Some thoughts on Cuba and SAITM


by Shivanthi Ranasinghe


Fidel Castro’s death reverberated throughout the world. He was truly an extraordinary man. He proved that the world will still go around, the sun will still rise even without the blessings of the world’s superpower. He gave courage to Sri Lankans who quake in their boots at the very thought of being alienated by the West. As socialists here gathered in their red attire with Castro’s face painted on their shirts to celebrate his life, he exposed them as well.

Before his revolution in 1959, Cuba had about 6,000 doctors. Half of them left the country in the immediate aftermath. Yet, through sheer force of character, he proved his ideology against all odds. By 2005, there were over 70,000 doctors in Cuba. Even by 2012, the Cuban population was barely over 11 million. This gives a doctor to every 155 people. This shames even U.S., whose ratio is 1:396. Apart from the local doctors, Cuba also produces over 5,000 foreign medical graduates annually.

While U.S. imports doctors, mostly from developing countries leading to brain drain in those countries, Cuba exports nearly 40,000 doctors and health officials to over 75 countries. In this respect, Sri Lanka, where education is free like in Cuba, has also failed. Scattered throughout the Island, we have 15 universities and three campuses under the direct authority of the University Grants Commission. Still, taking 30,000 new entrants annually is a vision in the horizon. The incumbent chairman of the Sri Lanka Medical Council (SLMC), Professor Carlo Fonseka in 2012 categorically stated on ‘Check Mate’ that we have insufficient numbers of doctors due to this inability or unwillingness of the State to increase the numbers.

He challenged, "If you doubt me, let’s go right now to any of these private hospitals, where doctors are working at late hours just trying to clear the crowds. It’s the non-communicable diseases (NCD) that are confronting us."

According to Professor Fonseka, annually we lose in the same proportion as the 2004 tsunami for NCD such as cardiovascular diseases, diabetes, cancer and lung diseases. Therefore, there is a clear need to address this issue.

Yet, like the ostrich, we take comfort in our comparatively high human development index and our successful combating of communicable diseases such as polio. Therefore, we do not appreciate the need to increase our number of medical graduates.

Our obstinacy is in direct contrast to Castro’s vision; he saw the value in a surplus medical professional cadre. It is in the absence of that intellectual capacity that we shamefully resort to exporting our young human resources to earn much of our foreign exchange. We turn a blind eye to the fact that our people are working in almost semi-slavery, denied most of their human rights.

Despite this shame, the will to change our systems, that currently denies so many a complete education, is very low. It is those who are in the lowest income brackets that get penalized first and suffer the most.

Ironically, those who gathered in their reds to salute Castro’s life represent this segment. They may not necessarily belong to this segment, but it is on their plight these comrades’ ideology survives. As they stood in solidarity, remembering Castro, the great leader in turn exposed them for their failures.

The bitter truth is we prefer to revel in misery than develop. That is the reason why the milestones of CWW Kannangara and Lalith Athulathmudali come and go without much ado - the former as the father of free education and the latter as the creator of the Mahapola scholarship have contributed tremendously to provide an education to all Lankans. Yet the very people who gathered to pay tribute to Castro, fail to acknowledge these two heroes who have directly contributed to our own lives whereas, Castro’s direct contribution to our own lives is actually minuscule. It is that great irony that Castro exposed.

If our local comrades’ goal is in line of Castro’s and that is to provide an education to all, they have two options. One is to have a leader like Castro - a man so fearsome that opposition took cover under America’s sanctimonious skirts and remains there to date. We had such a leader in the form of President Mahinda Rajapaksa who was actually a much diluted version of the real Castro. Yet, comrades like the Janatha Vimukthi Peramuna played an active role in the regime change. As they salute Castro, a man who committed in greater magnitude the same sins that outraged the JVP when President Rajapaksa committed them, they stand exposed.

The other option, as unpalatable as it is to the comrades, is to encourage people like Dr. Neville Fernando, founder and Chairman of SAITM, to step in and fill in the lacuna. The fact that he gives back the lost opportunity to those the State could not accommodate is beyond us. The reason being we are fixated on the profits he must be earning in providing a private medical college (PMC). In our indignation, we fail to realize the benefits we as a society gets in turn.

Surprisingly, the opposition to South Asian Institute of Technology and Medicine (SAITM) comes not only from the comrades, but also from educated composites like the Government Medical Officers Association and even from SLMC. Professor Carlo Fonseka who gave four reasons for a need of a PMC in 2012 is clearly not in the same place today.

