The South Asian Institute of Technology and Medicine (SAITM) is in the news again ‒ and, as you might expect, for all the wrong reasons. The integrity of the institute has been called into question for some time now, with critics alleging that the standards of education at the controversial private medical college aren’t up to scratch, particularly with regard to clinical training. The Sri Lanka Medical Council (SLMC) has refused to allow SAITM graduates internship at state hospitals and, adding insult to injury, eminent scholar and SLMC President Prof. Carlo Fonseka recently went on record saying that he would go as far as to defy a court order just to ensure that SAITM graduates don’t receive government recognition as medical practitioners. This has resulted in a no doubt frustrating chicken-and-egg type stalemate where SAITM graduates can’t intern at state hospitals because they aren’t recognised by the SLMC and they can’t be recognised by the SLMC because they haven’t interned at a state hospital. (It’s obviously a bit more complicated than that; which we’ll get to shortly).
While it goes without saying that this seemingly harsh position adopted by the SLMC has put the career prospects of the hapless graduates in serious jeopardy, those on the opposing camp, ably led by the Government Medical Officers Association (GMOA), make the not altogether unconvincing argument that the careers of a handful of students cannot be more important than the lives of 20 million people.
Established in 2009, the SAITM medical faculty started off as a twin-programme, with one-half of its medical course conducted locally, and the rest abroad via a Russian university affiliated to the institute. The GMOA, however, claims that the institute was never meant to be a medical faculty, adding that the letter ‘M’ in SAITM originally stood for ‘Management’. There were also media reports to the effect that the Russian Government had “not given registration to SAITM to grant the medical qualification of Doctor of Medicine (MD) of the Nizhny Novgorod State Academy of Medicine in Russia (NNSAM) or transfer the students of SAITM to the NNSAM in Russia.”
The application the institute had submitted to the Board of Investment (BoI) prior to its inception, claims the GMOA, did not include a proposal to set up a medical school in its premises. Additionally, a report issued by the GMOA in 2010 concluded that the campus in Malabe had been maintaining “poor quality” and would have a “negative impact” on national healthcare.
On top of this is the allegation that the institute engaged in false advertising in an effort to recruit students without adequately notifying them of the complications involved, making it seem as though, among other things, the degree awarded by SAITM would be recognised by the SLMC.
A medical school has to be recognised by the SLMC to award its students MBBS or equivalent. The SLMC gives a year’s provisional registration for internship for medical students, and once said internship has been satisfactorily completed, the council is mandated to give full registration to practice medicine and surgery in Sri Lanka. The problem here seems to be that SAITM reportedly doesn’t meet the standards required by the SLMC.
Meanwhile, Professor of Surgery at SAITM Neville Perera, said on one of numerous TV debates on the issue, that the SLMC was opposed to the twin-programme concept and had recommended that SAITM be converted to a degree-awarding institute instead. (Twin programmes are not recognised by the SLMC under the Medical Ordinance). A gazette notification issued in 2011 announced that the Ministry of Health and the University Grants Commission (UGC) had officially recognised SAITM as a private medical college.
Says Former Minister of Higher Education S. B. Dissanayake in the gazette:
“I, Dissanayake Mudiyanselage Sumanaweera Banda Dissanayake, Minister of Higher Education, having obtained a report under section 70C of the aforesaid Act in respect of the South Asian Institute of Technology and Medicine (Pvt). Ltd. (SAITM) a company incorporated in Sri Lanka under the Companies Act, No. 7 of 2007, do by this Order and subject to the conditions specified in the Schedule hereto, recognize the South Asian Institute of Technology and Medicine (Pvt) Ltd. (SAITM) as a Degree Awarding Institute for the purpose of developing higher education therein, leading to the award of the Degree of Bachelor of Medicine and Bachelor of Surgery (MBBS).”
Despite widespread protest, the SAITM medical faculty eventually set up shop; but, claims the GMOA, this was done without linking up with a state or private hospital for the purpose of clinical training ‒ a clear violation of SLMC regulations, according to the critics of SAITM.
It had first been proposed that SAITM students could use the Awissawella hospital for clinicals, but according to Prof. Perera, the GMOA was opposed to it. Fingers were pointed at the GMOA for allegedly sabotaging the process. It was as a consequence of this that the Neville Fernando Teaching Hospital (NFTH) was constructed in Malabe, so that medical students at SAITM could undergo their clinical training unobstructed.
