clinical training which will affect the quality of the doctors graduating from such institutions. “They pay money so students are not even failed despite not being up to mark,” he alleges. Gajasinghe says the Government needs to understand that youth may get disgruntled due to several reasons leading to even bigger problems in society.
“If a student with much lesser marks is able to become a doctor by entering a private medical university this can upset a youth who is much talented than him but could not afford to enter such a university while the z-score means he will lose on local university entrance as well,” he points out.
According to Gajasinghe allowing private universities can even lead to a surplus of doctors in the country leading to unemployment of medical professionals.
According to him therefore the government needs to understand the number of doctors needed in the country and act accordingly.
“A standardized quality medical education can only be provided by a Government university,” Gajasinghe says adding that this is the only way to ensure the standards of the profession.
Ryan Jayalath the Convener of the Medical Faculty Students Action Committee is of the opinion that allowing private medical institutes in the country will open a flood gate of issues for medical education in Sri Lanka.
“The government has no stance or policy regarding the medical profession,” he says adding that no research has even been done to evaluate the number of medical professionals needed for the country in the future.
According to him if several such institutions as SAITM are allowed the profession will see a surplus of doctors causing serious issues.
“Therefore the only solution acceptable to us is the abolishment of SAITM,” he says adding that the stance of the students is unlikely to change.
Since students have boycotted lectures for the past six months according to Jayalath the intake of doctors for internships in 2019 will be delayed as a result. “This is a serious issue which not should be taken lightly” he says.
According to Jayalath many have attempted to say that private education is the way forward. “The trend in now changing across the world,” he pointed out presenting the issues faced by the India in this regard.
“Privatizing medical education has brought down the standards of Indian doctors” he says adding that this should be prevented from taking place in Sri Lanka.
“The students are not fighting for personal gain but for the future of the country,” he says concluding that therefore the government should listen to the voices of dissent emanating within society and act accordingly.
“We believe in the need for standardized private medical education in this country,” says Shanaka De Sarem the Convenor of the Student Action Committee of SAITM. According to De Sarem the rationale behind their belief is due to non admittance of students doing London Ordinary and Advanced Level examination within the country to local universities. “They too need a path to enter university,” he says adding that going abroad for studies is not a practical solution for the majority.
“It is a misconception that students of SAITM are from privileged families,” he says. According to him better part of the students come from middle class families that have taken loans while some have even sold their property in order to fund the education of their child.
“When a parent takes a loan they believe the child will complete his or her studies in five years time and help the parents to pay it back,” he says pointing out that instead today many graduates are left without employment having to depend on their parents for their needs.
Therefore the unresolved situation has caused much grief among students and parents alike, says De Sarem. “They are worried as their lives have stalled due to these issues,” he explains adding that graduates of the institute are frustrated as well since they have not been absorbed to the local medical fraternity. According to De Sarem despite the continuation of lectures and clinical training with the court decision still pending the university will not be able to hold till a court arrives at a decision.
“Despite receiving good results many of us could not enter local universities due to the quota system,” he says adding that their only request is that they be allowed to complete their education. “If there are issues with SAITM these should be resolved and acceptable standards introduced,” he says. While saying that abolishing SAITM will in no way provide a fair solution De Sarem appealed for the local university students to also take into account the fact that many London Ordinary and Advanced level students in the country do not have the opportunity to enter government universities in Sri Lanka.
By last Thursday (29) the Government Medical Officers’ Association (GMOA) took a decision to continue with their islandwide strike without further notice if their demands are not met by the Government.
The Government earlier put forward its solutions on SAITM, resulting in a deadlock. With all stakeholders taking different positions, it is the public that is the hardest hit.
The demands forwarded by the GMOA require that the medical education standards be gazetted as promised in the Court of Appeal by the Minister of Health, and the legalisation of the technical report of the Medical Council. Secondly, to inform court that SAITM does not have the necessary certification by the medical council, thirdly, to stop enrolling new students to SAITM and ban the institute from issuing degrees. Fourthly, to appoint a committee to provide solutions to the current students at SAITM, acceptable to the medical council and finally, to take steps to nationalize SAITM.
