Engaging Gammanpila in the SAITM Debate

Joint Opposition surprised many when they joined the camp opposing South Asian Institute of Technology and Medicine. SAITM was established and functioned for four years during their administration. Hence, the JO’s dissociation from SAITM is seen as playing politics, without standing by their own policies.

Reasons to oppose SAITM

JO live wire Udaya Gammanpila explains different people oppose SAITM for different reasons.

“The Government Medical Officers Association and President Rajapaksa are not against private universities, but oppose SAITM for functioning without proper standards.

“According to parties as Janatha Vimukthi Peramuna and Frontline Socialist Party, education is a right and not a commodity. But without opposing tuition or private schools, when they protest against SAITM, they contradict themselves.

“Fee-based education is acceptable to us at Pivithuru Hela Uramaya, as long as it’s not profit-orientated. All leading universities in the world such as Oxford, Cambridge, Yale, Harvard and Princeton are private universities, but none are profit-driven. Most have been established by church or charity funds. Alternatively, a group of rich companies might establish one as their Corporate Social Responsibility project. They charge fees to maintain the university, but also make regular contributions. Their objective is not profit.”

Is profit an ineligibility only for medical education?

We have many private institutes conducting degree programs for different fields. None have been hounded for being profit-driven, nor questioned of their standard or quality.

Gammanpila acknowledges all professions, directly or indirectly, affect life. Therefore education in all professions must maintain standard.

“We must promote other professionals to follow the doctors’ keenness on their standards, than say to the doctors, look others are so negligent about their fields, so be like that.

“To justify private medical universities without proper standards just because it’s absent in other professions is like asking the traffic police to let you go for committing a traffic offense because others have escaped. Police should stop you and others from committing the same offense. Likewise, we should introduce standards for other disciplines also.”

As medical education deals directly with educating future doctors to save lives, its standard must be beyond reproach – perhaps more than in other professions, he muses.

Private practice vs. private medical faculties

“When doctors can have private practices, what is the problem with private universities?,” he dives into the apparent hypocrisy. “There’s a huge difference. When we fall sick, we go to the best hospital, best doctor for the best treatment. However, people might try to become a doctor the most comfortable way rather than the best way.

“Currently, we have only SAITM. So, there’s not much of an issue. Problems will arise when more players come and this becomes competitive. Then, certain institutes may try to be more attractive by increasing their pass rate. When investing about 12 million rupees, would parents select the best course where their child might fail or the easy one?”

Does profit affect education’s quality?

If profit may affect education’s quality, it should be true to all education levels. Certain private schools charge exorbitant fees. For instance, some international schools hire foreign teachers with salary scales around Rs. 300,000 justifying the high fee. However, for the local teacher that makes up the bulk of the academic staff, the monthly salary can be as measly as Rs. 25,000.

“There is a difference between schools and universities,” responds Gammanpila. “In schools, Ordinary Level and Advanced Level is set by either the Sri Lankan or a foreign government. So parents will select schools that produces good results.

“University education is different. There, the lecturer not only teaches, but also conducts the exams.”

Not necessarily, counters SAITM and provided this writer with a list of both their internal and external examiners. Amongst the external examiners were reputed specialists from leading private hospitals as well as from government establishments such as the National Hospital, teaching hospitals and Sri Jayawardenapura General Hospital.

Passing out as a doctor is however only half the challenge, the graduate must be employable as well. Thus, medical colleges would try to ensure that leading hospitals would have confidence in their graduates than just the pass rate.

These are not always measured objectively, and boils down to perception, says Gammanpila. “When analyzing recent O/L results, there was not a single Royalist within the top ten. Most good results were not from Colombo. Still, everybody wants to admit their children to Colombo schools. If results are the main decision-making criteria, then they shouldn’t come to Colombo, as in the recent past best results are from schools from Ratnapura, Tangalle, and Kegalle.”

Does privatization leads to high unemployment?

An important point missing from the debate, states Gammanpila, is the world trends.

“The British education system is the oldest along with the French and Italy in the so-called western education. But in UK, there are just three private universities, which are unknown, and very subject specific universities.

“However, countries like India, Bangladesh, Nepal, Malaysia, Philippines and Russia have many private universities. Are their education standards high? Three-four decades ago, Indian qualifications were highly respected like ours. It’s not the case now. An year ago, when applications for a peon was called in Uthara Pradesh, around 15,000 applications were received that included a number of PhD holders. This shows how much their education standard has deteriorated.”