It is interesting to note that the GMOA, itself mired in controversy, is officially of a neutral position with regard to private medical schools. This, laments the organisation, had in the past has been misconstrued to mean that they were in favour of SAITM, which the GMOA insists it has consistently and vehemently opposed to on the grounds that the institute didn’t meet the standards required by the statutory body.
The GMOA points to a memorandum of understanding that was signed on 27 April 2011 between SAITM and the Western Province Health Department to facilitate clinical training of SAITM students at provincial hospitals of the Western Province.
Citing this MoU, a group of students filed a fundamental rights petition in the Supreme Court in 2014 (SC FR NO 208/2014), demanding training at government hospitals.
According to the GMOA, then Health Secretary Sudharma Karunaratne, writing to the Attorney General on 17 September 2014 had said that, in principle, the Minister of Health was “agreeable to cooperate with SAITM in order to facilitate the required clinical training at designated state hospitals, in respect of batches registrable under the Medical Ordinance.” The letter, said the GMOA in a statement on its website, also implied that the SAITM management should adhere to all the laws, regulations, specifications and guidance of the SLMC.
GMOA General Secretary Dr. Nalinda Herath said on a televised debate that any private medical school needs to meet certain conditions in order to teach medicine. Among these are a teaching hospital and a minimum number of patients and bed occupancy per student. Such patients should be receiving treatment for a variety of ailments such as heart diseases, skin conditions, etc. Only a hospital approved by the SLMC as a teaching hospital can accommodate medical graduates, and only the number of students as recommended by the SLMC can be recruited.
“Why all these rules and regulations for medicine and not for other disciplines? These are doctors. They’re dealing with people’s lives. They need to be highly qualified. Therefore, standard is of utmost importance,” Dr. Herath said on the aforementioned debate, likening the hurried establishment of SAITM to starting a swimming camp before the pool was built.
According to Prof. Perera, the conversion of the fledgling institute into a medical college was carried out legally. This could not be contested in courts as there was no grounds for it, he said. There is also no law that states a medical school has to be started with a teaching hospital already in place. For example, a state-run medical school recently opened in Sri Lanka recently did not have teaching hospitals attached to it.
Prof. Perera claims that the state hospital in Homagama was given to SAITM to be developed into a teaching hospital. The GMOA, however, disputes this claim, pointing out that it was not a decision made by the Ministry of Health, but rather an MoU signed between the institute and the Western Province Health Department.
State-run Medical Schools
The faculty of medicine at the Kotelawala Defence University (KDU), too, started without a teaching hospital. The KDU medical faculty is a state-run institute that, not unlike SAITM, awards medical degrees to students that couldn’t make it to a state university. SAITM has insinuated that the SLMC is engaged in favouritism towards state-run medical schools such as the KDU while neglecting if not being downright hostile towards private medical schools.
The GMOA, however, maintains that, unlike a privately owned medical school, a government institute such as the KDU ensures that SLMC recommendations are met to the letter.
Standardisation And Foreign-Educated Students
The standardisation of medical education has to be carried out by an independent body, insists SAITM, charging that the GMOA would not allow the establishment of such a body.
The GMOA points out that the Medical Ordinance only allows the SLMC to standardise medical education. “It’s not up to some independent body. We don’t have any doubts of the SLMC’s independence,” Dr. Herath said on the aforementioned debate.
The SLMC recognises up to 232 foreign medical schools. Students who study at these schools, upon their return to the country, are required by the SLMC to sit for an Examination for Registration to Practise Medicine (ERPM). This only applies to foreign educated students, however, and not to local students, whether state or private. (State students, however, sit for a separate common examination which they have to pass in order to be registrable with the SLMC). According to Prof. Perera, only 10% of foreign educated medical students pass the ERPM.
It is estimated that up to Rs. 2 billion is spent every year on medical education abroad.
SAITM Wants To Improve
While acknowledging that SAITM isn’t perfect, Prof. Perera has on several occasions insisted that SLMC committee appointed to inspect SAITM had largely been in favour of the institute, its curriculum as well as its academic staff, but highlighted the need for improvement – especially with regard to clinical exposure. The report noted a “general inadequacy of clinical exposure in all areas in terms of numbers and case, which is a grave concern.”