President of the GMOA, Dr. Anuruddha Padeniya is of the view that what is more important than the type of the entity is that it receives the blessings of the Medical Council.
“What we say here and ask for is not something difficult to comprehend. It is not rocket science. The Institution being private, public or a mixture of both is irrelevant, firstly, it needs to obtain the blessings of the Medical Council, which is a universal norm. It is a requirement stipulated by the Medical Council Act,” he said.
Concluding the controversial meeting the GMOA held with President Maithripala Sirisena last week, the President’s office issued a statement under its secretary, P B Abeykoon’s signature stating that the government will gazette the following decisions with respect to SAITM:
-Admission of students to SAITM and offer of degrees will be stopped until SAITM fulfils relevant conditions of the Government Gazette.
-As the minimum standards of medical education should be ensured under the law, to expeditiously gazette the minimum standards of medical education.
-No institute or person should influence the autonomy and the impartiality of the Sri Lanka Medical Council (SLMC).
-Formation of current courses of SAITM according to a method accepted by the SLMC and forming a system to register the degrees which have already been offered.
-Informing the Government’s position about SAITM, to the Supreme Court.
Meanwhile, all medical faculties islandwide too have come to a standstill. Speaking to the Sunday Observer, Dean of the Colombo Medical Faculty, Professor Jennifer Perera said, the faculties are open but with no student participation they face a practical dilemma in conducting lectures, eventually resulting in dragging the academic year over and above its stipulated time.
When asked if the administration will take disciplinary action against students who fail to attend lectures she said, no such action will be taken against the students. When inquired about year-end examinations, she went on to state that nothing can be said definitely about the year end exams since things are unforeseeable at the moment.
Dr. Anuruddha Padeniya drawing up a simple inference, the current situation to obtaining a driver’s licence says, in order to drive a vehicle one must have a licence.
“If you drive without a licence, the fact that you are driving correctly or not is immaterial as there has already been a violation by not obtaining the licence before driving on the public road. You are liable for not having a licence. This is exactly what we are saying. SAITM needs to first and foremost obtain a licence to conduct its courses as a medical faculty,” he said.
Referring to the standards maintained by India, pertaining to their medical education he said, recently the Indian Medical Council decided to revoke the licences of 32 medical institutes for not maintaining standards.
“The Indian system is very much sound compared to ours, simply for the reason that although these were institutions that had been given approval, it was later withdrawn as they observed that the facilities which were available at the inception have not been sustained. So, when they grant approval it is not just a onetime thing but they have to renew periodically. If a given institution fails to satisfy they will shut it down” Dr. Padeniya explained.
The GMOA says, “this is a fight they will take to the very end until they win. Such a win according to them is for the benefit of the people. It is to ensure that doctors or even medical students at one point will not exploit patients for their benefit. Hence, it is the universal norm that any institution established for medical education should be under the purview of that country’s Medical Council.”
According to Dr. Padeniya the President has indicated a very clear stance on this matter as it is reflected in the five member committee report and it is exactly what SAITM was not adhering to.
“The crime we have committed is standing for the right thing or standing for the universal norm. The Medical Ordinance clearly stipulates that the medical faculty cannot exist without the approval of the Medical Council,” he said.
The practical impact of allowing this, according to him, is that it will generate doctors who are not under the purview of the Medical Council. If patients are wrongly treated or abused by such a doctor then the patient will have no recourse to complain or take disciplinary action against them.
Contradicting the public view, he said, the GMOA does not enjoy resorting to strikes, and burdening the general public. “But, it has become the need of the hour to send a strong message. It is to ensure that politicians will stand by the policies and the law of the country and most importantly, by their conscience and public interest.”
Dr. Neville Fernando, with a vision to make medical education available to more students, started the South Asian Institute of Technology and Medicine (SAITM) as far back as 2009.
Initially it provided a program for medical students where the first half would be conducted locally and the second half in Russia with its affiliated university. Although the establishment of SAITM did attract a certain degree of negative response, it has never been this loud.