"First, there are not enough doctors," he then said. "Second, our system of selecting medical students by the State, this reverse discrimination on district quota leaves out many well qualified students. Third, there’s a demand for medical education - 200 or more leave Sri Lanka every year in search of education and are a drain on our forex. Fourth, if we set up medical colleges here, our forex will be saved and we can draw students from outside."

Between the GMOA and the SLMC one might construe that this is the position of all medical professionals. However, many senior doctors privately disagree with the SLMC’s and GMOA’s stand.

Speaking exclusively to Sunday Island, Professor Ananda Samarasekera - Medico Legal Consultant and Vice Chancellor of SAITM feels that the real reasons for opposing PMC are not the ones actually expressed. Protestors’ one main contention is that this subverts the existing system that merits the best of the lot. Private colleges distort this system by allowing those who can afford to ‘buy’ their qualification.

"Have you heard of any protest for the engineering faculty or any other field than medicine?" he asks "No. People who are protesting against SAITM are not protesting the same way for people who are going abroad and doing medicine. Why is that?

"Different attitudes. Some people do it for their political gain. Certain trade unions have different motives. Their motive is that they don’t want a sufficient number of doctors in this country. Their strength, position and monopoly will be affected. So, they would like to have a lesser number of doctors. That’s from the trade union point of view.

"Then, certain students are affiliated to some political parties. They say however good these private institutions are, they are against private education.

"So those people have ganged up together. They have different motives, but have come together for a common cause. That is to stop non-state medical schools from establishing and functioning in this country."

He points out that in reality their purported concern, that doctors produced by a PMC would be incompetent and thus would be a danger to patients, is without basis.

"Studies were published that more than 50 percent of the North Colombo Medical College graduates (NCMC), numbering around 600-700, are practicing as a specialist. All these doctors are very popular, doing very well and devoted in all specialties. So that’s one good example that says to our country, ‘just because they are from a PMC, or they haven’t fulfilled the highest results at the AL, doesn’t mean they will not become good doctors."

Yet, because of this strong opposition, he explains that it took more than 20 years between the closing of the NCMC and the starting of the SAITM.

"No one wanted to invest money and then waste their time because there were objections for medicine - but only for medicine and no other field."

Chairman of SAITM, Dr. Neville Fernando relates the sequence of events that led him to venture into this taboo area.

"I started this venture because when Professor Wiswa Warnapala was the minister for higher education, he lamented that out of the 200,000 students who sit for the Advanced Level exam, 100,000 are fit to enter the State universities, but only 18,000 are taken. He asked the private sector that had money, to invest in higher education. That was what convinced me."

One of the main hypes against PMC is that as a fee levying institute, it is a threat to the free education.

"‘Free’ is not an accurate term," points out Professor Samarasekera, "as somebody has to pay for it. Students may not need to pay by themselves. There are other mechanisms to bear the cost. This mechanism in most countries is either born by the government, the tax payer, or the students themselves or there could be a certain government-semi government arrangement. Most universities - even the world’s best - are run by a fund, like a trust fund and have different sources of income.

"In countries like Sri Lanka, universities are largely state dependent. But the government is not able to provide education free to everyone who needs it. "

When education is a right of a person - irrespective of his age, states Professor Samarasekera, there should be avenues for a person to educate themselves and even obtain qualifications such as a degree. For the younger generation particularly, such avenues are important.


SAITM was founded on the notion of providing such an avenue, he explains. Despite the experience of the NCMC, SAITM was deep in uncharted waters as they incorporated their PMC. He explains the many blind corners and turns SAITM had to take to reach the point they are today. As they tackled that confused maze, the allegation that this is an illegal institute became more established. However, assures Professor Samarasekera with all responsibility, SAITM is a degree awarding institution, in terms of the current law prevailing in the country.


At the beginning, SAITM started its medical course with an affiliation with the Nizhny Novgorod State Medical Academy in Russia. This is an internationally accepted and known medical school. The program to do their MD program thus started in 2009, where they visited and inspected the curriculum and other related aspects Initially, it was to be a four year course (now it’s six years), with the non-clinical subjects to be taught in Sri Lanka. There was to be no dealing with patients. Afterwards, students were to complete the program in Russia and sit for the final examination.