“The GMOA won’t allow SAITM to arrive at the proper standards. The Medical Ordinance states that if a private college is being built, the Government should support it in fixing its flaws. The former Health Minister allowed us to finish our clinical training in a government hospital. Even after Kaduwela and Awissawella hospitals were given to our students, the GMOA is acting against it and turning state students against our students. The pre-clinical assessment reports have given positive reviews about the SAITM curriculum, labs, etc. If we’re given an opportunity to use teaching hospitals, SAITM can be as good as any other medical college,” a passionate Prof. Perera said on the televised debate. It is unclear, however, where in the Medical Ordinance it is said that the Government is required to support the establishment of a private medical school.
“[The SLMC committee] made recommendations to fix the clinical issue. But everything else was good. They didn’t recommend a complete reboot of clinical training. If there was a big issue there as the GMOA claims, the SLMC would’ve recommended it,” he added.
The GMOA claims that the SLMC committee concluded that “the degree awarded by SAITM should not be recognised for the purpose of registration under the Medical Ordinance.” However, SAITM maintains that the committee recognised graduates of the faculty of medicine at SAITM as suitable for provisional registration subject to certain conditions.
The GMOA counter-argues that this report wasn’t the one finally approved by Prof. Carlo Fonseka.
Clinical training at SAITM begins after the third year and continues in the fourth and final years, at the end of which students sit for the final MB exam. Students that pass the final exam are, ideally, supposed to receive provisional registration from the SLMC for a year’s internship at a recognised hospital in order to be eligible for MBBS registration.
A court case filed by some students requesting SLMC registration is now pending. A newly formed Private Medical College Parents’ Society (PMCPS) in a press conference held early this month said they were expecting a favourable decision from the courts. Their children’s futures had been put in jeopardy due to what the association called the personal vendettas of a misguided few.
A Student’s Perspective
A third-year student at SAITM that spoke to Roar on grounds of anonymity said that, while things could’ve been better at the start, standards of education at the institute were satisfactory.
“Although the standard may have been unsatisfactory when it first opened because the hospital took a few years to be built and they were just getting started and ironing out the creases, the standard is definitely satisfactory now. We have some of the best lecturers in the country including Prof. Neville Perera, other senior professors who come on sabbatical to teach us. Prof. Chandanie Wanigatunga is an example. We also have other external lecturers who come on Saturdays from the Universities of Sri Jayawardenapura, Colombo, and Peradeniya. External lecturers are also in the viva panels for all our exams,” said the student.
Touching on the controversial clinical studies issue, the student confirmed that initially, clinical exposure was insufficient due to a lack of patients at the NFTH but after the court order had been granted, students could go to the Awisawella base hospital and the Kaduwela MOH District for forensics and several other subjects.
“It hasn’t been easy. Even with the court order, the state university students union and the GMOA convinced the doctors at those hospitals to go on strike. They refused to teach us and sign our log books so that our clinical hours would not be counted,” charged the student.
The student went on to say that SAITM is as good as, if not better, than other medical faculties in the country as it has experienced lecturers from all over the country, with a new hospital and modern equipment at its disposal. “We have enough resources for each patient, unlike the state hospitals which have long waiting lists, are overcrowded and lack doctors and medicines,” the student said.
“And I want to say that there’s a serious lack of doctors in this country, especially in rural areas, and the state universities can only handle a small percentage of students that pass A/Levels. The only way to fill this gap is to have private education like they do for every other field except medicine. And if graduates from abroad can come and practice here, why on Earth can’t Sri Lankans who are being taught by some of their own lecturers work here? Plus we are paying for our education, so it’s not a burden on the Government,” the student added.
What Lies Ahead
Needless to say, these students find themselves in quite the quagmire. If, indeed, their futures are in the hands of a “misguided few”, as claimed, it is unfortunate that the authorities cannot or are not interested in stepping in to resolve the matter. Although, some might argue that it was a quagmire the students and their parents had walked right into with their eyes open by making a bad investment without doing their research. The GMOA and critics of SAITM, for their part, make a valid point in that the medical profession is too important a field to be trifled with, and employing students out of what they allege is a substandard school sets a dangerous precedent, to say the least. However, it is hoped that a compromise will be arrived at that will be agreeable to all parties concerned and, above all else, doesn’t in any way hurt the industry.
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Featured image credit: Ishara S. Kodikara/AFP/Getty Images