Speaking to the Sunday Observer creator and Chairman of SAITM and Dr. Neville Fernando, said the teaching hospital shared his view on the current impenetrability that has brought the whole country to a chaotic stage.
The current students stuck in between this chaos maybe the worst hit.
Dr. Fernando says they have faith in the current Government, being a responsible government, will not leave students in the lurch.
According to Dr. Fernando there is no problem that exists with the establishment or operation of SAITM but is blown out of proportion by various political parties; trade unions are seen capitalizing this issue purely for political mileage or vested interests.
The establishment of Private medical colleges will be a threat to the monopoly of government doctors and also to those who survive on the commission of sending students abroad.
Refuting allegations stating that SAITM has been a fraud since inception, Dr. Fernando states that all allegations are the result of propaganda created by those who oppose private medical education.
“ SAITM from its inception acquired the license in terms of the Board of Investment Law of Sri Lanka Act No 4 of 1978 (as amended) having being registered under Section 17(2) of the said Act, to set up a higher education institute to provide training in Information Technology, Management and Finance, Engineering, Vocational Studies, Nursing, Languages and Health Sciences.” Dr. Fernando explained.
BOI approval received has mandated the establishment of a higher education institute to train students in Health Science, among other fields of study since the inception. It is clearly stated in the BOI agreement. Therefore the name of an institution is irrelevant. Health Sciences includes Medicine and other related sciences such as dentistry, nursing, physiotherapy and psychology. Currently in the Eastern University of Sri Lanka, the MBBS degree is offered under Faculty of Health Care Sciences, McMasters University Canada has a Faculty of Health Sciences and grants the MBBS, University of Dublin has a faculty of Health Sciences but grants the MBBS.
According to Dr. Fernando another common misconception is that the name was converted to Medicine from Management and that it is illegal.
“Any incorporated company with a resolution by the Board of directors can make the change which has to be registered with the Registrar of the Company. That is what we did and it was all legally done. All these people who shout about how fraudulent the institution is should first learn the law of the country,” Dr. Fernando explained.
In 2011, SAITM was granted Degree awarding status by Gazette 1721/19 dated 30.08.2011 and the Faculty of Medicine offers the MBBS program. Anyone can go through the University Grants Commission (UCG) website where they list all recognized Degrees of Degree Awarding Institutes. All students who have enrolled at SAITM have been endorsed by the University Grants Commission and the Ministry of Higher Education and they are directly responsible for the future of these students. SAITM has been recognized as a Degree Awarding Institute under the Universities Act by Gazette 1721/19 dated 30.08.2011 and 1829/36 dated 26.09.2013. Commenting on students engaged in protests being used for political mileage he stated that it’s a very sad situation and it is only the students who lose. No one else loses in this campaign. “I pity the students who are misguided and are told to get onto the roads and behave like terrorists. Behind all these are a few agents who send students abroad including three members of the GMOA. They are all funded by the Agents. How can a Medical student getting only Rs. 5000/- from Mahapola afford a Prado Jeep costing Rs. 50 Million? The Government must look in to this.” In response to our question whether SAITM students were receiving adequate clinical experience to meet required standards he said that it is for this reason that the need for the Neville Fernando Teaching Hospital (NFTH) arose.
“When the GMOA opposed the use of Homagama Hospital for our students I had to build my own hospital to provide the clinical training. We have all the main specialties and subspecialties in the Dr. Neville Fernando Teaching Hospital. In addition our students go to Avissawella Base hospital for Forensic medicine and Psychiatry and Kaduwela MOH for Community Health. We have an expert team of Professors and Senior Consultants who are devoted to teaching and who will under no circumstance, compromise the standards required for clinical training. Although the hospital attracts a good number of patients, as it is a private hospital it is not flooded with patients as in a Government hospital. Since this hospital was built solely for the clinical training of our students I decided to hand it over to the Government, so that it can be converted into a free Hospital which will in turn benefit the public as well as facilitate our students in their training,” he explained. Discussing government’s plans for SAITM and NFTH, he says he is open to rational and sound suggestions. Speaking on the statement made by Minister Lakshman Kiriella to convert NFTH to a dengue treatment hospital he said they very much appreciate the suggestion and the hospital continues to treat dengue patients. “NFTH already has a Dengue Treatment Unit headed by Prof. Kolitha Sellahewa. The Unit is full now. According to the figures supplied by the Health Ministry at the Seminar held in the hospital yesterday the projected number of dengue patients will be 200,000. We must get ready for that.”