In Sri Lanka too many unemployed graduates agitate on the roadside for jobs.

“The two situations cannot be compared,” he responds. “Our problem is unique. In Sri Lanka those days, many schools didn’t have a science stream because they didn’t have laboratories. Then, there was only one school per area, called the central collage. It had all the facilities, including a hostel. The best students from other schools were selected through the grade five scholarship exam and enrolled into the central college. So, our science intake was very low compared to the arts graduate.

“In other countries, art graduates are produced in small numbers. Say, you are political science graduate, what are your prospects? You can be a journalist, teacher, or political analyst. You can have about 10-15 political analysts like Dr. Dayan Jayatilleke for the entire country. Everyone from political parties to news agencies will consult him, but the job prospects are very limited.”

Despite most schools now having science and computer laboratories, “We still produce more art graduates than we need, but not enough science graduates, despite science graduates having more job prospects than art graduates. So, it’s not a problem with the degree’s quality, but with the numbers.”

This implies a problem with the national policy, that has not identified the educational needs of the country.

Gammanpila agrees and explains administrations are reluctant to take this up with the academic community, for they are the opinion-makers. Some in this academic community has unfortunately linked producing art graduates to their revenue. As no government wants public perception to tilt against them, they leave this issue alone than antagonize those whose revenue might thus get affected.

Foreign medical faculties vs. local private medical faculties

“Sri Lankan qualifications are highly respected throughout the world,” insists Gammanpila. “So, should we also go down the path of countries like India and Bangladesh? Even they are now reviewing if they should continue with private medical faculties. Recently, the Bangladesh government cancelled the permit of Chithagone University’s medical faculty, which is the leading faculty in Bangladesh. Even Sri Lankans have gone there as the course is cheaper, though inferior.”

Yet, obtaining a foreign degree has not met any opposition. Hundreds travel annually to foreign universities. They return with degrees that sometimes do not have adequate clinical training, and/or subject knowledge, especially on health issues specific to Sri Lanka. Yet, they are offered additional courses, training and finally examined for competency and if successful, then registered.

There are over 2000 universities with medical faculties, points out Gammanpila. However, SLMC has approved only 192, which SLMC assures has met its standards.

Curiously, the foreign university list in the SLMC website had listed nine Indian (currently under review for renewal of recognition), eight Chinese (four under review and others with five years of recognition), seven Malaysian (three with recognition for five years, others under review), five Nepalese (four under review and one with five years of recognition), one Pakistani (under review), six Russian (under review). However, there is only one British university, two from Australia, but none from USA, Canada, France, or Germany.

Gammanpila notes, “though you pay a fee from non-profit orientated universities like Oxford, Cambridge and Yale, you receive the best education. However, countries like India, Bangladesh, Philippines, Malaysia, Russia and China have set up medical faculties to attract foreign students.

“So, there’s a strong possibility that though SLMC has been assured of these universities’ standards, with course material, lecturers, facilities, clinical and other exposure, as expected by SLMC, but not actually met in reality. These issues however does not give SAITM the right to maintain a medical faculty, if they have not followed proper protocol,” replies Gammanpila.

Has SAITM met expected standards?

According to SAITM, SLMC has not still published the prescribed standards. At a recent interview with an English daily, GMOA General Secretary Dr. Naveen de Soysa accusers the Health Minister for the lapse.

“We have been raising concerns regarding the existence of SAITM from 2010,” explains Dr. Soysa. “The fight against SAITM came to a turning point with the Court decision; most of those supporting SAITM interpret this decision in their favor. Court has acknowledged the investigations carried out by the SLMC regarding the standards of the SAITM. However, the Health Minister has to make recommendations of the SLMC legitimate.

“There is no gazette specifying the minimum standards for medical education. As a result, there is no legal value for standards on medical education. It is the Health Minister who has failed to do his job. Then he informed the Court that the SLMC has no power.”

On April 06, The Island reported Health Minister Rajitha Senaratne’s recalling SLMC, in response to a ruling requested by SAITM in 2010, that there is no need for it to set minimum qualifications since SAITM was affiliated to a recognized Russian university. The SLMC has since decided to discuss the requirements to study medicine, which was a good move, he noted.

“If SLMC has not given certain information to SAITM, then SAITM ought to have gone to the Court of Appeal,” replies Gammanpila, “and obtained a writ against the SLMC, compelling them to provide the information required by them.”

