From Hippocrates to Hypocrisy

By Professor
Asoka N. I. Ekanayaka
Emeritus Professor


I share with many millions of people in this country (who may not even know what the letters SAITM stand for) a certain indifference to the SAITM controversy that seems to be occupying so much media attention at this time. I have never been a teacher in that medical school and no child of mine ever been educated there. Having never done private practice in a lifetime as a health professional neither do I feel at all threatened that those who have actually been educated in a private medical school might in some way compete with me for a livelihood! Nor have my powers of critical thinking become hamstrung by blind servitude to antiquated leftwing ideology that has a lofty disdain for the private sector other than when it can make one rich personally. Therefore I have no vested interest in the outcome of the current controversy.

Nevertheless one cannot but be appalled by the self righteous hypocrisy and sanctimonious humbug surrounding the debate. The worst thing about fallen human nature is not so much the bad things people do or the wrong judgments they make, but the deceit of the heart that makes them hide their evil intentions in a cloak of righteousness, their selfish motives in a deceptive veneer of pretentious selfless commitment to some highfaluting principle. One observes something like this at play in the prevailing obsession with "standards of medical education" that seems to dominate the SAITM discussion where some alleged shortfall in the standard of training is the ammunition used by opponents of SAITM like the GMOA and SLMC and militant medical students to blast their quarry.

Only God knows the real motives in the minds of men whatever the outward posturing. In the present case to what extent real motives may have to do with politics, ideology, fear of market competition or plain envy is a matter of speculation. However there has been plenty of discussion about the inconsistency of those who are on the one hand ever so particular about shortcoming in the standard of training at SAITM, and on the other quite tolerant of the glaring shortcomings that continue to bedevil the quality of medical training in several existing medical schools in the island. It would seem that amidst all the pompous talk about standards of medical training there is in practice a sickening double standard! We need not here further embarrass those other medical schools whose own shortcomings and failures conveniently ignored by the medical establishment make a mockery of all the fuss about standards at SAITM.

However having served as the Dean of the Faculty of Dental Science of the University of Peradeniya from 1991 – 1996 (the one and only University faculty that has trained dentists for Sri Lanka for the past 63 years ) my own experience is that in practice decisions to recognize, de-recognize or not recognize medical / dental faculties frequently have little or nothing to do with standards of training. On the contrary they have everything to do with things like the demand for health manpower, political expediency, social pressure, and the power of professional vested interests. That may not be how it ought to be. But that is how it is. To pretend that what is at issue is only uncompromising adherence to pristine standards of training is pure humbug.

Otherwise when I took over as Dean of the Faculty in 1991 conditions of dental training fell so far below international standards that if "standards of training" was the sole criterion the dental school Peradeniya ought to have been the first place to be shut down by the SLMC. However as I recall the SLMC was nowhere to be seen – and this was 39 years after commencement of dental training in Peradeniya far back in 1954 !

It was left to me as Dean to give leadership to a dedicated faculty in the successful struggle to obtain a massive programme of Japanese grant aid amounting to over US $ 23 million for the construction of a new modern dental faculty and hospital consistent with international standards of dental education. In the event what came to be known as the "Japanese Project" was a historic development for the University of Peradeniya and as everyone knows the brand new modern facility on a different site was ceremonially opened in 1998. All that is now history. However amidst the prevailing sanctimonious hue and cry about standards of medical education it is instructive to recount the woeful in many ways hilarious conditions of dental training when I took over as Dean in 1991.

From 1954 – 1998 the Dental Faculty was situated in a semi rural area in the backwoods of the Peradeniya campus up on a hill hardly ideal for patient access. Except for one new block that came up about 30 years after training commenced back in 1954 most of the buildings were old and dilapidated relics of what at one time was the Kingswood College boys hostel! There were no proper lecture theatres. Lectures were conducted in two small rooms with old fashioned blackboard and chalk. I recall a Vice Chancellor during a visitation frankly ‘apologizing’ to me for these appalling conditions in a remote corner of his campus. However the SLMC and medical / dental trade unions for all their paranoid posturing about "standards of training" now couldn’t care less then.

Staff and facilities for pre clinical training were almost nonexistent resulting in heavy dependence on the Peradeniya medical school whose teachers already overburdened with their own medical students justifiably resented having to take responsibility for dental students. By 1991 their patience exhausted relations between the two faculties were at rock bottom with pre clinical students the potential victims virtually facing eviction.

The clinical equipment was for the most part old and antiquated with many items fit to be museum pieces. The fragile equipment infrastructure was sustained by means of a dubious arrangement where every year a group of charitable dentists in Denmark would ship us a container load of dental equipment they were discarding. The dentist co-ordinating this line of charitable assistance would follow and spend some time in Peradeniya assembling the equipment as best he could. Come the 1990’s this had been going on for some years and there was a concern that notwithstanding the charitable impulse of the donors these annual container loads should have more quality usable equipment than junk. And so this humiliating dependence on discarded equipment to sustain what is the only University faculty training dentists for Sri Lanka came to an end. And that is not all.

Rats were known to raid he primitive dilapidated pathology laboratory in the nights upsetting biopsy specimens. A former technician recently reminded me how the liquid clinical waste rinsed out by patients in clinics as well as the washings of biopsy specimens from the lab emptied into open drains from where they would presumably find their way eventually into the streams surrounding the adjacent village. Such are the conditions that drove dedicated staff to struggle night and day for the foreign grant aid through which a brand new school and hospital was constructed by 1998.

Moreover what passed for a dental teaching hospital did not have a single operating theatre. Our oral surgeons had to beg for theatre time in neighboring hospitals where they often experienced humiliating rejection. The X-ray equipment was old and primitive with serious deficiencies in the standard of radiation protection. Throughout a large period of its history the school was badly underfunded with chronic shortages of essential consumables required for dental teaching. The pervasive backwardness of the whole institution even extended to the Dean’s office where at one stage the photocopy machine was being operated from within the Dean’s toilet by an obliging labourer !

Needless to say amidst such obsolescence visits by foreigners from schools overseas, were not without some embarrassment. That during its 44 year history this impoverished decadent school nevertheless produced several distinguished graduates is partly due to the dedication of the old teachers many of whom never did private practice as well as the quality of students many of whom were admitted on pure merit during the early years of its existence. Whether these two elements have been compromised in today’s medical schools that have the stamp of SLMC approval is an interesting question.

The point is that none of the bodies which are currently so vociferous about standards of medical education and their respective actors at that time seemed to care a hoot about the appalling standards that characterized dental training from 1954 – 1998. Where were the SLMC and medical / dental trade unions during all those years when a few dedicated teachers ( many of whom have since passed away ) struggled to train dentists for Sri Lanka under the most primitive conditions ?

We must of course be happy that dental training at that time was not suspended given a crumbling training facility that was years out of date. That would have had disastrous manpower, political and professional implications. But that only shows that in Sri Lanka at any rate the certification of medical / dental schools in practice have little to do with "standards of training". I would guess that SAITM is no exception. As a disinterested observer of the present conflict this personal testimony is intended to persuade belligerent doctors in our day and age to be honest about their motives. They may have embalmed Hippocrates – but they need not embrace hypocrisy!

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