After signing the MOU with the Russian Academy, this was communicated to the SLMC. Then president of the SLMC, Dr. HHR Samarasinghe, however communicated that they do not have prescribed standard with regard to the foreign medical schools and local affiliations. He subsequently noted that this prescribed standard was underway for this kind of programs between foreign universities and local institutes and pending approval by the parliament. Once approved, SLMC assured they will be able to proceed with the SAITM request.


However, the prescribed standards that were submitted to the Parliament were not approved. It was said that there cannot be one set of standards applicable to foreign medical schools and another for the local. schools


When Professor Lalitha Mendis succeeded as president of SLMC, she obtained legal advise on this matter. She then wrote to the then Secretary of Health stating that in terms of the present law, there are no provisions for SLMC to approve this kind of twin programs - where part of the course is done here and the rest completed elsewhere.


As this question of twin program had never come up before in SLMC, obstacles were not anticipated and SAITM had already taken students. This was to be a Russian degree program, with only the theoretical aspects to be conducted in Sri Lanka and the balance including clinical studies and final exam to be in Russia. Thus, it was only in terms geographical locations, the course differed from other foreign degrees.


"If it is the same curriculum and the same exam, what does it matter whether this is done in or outside Sri Lanka?" asks Professor Samarasekera.


The advantage of doing a larger portion of the program - four years out of the six year course - is that it would be convenient for the students as well as cheaper, he points out. However, this legal opinion identified it as a twin program, and that there were no provisions for a twin program.


Prof. Lalitha Mendis thus suggested the only solution would be to get the degree awarding status for SAITM from the Ministry under the University Act of Sri Lanka. It is a very clear, laid down procedure, notes Professor Samarasekera. Having followed that procedure, Ministry of Higher Education gazetted SAITM as a degree awarding institute for MBBS in August 30, 2011, which was approved by Parliament.


One condition that SAITM had to fulfill within one and a half years of the gazette notification was to have its own teaching hospital. Alternatively, SAITM could also affiliate with another hospital for clinical training.


SAITM thus negotiated with the Western Province governor and the provincial director of health services and signed a MOU to use the base hospitals in Homagama, Avisawella and Thalangama as clinical teaching centers. Though it was a legally established, valid document, this MOU could not be implemented because of the pressures exerted by a certain trade union.


Hence, arrangements were made to send SAITM students to private hospitals like Nawaloka and Asiri. That too was prevented by the same trade union. It was at that point Dr. Fernando decided to establish a teaching hospital - the Neville Fernando Teaching Hospital (NFTH).


"I didn’t want the people to suffer," said Dr. Fernando, referring to the trade union’s threat. "I didn’t have the money as it was already invested in SAITM, and I had already started work on the engineering faculty. But, I promptly changed those plans to put up the hospital. My old bankers were scared of the threats. Then I met the Bank of Ceylon’s then Chairman, Dr. Gamini Wickramasinghe. He too agreed that this was a national need and ultimately funded up to Rs. 2,000 million."


 It was completed within one and a half years and the hospital started functioning in 2013 as a new, teaching hospital. This hospital is registered under the health regulator as a private hospital.


A teaching hospital by convention should have professorial units in five main clinical units.


"Of course, we couldn’t do everything overnight," remarks Professor Samarasekera. "But it has professorial units, and units like orthopedics and other things which must be in a teaching hospital. We started with the main things first and gradually expanded."


Though it is a teaching hospital built to keep in line with the conditions stipulated by the gazette notification, it is registered as a private hospital.


"This is because," he explains, "even to date, there are no regulations for categorization of hospitals. A teaching hospital has no regulations. It can only be registered as a private hospital, which we did. There are some hospitals which don’t even have facilities like our NFTH ?????. For example, Kegalle Hospital and Gampola Hospital are teaching hospitals. But in reality, they are very basic base hospitals."


Speaking of this arduous journey, Professor Samasekera reflects, "It is sad that in this country when someone tries to do something new - mistakes do happen, and there could be shortcomings - but rather than supporting and advising, all you see is obstacles."


At the end, the lesson Castro leaves is not socialism but patriotism. A tiny country with a minuscule population took on the might and the main of the West - even after their ardent supporter, the USSR, collapsed. He as a leader might have been brutal, and a dictator. Yet, the people rallied around him, put their country before self interest and wowed the world. As Lankans, we are too much in love with our ideologies (though not so keen to walk the talk) and political affiliations to worry about our country’s actual needs. We need to change that mindset before we salute Castro.

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