In response, SAITM provided this writer two documents, referring to the two gazetted approved in 2011 and 2013, where the University Grants Commission and Ministry of Higher Education granted SAITM the Degree Awarding Status. 2011 gazette referers to students who joined in 2011 and afterwards and 2013 gazette was for students who joined from 2009 to 2011. The letter dated 27 August, 2014 from the Secretary, Ministry of Higher Education, Dr. Sunil Jayantha Nawaratne stipulates that all conditions have been fulfilled by SAITM.

“SLMC says,” says Gammanpila, “in order for SLMC to register medical practitioners, the prerequisite is that they should be a medical graduate from a recognized institute. On 29 August 2011, the then minister of higher education has published a gazette recognizing SAITM for medical education. This approval comes with a lot of conditions. This approval will only be valid if these conditions are met by SAITM. SLMC has written to SAITM, requiring them to submit proof of those conditions within a time frame, which SAITM has not done.

“If that’s the case, this approval is invalid. Then, they are not a recognized degree awarding institute for medical education and SLMC is not in a position to register their graduates as medical practitioners. This important aspect has been overlooked by the Court of Appeal. This is a very significant question of law. Therefore, SLMC is of the view that the Court of Appeal erred in its judgement and has put this before the Supreme Courts.”

Independence of the judiciary

The JO opposes hybrid courts as proposed in the Geneva Resolution, yet they reject this court’s ruling.

“There’s a no contradiction at all,” Gammanpila asserts. “Judges are human beings and can make mistakes. The legal system has acknowledged that possibility. That’s why, there’s an appellate procedure. If you feel there’s a genuine mistake made by a magistrate, you may appeal to High Court. If there’s a mistake or judge has erred, you can appeal to the Court of Appeal. If the Court of Appeal has committed an error in their judgement, you may appeal to the SC. In the SC, it’s a three judge-panel who sit together for a judgement. Even then, if you feel there’s a strong legal flaw in their judgement, you may seek a bigger, larger bench.

“If you feel that the judge deliberately erred in their judgement to favor somebody, you can complain to the Judicial Service Commission. If the Chief Justice made a mistake, you can complain to the Parliament.

“Why has the legal system provided for such a lengthy appellate procedure? Because the legal system itself admits that judges may make mistakes. This is not only in Sri Lanka, but the case all over the world. Then, when a district judge in U.S. or UK makes a blunder, academic institutes, media, and legal seminars may criticize it, but no one suggests to bring foreign judges. Instead, they appeal to the higher court.

“Finding mistakes does not warrant foreign judges. If that’s the case, every single nation should get down foreign judges. If judges are subject to making mistakes in their own countries, bringing them down to Sri Lanka will not solve our problem.”

If judges as humans may make mistakes, the same is true for SLMC. As Gammanpila explains, an extensive appeal system exists in the judiciary. Yet, as he notes, “SLMC is the solitary expertise council in respect of medical education, consisting of highly respected, highly educated medical professionals of the country such as Professor Carlo Fonseka, Professor Ranjini Gamage, to mention just few names. Then, we as the general public must accept their word.”

In countries like UK, as explained by Professor JAP Jayasinghe in ‘Aberdeen Solution a Possibility for SAITM’, March 04, 2017, General Medical Council decisions can be appealed against. Then it will be heard by a panel that was not involved with the original decision. Failing there, one can appeal to an outside body or to an Ombudsman. When all fails, one can still go to courts.

Furthermore, he points out that “the GMC does not belong to the doctors. It consists of six doctors and six laypersons. They had not been appointed by the government – thus, there are no political appointees or by trade unions or any other body – hence their responsibility is to the public, not to as association and so free to act independently.”

Gammanpila’s solution

The solution to this hotly debated, controversial topic is simple, states Gammanpila.

“The world solution is, fee-based education in government and non-profit universities,” he explains. “I spoke of Oxford, which is not a profit-based university. The government gives a grant to students who excel at the British exams. So, their university education is free. The batch with the next best results is granted a loan, which is payable after employment. The third batch, along with foreign students pay a higher fee and pursue their tertiary education.

“Also, let all students, whether fee-paying or not, follow the same course, with same facilities and sit for the same exams. Then, the question of inferior graduates gets resolved.

“In the meantime,” he concludes, “the SAITM graduates should not be deserted. The SLMC should decide now, after evaluating their actual standards, what courses they need to follow to bring their knowledge up to required standard and register them and have this issue resolved for them promptly.”

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