“The Government up to date has not made any statement regarding a takeover of SAITM. What the government had proposed in the Cabinet paper was going to the stock exchange to which I am agreeable,” Dr. Neville Fernando reiterated.
President of the Government Nursing Officers Association (GNOA), Saman Ratnapriya says the government has presented the best possible solution through the proposal to nationalise the Dr. Neville Fernando Hospital and control it through a director board, while SAITM shares will be opened up to the stock market to divide its ownership. “We believe this is the final solution to this problem,” he says adding that private education institutions are needed in the country.
According to Ratnapriya providing education is not possible solely through government institutions. “All developing countries have a combination of both,” he explains. Ratnapriya says he believes that SAITM should be left as a private institution without any hindrance. “It will be detrimental to the development of the country if it is not,” he says adding that other unions therefore are collectively against nationalizing SAITM. Ratnapriya opines that it is selfish to prevent children from gaining an education whether it be free or fee-levying. “What is important is that students are given opportunities to pursue a career of their choice,” he says.
Ratnapriya also challenges the GMOA to halt private practice and boycott private hospitals if they wish the medical education to be solely controlled by the Government to maintain standards in the health sector.
Pointing out that last year only 26,000 out of the 160,000 students who pass the Advanced Level examinations gain entrance to government universities, he says private institutions can help these students to gain access to higher education. “The need for private medical colleges is a reality but the GMOA and some other parties are in denial,” he alleges.
According to him the GMOA even attempted to block the education of nursing officers as well when the Allied Health Sciences Degree was introduced he says adding that however higher education has been ensured for nurses. “Likewise the education of talented students should be ensured,” he says.
Ravi Kumudesh, the President of the Academy of Health Professionals mainly points out that every government after 1977 had implementing private education as a policy in their manifestoes. As a result according to him every degree is now available through private education except for the MBBS. “The Governments attempted to introduce private MBBS degrees but have faced challenges in following it through due to opposition from the GMOA,” he explains.
According to him a large number of students in the science stream face an injustice due to the Z-score quota system leaving them unable to enter local universities despite the good results received.
“This prompts some to go abroad to unsuitable countries in order to gain education while spending large amounts of money,” he points out adding that this can be prevented is if a private medical college is opened in Sri Lanka while students of other countries would also visit the country to be enrolled.
Admitting that there were issues in the procedure when establishing SAITM, Kumudesh said the majority of them were due to the lack of advice or incorrect advice provided by the Sri Lanka Medical Council. “They are now using these issues to create a mass protest against SAITM,” Kumudesh says.
While SLMC is now refusing to register SAITM students Kumudesh, SLMC registration is no assurance of the quality of existing doctors.
“If the Advanced Level qualification is the issue then it has to be said that today the minimum qualification to enter medical college in Sri Lanka is to obtain three simple passes,” he says adding that the GMOA should then work to raise the bar if students’ Advanced Level results are a matter of concern. According to Kumudesh despite the government working towards fixing the issues pertaining to SAITM by presenting very acceptable proposals, the SLMC has failed to respond in this regard.
Kumudesh also accused the SLMC of failing to ensure the competency of existing doctors. “Doctors in other countries have to face a yearly competency test with a possibility of losing registration if failed,” he points out explaining that the SLMC has failed to do this and instead is worrying about the degrees being presented by other institutions.
“To develop, medical education needs to move away from traditional education methods,” he says claiming that private medical education is in fact the need of the hour. Kumudesh also says that all other health professionals are in fact willing to accept private education. “We want to develop as professionals and have the freedom to educate ourselves in any means possible,” he claims.
Pictures by Nirosh Batepola